Download:
pdf |
pdfPetition for a Nonimmigrant Worker:
O Classifications
USCIS
Form I-129O
Department of Homeland Security
U.S. Citizenship and Immigration Services
Partial Approval (explain)
Receipt
OMB No. 1615-xxxx
Expires xx/xx/20xx
Action Block
For
USCIS
Use
Only
Class:
No. of Workers:
Job Code:
Validity Dates:
From:
To:
Classification Approved
Consulate/POE/PFI Notified
DRAFT
Not for
Production
09/04/2020
At:
Extension Granted
COS/Extension Granted
► START HERE - Type or print in black ink. Answer all questions fully and accurately. If a question does not apply to you (for
example, if you have never been married and the question asks, “Provide the name of your current spouse”), type or print “N/A”
unless otherwise directed. If your answer to a question which requires a numeric response is zero or none (for example, “How
many children do you have?” or “How many times have you departed the United States?”), type or print “None” unless otherwise
directed.
If you are filing this petition for an O-1 classification, you may only include one beneficiary on this petition. If you are filing this
petition for O-2 classification, you may include up to 25 beneficiaries on the same petition if they will be assisting the same O-1 for
the same events or performances, during the same period of time, and in the same location.
Part 1. Petitioner Information
If you are an individual or sole proprietor filing this petition, you must complete Item Numbers 1. - 2. If you are a company or an
organization filing this petition, complete Item Number 3. All petitioners should complete Item Numbers 4. - 11., as applicable.
1.
Legal Name of Petitioning Individual or Sole Proprietor
Family Name (Last Name)
Given Name (First Name)
2.
Date of Birth (mm/dd/yyyy)
3.
4.
Trade Name or “Doing Business As” Name
5.
USCIS Online Account Number
Middle Name
Petitioning Company or Organization Name
►
6.
Primary U.S. Office Address of Petitioner
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Form I-129O Edition 10/02/20
ZIP Code
(USPS ZIP Code Lookup)
Page 1 of 20
Part 1. Petitioner Information (continued)
7.
Is your mailing address different from your Primary U.S. Office Address?
Yes
No
If you answered “Yes,” to Item Number 7., provide your mailing address below.
8.
Mailing Address
In Care Of Name
Street Number and Name
Apt.Ste. Flr.
Number
City or Town
State
ZIP Code
Province
DRAFT
Not for
Production
09/04/2020
Postal Code
(USPS ZIP Code Lookup)
Country
Petitioner's Contact Information
9.
U.S. Daytime Telephone Number
11.
Email Address
10.
U.S. Mobile Telephone Number
13.
Individual Taxpayer Identification Number (ITIN)
Tax Payer Identification Numbers
Provide the following information, as applicable.
12.
Employer Identification Number (EIN)
►
14.
►
U.S. Social Security Number (SSN)
►
E-Verify Information
15.
Are you a participant in the E-Verify program and filing this petition as an employer?
Yes
No
If you answered “Yes” to Item Number 15., provide the information requested in Item Numbers 16. - 17.
16.
Employer's Name as Listed in E-Verify
17.
Employer's E-Verify Company Identification Number or an E-Verify Client Company Identification Number
Form I-129O Edition 10/02/20
Page 2 of 20
Part 2. Information About This Petition
1.
Requested Nonimmigrant Classification (Select only one box.)
A.
O-1A Alien of extraordinary ability in sciences, education, business, or athletics (not including the arts, motion
picture, or television industry).
B.
O-1B Alien of extraordinary ability in the arts.
C.
O-1B Alien of extraordinary achievement in the motion picture or television industry.
D.
O-2 Accompanying alien who is coming to the United States to assist in the performance of an O-1 artist or athlete.
E.
O-2 Accompanying alien who is coming to the United States to assist in the performance of an O-1 alien in the
motion picture or television industry.
DRAFT
Not for
Production
09/04/2020
2.
If filing for an O-2 classification, provide the total number of beneficiaries included in this petition. (You may include up to 25
beneficiaries on a single I-129O petition in certain instances. See the Information About Form I-129O section of these
Instructions.): ►
3.
Basis for Classification (Select only one box)
A.
New Employment
B.
Continuation of Previously Approved Employment Without Change With the Same Employer
C.
