Form I-485 Application to Register Permanent Residence or Adjust St

Application to Register Permanent Residence
or Adjust Status

USCIS
Form I-485

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0023
Expires 10/31/2021

DRAFT
NOT FOR
REPRODUCTION
03/12/2020
For USCIS Use Only
Receipt

Preference Category:

Action Block

Country Chargeable:
Priority Date:

Date Form I-693 Received:
Applicant
Interviewed
Date of
Initial Interview:

Interview
Waived

Lawful Permanent
Resident as of:

Section of Law

INA 209(a)
INA 209(b)
INA 245(a)
INA 245(i)
INA 245(m)

INA 249
Sec. 13, Act of 9/11/57
Cuban Adjustment Act
Other

To be completed by an attorney or accredited representative (if any).

Select this box if
Form G-28 is
attached.

Volag Number
(if any)

Attorney State Bar Number
(if applicable)

► START HERE - Type or print in black ink.

Attorney or Accredited Representative
USCIS Online Account Number (if any)

A-Number ► A-

NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, U.S. Citizenship and Immigration Services (USCIS) may deny your application.

Part 1. Information About You (individual
applying for lawful permanent residence)

3.a. Family Name
(Last Name)
3.b. Given Name
(First Name)

Your Current Legal Name (do not provide a
nickname)

3.c. Middle Name

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)

1.c. Middle Name

4.c. Middle Name

Other Names You Have Used Since Birth (if
applicable)

Other Information About You

NOTE: Provide all other names you have ever used, including
your family name at birth, other legal names, nicknames,
aliases, and assumed names. If you need extra space to
complete this section, use the space provided in Part 14.
Additional Information.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

5.

Date of Birth (mm/dd/yyyy)
NOTE: In addition to providing your actual date of birth,
include any other dates of birth you have used in
connection with any legal names or non-legal names in
the space provided in Part 14. Additional Information.

6.

Gender

Male

7.

City or Town of Birth

Female

2.c. Middle Name
Form I-485 Edition 10/15/19

Page 1 of 20

A-Number ► A-

Part 1. Information About You (Person applying
for lawful permanent residence) (continued)
8.

9.

10.

DRAFT
NOT FOR
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03/12/2020

Country of Birth

15.

Passport Number Used at Last Arrival

16.

Travel Document Number Used at Last Arrival

17.

Expiration Date of this Passport or Travel Document

Alien Registration Number (A-Number) (if any)

NOTE: If you have EVER used other A-Numbers,
include the additional A-Numbers in the space provided
in Part 14. Additional Information.
USCIS Online Account Number (if any)
►

12.

Provide the information for Item Numbers 15. - 19. if you last
entered the United States using a passport or travel document.

Country of Citizenship or Nationality

► A-

11.

Recent Immigration History

U.S. Social Security Number (if any)
►

(mm/dd/yyyy)

18.

Country that Issued this Passport or Travel Document

19.

Nonimmigrant Visa Number from this Passport (if any)

Place of Last Arrival into the United States
20.a. City or Town

U.S. Mailing Address

20.b. State

13.a. In Care Of Name (if any)

21.

13.b. Street Number
and Name
13.c.

Apt.

When I last arrived in the United States, I:

Ste.

Flr.

22.a.

Was inspected at a port of entry and admitted as (for
example, exchange visitor; visitor, waived through;
temporary worker; student):

22.b.

Was inspected at a port of entry and paroled as (for
example, humanitarian parole, Cuban parole):

22.c.

Came into the United States without admission or
parole.

22.d.

Other:

13.d. City or Town
13.e. State

Date of Last Arrival (mm/dd/yyyy)

13.f. ZIP Code
(USPS ZIP Code Lookup)

Alternate and/or Safe Mailing Address
If you are applying based on the Violence Against Women Act
(VAWA) or as a special immigrant juvenile, human trafficking
victim (T nonimmigrant), or victim of qualifying criminal
activity (U nonimmigrant) and you do not want USCIS to send
notices about this application to your home, you may provide an
alternative and/or safe mailing address.

If you were issued a Form I-94 Arrival-Departure Record Number:

14.a. In Care Of Name (if any)

23.a. Form I-94 Arrival-Departure Record Number
►

14.b. Street Number
and Name
14.c.

Apt.

23.b. Expiration Date of Authorized Stay Shown on Form I-94
Ste.

Flr.

23.c. Status on Form I-94 (for example, class of admission, or
paroled, if paroled)

14.d. City or Town
14.e. State

(mm/dd/yyyy)

14.f. ZIP Code

Form I-485 Edition 10/15/19

Page 2 of 20

A-Number ► A-

Part 1. Information About You (Person applying
for lawful permanent residence) (continued)
24.

Employment-based

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03/12/2020

What is your current immigration status (if it has changed
since your arrival)?

3.a.

Alien worker, Form I-140 (if you select this box, you
must answer Item Number 9.a.)

3.b.

Alien entrepreneur, Form I-526

Special Immigrant

Provide your name exactly as it appears on your Form I-94 (if
any)

4.a.

Religious worker, Form I-360

4.b.

Special immigrant juvenile, Form I-360

4.c.

Certain Afghan or Iraqi national, Form I-360

4.d.

Certain international broadcaster, Form I-360

25.c. Middle Name

4.e.

Certain G-4 international organization or family
member or NATO-6 employee or family member,
Form I-360

Part 2. Application Type or Filing Category

4.f.

Certain U.S. armed forces members (also known as
the Six and Six program), Form I-360

4.g.

Panama Canal Zone employees, Form I-360

4.h.

Certain Physicians, Form I-360

4.i.

Certain employee or former employee of the U.S.
Government abroad, Form I-360

25.a. Family Name
(Last Name)
25.b. Given Name
(First Name)

1.

I am filing this Form I-485 as a (select only one box):
Principal applicant

Derivative applicant

NOTE: Attach a copy of the Form I-797 receipt or approval
notice for the underlying petition or application, as appropriate.

I am applying as a principal or derivative applicant to register
lawful permanent residence or adjust status to that of a lawful
permanent resident based on the following immigrant category
(select only one category). (See the Form I-485 Instructions for
more information, including any Additional Instructions that
relate to the immigrant category you select.):

Family-based
2.a.

