Application for Temporary Protected Status (online filed)

myUSCIS copy deck
I-821 Application for Temporary Protected Status
OMB control number 1615-0043
Baseline version: 07/03/2019

Copy Deck Version

I-821 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

Heading
I-821, Application for
Temporary Protected
Status (TPS)

Sub-Heading

Body Text (First Release - Initial Filing Only)
If you are an eligible national of certain countries that the Secretary of Homeland Security (Secretary) has designated for Temporary
Protected Status (TPS) or a person without nationality who last habitually resided in the designated country, then you may apply for TPS by
filing Form I-821, Application for Temporary Protected Status. This form is also used if you have TPS and are filing for TPS re-registration.

Body Text (Second Release - Re-registration: Differences from Initial Filing in red font)
If you are an eligible national of certain countries that the Secretary of Homeland Security (Secretary) has designated for Temporary Protected Status
(TPS) or a person without nationality who last habitually resided in the designated country, then you may apply for TPS by filing Form I-821, Application
for Temporary Protected Status. This form is also used if you have TPS and are filing for TPS re-registration.

Do not use Form I-821 to request Consideration Of Deferred Action for Childhood Arrivals (DACA). Form I-821D must be used to request
DACA.

Do not use Form I-821 to request Consideration Of Deferred Action for Childhood Arrivals (DACA). Form I-821D must be used to request DACA.

Review countries currently designated for TPS.

Before You Start Your
Application

Eligibility

You may file Form I-821 online only if you are an eligible national of Burma, Haiti, Syria, or Venezuela or an individual without nationality
who last habitually resided in Burma, Haiti, Syria or Venezuela filing an initial application for TPS. All other TPS applicants and re-registrants
must submit a paper Form I-821.
To be eligible for TPS, you must be admissible to the United States as an immigrant under the applicable grounds in INA section 212(a), with
certain exceptions.
We may grant discretionary waivers of certain inadmissibility grounds for humanitarian purposes, to assure family unity, or because it is
otherwise in the public interest. However, we cannot waive some inadmissibility grounds, by law, including certain criminal grounds in INA
sections 212(a)(2)(A-C) and national security, terrorism- related, and persecution grounds in INA sections 212(a)(3)(A-C, E). If you are
inadmissible on grounds that can be waived, you may be able to obtain a discretionary waiver.
Each person seeking TPS must apply for themselves on a separate Form I-821. There is no derivative TPS status, meaning that your spouse,
children or parents cannot obtain TPS as a result of your approval for TPS. They must each qualify for TPS individually. However, we may
accept late initial TPS applications from certain individuals who had a qualifying relationship to a spouse or child during the initial registration
period for the TPS-designated country and that relative is also currently eligible for TPS. Even where such a relationship exists, the applicant
must still meet all other TPS eligibility requirements before we may grant TPS.
You may submit this form with Form I-765 online if you also want to request an Employment Authorization Document (EAD). If you request
an EAD in Form I-821, we will add Form I-765 for you to complete after you sign your Form I-821.

Link
https://www.uscis.gov/humanitarian/temporary-protected-status

CTA

Notes
Form I-821 Instructions, page 1

Review our website for more information on countries currently designated for TPS and registration dates.

(not applicable fo re-registration)
To be eligible for TPS, you must be admissible to the United States as an immigrant under the applicable grounds in INA section 212(a), with certain
exceptions.

https://www.uscis.gov/i-821

Form I-821 Instructions, page 1-2;
12

We may grant discretionary waivers of certain inadmissibility grounds for humanitarian purposes, to assure family unity, or because it is otherwise in the
public interest. However, we cannot waive some inadmissibility grounds, by law, including certain criminal grounds in INA sections 212(a)(2)(A-C) and
national security, terrorism- related, and persecution grounds in INA sections 212(a)(3)(A-C, E). If you are inadmissible on grounds that can be waived,
you may be able to obtain a discretionary waiver. If you are re-registering for TPS and you were already granted a waiver of a ground of inadmissibility in
conjunction with your prior TPS application, you do not need to seek another waiver for the same action, incident, or circumstance.
Each person seeking TPS must apply for themselves on a separate Form I-821. There is no derivative TPS status, meaning that your spouse, children or
parents cannot obtain TPS as a result of your approval for TPS. They must each qualify for TPS individually. However, we may accept late initial TPS
applications from certain individuals who had a qualifying relationship to a spouse or child during the initial registration period for the TPS-designated
country and that relative is also currently eligible for TPS. Even where such a relationship exists, the applicant must still meet all other TPS eligibility
requirements before we may grant TPS.
You may submit this form with Form I-765 online if you also want to request an Employment Authorization Document (EAD). If you request an EAD in
Form I-821, we will add Form I-765 for you to complete after you sign your Form I-821.

Note: If you were ever convicted of or ever committed a “particularly serious crime” that constitutes a “danger to the community of the United States,”
or there are serious reasons for believing that you have committed “serious nonpolitical crimes” outside of the United States before your arrival in this
Note: If you were ever convicted of or ever committed a “particularly serious crime” that constitutes a “danger to the community of the
United States,” or there are serious reasons for believing that you have committed “serious nonpolitical crimes” outside of the United States country, you cannot be granted TPS. We will make the determination as to whether your crimes fall into either of these categories.
before your arrival in this country, you cannot be granted TPS. We will make the determination as to whether your crimes fall into either of
these categories.
Fee

Fee: $50. If you are 14 years of age or older, you must also pay an $85 biometric services fee.
Note: You cannot use a fee waiver if applying online.
Refund policy:
USCIS does not refund fees, regardless of any action we take on your application, petition or request, or how long USCIS takes to reach a
decision. By continuing this transaction, you acknowledge that you must submit fees in the exact amount and that you are paying the fees
for a government service.

Fee: $50. There is no application fee if you are re-registering for TPS. All applicants and re-registrants who are 14 years of age or older must pay an $85
biometric services fee.

Form I-821 Instructions, page 14

Note: You cannot use a fee waiver if applying online.
Refund policy:
USCIS does not refund fees, regardless of any action we take on your application, petition or request, or how long USCIS takes to reach a decision. By
continuing this transaction, you acknowledge that you must submit fees in the exact amount and that you are paying the fees for a government service.

Please refer to the instructions for the form(s) you are filing for additional information or you may call the USCIS Contact Center at 800-375- Please refer to the instructions for the form(s) you are filing for additional information or you may call the USCIS Contact Center at 800-375-5283. For TTY
(deaf or hard of hearing) 800-767-1833.
5283. For TTY (deaf or hard of hearing) 800-767-1833.

After You Submit Your
Application

Completing Your Form
Online

Documents you may need

We will automatically determine which documents you should provide us as you fill out your application. At the time of filing, you must
submit all evidence and supporting documentation listed.

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Biometric services appointment

USCIS may require that you appear for an interview or provide fingerprints, photograph, and/or signature at any time to verify your identity,
obtain additional information, and conduct background and security checks, including a check of criminal history records maintained by the
Federal Bureau of Investigation (FBI), before making a decision on your application, petition, or request. After USCIS receives your
application and ensures it is complete, we will inform you in writing or by email notice if you e-file your application, if you need to attend a
biometric services appointment. If an appointment is necessary, the notice will provide you the location of your local or designated USCIS
Application Support Center (ASC) and the date and time of your appointment or, if you are currently overseas, instruct you to contact a U.S.
Embassy, U.S. Consulate, or USCIS office outside the United States to set up an appointment.

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Track your case online

After you submit your form, you can track its status through your USCIS account. Sign in to your account often to check your case status and
read any important messages from USCIS.

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Respond to requests for information

If we need more information from you, we will send you a Request for Evidence (RFE) or Request for Information (RFI). You can respond to
our request and upload your documents through your USCIS account.