Change in Previously Approved Employment (provide an explanation in Part 11. Additional Information)
D.
New Concurrent Employment
E.
Change of Employer For a Beneficiary Already in the Requested Classification
F.
Amended Petition (provide an explanation in Part 11. Additional Information)
4.
If you selected Item F. Amended petition in Item Number 3., provide the receipt number of the petition you seek to amend.
►
5.
Requested Action (Select only one box)
A.
Notify the office in Part 5. so that each beneficiary can apply for and obtain a visa or be admitted, if eligible.
B.
Change the status and extend the stay of each beneficiary because the beneficiary(ies) is/are now in the United
States in another status (see the Instructions for limitations). This is available only when you select Item A. New
Employment in Item Number 3. above.
C.
Extend the stay of each beneficiary because the beneficiary(ies) now hold(s) this status.
D.
Amend the stay of each beneficiary because the beneficiary(ies) now hold(s) this status.
Part 3. Beneficiary Information
Provide the information requested about the beneficiary(ies) for whom you are filing. Use Attachment 1-Additional Beneficiary for
Form I-129O to provide information about each additional beneficiary included in this petition.
1.
Beneficiary's Full Name
Family Name (Last Name)
2.
Given Name (First Name)
Middle Name
Provide all other names the beneficiary has ever used. Include nicknames, aliases, maiden name, and names from all previous
marriages. If you need extra space to complete this section, use the space provided in Part 11. Additional Information.
Family Name (Last Name)
Form I-129O Edition 10/02/20
Given Name (First Name)
Middle Name
Page 3 of 20
Part 3. Beneficiary Information (continued)
Other Information
3.
Date of Birth (mm/dd/yyyy)
4.
Gender
Male
6.
Alien Registration Number (A-Number)
5.
Female
7.
► A-
USCIS Online Account Number
►
8.
City or Town of Birth
10.
Country of Birth
12.
Beneficiary's Foreign Address
9.
Province of Birth
DRAFT
Not for
Production
09/04/2020
11.
Country of Citizenship or Nationality
Street Number and Name
City or Town
Province
13.
U.S. Social Security Number
►
Apt. Ste. Flr. Number
Postal Code
Country
If the beneficiary is in the United States, complete the following:
Date of Last Arrival
Form I-94 Arrival-Departure Record Number
(mm/dd/yyyy)
►
Passport or Travel Document Number
Date Passport or Travel Document Issued
(mm/dd/yyyy)
Date Passport or Travel Document Expires
(mm/dd/yyyy)
Passport or Travel Document Country of Issuance
Current Nonimmigrant
Category
Date Status Expires or Duration of Status (D/S)
(see Form I-94 Arrival/Departure Document)
(mm/dd/yyyy)
Student and Exchange Visitor Information System (SEVIS)
Number
14.
Employment Authorization Document (EAD)
Number
Does the beneficiary have a U.S. residential address?
Yes
No
If you answered “Yes” to Item Number 14., you must provide the beneficiary's U.S. residential address information in Item
Number 15.
15.
Beneficiary's Current U.S. Residential Address (Do not list a P.O. Box unless the beneficiary resides in the Commonwealth of
Northern Mariana Islands (CNMI).)
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Form I-129O Edition 10/02/20
ZIP Code
Page 4 of 20
Part 3. Beneficiary Information (continued)
16.
Provide the most recent petition/application receipt number for the beneficiary. If none exists, indicate "None."
►
17.
Have you ever filed an immigrant petition for this beneficiary?
Yes
No
If you answered “Yes” to Item Number 17., provide the receipt number for each petition you have filed for this beneficiary in
Part 11. Additional Information.
18.
Yes
Have you ever filed a nonimmigrant petition for this beneficiary?
No
If you answered “Yes” to Item Number 18., identify the classification requested and the receipt number for each petition in
Part 11. Additional Information.
DRAFT
Not for
Production
09/04/2020
Part 4. Information About the Beneficiary's Public Benefits
Part 4. only applies to petitions that also seek a change of a beneficiary's status or an extension of a beneficiary's nonimmigrant stay
in the United States. If you are filing this petition without a request for the beneficiary's change of status or extension of stay, you
may skip Part 4.