Immediate relative spouse of a U.S. citizen, parent of
a U.S. citizen if the U.S. citizen is 21 years of age or
older, and unmarried child under 21 years of age of a
U.S. citizen, Form I-130

2.b.

Other relative of a U.S. citizen or relative of a lawful
permanent resident under the family-based preference
categories, Form I-130

2.c.

Individual admitted to the United States as a fiancé(e)
or child of a fiancé(e) of a U.S. citizen, Form I-129F
(K-1/K-2 Nonimmigrant)

2.d.

Widow or widower of a U.S. citizen, Form I-360

2.e.

VAWA self-petitioner, Form I-360

2.f.

Spouse, child, or parent of a deceased U.S. active
duty service member in the armed forces under the
National Defense Authorization Act (NDAA), Form
I-130 or Form I-360

Form I-485 Edition 10/15/19

Asylee or Refugee

5.a.

Asylum status (INA section 208), Form I-589 or
Form I-730

5.b.

Refugee status (INA section 207), Form I-590 or
Form I-730

Human Trafficking Victim or Victim of Qualifying
Criminal Activity
6.a.

Human trafficking victim (T Nonimmigrant), Form
I-914 or derivative family member, Form I-914A

6.b.

Victim of Qualifying Criminal Activity (U
Nonimmigrant), Form I-918, derivative family
member, Form I-918A, or qualifying family member,
Form I-929

Page 3 of 20

A-Number ► AIf you answered "Yes" to Item Number 9.a., answer
Item Numbers 9.b. - 9.c. If you answered "No," skip to
Item Number 10.

Part 2. Application Type or Filing Category
(continued)

DRAFT
NOT FOR
REPRODUCTION
03/12/2020

Special Programs Based on Certain Public Laws
7.a.

Applicant adjusting under the Cuban Adjustment Act

7.b.

Applicant adjusting under the Cuban Adjustment Act
for battered spouses and children

7.c.

Applicant adjusting based on dependent status under
the Haitian Refugee Immigrant Fairness Act

7.d.

Applicant adjusting based on dependent status under
the Haitian Refugee Immigrant Fairness Act for
battered spouses and children

7.e.

Lautenberg Parolees

7.f.

Diplomats or high ranking officials unable to return
home (Section 13 of the Act of September 11, 1957)

7.g.

Applicant adjusting under the Indochinese Parole
Adjustment Act of 2000

7.h.

9.b. How is your relative related to you?
Brother or sister

Husband, wife, father, mother, child, adult son, or
adult daughter

9.c. This relative is a:
U.S. citizen

U.S. national

Lawful permanent resident
None of the above

10.

Regardless of the immigrant category you are adjusting
under, do you hold:
VAWA self-petitioner status

Yes

No

Victim of Qualifying Criminal Activity (U nonimmigrant)
status
Yes
No

Applicant adjusting under the Amerasian Act
(October 22, 1982), Form I-360

Human trafficking victim (T nonimmigrant) status

Additional Options
8.a.

Diversity Visa program

8.b.

Continuous residence in the United States since
before January 1, 1972 ("Registry")

8.c.

Yes

INA Section 245(i)

11.

Individual born in the United States under diplomatic
status

8.d.

S nonimmigrants and qualifying family members
(only law enforcement agencies can file Form I-485
for someone in this category.)

8.e.

Other eligibility (see the Form I-485 Instructions,
Who May Form I-485, Item Number 3. Other
Immigrant Categories for examples)

9.a. Did a relative file the associated Form I-140 for you or
does a relative have a significant ownership interest (five
percent or more) in the business that filed Form I-140 for
you? (The relative must be your husband, wife, father,
mother, child, adult son, adult daughter, brother, or sister.)
Yes
No

Form I-485 Edition 10/15/19

Are you applying for adjustment based on the
Immigration and Nationality Act (INA) section 245(i)?
Yes

No

NOTE: If you answered "Yes" to Item Number 11., you
must have selected a family-based, employment-based,
special immigrant, or Diversity Visa immigrant category
listed above in Item Numbers 2.a. - 8.e. as the basis for
your application for adjustment of status. Fill out the rest
of this application AND Supplement A to Form I-485,
Adjustment of Status Under Section 245(i) (Supplement
A). For detailed filing instructions, read the Form I-485
Instructions (including any Additional Instructions that
relate to the immigrant category that you selected in Item
Numbers 2.a. - 8.e.) and Supplement A Instructions.

Additional Alien Worker Information
Answer Item Number 9.a. only if you selected Item Number
3.a. “Alien worker, Form I-140.”

No

Information About Your Immigrant Category
If you are the principal applicant, provide the following
information.
12.

Receipt Number of Underlying Petition (if any)

13.

Priority Date from Underlying Petition (if any)
(mm/dd/yyyy)

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A-Number ► A-

Part 2. Application Type or Filing Category
(continued)

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If you are a derivative applicant (the spouse or unmarried
child under 21 years of age of a principal applicant), provide the
following information for the principal applicant.
Principal Applicant's Name
14.a. Family Name
(Last Name)
14.b. Given Name
(First Name)

Physical Address 1 (current address)

5.b.

Apt.

Ste.

Flr.

5.c. City or Town

Principal Applicant's A-Number (if any)
► A-

16.

Provide physical addresses for everywhere you have lived
during the last five years, whether inside or outside the United
States. Provide your current address first. If you need extra
space to complete this section, use the space provided in
Part 14. Additional Information.

5.a. Street Number
and Name

14.c. Middle Name
15.

Address History

Principal Applicant's Date of Birth (mm/dd/yyyy)

5.d. State
5.f.

5.e. ZIP Code

Province

5.g. Postal Code

17.

Receipt Number of Principal's Underlying Petition (if any)
►

18.

Priority Date of Principal Applicant's Underlying Petition
(if any) (mm/dd/yyyy)

5.h. Country

Dates of Residence

6.a. From (mm/dd/yyyy)

Part 3. Additional Information About You
1.

Have you ever applied for an immigrant visa to obtain
permanent resident status at a U.S. Embassy or U.S.
Consulate abroad?
Yes
No

If you answered "Yes" to Item Number 1., complete
Item Numbers 2.a. - 4. below. If you need extra space to
complete this section, use the space provided in Part 14.
Additional Information.