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Receive your decision

The decision on Form I-821 involves a determination of whether you have established eligibility for the immigration benefit you are seeking.
USCIS will notify you of the decision in writing.

Filing online

Submitting your application online is the same as mailing in a completed paper form. They both gather the same information.

Complete the Getting Started section first

You should answer all questions in the Getting Started section first so we can best customize the rest of your online form experience.

Provide as many responses as you can

How to continue filling out your form

You should provide as many responses as you can. Incomplete fields or sections and missing information can slow down the process after
you submit your form.
We will automatically save your information when you select next to go to a new page or navigate to another section of the form. We will
save your information for 30 days from today, or from the last time you worked on the form.
After you start your form, you can sign in to your account to continue where you left off.

DHS Privacy Notice

AUTHORITIES: The information requested on this application, and the associated evidence, is collected under INA sections 101 and 244.

We will automatically save your responses

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Form I-821 Instructions, page 16

PURPOSE: The primary purpose for obtaining the requested information on this application is to determine whether you have established
eligibility for TPS, if you have not yet been granted TPS. DHS will use the information you provide to grant or deny the benefit you are
seeking.

Form I-821 Instructions, page 16

DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, including your Social
Security number (if applicable), and any requested evidence, may delay a final decision or result in denial of your application.

Form I-821 Instructions, page 16

Application Overview

I-821 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

Heading

Sub-Heading

Paperwork Reduction Act

Body Text (First Release - Initial Filing Only)

Body Text (Second Release - Re-registration: Differences from Initial Filing in red font)

Link

CTA

Notes

ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you provide on this application
and any additional requested evidence with other Federal, state, local, and foreign government agencies and authorized organizations. DHS
follows approved routine uses described in the associated published system of records notices [DHS/USCIS-001 - Alien File, Index, and
National File Tracking System, DHS/USCIS-007 - Benefits Information System, and DHS/USCIS-018 Immigration Biometric and Background
Check System] and the published privacy impact assessment [DHS/USCIS/PIA-056 USCIS Electronic Immigration System] which you can find
at www.dhs.gov/privacy. DHS may also share the information, as appropriate, for law enforcement purposes or in the interest of national
security.

Form I-821 Instructions, page 17

An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection of information,
unless it displays a currently valid Office of Management and Budget (OMB) control number. The public reporting burden for this collection
of information is estimated at 1.92 hours per response, including the time for reviewing instructions, gathering the required documentation
and information, completing the application, attaching necessary documentation, and submitting the application. The collection of
biometrics, where required, is estimated to require 1 hour and 10 minutes. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden to:

Form I-821 Instructions, page 17

U.S. Citizenship and Immigration Services
Office of Policy and Strategy, Regulatory Coordination Division
5900 Capital Gateway Drive, Mail Stop #2140
Camp Springs, MD 20588-0009
Do not mail your completed Form I-821 to this address.
OMB No. 1615-0043
Expires: 7/31/2022

Security reminder

If you do not work on your application for more than 30 days, we will delete your data in order to prevent storing personal information
indefinitely.

Start

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Application Overview

I-821: GETTING STARTED
Primary Nav

Secondary Nav

Getting Started Reason for applying

Tertiary Nav

Paper Form Question
Question

Sub-Question

Field Type

1.1.a

This is my initial (first time) application for Temporary
Protected Status (TPS). I do not currently have TPS.

Radio

Required field

This is my re-registration application for TPS. I currently
have TPS, and am applying to re-register.

Radio

display for re-registration

USCIS

Radio

display for re-registration

Immigration Judge/Board of Immigration Appeals

Radio

display for re-registration

What is your reason for applying?

1.1.b
(If 1.1.b)
1.2

Who granted you TPS?

1.3.a

Are you also filing a request for employment authorization? Yes, I am requesting an Employment Authorization
Document (EAD), and I am filing Form I-765, Application
for Employment Authorization, together with my Form I821.

1.3.b

Are you filing this application late?

1.4

Preparer and
interpreter
information

(IF YES TO PREPARER
QUESTION) Preparer
information

Radio

Yes/No

Radio

Review www.uscis.gov/TPS for information on late initial filing
for TPS and late re-registration.

added for re-registration/late re-registration

Dropdown

Is someone assisting you with completing this application?

Yes/No

Radio

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(IF YES) Is a preparer assisting you with completing this
application?

Yes/No

Radio

(IF YES) Is an interpreter assisting you with completing this
application?

Yes/No

Radio

10.1.b

What is your preparer's full name?

Given name (first name)

Text

A preparer is anyone who completes or helps you complete all or Content specific to digital environment
part of your application using information and answers that you
provide.
An interpreter is anyone who translates or helps you translate all Content specific to digital environment
or part of your application using information and answers that
you provide.

10.1.a
10.2

What is your preparer's business or organization name?

Family name (last name)

Text
Text

What is your preparer's mailing address?

My preparer is not part of a business or organization.
Country

Checkbox
Dropdown

What is your preparer's contact information?

Address line 1
Address line 2
City or town
State/Province
ZIP code/Postal code
Daytime phone number

Text
Text
Text
Dropdown/Text
Text
Text

9.1.b

What is your interpreter's full name?

Mobile telephone number
My preparer does not have a mobile telephone number
Email address
My preparer does not have an email address.
Given name (first name)

Text
Checkbox
Text
Checkbox
Text

9.1.a
9.2

What is your interpreter's business or organization name?

Family name (last name)

Text
Text

9.3

What is your interpreter's mailing address?

My interpreter is not part of a business or organization.
Country

Checkbox
Dropdown

What is your interpreter's contact information?

Address line 1
Address line 2
City or town
State/Province
ZIP code/Postal code
Daytime telephone number

Text
Text
Text
Dropdown/Text
Text
Text

Mobile telephone number

Text

10.3.a.10.3.h.

10.4
10.5
10.6
(IF YES TO
INTERPRETER)
Interpreter
information

Notes

Radio

No, I am not currently requesting an EAD.

What is the name of the designated TPS country under which
you are applying?

Instructional Text

9.4
9.5

Street number and name
Apartment, suite, unit, or floor

Street number and name
Apartment, suite, unit, or floor

Getting Started

I-821: GETTING STARTED
Primary Nav

Secondary Nav

Tertiary Nav

Paper Form Question
Question

Sub-Question

Field Type

Instructional Text

Notes

My interpreter does not have a mobile telephone number Checkbox
9.6
What language is your interpreter using to interpret this
application for you?

Email address
My interpreter does not have an email address.

Text
Checkbox
Text

Getting Started

I-821: ABOUT YOU

The About You step is the second part of the paper form that the applicant will complete. Questions relating to the applicant's personal information should be grouped in the About you step of the form and should be organized by the appropriate section. This step and section structure will inform the navigation and subnavigation for the form. Personal information questions include questions about the applicant's name, contact information, immigration information, demographics, school and employment, military service, requests for accommodations, etc.
Primary Nav

Secondary Nav

About You

Your name

Tertiary Nav

Paper Form Question
Question

Sub-Question

Field Type

2.1.b

Given name (first name)

Text

Middle name
Family name (last name)
Yes/No

Text
Text
Radio

Given name (first name)

Text

Middle name
Family name (last name)
Daytime telephone number

Text
Text
Text (9 digits)

8.4

Mobile telephone number (if any)

Text (9 digits)
Checkbox

8.5
2.4.a

This is the same as my daytime
telephone number.
Email address
In care of name (if any)

2.1.c
2.1.a

Your contact
information

2.2.b

Have you used any other names since
birth?
(If yes)

2.2.c
2.2.a
8.3

How may we contact you?

2.4.b
2.4.c
2.4.d
2.4.e
2.4.f
2.5
2.6.a

When and where
you were born

What is your current legal name?