For the beneficiary named above in Part 3. Beneficiary Information, provide the requested information and submit documentation as
outlined in the Instructions. For each additional beneficiary, please respond to the questions in a separate copy of the Attachment 1Additional Beneficiary for Form I-129O.
1.
Has the beneficiary received, since obtaining the nonimmigrant status that you seek to extend or that you seek to change on
behalf of the beneficiary, received, or is the beneficiary currently certified to receive, the following public benefits? (select all
that apply).
Yes, the beneficiary has received or is currently certified to receive the following public benefits: (select all that apply)
Any Federal, State, local or tribal cash assistance for income maintenance
Supplemental Security Income (SSI)
Temporary Assistance for Needy Families (TANF)
General Assistance (GA)
Supplemental Nutrition Assistance Program (SNAP, formerly called "Food Stamps")
Section 8 Housing Assistance under the Housing Choice Voucher Program
Section 8 Project-Based Rental Assistance (including Moderate Rehabilitation)
Public Housing under the Housing Act of 1937, 42 U.S.C. 1437 et seq.
Federal-funded Medicaid
No, the beneficiary has not received any of the above listed public benefits.
No, the beneficiary is not certified to receive any of the above listed public benefits.
2.
If the beneficiary has received or is currently certified to receive any of the above public benefits, provide information about the
public benefits below. If you need additional space to complete any Item Number in this Part, use the space provided in Part 11.
Additional Information. Submit evidence as outlined in the Instructions.
A.
Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
Form I-129O Edition 10/02/20
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Page 5 of 20
Part 4. Information About the Beneficiary's Public Benefits (continued)
B.
Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
C.
Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
Type of Benefit
Agency that Granted the Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
3.
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
DRAFT
Not for
Production
09/04/2020
(mm/dd/yyyy)
D.
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
If you answered “Yes” to Item Number 1., do any of the following apply to the beneficiary? Provide the evidence listed in the
Form I-129 Instructions.
The beneficiary is enlisted in the Armed Forces, or is serving in active duty or in the Ready Reserve Component of the U.S.
Armed Forces.
The beneficiary is the spouse or the child of an individual who is enlisted in the Armed Forces, or who is serving in active
duty or in the Ready Reserve Component of the U.S. Armed Forces.
At the time the beneficiary received the public benefits, the beneficiary (or the beneficiary's spouse or parent) was enlisted
in the Armed Forces, or was serving in active duty or in the Ready Reserve Component of the U.S. Armed Forces.
At the time the beneficiary received the public benefits, the beneficiary was present in the United States in a status exempt
from the public charge ground of inadmissibility.
At the time the beneficiary received the public benefits, the beneficiary was present in the United States after being granted
a waiver of the public charge ground of inadmissibility.
The beneficiary is a child currently residing abroad who entered the United States with a nonimmigrant visa to attend an
N-600K, Application for Citizenship and Issuance of Certificate Under INA Section 322 interview.
None of the above statements apply to the beneficiary.
4.
A.
Has the beneficiary received, applied for, or has been certified to receive federally-funded Medicaid in connection with
any of the following (select all that apply): Submit evidence as outlined in the Instructions.
An emergency medical condition
For a service under the Individuals with Disabilities Education Act (IDEA)
Other school-based benefits or services available up to the oldest age eligible for secondary education under State law
While under the of age 21
While pregnant or during the 60-day period following the last day of pregnancy
B.
Provide the applicable dates mm/dd/yyyy
Form I-129O Edition 10/02/20
to mm/dd/yyyy
Page 6 of 20
Part 5. Processing Information
1.
Indicate the U.S. Consulate or U.S. Customs and Border Protection (CPB) inspection facility you would like notified if the
petition will be approved with consular notification (for example, you requested consular notification or a requested extension of
stay or change of status cannot be granted).
A.
Type of Office (Select only one box)
U.S. Consulate
B.
2.
City Where Office is Located
U.S. State or Foreign Country
DRAFT
Not for
Production
09/04/2020
Yes
No
Yes
No
Yes
No
►
Are you filing any applications for replacement/initial Form I-94, Arrival-Departure Records with this
petition? (If the beneficiary(ies) was/were issued an electronic Form I-94 by CBP when admitted to the
United States at an air or sea port, they may be able to obtain the Form I-94 from the CBP website at
www.cbp.gov/i94 instead of filing an application for a replacement/initial I-94.)