6.b. To (mm/dd/yyyy)

Physical Address 2

7.a. Street Number
and Name
7.b.

Apt.

Ste.

Flr.

7.c. City or Town

Location of U.S. Embassy or U.S. Consulate

7.d. State

2.a. City

7.f.

2.b. Country

7.g. Postal Code

7.e. ZIP Code

Province

7.h. Country
3.

Decision (for example, approved, refused, denied,
withdrawn)

4.

Date of Decision (mm/dd/yyyy)

Form I-485 Edition 10/15/19

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A-Number ► A-

Part 3. Additional Information About You
(continued)

Address of Employer or Company

Dates of Residence

12.b.

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8.a. From (mm/dd/yyyy)

9.a. Street Number
and Name

9.f.

Flr.

12.e. ZIP Code

12.f. Province

12.g. Postal Code
12.h. Country

Ste.

Flr.

13.

9.c. City or Town
9.d. State

Ste.

12.d. State

Provide your most recent address outside the United States
where you lived for more than one year (if not already listed
above).

Apt.

Apt.

12.c. City or Town

8.b. To (mm/dd/yyyy)

9.b.

12.a. Street Number
and Name

9.e. ZIP Code

Province

9.g. Postal Code

Your Occupation

Dates of Employment

14.a. From (mm/dd/yyyy)
14.b. To (mm/dd/yyyy)

9.h. Country

Employer 2

Dates of Residence

10.a. From (mm/dd/yyyy)

15.

Name of Employer or Company

Address of Employer or Company
10.b. To (mm/dd/yyyy)

16.a. Street Number
and Name

Employment History

16.b.

Provide your employment history for the last five years,
whether inside or outside the United States. Provide the most
recent employment first. If you need extra space to complete
this section, use the space provided in Part 14. Additional
Information.

16.c. City or Town

Employer 1 (current or most recent)
11.

Name of Employer or Company

Apt.

Ste.

16.d. State

Flr.

16.e. ZIP Code

16.f. Province
16.g. Postal Code
16.h. Country

17.

Your Occupation

Dates of Employment
18.a. From (mm/dd/yyyy)
18.b. To (mm/dd/yyyy)

Form I-485 Edition 10/15/19

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A-Number ► A-

Part 3. Additional Information About You
(continued)

Date of Birth (mm/dd/yyyy)

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Provide your most recent employment outside of the United
States (if not already listed above).
19.

3.
4.

Gender

Male

Female

5.

City or Town of Birth

6.

Country of Birth

7.

Current City or Town of Residence (if living)

8.

Current Country of Residence (if living)

Name of Employer or Company

Address of Employer or Company
20.a. Street Number
and Name
20.b.

Apt.

Ste.

Flr.

20.c. City or Town
20.d. State

20.e. ZIP Code

20.f. Province

20.g. Postal Code
20.h. Country

Information About Your Parent 2

Parent 2's Legal Name
9.a. Family Name
(Last Name)
9.b. Given Name
(First Name)

9.c. Middle Name

21.

Your Occupation

Dates of Employment

22.a. From (mm/dd/yyyy)
22.b. To (mm/dd/yyyy)

Parent 2's Name at Birth (if different than above)
10.a. Family Name
(Last Name)
10.b. Given Name
(First Name)

10.c. Middle Name
11.

Date of Birth (mm/dd/yyyy)

Part 4. Information About Your Parents

12.

Gender

Information About Your Parent 1

13.

City or Town of Birth

14.

Country of Birth

15.

Current City or Town of Residence (if living)

16.

Current Country of Residence (if living)

Male

Female

Parent 1's Legal Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
Parent 1's Name at Birth (if different than above)
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name

Form I-485 Edition 10/15/19

Page 7 of 20

A-Number ► A-

Part 5. Information About Your Marital History
1.

Place of Marriage to Current Spouse

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9.a. City or Town

What is your current marital status?
Single, Never Married
Widowed

Married

Divorced

Marriage Annulled

9.b. State or Province

Legally Separated
2.

3.

If you are married, is your spouse a current member of the
U.S. armed forces or U.S. Coast Guard?
N/A
Yes
No

9.c. Country

10.

Is your current spouse applying with you?

Yes

How many times have you been married (including
annulled marriages and marriages to the same individual)?

No

Information About Prior Marriages (if any)

Information About Your Current Marriage
(including if you are legally separated)

If you are currently married, provide the following information
about your current spouse.
Current Spouse's Legal Name
4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)

Prior Spouse's Legal Name (provide family name before
marriage)
11.a. Family Name
(Last Name)
11.b. Given Name
(First Name)

4.c. Middle Name
5.

If you have been married before, whether in the United States or
in any other country, provide the following information about
your prior spouse. If you have had more than one previous
marriage, use the space provided in Part 14. Additional
Information to provide the information below.

11.c. Middle Name

A-Number (if any)

► A6.

Current Spouse's Date of Birth (mm/dd/yyyy)

7.

Date of Marriage to Current Spouse (mm/dd/yyyy)

12.

Prior Spouse's Date of Birth (mm/dd/yyyy)

13.

Date of Marriage to Prior Spouse (mm/dd/yyyy)

Place of Marriage to Prior Spouse
14.a. City or Town

Current Spouse's Place of Birth
8.a. City or Town

8.b. State or Province

8.c. Country

Form I-485 Edition 10/15/19

14.b. State or Province

14.c. Country

15.

Date Marriage with Prior Spouse Legally Ended
(mm/dd/yyyy)

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Part 5. Information About Your Marital History
(continued)

Child 2

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Current Legal Name

7.a. Family Name
(Last Name)
7.b. Given Name
(First Name)

Place Where Marriage with Prior Spouse Legally Ended
16.a. City or Town

7.c. Middle Name

16.b. State or Province

8.

A-Number (if any)

► A-

16.c. Country

9.

Date of Birth (mm/dd/yyyy)

10.

Country of Birth

Indicate the total number of ALL living children
(including adult sons and daughters) that you have.

11.

Is this child applying with you?