2.6.b
2.6.c
2.6.d
2.6.e
2.10

What is your current U.S. mailing
address?

Address line 1
Address line 2
City or town
State
ZIP code
Is your current mailing address the same Yes/No
as your physical address?
(If no) Where in the United States do
Address line 1
you live?
Address line 2
City or town
State
ZIP code
What is your date of birth?
(mm/dd/yyyy)

2.11.a-b
2.13

Describe yourself

(mm/dd/yyyy)

Instructional Text

Help Text

Your current legal name is the name on your birth
certificate, unless it changed after birth by a legal
action such as marriage or court order. Do not provide
any nicknames here.

Other names used may include nicknames, aliases,
and maiden names.
Provide the other names you have used.

Text
Text

small table

We will use your current mailing address to contact
you throughout the application process. We may not
be able to contact you if you do not provide a
complete and valid address. Please provide a U.S.
address only.
Street number and name
Apartment, suite, unit, or floor

Text
Text
Text
Dropdown
Text
Radio
Text

Street number and name

Text
Text
Dropdown
Text
Date

Apartment, suite, unit, or floor

Date

Notes

List all other dates of birth you have ever
used.

2.14
2.12

What is your city, town, or village of
birth?
What is your country of birth?
What is your gender?

Text

3.10

What is your ethnicity?

Hispanic or Latino
Not Hispanic or Latino

Radio

Hispanic or Latino refers to a person of Cuban,
Mexican, Puerto Rican, South or Central

3.2.

What is your race?

White 

Checkbox

Select all that apply. Your race is different
from your ethnicity and should reflect your
geographical origins.

Male/Female

Dropdown
Radio

White
A person having origins in any of the original peoples
of Europe, the Middle East, or North Africa.

About You

I-821: ABOUT YOU

The About You step is the second part of the paper form that the applicant will complete. Questions relating to the applicant's personal information should be grouped in the About you step of the form and should be organized by the appropriate section. This step and section structure will inform the navigation and subnavigation for the form. Personal information questions include questions about the applicant's name, contact information, immigration information, demographics, school and employment, military service, requests for accommodations, etc.
Primary Nav

Secondary Nav

Tertiary Nav

Paper Form Question
Question

Sub-Question

Field Type

Asian 

Checkbox

Instructional Text

Help Text

Notes

Asian
A person having origins in any of the original peoples
of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia,
China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam.

Black or African American 

American Indian or Alaska Native 

Checkbox

Black or African American

Checkbox

A person having origins in any of the black racial
groups of Africa.
American Indian or Alaska Native
A person having origins in any of the original peoples
of North and South America (including Central
America), and who maintains tribal affiliation or

Where you have
lived
Your immigration
information

Checkbox

What is your height?

Feet/Inches

Dropdown

3.4.

What is your weight?

Pounds

Text

3.5.

What is the color of your eyes?

Black/Blue/Brown/Gray/Green/Haze Dropdown
l/Maroon/Pink/ Unknown/other

3.6

What is the color of your hair?

2.15.a-d

What countries did you live in before
coming to the United States?
What is your country of citizenship or
nationality?

Bald/Black/Blonde/Brown/Gray/Red Dropdown
/Sandy/White/other
Dropdown

2.19
2.21
2.22.a.
2.22.b
2.20.

When did you last enter the United
States?
Where did you last enter the United
States?

What was your immigration status when
you last entered the United States?

2.23

What is your Form I-94 ArrivalDeparture Record Number (if any)?

2.24

What is the expiration date of the
authorized stay shown on your Form I94 or Form I-95?
Duration of Status
What is the passport number of your
most recently issued passport (if any)?

2.24
2.25

2.26
2.29
2.30.

2.27-2.28

Dropdown

mm/dd/yyyy

Date

Port of entry

Dropdown?

City or town
State

Text
Dropdown
Dropdown?

mm/dd/yyyy

What is your travel document number
(if any)?
What country issued your most recent Country
passport or travel document?
What is the expiration date of your most (mm/dd/yyyy)
recent passport or travel document?
What other passport or travel document
numbers do you have (if any)?

Native Hawaiian or Other Pacific Islander
A person having origins in any of the original peoples
of Hawaii, Guam, Samoa, or other Pacific Islands.

3.3.

2.16.a-d

Your immigration
information page 2

Native Hawaiian or Other Pacific
Islander

Small table
List all countries where you are currently a
citizen or national. If you are stateless, choose
"Stateless."

Small table

List the passport or travel document numbers
for all additional documents you have.

Small table

11 character
restricted
text
Date

Checkbox
Text

Text
Dropdown
Date

Text

About You

I-821: ABOUT YOU

The About You step is the second part of the paper form that the applicant will complete. Questions relating to the applicant's personal information should be grouped in the About you step of the form and should be organized by the appropriate section. This step and section structure will inform the navigation and subnavigation for the form. Personal information questions include questions about the applicant's name, contact information, immigration information, demographics, school and employment, military service, requests for accommodations, etc.
Primary Nav

Secondary Nav

Immigration status

Tertiary Nav

Paper Form Question
Question
2.31
2.32
(If Yes to
2.32)

What is you current immigration status
or lack of status?
Are you now or were you ever in
Yes/No
immigration proceedings?
What type of proceedings were you in Immigration court (before an
or are you currently in? Select all that
immigration judge)
apply.

2.33.b
2.33.c

(If Yes to
2.32) 2.34
(If 2.33c
selected)
2.35

Other information

2.36.a
2.36.b
2.36.c
2.7

2.9

2.8

Sub-Question

Field Type

Help Text

Notes

Text
Radio
Checkbox

Board of Immigration Appeals (BIA) Checkbox
I am no longer in Department of
Checkbox
Justice (DOJ) or Department of
Homeland Security (DHS)
immigration proceedings, but I am
or was in Federal court proceedings
regarding immigration issues.
Where were your DOJ and/or DHS
proceedings held, or are currently being
held (if applicable)?
Where were your federal court
proceedings regarding immigration
issues held, or are currently being held
(if applicable)?
When did the proceedings take place? From
To
Present
What is your A-Number?
A-Number

Text

I do not have or know my A-Number.
What is your U.S. Social Security
number?
I do not have or know my U.S. Social
Security number.
What is your USCIS Online Account
Number?

Checkbox
Text (9 digits)

I do not have or know my USCIS Online
Account Number.

Instructional Text

If your proceedings are ongoing, leave the
"To" date blank. List any other immigration
proceedings in the “Additional Information”
section. Include the type of proceedings you
were in, the dates, and the location.

Text

Date
Date
Checkbox
Text (9 digits)

Checkbox
Text (12
digits)

Providing your unique USCIS Online Account The phrase "certain paper forms" will have a tooltip
Number (OAN) helps us manage your account. that would list the forms: "I-90, I-130, I-485, I-821, I821D, N-336, N-400, N-565, N-600, N-600K"
You may already have an OAN if you
previously filed certain paper forms and
received an Account Access Notice in the mail.
You can find the OAN at the top of the notice;
it is not the same as an A-Number.

Checkbox

About You

I-821: YOUR FAMILY

The Your Family step is for forms that collect in-depth information about an applicant's family. Questions relating to the applicant's family should be grouped in the Your family step of the form and should be organized by the appropriate section. This
step and section structure will inform the navigation and sub-navigation for the form. This includes questions about the applicant's marital status, their current spouse, any prior marriages, children, parents, etc.
Primary Nav Secondary Nav
Your Family Marital status

Tertiary Nav Paper Form Question
Question
2.17

2.17
2.18

Sub-Question

Field Type

What is your spouse's legal
name?

4.3.b
4.3.c

What is your spouse's
current mailing address?