If yes, how many?
4.
C.
U.S. Port of Entry
Are you filing any other petitions with this one?
If yes, how many?
3.
CBP Pre-flight inspection Facility
►
Is any beneficiary in this petition in removal proceedings?
If you answered “Yes” to Item Number 4., list the beneficiary's(ies) name(s) in Part 11. Additional Information.
5.
Has any beneficiary in this petition ever been granted the classification you are now requesting?
Yes
No
Yes
No
Yes
No
If you answered “Yes” to Item Number 5., provide an explanation in Part 11. Additional Information.
6.
Has any beneficiary in this petition ever been denied the classification you are now requesting?
If you answered "Yes" to Item Number 6., provide explanation in Part 11. Additional Information.
7.
Has this beneficiary ever been a J-1 exchange visitor or J-2 dependent of a J-1 exchange visitor?
If you answered "Yes" to Item Number 7., provide a response to Item Number 8.
8.
If you answered “Yes” to Item Number 7., provide the dates the beneficiary maintained status as a J-1 exchange visitor or J-2
dependent. Also, provide evidence of this status by attaching a copy of either a DS-2019, Certificate of Eligibility for Exchange
Visitor (J-1) Status, a Form IAP-66, or a copy of the passport that includes the J visa stamp. Additionally, if applicable, provide
evidence that the applicant or employee fulfilled the two-year foreign residence requirement or had such residence requirement
waived.
9.
Does any beneficiary in this petition have ownership interest in the petitioning organization?
Yes
No
If you answered “Yes” to Item Number 9., provide an explanation of the beneficiary's(ies) ownership interests in Item
Number 10.
10.
Explanation
11.
Does an appropriate labor organization exist for the petition?
Yes
No
If you answered “No” to Item Number 11., provide an explanation in Part 11. Additional Information.
Form I-129O Edition 10/02/20
Page 7 of 20
Part 5. Processing Information (continued)
12.
Is the required consultation or written advisory opinion being submitted with this petition?
Yes
No - a copy of the request is attached
Consultation not required
If you answered “No” to Item Number 12., indicate to which organizations you have sent a duplicate of this petition. In either
Item Numbers 13. - 14. or Item Numbers 15. - 17., provide the information about the organizations to which you have sent a
duplicate of this petition, as relevant to the O classification you are seeking.
If you are filing for an O-1 beneficiary, complete Item Numbers 13. and 14.
13.
Explain the nature of the event in which the O-1 beneficiary will participate.
14.
Describe the services the O-1 beneficiary will perform.
DRAFT
Not for
Production
09/04/2020
If you are filing for one or more O-2 beneficiaries, complete Item Numbers 15. - 17.
15.
Explain the nature of the event in which the O-2 beneficiary(ies) will participate.
16.
Describe the services the O-1 beneficiary(ies) will perform.
17.
List the dates of the prior work experience under the principal O-1 alien for the O-2 beneficiary listed in Part 3. Beneficiary
Information. If you need extra space to complete this section, use the space provided in Part 11. Additional Information or
attach an additional sheet of paper. If you are applying for more than one beneficiary, provide this information for each
additional beneficiary in the Attachment 1-Additional Beneficiary for Form I-129O.
Prior Work Experience
Form I-129O Edition 10/02/20
Start Date (mm/dd/yyyy)
End Date (mm/dd/yyyy)
Page 8 of 20
Part 5. Processing Information (continued)
Additional Information for O Classifications
Provide the information requested below, as relevant to the type of O classification you are seeking.
O-1 Extraordinary Ability
18.
Name of Recognized Peer/Peer Group or Labor Organization
19.
Physical Address
20.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
DRAFT
Not for
Production
09/04/2020
Date Sent (mm/dd/yyyy)
21.
ZIP Code
Daytime Telephone Number
O-1 Extraordinary Achievement in Motion Picture or Television Industry
Labor Organization
22.
Name of Labor Organization
23.
Complete Address
24.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Date Sent (mm/dd/yyyy)
25.
ZIP Code
Daytime Telephone Number
Management Organization
26.
Name of Management Organization
27.