NOTE: The term “children” includes all biological or
legally adopted children, as well as current stepchildren,
of any age, whether born in the United States or other
countries, married or unmarried, living with you or
elsewhere and includes any missing children and those
born to you outside of marriage.

Child 3

Part 6. Information About Your Children
1.

Provide the following information for each of your children.
If you have more than three children, use the space provided in
Part 14. Additional Information.

Yes

No

Yes

No

Current Legal Name
12.a. Family Name
(Last Name)
12.b. Given Name
(First Name)

12.c. Middle Name
13.

A-Number (if any)

► A-

Child 1
Current Legal Name

14.

Date of Birth (mm/dd/yyyy)

2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

15.

Country of Birth

16.

Is this child applying with you?

2.c. Middle Name
3.

A-Number (if any)

Part 7. Biographic Information

► A-

1.

Ethnicity (Select only one box)

4.

Date of Birth (mm/dd/yyyy)

Hispanic or Latino

5.

Country of Birth

Not Hispanic or Latino
2.

6.

Is this child applying with you?

Yes

No

Race (Select all applicable boxes)
White
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

Form I-485 Edition 10/15/19

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Part 7. Biographic Information (continued)

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3.

Height

4.

Weight

5.

Eye Color (Select only one box)

6.

Dates of Membership or Dates of Involvement

Feet

Inches

Pounds

5.a. From (mm/dd/yyyy)
5.b. To (mm/dd/yyyy)
Organization 2
6.

Name of Organization

Black

Blue

Brown

Gray

Green

Hazel

Maroon

Pink

Unknown/Other

7.a. City or Town

7.b. State or Province

Hair Color (Select only one box)
Bald (No hair)

Black

Blond

Brown

Gray

Red

Sandy

White

Unknown/Other

7.c. Country

Part 8. General Eligibility and Inadmissibility
Grounds

8.

1.

Dates of Membership or Dates of Involvement

Have you EVER been a member of, involved in, or in
any way associated with any organization, association,
fund, foundation, party, club, society, or similar group in
the United States or in any other location in the world
including any military service?
Yes
No

If you answered "Yes" to Item Number 1., complete Item
Numbers 2. - 13.b. below. If you need extra space to complete
this section, use the space provided in Part 14. Additional
Information. If you answered "No," but are unsure of your
answer, provide an explanation of the events and circumstances
in the space provided in Part 14. Additional Information.

Nature of Group

9.a. From (mm/dd/yyyy)
9.b. To (mm/dd/yyyy)
Organization 3
10.

Name of Organization

11.a. City or Town

Organization 1
2.

Name of Organization

3.a. City or Town

3.b. State or Province

3.c. Country

11.b. State or Province

11.c. Country

12.

Nature of Group

Dates of Membership or Dates of Involvement
13.a. From (mm/dd/yyyy)

4.

Nature of Group

Form I-485 Edition 10/15/19

13.b. To (mm/dd/yyyy)

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A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)

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Answer Item Numbers 14. - 80.b. Choose the answer that you
think is correct. If you answer “Yes” to any questions (or if
you answer "No," but are unsure of your answer), provide
an explanation of the events and circumstances in the space
provided in Part 14. Additional Information.
14.

Have you EVER been denied admission to the United
States?
Yes
No

15.

Have you EVER been denied a visa to the United States?
Yes

16.

No

Have you EVER worked in the United States without
authorization?
Yes
No

17.

Have you EVER violated the terms or conditions of your
nonimmigrant status?
Yes
No

18.

Are you presently or have you EVER been in removal,
exclusion, rescission, or deportation proceedings?
Yes

19.

Have you EVER been issued a final order of exclusion,
deportation, or removal?
Yes
No
Have you EVER had a prior final order of exclusion,
deportation, or removal reinstated?
Yes
No

21.

Have you EVER held lawful permanent resident status
which was later rescinded?
Yes
No

23.

For Item Numbers 25. - 45., you must answer "Yes" to any
question that applies to you, even if your records were sealed or
otherwise cleared, or even if anyone, including a judge, law
enforcement officer, or attorney, told you that you no longer
have a record. You must also answer "Yes" to the following
questions whether the action or offense occurred here in the
United States or anywhere else in the world. If you answer
"Yes" to Item Numbers 25. - 45., use the space provided in
Part 14. Additional Information to provide an explanation
that includes why you were arrested, cited, detained, or charged;
where you were arrested, cited, detained, or charged; when
(date) the event occurred; and the outcome or disposition (for
example, no charges filed, charges dismissed, jail, probation,
community service).
25.

Have you EVER been arrested, cited, charged, or
detained for any reason by any law enforcement official
(including but not limited to any U.S. immigration
official or any official of the U.S. armed forces or U.S.
Coast Guard)?
Yes
No

26.

Have you EVER committed a crime of any kind (even if
you were not arrested, cited, charged with, or tried for that
crime)?
Yes
No

27.

Have you EVER pled guilty to or been convicted of a
crime or offense (even if the violation was subsequently
expunged or sealed by a court, or if you were granted a
pardon, amnesty, a rehabilitation decree, or other act of
clemency)?
Yes
No

No

20.

22.

Criminal Acts and Violations

Have you EVER been granted voluntary departure by an
immigration officer or an immigration judge but failed to
depart within the allotted time?
Yes
No

NOTE: If you were the beneficiary of a pardon, amnesty,
a rehabilitation decree, or other act of clemency, provide
documentation of that post-conviction action.
28.

Have you EVER been ordered punished by a judge or had
conditions imposed on you that restrained your liberty
(such as a prison sentence, suspended sentence, house
arrest, parole, alternative sentencing, drug or alcohol
treatment, rehabilitative programs or classes, probation, or
community service)?
Yes
No

29.

Have you EVER been a defendant or the accused in a
criminal proceeding (including pre-trial diversion,
deferred prosecution, deferred adjudication, or any
withheld adjudication)?
Yes
No

30.

Have you EVER violated (or attempted or conspired to
violate) any controlled substance law or regulation of a
state, the United States, or a foreign country?