4.4.e

4.1

Notes

Given name (first name)

Text

Complete this section only if you are filing a
late initial application for TPS. Provide
information about your spouse, if any.
Your spouse's legal name is the name on
their birth certificate, unless it changed after
birth by a legal action such as marriage or
court order. Do not provide a nickname here.

section not included in
first release or if reregistration application

Middle name (if applicable) Text

4.4h
4.4.a
4.4.b
4.4.c
4.4.d

4.2

Help Text

What is your current marital Single, never
Radio
married/Married/Divorced
status?
/Widowed/Separated/Marr
iage annulled/Other
(IF OTHER) Provide an
Text
explanation.
(If Married OR Separated)
Month/Day/Year
Date
On what date did you marry
your spouse?

(IF Married or Separated)
Your spouse

4.3.a

Instructional Text

What is your spouse's ANumber?

What is your spouse's USCIS
Online Account Number?

Family name (last name)

Text

My spouse's current
Checkbox
mailing address is the same
as my mailing address.
Country
Address line 1
Address line 2
City or town
State/Province or region
(FOR FOREIGN ADDRESS)
ZIP code/Postal code (FOR
FOREIGN ADDRESS)

Text
Text
Text
Text
Dropdown

My spouse does not have
or know their A-Number.

Checkbox

Text
Text

Providing your unique USCIS Online Account
Number (OAN) helps us manage your
account. You may already have an OAN if you
previously filed certain paper forms and
received an Account Access Notice in the
mail. You can find the OAN at the top of the
notice; it is not the same as an A-Number.

The phrase "certain
paper forms" will have a
tooltip that would list
the forms: "I-90, I-130, I485, I-821, I-821D, N336, N-400, N-565, N600, N-600K"

Your Family

I-821: YOUR FAMILY

The Your Family step is for forms that collect in-depth information about an applicant's family. Questions relating to the applicant's family should be grouped in the Your family step of the form and should be organized by the appropriate section. This
step and section structure will inform the navigation and sub-navigation for the form. This includes questions about the applicant's marital status, their current spouse, any prior marriages, children, parents, etc.
Primary Nav Secondary Nav

Tertiary Nav Paper Form Question
Question

4.5
4.7
4.8.d
4.8.a
4.8.b/c
4.9
4.10.a
4.10.b
4.10.c
4.10.d

Your former spouses

5.1.b

What is your spouse's date
of birth?
Where were you and your
spouse married?

If you know, has your
spouse ever had TPS?
(IF YES) When did your
spouse have TPS?

5.3

5.4
5.5

5.6.a-b
5.7

Field Type

Instructional Text

Help Text

Notes

My spouse does not have
or know their USCIS Online
Account Number.
Month/Day/Year
Date
Place of marriage

Text

Country
City or town
State/Province or region
(FOR FOREIGN ADDRESS)
Yes/No

Dropdown
Text
Dropdown/T
ext
Radio

From

Date

To
Present
I do not know the dates
(If YES) Is your spouse's TPS Yes/No/I do not know
still valid?
Former Spouses

Date
Checkbox
Checkbox
Radio

What is your former
spouse's legal name?

Text

5.1.c
5.1.a
5.2

Sub-Question

Given name (first name)

Complete this section only if you are filing a
late initial application for TPS. Provide
information about your former spouses, if
any.
Your former spouse's legal name is the name
on their birth certificate, unless it changed
after birth by legal action such as marriage or
court order. Do not provide a nickname here.

section not included in
first release or if reregistration application

Middle name (if applicable) Text

What are your former
spouse's nationalities?
What is your former
spouse's A-Number?

Family name (last name)

Text
Text

Provide your former spouse’s nationality
or nationalities, if more than one.

Text
My former spouse does
not have or know their ANumber.
Month/Day/Year

What is your former
spouse's date of birth?
What is the date of your
former spouse’s death (if
deceased)?
When were you married to From/To
your former spouse?
How did this marriage end? Annulled/Divorced/Spouse
deceased/Other
(IF OTHER) Provide an
explanation.

Checkbox

Date
Date

Date
Radio
Text

Your Family

I-821: YOUR FAMILY

The Your Family step is for forms that collect in-depth information about an applicant's family. Questions relating to the applicant's family should be grouped in the Your family step of the form and should be organized by the appropriate section. This
step and section structure will inform the navigation and sub-navigation for the form. This includes questions about the applicant's marital status, their current spouse, any prior marriages, children, parents, etc.
Primary Nav Secondary Nav

Tertiary Nav Paper Form Question
Question
5.8

5.9.a
5.9.b
5.9.c
5.9.d
5.10.

Your children

6.1.b

Did your former spouse
have TPS or do they
currently have TPS?
(IF YES) When did your
former spouse have TPS?

Is your former spouse
currently applying for TPS or
re-registering for TPS?
Children Information

6.5.h
6.5.a
6.5.b
6.5.d/f
6.5.e/g
6.2

6.3

Field Type

Yes/No/I do not know

Radio

From

Date

To
Present
I do not know the dates
Yes/No/I do not know

Date
Checkbox
Checkbox
Radio

What is your child's current Given name (first name)
legal name?

6.1.c
6.1.a
6.4

Sub-Question

Text

Instructional Text

Help Text

Notes

Complete this section only if you are filing a
late initial application for TPS. Provide
information about your children, if any.
Your child's legal name is the name on their
birth certificate, unless it changed after birth
by legal action such as marriage or court
order. Do not provide a nickname here.

section not included in
first release or if reregistration application

Providing your unique USCIS Online Account
Number (OAN) helps us manage your
account. You may already have an OAN if you
previously filed certain paper forms and
received an Account Access Notice in the
mail. You can find the OAN at the top of the
notice; it is not the same as an A-Number.

The phrase "certain
paper forms" will have a
tooltip that would list
the forms: "I-90, I-130, I485, I-821, I-821D, N336, N-400, N-565, N600, N-600K"

Middle name (if applicable) Text
Family name (last name)
What is your child's date of Month/Day/Year
birth?
What is your child's current
mailing address?
My child's current mailing
address is the same as my
mailing address.
Country
Address line 1
Address line 2
State/Province or region
(FOR FOREIGN ADDRESS)
ZIP code/Postal code (FOR
FOREIGN ADDRESS)
What is your child's USCIS
Online Account Number?

What is your child's ANumber?

My child does not have or
know their USCIS Online
Account Number.

Text
Date

Checkbox

Text
Text
Text
Text
Dropdown
Text (12
digits)

Checkbox

Text

Your Family

I-821: YOUR FAMILY

The Your Family step is for forms that collect in-depth information about an applicant's family. Questions relating to the applicant's family should be grouped in the Your family step of the form and should be organized by the appropriate section. This
step and section structure will inform the navigation and sub-navigation for the form. This includes questions about the applicant's marital status, their current spouse, any prior marriages, children, parents, etc.
Primary Nav Secondary Nav

Tertiary Nav Paper Form Question
Question

6.6a

6.6.b
6.7

If your child had TPS or
currently has TPS, enter the
dates of their TPS, if known.

Is your child currently
applying for TPS or reregistering for TPS, if
known?

Sub-Question

Field Type

My child does not have or
know their A-Number.
From

Checkbox

To
Yes/No

Date
Radio

Instructional Text

Help Text

Notes

Date

Your Family

I-821: BASIS OF ELIGIBILITY

Primary Nav
Basis of Eligibility

Secondary Nav

Tertiary Nav

Paper Form Question

Question

Sub-Question Field Type

Instructional Text
Help Text
To be eligible for TPS, you must be admissible as an immigrant to
the United States, with certain exceptions. The questions below
and your responses to these questions will help USCIS determine
if you are eligible for TPS.
If any of the questions apply to you, please provide information
about the events, including the places and dates of occurrence.
Provide a full explanation of the circumstances related to the
specific event. If you need additional space to respond to a
question, use the "Additional Information" section.