Physical Address
28.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Date Sent (mm/dd/yyyy)
Form I-129O Edition 10/02/20
29.
ZIP Code
Daytime Telephone Number
Page 9 of 20
Part 5. Processing Information (continued)
O-2 Accompanying an O-1 Artist or Athlete
Labor Organization
30.
Name of Labor Organization
31.
Complete Address
Street Number and Name
City or Town
32.
Apt. Ste. Flr. Number
DRAFT
Not for
Production
09/04/2020
Date Sent (mm/dd/yyyy)
State
33.
ZIP Code
Daytime Telephone Number
O-2 Accompanying an O-1 in motion picture or television industry
Labor Organization
34.
Name of Labor Organization
35.
Complete Address
36.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Date Sent (mm/dd/yyyy)
37.
ZIP Code
Daytime Telephone Number
Management Organization
38.
Name of Management Organization
39.
Physical Address
40.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Date Sent (mm/dd/yyyy)
Form I-129O Edition 10/02/20
41.
ZIP Code
Daytime Telephone Number
Page 10 of 20
Part 6. Basic Information About the Proposed Employment and Employer
1.
Job Title/Title
2.
Address where the beneficiary(ies) will work if different from the address in Part 1. (If beneficiary(ies) will work at more than
one different address, include the additional addresses in the itinerary information submitted with the petition.)
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code
DRAFT
Not for
Production
09/04/2020
3.
Did you include an itinerary with the petition?
Yes
No
4.
Will the beneficiary(ies) work for you off-site at another company or organization's location?
Yes
No
5.
Will the beneficiary(ies) work exclusively in the (CNMI)?
Yes
No
6.
Is this a full-time position?
Yes
No
7.
If you answered "No" to Item Number 6., how many hours per week for the position? ►
8.
Wages (in U.S. dollars): $
9.
Other Compensation (Explain)
10.
Dates of Intended Employment
per (Specify hour, week, month, or year) ►
From (mm/dd/yyyy)
To (mm/dd/yyyy)
11.
Type of Business
12. Year Established
13.
Current Number of Employees in the United States ►
14.
Gross Annual Income
$
15.
Net Annual Income
$
Part 7. Certification Regarding the Release of Controlled Technology or Technical Data to Foreign
Persons in the United States
If you are seeking an O-1A classification, you must complete Part 7. Please review the Form I-129O Instructions before
completing this section. If you are petitioning for any other O classifications, you do not need to complete Part 7.
Select Item Number 1. or Item Number 2., as appropriate. Select only one option.
1.
With respect to the technology or technical data the petitioner will release or otherwise provide access to the beneficiary, the
petitioner certifies that it has reviewed the Export Administration Regulations (EAR) and the International Traffic in Arms
Regulations (ITAR) and has determined that either:
A.
A license is not required from either the U.S. Department of Commerce or the U.S. Department of State to release
such technology or technical data to the foreign person; or
B.
A license is required from the U.S. Department of Commerce and/or the U.S. Department of State to release such
technology or technical data to the beneficiary and the petitioner will prevent access to the controlled technology or
technical data by the beneficiary until and unless the petitioner has received the required license or other authorization
to release it to the beneficiary.
Form I-129O Edition 10/02/20
Page 11 of 20
Part 8. Statement, Contact Information, Certification, and Signature of the Petitioner or Authorized
Signatory
NOTE: Read the Penalties section of the Form I-129O Instructions before completing this section.
Petitioner's or Authorized Signatory's Statement
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.
Petioner's or Authorized Signatory's Statement Regarding the Interpreter
A.
I can read and understand English, and I have read and understand every question and instruction on this petition and
my answer to every question.
B.
The interpreter named in Part 9. has read to me every question and instruction on this petition and my answer to
every question in
, a language in which I am fluent, and I
DRAFT
Not for
Production
09/04/2020
understood all of this information as interpreted.
2.
Petitioner's or Authorized Signatory's Statement Regarding the Preparer
At my request, the preparer named in Part 10.,
,
prepared this petition for me based only upon information I provided or authorized.
Petitioner's or Authorized Signatory's Certification
Copies of any documents submitted are exact photocopies of unaltered, original documents, and I understand that, as the petitioner or
authorized signatory, I may be required to submit original documents to USCIS at a later date.