Have you EVER applied for any kind of relief or
protection from removal, exclusion, or deportation?
Yes
No

24.a. Have you EVER been a J nonimmigrant exchange visitor
who was subject to the two-year foreign residence
requirement?
Yes
No
If you answered "Yes" to Item Number 24.a., complete Item
Numbers 24.b. - 24.c. If you answered "No" to Item Number
24.a., skip to Item Number 25.
24.b. Have you complied with the foreign residence
requirement?
Yes

No

Yes

No

24.c. Have you been granted a waiver or has Department of
State issued a favorable waiver recommendation letter
for you?
Yes
No
Form I-485 Edition 10/15/19

Page 11 of 20

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)
31.

32.

33.

Have you EVER illicitly (illegally) trafficked or benefited
from the trafficking of any controlled substances, such as
chemicals, illegal drugs, or narcotics?
Yes
No

No

Have you EVER engaged in prostitution or are you
coming to the United States to engage in prostitution?

No

36.

Have you EVER directly or indirectly procured (or
attempted to procure) or imported prostitutes or persons
for the purpose of prostitution?
Yes
No

37.

Have you EVER received any proceeds or money from
prostitution?
Yes
No

39.

Have you EVER knowingly aided, abetted, assisted,
conspired, or colluded with others in trafficking persons
for commercial sex acts or involuntary servitude,
peonage, debt bondage, or slavery?
Yes
No

44.

Are you the spouse, son or daughter of a foreign national
who engaged in the trafficking of persons and have
received or obtained, within the last five years, any
financial or other benefits from the illicit activity of your
spouse or your parent, although you knew or reasonably
should have known that this benefit resulted from the illicit
activity of your spouse or parent?
Yes
No

45.

Have you EVER engaged in money laundering or have
you EVER knowingly aided, assisted, conspired, or
colluded with others in money laundering or do you seek
to enter the United States to engage in such activity?

No

Are you the spouse, son, or daughter of a foreign national
who illicitly trafficked or aided (or otherwise abetted,
assisted, conspired, or colluded) in the illicit trafficking of
a controlled substance, such as chemicals, illegal drugs, or
narcotics and you obtained, within the last five years, any
financial or other benefit from the illegal activity of your
spouse or parent, although you knew or reasonably should
have known that the financial or other benefit resulted
from the illicit activity of your spouse or parent?

Yes

38.

43.

Have you EVER knowingly aided, abetted, assisted,
conspired, or colluded in the illicit trafficking of any
illegal narcotic or other controlled substances?

Yes

35.

Have you EVER trafficked a person into involuntary
servitude, peonage, debt bondage, or slavery? Trafficking
includes recruiting, harboring, transporting, providing, or
obtaining a person for labor or services through the use of
force, fraud, or coercion.
Yes
No

DRAFT
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03/12/2020

Have you EVER been convicted of two or more offenses
(other than purely political offenses) for which the
combined sentences to confinement were five years or
more?
Yes
No

Yes

34.

42.

Do you intend to engage in illegal gambling or any other
form of commercialized vice, such as prostitution,
bootlegging, or the sale of child pornography, while in the
United States?
Yes
No
Have you EVER exercised immunity (diplomatic or
otherwise) to avoid being prosecuted for a criminal
offense in the United States?
Yes
No

40.

Have you EVER, while serving as a foreign government
official, been responsible for or directly carried out
violations of religious freedoms?
Yes
No

41.

Have you EVER induced by force, fraud, or coercion (or
otherwise been involved in) the trafficking of persons for
commercial sex acts?
Yes
No

Form I-485 Edition 10/15/19

Yes

No

Security and Related

Do you intend to:

46.a. Engage in any activity that violates or evades any law
relating to espionage (including spying) or sabotage in the
United States?
Yes
No
46.b. Engage in any activity in the United States that violates or
evades any law prohibiting the export from the United
States of goods, technology, or sensitive information?
Yes

No

46.c. Engage in any activity whose purpose includes opposing,
controlling, or overthrowing the U.S. Government by
force, violence, or other unlawful means while in the
United States?
Yes
No
46.d. Engage in any activity that could endanger the welfare,
safety, or security of the United States?

46.e. Engage in any other unlawful activity?
47.

Yes

No

Yes

No

Are you engaged in or, upon your entry into the United
States, do you intend to engage in any activity that could
have potentially serious adverse foreign policy
consequences for the United States?
Yes
No

Page 12 of 20

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)

51.d. Provided money, a thing of value, services or labor, or
any other assistance or support for any of the activities
described in Item Number 51.a.?
Yes
No

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Have you EVER:

48.a. Committed, threatened to commit, attempted to commit,
conspired to commit, incited, endorsed, advocated,
planned, or prepared any of the following: hijacking,
sabotage, kidnapping, political assassination, or use of a
weapon or explosive to harm another individual or cause
substantial damage to property?
Yes
No
48.b. Participated in, or been a member of, a group or
organization that did any of the activities described in
Item Number 48.a.?
Yes
No

48.c. Recruited members or asked for money or things of value
for a group or organization that did any of the activities
described in Item Number 48.a.?
Yes
No

51.e. Provided money, a thing of value, services or labor, or
any other assistance or support to an individual, group, or
organization who did any of the activities described in
Item Number 51.a.?
Yes
No

51.f. Received any type of military, paramilitary, or weapons
training from a group or organization that did any of the
activities described in Item Number 51.a.?
Yes
No
NOTE: If you answered “Yes” to any part of Item Number
51., explain the relationship and what occurred, including the
dates and location of the circumstances, in the space provided
in Part 14. Additional Information.
52.

48.d. Provided money, a thing of value, services or labor, or
any other assistance or support for any of the activities
described in Item Number 48.a.?
Yes
No
48.e. Provided money, a thing of value, services or labor, or
any other assistance or support for an individual, group,
or organization who did any of the activities described in
Item Number 48.a.?
Yes
No
49.

50.

Have you EVER received any type of military,
paramilitary, or weapons training?
Yes

Yes

Have you EVER worked, volunteered, or otherwise
served in any prison, jail, prison camp, detention facility,
labor camp, or any other situation that involved detaining
persons?
Yes
No

54.

Have you EVER been a member of, assisted, or
participated in any group, unit, or organization of any
kind in which you or other persons used any type of
weapon against any person or threatened to do so?