Immigration eligibility

7.28

(If Yes to 7.28)
7.23.a
(If Yes to 7.23.a)
7.23.b

(If Yes 7.23.b)
Immigration eligibility 7.1.a
page 2
7.1.b
7.1.c

(If Yes to 7.1.c)
Immigration eligibility
page 3

Radio

Provide an explanation.
What is your country of nationality?

Text
Dropdown

I entered the United States on the following date, and
have resided in the United States since that time.
Have you ever traveled to and entered a country other than your
country of nationality or last habitual residence before you last
entered the United States?
Countries You Traveled To

(If Yes to 7.1.c) 7.2
(If Yes to 7.1.c) 7.3.a-b
(If Yes to 7.1.c) 7.4

What country did you travel to and enter?
When were you in this country?
What was your immigration status in this country, if any?

7.5

(If Yes to 7.20.b)
(If Yes to 7.20.a or
7.20.b)7.20.c
(If Yes to 7.20.c)
(If Yes to 7.20.c) 7.20.d.

Have you ever been offered any immigration status by another
country that you did not accept?
Provide the country or countries, the nature of the immigration
status you were offered, and the dates when it was offered.
Describe why you chose not to accept the immigration status
offered to you.
Have you ever unlawfully voted in a United States Federal, state,
or local election?
Provide an explanation.
Have you ever claimed to be a U.S. citizen (in writing or in any
other way)?
Provide an explanation.
Have you ever been ordered removed, and been deported from
the United States?
Provide an explanation.
Have you ever voluntarily departed the United States under an
order of removal?
Provide an explanation.
Have you re-entered the United States unlawfully at any time after
you were deported or you voluntarily departed?
Provide an explanation.
Has DHS reinstated your prior order of removal?

(If Yes to 7.20.d)

Provide an explanation.

(If Yes to 7.5) 7.6
(If Yes to 7.5)7.7
Citizenship claims and
immigration violations

Are you now the guardian of, and are you accompanying, another Yes/No
individual who has been found to be inadmissible and who has
been certified by a medical examiner to be helpless due to
sickness, physical or mental disability, or infancy?
Provide an explanation.
Do you now have a communicable disease of public health
Yes/No
significance?
Provide an explanation.
Do you now have or have you ever had a physical or mental
Yes/No
disorder and behavior (or a history of behavior that is likely to
recur) associated with the disorder which has posed or may pose a
threat to the property, safety, or welfare of yourself or others?

7.35
(If Yes to 7.35)
7.36
(If Yes to 7.36)
7.20.a
(If Yes to 7.20.a)
7.20.b

Text
Radio
Text
Radio

mm/dd/yyyy

Date

Yes/No

Radio

If you have no nationality, enter the country where you last
habitually resided.

Provide information for each country you traveled to and
entered prior to entering the United States.

From/To

Dropdown
Date
Text

Yes/No

Radio

Ex: citizen, legal permanent
resident, refugee, asylee, visitor,
student, temporary resident, or
no status.

Text
Text
Yes/No

Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No/I do
not know

Text
Radio
Text

Basis of Eligibility

I-821: BASIS OF ELIGIBILITY

Primary Nav

Secondary Nav

Tertiary Nav

Paper Form Question

Question

Sub-Question Field Type

7.20.e

Have you ever failed to attend or remain in attendance at any
immigration proceedings to determine your admissibility or
deportability?
Provide an explanation.
Has an immigration judge or the Board of Immigration Appeals
ever determined that you filed a frivolous asylum application in
the past?
Provide an explanation.
Have you ever, by fraud or willfully misrepresenting a material fact,
sought to obtain a visa or other documentation, admission to the
United States, or any other immigration benefit?
Provide an explanation.
Have you ever assisted any other person to enter the
United States in violation of the law?
Provide an explanation.
Have you ever entered the United States as a stowaway?

Yes/No

Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

(If Yes to 7.20.e)
7.41

(If Yes to 7.41)
7.21

(If Yes to 7.21)
7.22
(If Yes to 7,22)
Citizenship claims and 7.24
immigration
violations page 2
(If Yes to 7.24)
7.25

(If Yes to 7.25)
7.26

(If Yes to 7.26)
7.14.c

Affiliations

(If Yes to 7.14.c)
7.14.d
(If Yes to 7.14.d)
7.9.a

(If Yes to 7.9.a)
7.30.a

(If Yes to 7.30.a)
7.30.b
(If Yes to 7.30.b)
7.30.c

(If Yes to 7.30.b)
7.14.a
(If Yes to 7.14.a)
7.30.d

(If Yes to 7.30.d)
7.30.e

Affiliations page 2

(If Yes to 7.30.e)
7.31.a

(If Yes to 7.31.a)

Provide an explanation.
Did the former Immigration and Naturalization Service (INS) ever
impose, or has DHS ever imposed, civil monetary penalties on you
for producing or using false documentation to obtain an
immigration benefit?
Provide an explanation.
Are you now subject to a final order for violation of section 274C
(producing and/or using false documentation to unlawfully satisfy
a requirement of the Immigration and Nationality Act)?
Provide an explanation.
Have you ever been or are you now a member of the Communist
or other totalitarian party, except when membership was
involuntary?
Provide an explanation.
Have you ever participated in Nazi persecution or genocide?
Provide an explanation.
Have you ever ordered, incited, assisted, or otherwise participated
in the persecution of any person on account of race, religion,
nationality, membership in a particular social group, or political
opinion?
Provide an explanation.
Have you ever ordered, incited, called for, committed, helped with,
or otherwise participated in acts involving torture or genocide?
Provide an explanation.
Have you ever ordered, incited, called for, committed, helped with,
or otherwise participated in killing any person?
Provide an explanation.
Have you ever ordered, incited, called for, committed, helped with,
or otherwise participated in intentionally and severely injuring any
person?
Provide an explanation.
Have you ever or are you now engaged in terrorist activities?
Provide an explanation.
Have you ever ordered, incited, called for, committed, helped with,
or otherwise participated in any kind of sexual contact or relations
with any person who was being forced or threatened?
Provide an explanation.
Have you ever ordered, incited, called for, committed, helped with,
or otherwise participated in limiting or denying any person's ability
to exercise religious beliefs?
Provide an explanation.
Have you ever served in, been a member of, assisted in, or
participated in any military unit, paramilitary unit, police unit, selfdefense unit, vigilante unit, rebel group, guerrilla group, militia, or
insurgent organization?
Provide an explanation.

Yes/No

Text
Radio
Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Yes/No

Text
Radio
Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Instructional Text

Help Text

Text

Basis of Eligibility

I-821: BASIS OF ELIGIBILITY

Primary Nav

Secondary Nav

Tertiary Nav

Question

7.31.b

Have you ever served or worked in any prison, jail, prison camp,
Yes/No
detention facility, labor camp, or any other situation that involved
detaining persons?
Provide an explanation.
Have you ever been a member of, assisted in, or participated in
Yes/No
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?
Provide an explanation.
Have you ever assisted with or participated in selling or providing Yes/No
weapons to any person who to your knowledge used them against
another person, or in transporting weapons to any person who to
your knowledge used them against another person?

Radio

Provide an explanation.
Have you ever received any type of military, paramilitary, or
Yes/No
weapons training?
Provide an explanation.
Have you ever recruited, enlisted, conscripted, or used any person Yes/No
under 15 years of age to serve in or help an
armed force or group?
Provide an explanation.
Have you ever used any person under 15 years of age to take part Yes/No
in hostilities or to help or provide services to people in combat?

Text
Radio

(If Yes to 7.37.b)
7.40.

Provide an explanation.
Have you ever been responsible for or directly carried out
Yes/No
particularly severe violations of religious freedom, as defined in
section 3 of the International Religious Freedom Act of 1998 (22
U.S.C. section 6402) while serving as a foreign government official?