I authorize the release of any information contained in this petition, in supporting documents, in my USCIS records, and in the
petitioning organization's USCIS records, to USCIS or other entities and persons where necessary to determine eligibility for the
immigration benefit sought or where authorized by law. I recognize the authority of USCIS to conduct audits of this petition using
publicly available open source information. I also recognize that any supporting evidence submitted in support of this petition may be
verified by USCIS through any means determined appropriate by USCIS, including but not limited to, on-site compliance reviews.
If filing this petition on behalf of an organization, I certify that I am authorized to do so by the organization.
I certify that the petitioner and the employer whose offer of employment formed the basis of status (if different from the petitioner)
will be jointly and severally liable for the reasonable costs of return transportation of the beneficiary abroad if the beneficiary is
dismissed from employment by the employer before the end of the period of authorized stay.
I certify, under penalty of perjury, that I provided or authorized all of the information contained in, and submitted with, my petition,
and that all of this information is complete, true, and correct.
Petitioner's or Authorized Signatory's Signature
3.
Petitioner's or Authorized Signatory's Signature
Form I-129O Edition 10/02/20
Date of Signature (mm/dd/yyyy)
Page 12 of 20
Part 8. Statement, Contact Information, Certification, and Signature of the Petitioner or Authorized
Signatory (continued)
If Part 8. is being completed by an Authorized Signatory, provide the following information.
Authorized Signatory's Contact Information
4.
Authorized Signatory's Family Name (Last Name)
Authorized Signatory's Given Name (First Name)
5.
Authorized Signatory's Title
6.
Authorized Signatory's Daytime Telephone Number
7.
Authorized Signatory's Mobile Telephone Number (if any)
8.
Authorized Signatory's Email Address (if any)
DRAFT
Not for
Production
09/04/2020
NOTE TO ALL PETITIONERS AND AUTHORIZED SIGNATORIES: If you do not completely fill out this petition or fail to
submit required documents listed in the Instructions, USCIS may deny your petition.
Part 9. Interpreter's Contact Information, Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
1.
Interpreter's Family Name (Last Name)
Interpreter's Given Name (First Name)
2.
Interpreter's Business or Organization Name (if any)
Interpreter's Mailing Address
3.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
Country
Interpreter's Contact Information
4.
Interpreter's Daytime Telephone Number
6.
Interpreter's Email Address (if any)
Form I-129O Edition 10/02/20
5.
Interpreter's Mobile Telephone Number (if any)
Page 13 of 20
Part 9. Interpreter's Contact Information, Certification, and Signature (continued)
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
, which is the same language specified in Part 8.,
Item B., in Item Number 1., and I have read to this petitioner or the authorized signatory in the identified language every question
and instruction on this petition and his or her answer to every question. The petitioner or authorized signatory informed me that he or
she understands every instruction, question, and answer on the petition, including the Petitioner's or Authorized Signatory's
Certification, and has verified the accuracy of every answer.
Interpreter's Signature
7.
DRAFT
Not for
Production
09/04/2020
Interpreter's Signature
Date of Signature (mm/dd/yyyy)
Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner or Authorized Signatory
Provide the following information about the preparer.
Preparer's Full Name
1.
Preparer's Family Name (Last Name)
Preparer's Given Name (First Name)
2.
Preparer's Business or Organization Name (if any)
Preparer's Mailing Address
3.
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
Country
Preparer's Contact Information
4.
Preparer's Daytime Telephone Number
6.
Preparer's Email Address (if any)
Form I-129O Edition 10/02/20
5.
Preparer's Mobile Telephone Number (if any)
Page 14 of 20
Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner or Authorized Signatory (continued)
Preparer's Statement
7.
A.
I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and with the
petioner's or authorized signatory's consent.
B.
I am an attorney or accredited representative and my representation of the petitioner or authorized signatory in this case
extends
does not extend beyond the preparation of this petition.
NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative, with this petition.
DRAFT
Not for
Production
09/04/2020
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner or authorized signatory.
The petitioner or authorized signatory has reviewed this completed petition, including the Petitioner's or Authorized Signatory's
Certification, and informed me that all of the information in the petition and in the supporting documents is complete, true, and
correct.
Preparer's Signature
8.