Do you intend to engage in any of the activities listed in
any part of Item Numbers 48.a. - 49.?
Yes
No

Yes

51.b. Participated in, or been a member or a representative of a
group or organization that did any of the activities
described in Item Number 51.a.?
Yes
No
51.c. Recruited members, or asked for money or things of value,
for a group or organization that did any of the activities
described in Item Number 51.a.?
Yes
No

Form I-485 Edition 10/15/19

No

55.

Have you EVER served in, been a member of, assisted,
or participated in any military unit, paramilitary unit,
police unit, self-defense unit, vigilante unit, rebel group,
guerilla group, militia, insurgent organization, or any
other armed group?
Yes
No

56.

Have you EVER been a member of, or in any way
affiliated with, the Communist Party or any other
totalitarian party (in the United States or abroad)?

Are you the spouse or child of an individual who EVER:
51.a. Committed, threatened to commit, attempted to commit,
conspired to commit, incited, endorsed, advocated,
planned, or prepared any of the following: hijacking,
sabotage, kidnapping, political assassination, or use of a
weapon or explosive to harm another individual or cause
substantial damage to property?
Yes
No

No

53.

No

NOTE: If you answered “Yes” to any part of Item Numbers
46.a. - 50., explain what you did, including the dates and
location of the circumstances, or what you intend to do in the
space provided in Part 14. Additional Information.

Have you EVER assisted or participated in selling,
providing, or transporting weapons to any person who,
to your knowledge, used them against another person?

Yes
57.

No

During the period from March 23, 1933 to May 8, 1945,
did you ever order, incite, assist, or otherwise participate
in the persecution of any person because of race, religion,
national origin, or political opinion, in association with
either the Nazi government of Germany or any
organization or government associated or allied with the
Nazi government of Germany?
Yes
No

Page 13 of 20

A-Number ► A-

Affidavit of Support Under Section 213A of the
INA (Form I-864)

Part 8. General Eligibility and Inadmissibility
Grounds (continued)

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Have you EVER ordered, incited, called for, committed, assisted,
helped with, or otherwise participated in any of the following:
58.a. Acts involving torture or genocide?

Yes

No

58.b. Killing any person?

Yes

No

58.c. Intentionally and severely injuring any person?
Yes

You may need to file Form I-864. For more information, read
the Form I-485 Instructions, What Evidence Must You
Submit, Item Number 9. Public Charge: Declaration of SelfSufficiency (Form I-944) and Affidavit of Support Under
INA section 213A (Form I-864).
I am EXEMPT from filing Form I-864 because:
62.a.

I have earned or can receive credit for 40 qualifying
quarters (credits) of work in the United States (as
defined by the Social Security Act (SSA). (Attach
your SSA earnings statements. Do not count any
quarters during which you received a means-tested
public benefit).

62.b.

I am under 18 years of age, unmarried, immigrating
as the child of a U.S. citizen, and will automatically
become a U.S. citizen under the Child Citizenship
Act of 2000 upon my admission to the United States.

62.c.

I am applying under the widow or widower of a U.S.
citizen (Form I-360) immigrant category.

62.d.

I am applying under an alien worker (Form I-140)
employment-based preference immigrant category
and both of the following apply:

No

58.d. Engaging in any kind of sexual contact or relations with
any person who did not consent or was unable to consent,
or was being forced or threatened?
Yes
No
58.e. Limiting or denying any person's ability to exercise
religious beliefs?
Yes
No
59.

60.

Have you EVER recruited, enlisted, conscripted, or used
any person under 15 years of age to serve in or help an
armed force or group?
Yes
No

Have you EVER used any person under 15 years of age
to take part in hostilities, or to help or provide services to
people in combat?
Yes
No

(1) I am not a relative of the Form I-140 petitioner;
and

NOTE: If you answered “Yes” to any part of Item Numbers
52. - 60., explain what occurred, including the dates and
location of the circumstances, in the space provided in Part 14.
Additional Information.

Public Charge
Those who are subject to the public charge ground of
inadmissibility under INA section 212(a)(4) must complete
Form I-944, Declaration of Self-Sufficiency, and may also have
to submit Form I-864, Affidavit of Support Under Section 213A
of the INA. Answer the questions below to determine whether
you need to submit these forms together with this Form I-485.

(2) I do not have a relative with a significant
ownership interest (at least five percent) in the
business that filed Form I-140.

62.e.

I am applying under the alien entrepreneur (Form
I-526) immigrant category.

62.f.

I am applying under the human trafficking victim
(T nonimmigrant) immigrant category (INA section
245(l)).

62.g.

I am applying under a category other than the human
trafficking victim (T nonimmigrant) category (INA
section 245(l)), or as an alien worker under the
employment-based preference categories where a
relative filed Form I-140 for me or has a five percent
or more ownership interest in the business that filed
Form I-140, and I either have a pending application
for T nonimmigrant status or I am an individual who
is in valid T nonimmigrant status.

Declaration of Self-Sufficiency (Form I-944)
61.

Are you exempt from the public charge ground of
inadmissibility?
Yes

No

To determine if you are exempt from the public charge ground
of inadmissibility, and therefore exempt from filing Form I-944,
read the Form I-485 Instructions, What Evidence Must You
Submit, Item Number 9. Public Charge: Declaration of SelfSufficiency (Form I-944) and Affidavit of Support Under
Section 213A of the INA (Form I-864). If you answered
“Yes” to Item Number 61., proceed to Item Number 63.a. If
you answered “No,” complete Form I-944 and include it with
your Form I-485 filing, and proceed to Item Number 62.a.

Form I-485 Edition 10/15/19

NOTE: If, when USCIS adjudicates your adjustment
application, your Form I-914 is no longer pending a decision or
you are no longer in valid T nonimmigrant status, you may have
to submit a Form I-944 and Form I-864.
62.h.

I am applying under the victim of qualifying criminal
activity (U nonimmigrant) immigrant category (INA
section 245(m)).
Page 14 of 20

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)
62.i.

DRAFT
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03/12/2020

I am applying under a category other than the victim
of qualifying criminal activity (U nonimmigrant)
category under INA section 245(m) or as an alien
worker under the employment-based preference
categories where a relative filed Form I-140 for me or
has a five percent or more ownership interest in the
business that filed Form I-140, but I either have a
pending petition for U nonimmigrant status or I am
an individual who is granted U nonimmigrant status.