Text
Radio

(If Yes to 7.40.)
7.12.c

Provide an explanation.
Are you the spouse or child of an alien who unlawfully trafficked in
any controlled substance?
Provide an explanation.
Are you the spouse or child of an alien who assisted, abetted,
conspired, or colluded with others in the unlawful trafficking of
any controlled substance?
Provide an explanation.
Are you now the spouse or child of an alien who committed or
conspired to commit human trafficking offenses?
Provide an explanation.
Are you now the spouse or child of, or are you yourself, an alien
who knowingly aided, abetted, assisted, conspired, or colluded
with a human trafficker?
Provide an explanation.
Have you ever been convicted of any felony committed in the
United States?
Provide an explanation.
Have you ever been convicted of any misdemeanor committed in
the United States?
Provide an explanation.
Have you ever been convicted of any particularly serious crime
committed either in or outside the United States?
Provide an explanation.
Have you ever been convicted of or have you ever committed acts
which constitute the essential elements of a crime (other than a
purely political offense)?
Provide an explanation.
Have you ever been convicted of or have you ever committed acts
which constitute the essential elements of a violation of any law
relating to a controlled substance as defined in section 102 of the
Controlled Substances Act?
Provide an explanation.

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Tet
Radio

Yes/No

Text
Radio

(If Yes to 7.31.b)
7.32

(If Yes to 7.32)
7.33

(If Yes to 7.33)
7.34
(If Yes to 7.34)
7.37.a

(If Yes to 7.37.a)
7.37.b

Affiliations page 3

(If Yes to 7.12.c)
7.12.d

(If Yes to 7.12.d)
7.38.c
(If Yes to 7.38.c)
7.38.d

Crimes and offenses

Sub-Question Field Type

Paper Form Question

(If Yes to 7.38.d)
7.8.a
(If Yes to 7.8.a)
7.8.b
(If Yes to 7.8.b)
7.8.c
(If Yes to 7.8.c)
7.10.a

(If Yes to 7.10.a)
7.10.b

(If Yes to 7.10.b

Yes/No

Yes/No

Instructional Text

Help Text

Text
Radio

Text
Radio

Text
Radio

Text
Radio

Text

Text

Text

Basis of Eligibility

I-821: BASIS OF ELIGIBILITY

Primary Nav

Secondary Nav

Tertiary Nav

Paper Form Question
7.10.c

(If Yes to 7.10.c)
7.11

Crimes and offenses
page 2

(If Yes to 7.11)
7.15.a

(If Yes to 7.15.a)
7.15.b

(If Yes to 7.15.b)
7.15.c

(If Yes to 7.15.c)
7.16
(If Yes to 7.16)
7.17
(If Yes to 7.17)
7.9.b

Crimes and offenses
page 3

(If Yes to 7.9.b)
7.13.a

(If Yes to 7.13.a)
7.13.b

(If Yes to 7.13.b)
7.13.c

(If Yes to 7.13.c)
7.13.d

(If Yes to 7.13.d)
7.14.b

(If Yes to 7.14.b)
7.9.c

Moral character

(If Yes to 7.9.c)
7.12.a

Question
Have you ever been convicted of or have you ever committed acts
which constitute the essential elements of a conspiracy to violate
any law relating to a controlled substance as defined in section
102 of the Controlled Substances Act?
Provide an explanation.
Have you ever been convicted of two or more criminal offenses
(other than purely political offenses) for which you received
sentences to confinement that, when combined, total five years or
more?
Provide an explanation.
Have you ever, whether in the United States or any other country
been arrested, for breaking or violating any law or ordinance,
excluding minor traffic violations?
Provide an explanation.
Have you ever, whether in the United States or any other country
been cited, charged, or indicted, for breaking or violating any law
or ordinance, excluding minor traffic violations?
Provide an explanation.
Have you ever, whether in the United States or any other country
been convicted, fined, imprisoned, placed on probation, received a
suspended sentence or deferral of adjudication for breaking or
violating any law or ordinance, excluding minor traffic violations?
Provide an explanation.
Have you ever been the beneficiary of a pardon, amnesty,
rehabilitation decree, other act of clemency, or similar action?
Provide an explanation.
Have you ever committed a serious criminal offense in the United
States and asserted immunity from prosecution?
Provide an explanation.
Have you ever committed serious nonpolitical crimes outside of
the United States prior to your arrival in the United States?
Provide an explanation.
Have you ever engaged, or do you plan to engage, solely,
principally, or incidentally, in any activity to violate any law of the
United States relating to espionage or sabotage?
Provide an explanation.
Have you ever engaged, or do you plan to engage, solely,
principally, or incidentally, in any activity to violate or evade any
law prohibiting the export from the United States of goods,
technology, or sensitive information?
Provide an explanation.
Have you ever engaged, or do you plan to engage, solely,
principally, or incidentally, in any other unlawful activity in the
United States?
Provide an explanation.
Have you ever engaged, or do you plan to engage, solely,
principally, or incidentally, in any activity in which a purpose is to
oppose, control, or overthrow the Government of the United
States by force, violence, or other unlawful means, including but
not limited to participating in such activities, giving support to
others involved in such activities, or being a member or
representative of a terrorist organization?
Provide an explanation.
Have you ever or are you now engaged in or plan to engage in
activities in the United States that would have potentially serious
adverse foreign policy consequences for the United States?
Provide an explanation.
Have you ever or are you now engaged in activities that could be
reasonable grounds for concluding that you are a danger to the
security of the United States?
Provide an explanation.
Have you ever trafficked in or are you now trafficking in any
controlled substance?

Sub-Question Field Type

Instructional Text

Help Text

Yes/No

Yes/No

Yes/No

Text

Text
Radio

Text

Yes/No

Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Basis of Eligibility

I-821: BASIS OF ELIGIBILITY

Primary Nav

Secondary Nav

Tertiary Nav

Paper Form Question

Question

(If Yes to 7.12.a)
7.12.b

Provide an explanation.
Are you now or have you ever knowingly assisted, abetted,
conspired, or colluded with others in the unlawful trafficking of
any controlled substance?
Provide an explanation.
Within the previous five years, have you ever obtained any
financial or other benefit from the unlawful activity of your spouse
(including former spouses) or parents, and you knew, or
reasonably should have known, that the financial or other benefit
was the product of such illicit activity?
Provide an explanation.
Have you ever, within the past 10 years, or are you now engaged in
prostitution or procurement of prostitution?
Provide an explanation.
Have you ever, within the past 10 years (either directly or
indirectly) procured or attempted to procure or import prostitutes
or persons for the purpose of prostitution?
Provide an explanation.
Have you ever, within the past 10 years, received, in whole or in
part, the proceeds of prostitution?
Provide an explanation.
Have you ever been or do you intend to be involved in any other
commercial vice?
Provide an explanation.
Are you now or have you ever been a drug abuser or
drug addict?
Provide an explanation.
Do you now practice polygamy?

(If Yes to 7.12.b)
7.12.e

(If Yes to 7.12.e)
7.18.a
(If Yes to 7.18.a)
7.18.b

(If Yes to 7.18.b)
7.18.c
(If Yes to 7.18.c)
7.19
(If Yes to 7.19)
7.23.c
(If Yes to 7.23.c)
Moral character page 7.27
2
(If Yes to 7.27)
7.29

(If Yes to 7.29)
7.38.a

(If Yes to 7.38.a)
7.38.d

(If Yes to 7.38.d)
7.38.e

(If Yes to 7.38.e)
7.39.a

(If Yes to 7.39.a)
7.39.b

(If Yes to 7.39.b)

Sub-Question Field Type
Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Text
Radio

Yes/No

Yes/No

Yes/No

Text

Text
Radio
Text
Radio

Provide an explanation.