Preparer's Signature
Form I-129O Edition 10/02/20
Date of Signature (mm/dd/yyyy)
Page 15 of 20
Part 11. Additional Information
If you need extra space to provide any additional information within this petition, 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 petition or attach a separate sheet of paper. Type or
print the individual petitioner's legal name or the company or organization name 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.
1.
Individual Petitioner or Company Name (same as in Part 1.)
Family Name Name (Last Name)
2.
Petitioning Company or Organization Name
3.
A. Page Number
D.
4.
A. Page Number
D.
5.
A. Page Number
D.
6.
Given Name (First Name)
Middle Name
DRAFT
Not for
Production
09/04/2020
A. Page Number
B. Part Number
C. Item Number
B. Part Number
C. Item Number
B. Part Number
C. Item Number
B. Part Number
C. Item Number
D.
Form I-129O Edition 10/02/20
Page 16 of 20
Attachment 1-Additional Beneficiary for Form I-129O
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-129O
OMB No. 1615-xxxx
Expires xx/xx/20xx
Complete a separate copy of this attachment for each additional beneficiary included in this petition. (Do not complete a copy
of Attachment 1 for the beneficiary you already named in Part 3. of Form I-129O.)
Petitioner's Information
Provide the same petitioner name information that was provided in Part 1. of Form I-129O.
1.
Legal Name of Petitioning Individual Petitioner
DRAFT
Not for
Production
09/04/2020
Family Name (Last Name)
2.
Petitioning Company or Organization Name
3.
Beneficiary's Full Name
Family Name (Last Name)
4.
Middle Name
Given Name (First Name)
Middle Name
Provide all other names the beneficiary has ever used. Include nicknames, aliases, maiden name, and names from all previous
marriages. If you need extra space to complete this section, use the space provided in Part 11. Additional Information.
Family Name (Last Name)
Other Information
5.
Given Name (First Name)
Date of Birth (mm/dd/yyyy)
Given Name (First Name)
6.
Gender
Male
8.
Alien Registration Number (A-Number)
►
A-
7.
U.S. Social Security Number
►
Female
9.
Middle Name
USCIS Online Account Number
►
10.
City or Town of Birth
11.
Province of Birth
12.
Country of Birth
13.
Country of Citizenship or Nationality
14.
Beneficiary's Foreign Address
Street Number and Name
Apt. Ste. Flr. Number
City or Town
Province
Form I-129O Edition 10/02/20
Postal Code
Country
Page 17 of 20
15.
If the beneficiary is in the United States, complete the following:
Date of Last Arrival
Form I-94 Arrival-Departure Record Number
(mm/dd/yyyy)
►
Passport or Travel Document Number
Date Passport or Travel Document Issued
(mm/dd/yyyy)
Date Passport or Travel Document Expires
(mm/dd/yyyy)
Passport or Travel Document Country of Issuance
Current Nonimmigrant
Status
Date Status Expires or Duration of Status (D/S)
(see Form I-94 Arrival/Departure Document)
DRAFT
Not for
Production
09/04/2020
(mm/dd/yyyy)
Student and Exchange Visitor Information System (SEVIS)
Number
16.
Employment Authorization Document (EAD)
Number
Does the beneficiary have a U.S. residential address?
Yes
No
If you answered “Yes” to Item Number 16., you must provide the beneficiary's U.S. residential address information in Item
Number 17.
17.
18.
Beneficiary's Current U.S. Residential Address (Do not list a P.O. Box unless the beneficiary resides in the (CNMI).)
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Provide the most recent petition/application receipt number for the beneficiary. If none exists, indicate "None."
►
19.
ZIP Code
Have you ever filed an immigrant petition for this beneficiary?
Yes
No
Yes
No
If you answered “Yes” to Item Number 19., provide the receipt number for each petition you have
filed for this beneficiary in Part 11. Additional Information.
20.
Have you ever filed a nonimmigrant petition for this beneficiary?
If you answered “Yes” to Item Number 20., identify the classification requested and the receipt
numbers for each petition in Part 11. Additional Information.
21.
List the dates of the beneficiary's(ies') prior work experience under the principal O-1 alien. If you need extra space to complete
this section, use the space provided in Part 11. Additional Information.