NOTE: If, at the time of the adjudication of the Form I-485,
your Form I-918 is no longer pending a decision or you are no
longer in valid U nonimmigrant status, you may be required to
submit Form I-944 and Form I-864.
62.j.

62.k.

63.b. If your answer to Item Number 63.a. is "Yes," do you
believe you had reasonable cause?
Yes
No

I am applying under the diplomat or high ranking
official unable to return home (Section 13 of the Act
of September 11, 1957) immigrant category.

I am a law enforcement officer filing this Form I-485
for an S nonimmigrant immigrant (or a qualifying
family member).

62.l.

I am applying under the Diversity Visa program
immigrant category.

62.m.

I am applying under one of the following special
immigrant categories (select one):

63.c. If your answer to Item Number 63.b. is "Yes," attach a
written statement explaining why you had reasonable
cause.

64.

Have you EVER submitted fraudulent or counterfeit
documentation to any U.S. Government official to obtain
or attempt to obtain any immigration benefit, including a
visa or entry into the United States?
Yes
No

65.

Have you EVER lied about, concealed, or misrepresented
any information on an application or petition to obtain a
visa, other documentation required for entry into the
United States, admission to the United States, or any other
kind of immigration benefit?
Yes
No

66.

Have you EVER falsely claimed to be a U.S. citizen (in
writing or any other way)?
Yes
No

67.

Have you EVER been a stowaway on a vessel or aircraft
arriving in the United States?
Yes
No

68.

Have you EVER knowingly encouraged, induced,
assisted, abetted, or aided any foreign national to enter or
to try to enter the United States illegally (alien
smuggling)?
Yes
No

69.

Are you under a final order of civil penalty for violating
INA section 274C for use of fraudulent documents?

Armed forces (also known as the Six and Six
program)
Panama Canal Zone
Certain broadcasters
G-4 or NATO-6 employees and their family
members

Yes

Removal, Unlawful Presence, or Illegal Reentry
After Previous Immigration Violations
70.

International employees of the U.S. Government
abroad

Employed by or on behalf of the U.S.
Government
62.n.

I am applying under the Amerasian Act (October 22,
1982)

Illegal Entries and Other Immigration Violations
63.a. Have you EVER failed or refused to attend or to remain
in attendance at any removal proceeding filed against you
on or after April 1, 1997?
Yes
No

Form I-485 Edition 10/15/19

Have you EVER been excluded, deported, or removed
from the United States or have you ever departed the
United States on your own after having been ordered
excluded, deported, or removed from the United States?
Yes

Religious workers
Certain physicians

No

71.

No

Have you EVER entered the United States without being
inspected and admitted or paroled?
Yes
No

Since April 1, 1997, have you been unlawfully present in the
United States:
72.a. For more than 180 days but less than a year, and then
departed the United States?
Yes
No
72.b. For one year or more and then departed the United States?
Yes
No
NOTE: You were unlawfully present in the United States if
you entered the United States without being inspected and
admitted or inspected and paroled, or if you legally entered the
United States but you stayed longer than permitted.
Page 15 of 20

A-Number ► A-

Part 8. General Eligibility and Inadmissibility
Grounds (continued)

80.a. Have you EVER left or remained outside the United
States to avoid or evade training or service in the U.S.
armed forces in time of war or a period declared by the
President to be a national emergency?
Yes
No
80.b. If your answer to Item Number 80.a. is “Yes,” what was
your nationality or immigration status immediately before
you left (for example, U.S. citizen or national, lawful
permanent resident, nonimmigrant, parolee, present
without admission or parole, or any other status)?

DRAFT
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Since April 1, 1997, have you EVER reentered or attempted to
reenter the United States without being inspected and admitted
or paroled after:
73.a. Having been unlawfully present in the United States for
more than one year in the aggregate?
Yes
No
73.b. Having been deported, excluded, or removed from the
United States?
Yes
No

Part 9. Accommodations for Individuals With
Disabilities and/or Impairments

Miscellaneous Conduct
74.

Do you plan to practice polygamy in the United States?
Yes
No

75.

Are you accompanying another foreign national who
requires your protection or guardianship but who is
inadmissible after being certified by a medical officer as
being helpless from sickness, physical or mental
disability, or infancy, as described in INA section 232(c)?
Yes

1.

Have you EVER assisted in detaining, retaining, or
withholding custody of a U.S. citizen child outside the
United States from a U.S. citizen who has been granted
custody of the child?
Yes
No

77.

Have you EVER voted in violation of any Federal, state,
or local constitutional provision, statute, ordinance, or
regulation in the United States?
Yes
No

Are you requesting an accommodation because of your
disabilities and/or impairments?
Yes
No

If you answered "Yes" to Item Number 1., select any
applicable box in Item Numbers 2.a. - 2.c. and provide
an answer.

No

76.

78.

NOTE: Read the information in the Form I-485 Instructions
before completing this part.

2.a.

I am deaf or hard of hearing and request the
following accommodation. (If you are requesting a
sign-language interpreter, indicate for which
language (for example, American Sign Language).):

2.b.

I am blind or have low vision and request the
following accommodation:

2.c.

I have another type of disability and/or impairment.
(Describe the nature of your disability and/or
impairment and the accommodation you are
requesting.)

Have you EVER renounced U.S. citizenship to avoid
being taxed by the United States?
Yes
No

Have you EVER:
79.a. Applied for exemption or discharge from training or
service in the U.S. armed forces or in the U.S. National
Security Training Corps on the ground that you are a
foreign national?
Yes
No
79.b. Been relieved or discharged from such training or service
on the ground that you are a foreign national?
Yes
No
79.c. Been convicted of desertion from the U.S. armed forces?
Yes
No

Part 10. Applicant's Statement, Contact
Information, Certification, and Signature
NOTE: Read the Penalties section of the Form I-485
Instructions before completing this part. You must file Form
I-485 while in the United States.

Form I-485 Edition 10/15/19

Page 16 of 20

A-Number ► AI understand that USCIS may require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:

Part 10. Applicant's Statement, Contact
Information, Certification, and Signature
(continued)

DRAFT
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REPRODUCTION
03/12/2020

Applicant's Statement

NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
1.a.