Yes/No

Text
Radio

Yes/No

Text
Radio

Are you now or have you ever been a knowing aider, abettor,
assister, conspirator, or colluder with others in money laundering?
Provide an explanation.

Help Text

Text

Provide an explanation.
Have you ever detained, retained, or withheld the custody of a
Yes/No
child having a lawful claim to U.S. citizenship, outside the United
States, from a U.S. citizen granted custody?
Provide an explanation.
Have you ever committed or conspired to commit human
Yes/No
trafficking offenses, as defined in the section 103 of the Victims of
Trafficking and Violence Protection Act of 2000, in the United
States or outside the United States?
Provide an explanation.
Yes/No
Have you ever knowingly aided, abetted, assisted, conspired, or
colluded with a human trafficker?
Provide an explanation.
Within the previous five years, have you ever obtained any
Yes/No
financial or other benefit from the human trafficking activity of
your spouse (including former spouses) or parents, and you knew,
or reasonably should have known, that the financial or other
benefit that you received resulted from such human trafficking?

Are you now or have you ever engaged in money laundering as
described in section 1956 or 1957 of Title 18, United States Code?
Provide an explanation.

Instructional Text

Text
Radio

Text
Radio

Text
Radio

Text

Basis of Eligibility

I-821: EVIDENCE

The Evidence step is for forms that require the applicant to submit evidence to USCIS. As the applicant completes the form, the form's logic will dictate which pieces of evidence a particular applicant should be prompted to submit.
Primary Nav Secondary Nav
Evidence
EOIR or BIA order

Proof of identity and nationality

Evidence Title
Proof of Temporary Protected
Status

Instructional Text
If you are submitting a first-time re-registration with USCIS following an Immigration Judge or Board of Immigration Appeals decision granting your TPS application, upload a copy of the TPS decision order.

Document Type (For evidence uploader document type dropdown)
TPS Decision Order

Proof of Identity and Nationality

Upload proof of your identity and nationality. Examples of documents you may submit include copies of your:

Birth Certificate; Government ID; Passport - All Pages, Passport (ID Page)

Field Type
Upload

Logic
Notes
If 1.1.b AND 1.2 =
display if re-registration
Immigration Judge/Board of application
Immigration Appeals
If 1.1.a

Attestations; Birth Certificates; Employment Records; Medical Records; Other
Documents; Rent Receipt; School Records; Utility Bill; W-2

Upload

If 1.1.a

Upload

If 1.1.a

- Passport (cover to cover);
- Birth certificate accompanied by photo identification; or
- Any national identity document from your country of origin that includes your photo and/or fingerprint.
Proof of residence

Proof of Residence

Upload proof of your continuous residence in the United States. Examples of documents you may submit include copies of your:
•
Employment records (for example, pay stubs; Form W-2, Wage and Tax Statement; certification of the filing of Federal income tax returns; state verification of the filing of state income tax returns; letters from employers;
or, if you are self-employed, letters from banks and other firms with which you have done business.)
NOTE: In all of these documents, your name and the name of the employer or other interested organization must appear on the form or letter, as well as relevant dates. Letters from employers must be in affidavit form
and the employer must also sign and attest to the affidavit under penalty of perjury.
Such letters must include:
(1) Your address at the time of employment;
(2) Exact periods of employment;
(3) Periods of layoff; and
(4) Duties with the company.
If the employment records are unavailable, submit an affidavit explaining why you cannot obtain these records. Your employer must sign and attest to the affidavit under penalty of perjury.
•
Rent receipts, utility bills (for example, gas, electric and phone), and receipts or letters from companies showing the dates during which you received service.
•
School records (for example, letters, and report cards) from the schools that you or your children have attended in the United States, showing the names of the schools and periods of school attendance.
•
Hospital or medical records concerning treatment or hospitalization of you or your children, showing the name of the medical facility or physician, and the dates of the treatment or hospitalization.
•
Attestations by churches, unions, or other organizations to your residence, identifying you by name. The attestation must be signed by an official (whose title is shown); show inclusive dates of membership; state the
address where you resided during membership periods; include the seal of the organization impressed on the letter or the letterhead of the organization, if the organization has letterhead stationery; establish how the
author knows you; and establish the origin of the information being attested to.
•
Additional documents may include copies of money order receipts for money sent in or out of the country; passport entries; birth certificates of children born in the United States; dated bank transactions; correspondence
between you and another person or organization; U.S. Social Security card; Selective Service card; automobile license receipts, title, vehicle registration; deeds, mortgages, contracts to which you have been a party; tax
receipts; insurance policies; receipts; and letters.
•
Any other relevant documents.

Proof of entry

Proof of Entry

Upload proof of your date of entry into the United States. Examples of documents you may submit include copies of your:
- Passport (cover to cover);
- Form I-94, Arrival-Departure Record; or
- Any documents outlined under Proof of residence on the previous page.

Attestations; Birth Certificates; Employment Records; I-94; Medical Records;
Other Documents; Passport - All Pages, Passport (ID Page); Rent Receipt; School
Records; Utility Bill; W-2

Criminal history

Criminal History

If you were ever arrested, charged, and/or convicted for a criminal offense, you will need to provide court disposition records.
Upload a certified copy of all arrest reports, court dispositions, sentencing documents, and any other relevant documents. You may also include any mitigating evidence concerning the circumstances of your arrests or
convictions that you would like USCIS to consider if you have been arrested or convicted of a crime. If you were placed on probation, you must provide evidence to show that you completed your probationary period.

Court Records, Court Petition/Motion; Court/Custodian Order; Other Supporting
Documents, Photographs, Police/Arrest Records, Sentencing Documents; Written
Statement

If yes to 7.8.a-c; 7.10a-c;
7.11; or 7.15.a-c

You do not need to submit documentation for traffic fines and incidents (unless the traffic fines or incidents were alcohol- or drug-related) that did not involve an actual arrest if the penalty was only a fine of less than
$500 or points on your driver’s license. However, if you were arrested for any traffic offense, provide disposition documentation, so USCIS can properly assess whether your conviction may relate to your TPS eligibility.
If official documents are not available to you, you must establish that the documents are not available to you or your designated representative. If you claim that a record is not available because of a “confidentiality” law
or other reason, please submit:
(1) A copy of your petition or motion to the court or other custodian of the record seeking permission to obtain a copy to submit with your application; and
(2) A copy of the court’s or custodian’s order denying permission, if possible.
If you show that you cannot obtain a copy of the official record, you can submit any secondary evidence that might be
available, such as copies that you or your attorney may have retained.
If you cannot obtain primary or secondary evidence, you must provide at least one written statement. Each written statement must:
(1) Be from a named individual who has personal knowledge to the proceeding;
(2) Explain the source of the individual’s personal knowledge;
(3) Describe the nature of the proceeding, the underlying charges, and the disposition; and (4) Be signed by the individual under oath, affirmation, or penalty of perjury.

Late re-registration letter

Late Re-registration Letter

Upload a letter that explains your reason for filing late. Please note that processing may be delayed and can lead to gaps in your work authorization.

Letter

Upload

If 1.1b AND applying late

display if re-registration
application

Evidence

I-821: ADDITIONAL INFORMATION
Section
Additional
Information

Section
Paper Form Question Question
Additional Information
You may provide additional information for your application

Sub-Question
Field Type Required? Instructional Text
If you need to provide any additional information for
Additional information Textbox No
any of your answers to the questions in this form,
enter it into the space below. You should include the
questions that you are referencing.

Help Text

Notes

If you do not need to provide any additional
information, you may leave this section blank.