Prior Work Experience
Form I-129O Edition 10/02/20
Start Date (mm/dd/yyyy)
End Date (mm/dd/yyyy)
Page 18 of 20
Information About The Beneficiary's Public Benefits
Item Numbers 22. - 23.B. only apply to petitions that also seek a change of a beneficiary's status or an extension of a beneficiary's
nonimmigrant stay in the United States. If you are filing this petition without a request for the beneficiary's change of status or
extension of stay, you may skip Item Numbers 20. - 25.B.
22.
Has the beneficiary, since obtaining the nonimmigrant status that you seek to extend or that you seek to change on behalf of the
beneficiary, received, or is the beneficiary currently certified to receive, any of the following public benefits? (select all that apply).
Yes, the beneficiary has received or is currently certified to receive the following public benefits: (select all that apply)
Any Federal, State, local or tribal cash assistance for income maintenance
Supplemental Security Income (SSI)
Temporary Assistance for Needy Families (TANF)
DRAFT
Not for
Production
09/04/2020
General Assistance (GA)
Supplemental Nutrition Assistance Program (SNAP, formerly called "Food Stamps")
Section 8 Housing Assistance under the Housing Choice Voucher Program
Section 8 Project-Based Rental Assistance (including Moderate Rehabilitation)
Public Housing under the Housing Act of 1937, 42 U.S.C. 1437 et seq.
Federal-funded Medicaid
No, the beneficiary has not received any of the above listed public benefits.
No, the beneficiary is not certified to receive any of the above listed public benefits.
23.
If the beneficiary has received or is currently certified to receive any of the above public benefits, provide information about the
public benefits below. If you need additional space to complete any Item Number in this Part, use the space provided in Part 11.
Additional Information. Submit evidence as outlined in the Instructions.
A.
Type of Public Benefit
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
B.
Type of Public Benefit
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
C.
Type of Public Benefit
Form I-129O Edition 10/02/20
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
Page 19 of 20
D.
Type of Public Benefit
Agency that Granted the Public Benefit
Date the Beneficiary Started Receiving the Benefit or if Certified,
Date the Beneficiary Will Start Receiving the Benefit
(mm/dd/yyyy)
24.
Date Benefit or Coverage Ended
or Expires
(mm/dd/yyyy)
If you answered “Yes” to Item Number 1., do any of the following apply to the beneficiary? Provide the evidence listed in the
Form I-129 Instructions.
The beneficiary is enlisted in the Armed Forces, or is serving in active duty or in the Ready Reserve Component of the U.S.
Armed Forces.
The beneficiary is the spouse or the child of an individual who is enlisted in the Armed Forces, or who is serving in active
duty or in the Ready Reserve Component of the U.S. Armed Forces.
DRAFT
Not for
Production
09/04/2020
At the time the beneficiary received the public benefits, the beneficiary (or the beneficiary's spouse or parent) was enlisted
in the Armed Forces, or was serving in active duty or in the Ready Reserve Component of the U.S. Armed Forces.
At the time the beneficiary received the public benefits, the beneficiary was present in the United States in a status exempt
from the public charge ground of inadmissibility.
At the time the beneficiary received the public benefits, the beneficiary was present in the United States after being granted
a waiver of the public charge ground of inadmissibility.
The beneficiary is a child currently residing abroad who entered the United States with a nonimmigrant visa to attend an
N-600K, Application for Citizenship and Issuance of Certificate Under INA Section 322 interview.
None of the above statements apply to the beneficiary.
25.
A.
Has the beneficiary received, applied for, or has been certified to receive federally-funded Medicaid in connection with
any of the following (select all that apply): Submit evidence as outlined in the Instructions.
An emergency medical condition
For a service under the Individuals with Disabilities Education Act (IDEA)
Other school-based benefits or services available up to the oldest age eligible for secondary education under State law
While under the of age 21
While pregnant or during the 60-day period following the last day of pregnancy
B.
Provide the applicable dates mm/dd/yyyy
Form I-129O Edition 10/02/20
to mm/dd/yyyy
Page 20 of 20
| File Type | application/pdf |
| File Title | I-129O, Petition for a Nonimmigrant Worker: ..O Classifications |
| Author | USCIS |
| File Modified | 2020-09-04 |
| File Created | 2020-08-10 |