1.b.

I can read and understand English, and I have read
and understand every question and instruction on this
application and my answer to every question.
The interpreter named in Part 11. read to me every
question and instruction on this application and my
answer to every question in

1)

I reviewed and understood all of the information
contained in, and submitted with, my application;
and

2)

All of this information was complete, true, and
correct at the time of filing.

I certify, under penalty of perjury, that all of the information in
my application and any document submitted with it were
provided or authorized by me, that I reviewed and understand
all of the information contained in, and submitted with, my
application and that all of this information is complete, true,
and correct.

,

2.

a language in which I am fluent, and I understood
everything.

Applicant's Signature

At my request, the preparer named in Part 12.,

6.a. Applicant's Signature (sign in ink)

,

prepared this application for me based only upon
information I provided or authorized.

Applicant's Contact Information
3.

Applicant's Daytime Telephone Number

4.

Applicant's Mobile Telephone Number (if any)

5.

Applicant's Email Address (if any)

6.b. Date of Signature (mm/dd/yyyy)

NOTE TO ALL APPLICANTS: If you do not completely fill
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.

Part 11. Interpreter's Contact Information,
Certification, and Signature

Provide the following information about the interpreter.

Interpreter's Full Name
Applicant's Certification
Copies of any documents I have submitted are exact photocopies
of unaltered, original documents, and I understand that USCIS
may require that I submit original documents to USCIS at a later
date. Furthermore, I authorize the release of any information
from any and all of my records that USCIS may need to
determine my eligibility for the immigration benefit that I seek.

1.a. Interpreter's Family Name (Last Name)

1.b. Interpreter's Given Name (First Name)

2.

Interpreter's Business or Organization Name (if any)

I understand that if I am a male who is 18 to 26 years of age,
submitting this application will automatically register me with
the Selective Service System as required by the Military
Selective Service Act.
I furthermore authorize release of information contained in this
application, in supporting documents, and in my USCIS
records, to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.

Form I-485 Edition 10/15/19

Page 17 of 20

A-Number ► A-

Part 11. Interpreter's Contact Information,
Certification, and Signature (continued)

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Interpreter's Mailing Address
3.a. Street Number
and Name
3.b.

Part 12. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant

Apt.

Provide the following information about the preparer.

Preparer's Full Name

Ste.

Flr.

1.a. Preparer's Family Name (Last Name)

3.c. City or Town
3.d. State
3.f.

3.e. ZIP Code

1.b. Preparer's Given Name (First Name)

Province

2.

Preparer's Business or Organization Name (if any)

3.g. Postal Code
3.h. Country

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

Preparer's Mailing Address

3.a. Street Number
and Name
3.b.

Apt.

Ste.

Flr.

3.c. City or Town

5.

Interpreter's Mobile Telephone Number (if any)

6.

Interpreter's Email Address (if any)

3.d. State
3.f.

3.e. ZIP Code

Province

3.g. Postal Code

Interpreter's Certification

3.h. Country

I certify, under penalty of perjury, that:
I am fluent in English and
,
which is the same language specified in Part 10., Item
Number 1.b., and I have read to this applicant in the identified
language every question and instruction on this application and
his or her answer to every question. The applicant informed me
that he or she understands every instruction, question, and
answer on the application, including the Applicant's
Certification, and has verified the accuracy of every answer.

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

5.

Preparer's Mobile Telephone Number (if any)

6.

Preparer's Email Address (if any)

Interpreter's Signature
7.a. Interpreter's Signature (sign in ink)

7.b. Date of Signature (mm/dd/yyyy)

Form I-485 Edition 10/15/19

Page 18 of 20

A-Number ► A-

Part 12. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
(continued)

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Preparer's Statement
7.a.

7.b.

NOTE: Do not complete Part 13. until the USCIS Officer
instructs you to do so at the interview.

I am not an attorney or accredited representative but
have prepared this application on behalf of the
applicant and with the applicant's consent.

Part 13. Signature at Interview

I swear (affirm) and certify under penalty of perjury under the
laws of the United States of America that I know that the
contents of this Form I-485, Application to Register Permanent
Residence or Adjust Status, subscribed by me, including the
corrections made to this application, numbered

I am an attorney or accredited representative and my
representation of the applicant in this case
extends
does not extend beyond the
preparation of this application.

through

NOTE: If you are an attorney or accredited
representative, you may be obliged to submit a
completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited
Representative, with this application.

true, and correct. All documents submitted at this interview
were provided by me and are complete, true, and correct.

, are complete, true, and correct. All

additional pages submitted by me with this Form I-485, on
numbered pages

through

are complete,

Subscribed to and sworn to (affirmed) before me
USCIS Officer's Printed Name or Stamp

Preparer's Certification

By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
applicant then reviewed this completed application and
informed me that he or she understands all of the information
contained in, and submitted with, his or her application,
including the Applicant's Certification, and that all of this
information is complete, true, and correct. I completed this
application based only on information that the applicant
provided to me or authorized me to obtain or use.

Date of Signature (mm/dd/yyyy)

Applicant's Signature (sign in ink)

USCIS Officer's Signature (sign in ink)

Preparer's Signature
8.a. Preparer's Signature (sign in ink)

8.b. Date of Signature (mm/dd/yyyy)

Form I-485 Edition 10/15/19

Page 19 of 20

A-Number ► A5.a. Page Number

Part 14. Additional Information

5.b. Part Number

5.c. Item Number

DRAFT
NOT FOR
REPRODUCTION
03/12/2020

If you need extra space to provide any additional information
within this application, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this application or attach a separate
sheet of paper. Type or print your name and A-Number (if any)
at the top of each sheet; indicate the Page Number, Part
Number, and Item Number to which your answer refers; and
sign and date each sheet.

5.d.

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

1.c. Middle Name
2.

6.a. Page Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

A-Number (if any) ► A-

6.d.

3.a. Page Number

3.d.

3.b. Part Number

3.c. Item Number

7.a. Page Number

7.d.
4.a. Page Number

4.b. Part Number

4.c. Item Number

4.d.

Form I-485 Edition 10/15/19

Page 20 of 20