Additional Information

I-821: REVIEW AND SUBMIT

The Review and Submit step is the last step that an applicant completes before submitting their form. Sections and Questions in the Review and Submit step should be mostly consistent across all forms but copy should be updated to reflect the statements, certification, and attestations on the paper form. Review and Submit should contain all of the copy relating to reviewing the
application, the preparer/interpreter's certification and signature, the applicant's statements and signature, and paying/submitting the application.
Primary Nav

Review and Submit

Secondary Nav
Review your application

Tertiary Nav

Paper Form

Question
Check your application before you submit

Sub-Question

Field Type

Instructional Text
CTA
We will review your application to check for accuracy and completeness
before you submit it.

Notes
Content specific to digital environment

We encourage you to provide as many responses as you can throughout
the application, to the best of your knowledge. Missing information can
slow down the review process after you submit your application.
You can return to this page to review your application as many times as
you want before you submit it.

Your fee

Your form filing fee is: [$XXX}

Exact fee will be calculated and displayed

Refund Policy: USCIS does not refund fees, regardless of any action we
take on your application, petition or request, or how long USCIS takes to
reach a decision. By continuing this transaction, you acknowledge that
you must submit fees in the exact amount and that you are paying the
fees for a government service.
Alerts and warnings

You have one or more alerts and warnings based on the information you
provided in your application.

Content specific to digital environment

A red alert means you have incomplete or incorrect responses to certain
questions. You ​cannot​ submit your application with any alerts.
Your application summary

Review the I-821 form information

Here is a summary of all the information you provided in your
application.

Next

Content specific to digital environment

Make sure you have provided responses for everything that applies to
you before you submit your application. You can edit your responses by
going to each application section using the site navigation.
We also prepared a draft case snapshot with your responses, which you
(IF PREPARER) Preparer
statement

Preparer's statement

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

Radio

Your preparer must read the statements below and select the statement
that applies to him or her.
If your preparer is an attorney or accredited representative whose
representation extends beyond preparation of this application, he or she
may be obliged to submit a completed Notice of Entry of Appearance as
Attorney or Accredited Representative (G-28) with your application.

Preparer's certification and signature

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

Radio
Radio
Your preparer must read and agree to the certification below.

As the applicant's preparer, you must sign on paper and provide your signature page to the applicant. Follow
these steps:

Content specific to digital environment

1. Download the Preparer Signature page
2. Print the Preparer Signature page
3. Read and sign the Preparer Signature page
4. Give the signed Preparer Signature page to the applicant
The applicant will need to scan and upload your completed signature page on the next screen.
(IF PREPARER) Preparer
signature
(IF INTERPRETER)
Interpreter certification

Preparer's signature upload
Interpreter's certification and signature

Upload
I certify, under penalty of perjury, that: I am fluent in English and the language provided in the Getting Started
section of this application, 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.

Scan and upload your preparer's completed signature page below.
Your interpreter must read and agree to the certification below.

As the applicant's interpreter, you must sign on paper and provide your signature page to the applicant. Follow
these steps:

Content specific to digital environment

1. Download the Interpreter Signature page
2. Print the Interpreter Signature page
3. Read and sign the Interpreter Signature page
4. Give the signed Interpreter Signature page to the applicant
The applicant will need to scan and upload your completed signature page on the next screen.
(IF INTERPRETER)
Interpreter signature
Your statement

Interpreter's signature upload
Applicant's statement
Applicant's statement regarding the preparer
Applicant's statement regarding the interpreter

Upload
I can read and understand English, and have read and understand every question and instruction on this
Checkbox
application, as well as my answer to every question.
At my request, the preparer named in the Getting Started section of this application prepared this application
Checkbox
for me based only upon the information I provided or authorized.
The interpreter named in the Getting Started section of this application read to me every question and
Checkbox
instruction on this application and my answer to every question in the language I specified in the Getting Started
section, a language in which I am fluent, and I understood everything.

Scan and upload your interpreter's completed signature page below.
You must read and agree to the statement below.
You must read and agree to the statement below.
You must read and agree to the statement below.

Review & Submit

I-821: REVIEW AND SUBMIT

The Review and Submit step is the last step that an applicant completes before submitting their form. Sections and Questions in the Review and Submit step should be mostly consistent across all forms but copy should be updated to reflect the statements, certification, and attestations on the paper form. Review and Submit should contain all of the copy relating to reviewing the
application, the preparer/interpreter's certification and signature, the applicant's statements and signature, and paying/submitting the application.
Primary Nav

Secondary Nav
(If "Your Statement" is
complete) Your signature

Tertiary Nav

Paper Form

Question

Sub-Question

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 of my records that USCIS may need to determine my eligibility
for the immigration benefit I seek.

Field Type

Instructional Text

CTA

Notes

You must read and agree to the certification below. If you knowingly and
willfully falsify or conceal a material fact or submit a false document
with your application, we can deny your application and may deny any
other immigration benefit. You may also face criminal prosecution and
penalties provided by the law.

I further 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 laws.
I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints,
photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that:
1) I reviewed and provided or authorized all of the information in my application;
2) I understood all of the information contained in, and submitted with, my application; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I
understand all of the information contained in, and submitted with, my application, and that all of this
information is complete, true, and correct.

Applicant's signature

(If " Your statement" and
"Your signature are
complete AND 1.3b
selected) Pay and submit

I have read and agree to the applicant's statement

Pay for and submit your application

Checkbox

Content specific to digital environment
Required field

You must provide your digital signature below by typing your full legal
name. We may deny your application if you do not completely fill out
this application or fail to submit required documents. We will record the
date of your signature with your application.
The final step to submit your Form I-821, Application for Temporary
Protected Status (TPS) is to pay the required fee.

Exact fee will be calculated and displayed

Your application fee is: [$XXX]
Refund policy: By continuing this transaction, you agree that you are
paying for a government service and that the filing fee, biometric
services fee and all related financial transactions are final and not
refundable, regardless of any action USCIS takes on an application,
petition or request, or how long USCIS takes to reach a decision. You
must submit all fees in the exact amounts.
We will send you to Pay.gov — our safe, secure payment website — to
pay your fees and submit your application online.

Pay and
submit

Content specific to digital environment

Here are the steps in the payment and submission process:
1. Provide your billing information on Pay.gov
2. Provide your credit card or U.S. bank account information
3. Submit your payment
When you have paid your fee, your application will be submitted.
Pay.gov will redirect you to a uscis.gov confirmation screen, which will
include your receipt number. Please keep a copy of your receipt number
for your records. You can track the status of your application through
your USCIS online account.
You have successfully submitted your Application for Temporary Protected Status (I-821)

We will contact you if we have any questions or need additional
information. You can track the status of your application through your
USCIS online account.

You did not submit your Application for Temporary Protected Status (I-821)

Your payment failed because your credit or debit card was declined.

(Sucessful subnmission)
(No nav)

(Unsuccesful card
declined) (No nav)
You did not submit your Application for Temporary Protected Status (I-821)

(Unsucessful subnmission)
(No nav)

You can try again now to sign and submit your applications or save and
exit.
Your payment failed or was canceled before it could be processed on
Pay.gov.
You can try again now to sign and submit your application or save your
application and exit. We will save your application for 30 days from
when you started it.

Go to my
cases

Sign and
submit

Sign and
submit

Review & Submit

I-821: Alerts
Section

Type

Logic

Message

Message (re-registration)

Notes

h2. Only certain applicants may apply online

Application Overview
and Getting Started,
Reason for Applying

Review and Submit

Blue alert

If initial application

Red alert

If user has not answered
required field

You may submit this form online only if you are an eligible national or habitual resident of
Burma, Haiti, Syria, or Venezuela filing an initial application for TPS. All other applicants and reregistrants must submit a paper Form I-821. If you submit online and are not allowed to, your (Second release: Not displayed if
re-registration application)
application may be denied.
link to www.uscis.gov/i-821
h2. There are errors in (Section): (Sub section)
Edit my response

Alerts