Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons

Instructions for Supplement B, Declaration for
Trafficking Victim
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-914B

OMB No. 1615-0099
Expires 02/28/2026

What Is the Purpose of Form I-914 Supplement B?
You, as a Federal, State, Tribal, or local law enforcement official use Form I-914, Supplement B, Declaration for
Trafficking Victim, to provide evidence to United States Citizenship and Immigration Services (USCIS) that you believe
an individual (the applicant) submitting Form I-914, Application for T Nonimmigrant Status, is a victim of a severe form
of trafficking in persons and has cooperated with any reasonable requests for assistance in an investigation or prosecution
(if opened or initiated) of a crime where trafficking is at least one central reason for the commission of that crime. USCIS
(not the Federal, State, Tribal, or local law enforcement official) will decide whether the applicant meets the eligibility
requirements for T nonimmigrant status. A formal investigation or prosecution is not required in order for your agency to
complete this declaration.

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By signing the Form I-914, Supplement B, you are not conferring an immigration benefit. Submitting this declaration
does not lead to an automatic approval of the T visa application. USCIS is the only agency that can approve the
applicant’s Form I-914. USCIS requires fingerprints and police clearances from the victim and conducts background and
security checks. The applicant must submit other evidence in addition to the Form I-914, Supplement B. USCIS may
contact you if USCIS has any questions about the information provided in the supplement form.

When Should I Use Form I-914, Supplement B?

If you, the certifying Federal, State, Tribal, or local law enforcement official, believe the applicant is or has been a
victim of a severe form of trafficking in persons and has cooperated with any reasonable requests for assistance in your
investigation or prosecution (if opened or initiated), you may complete this Supplement B. You should complete all fields
of this form yourself. Supplement B must be signed with an original signature. A photocopy of a signed application or a
typewritten name in place of a signature is not acceptable. The applicant will submit Supplement B, to USCIS with their
Form I-914.
You must complete Supplement B based upon your knowledge of the case, including evidence developed by other law
enforcement officers involved with the case.
You do not need to formally launch an investigation or file charges to complete Form I-914, Supplement B.
You may complete Supplement B if an investigation does not lead to an arrest or a prosecution. Completing
Supplement B is not contingent on the outcome of a prosecution or investigation. Completing Supplement B is at
your discretion. There is no statute of limitations related to completing Supplement B.
Your agency may have its own procedures related to completing Supplement B.
To be eligible for T nonimmigrant status, the applicant must demonstrate to USCIS that they:
1. Are or were a victim of a severe form of trafficking in persons (see Supplement B, Part 3. Statement of Claim, for a
definition);
2. Are present in the United States on account of being a victim of a severe form of trafficking in persons (including
physical presence based on having been allowed entry into the United States to participate in investigative or judicial
processes associated with an act or perpetrator of trafficking);
3. Have complied with any reasonable requests from Federal, State, Tribal, or local law enforcement in the investigation
or prosecution of the trafficking crime of which they were a victim; unless
A. The applicant is under 18 years of age; or
B. They are unable to cooperate due to physical or psychological trauma; and
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4. Would suffer extreme hardship involving unusual and severe harm upon removal from the United States.
USCIS (not the certifying Federal, State, Tribal, or local law enforcement official) determines whether the evidence
is sufficient and whether the applicant meets each eligibility requirement. A signed Supplement B provides valuable
evidence of the victim’s cooperation. However, the applicant may establish eligibility without submitting the Supplement
B, as it is not a required form of evidence.

General Instructions
1. Type or print legibly in black ink.
2. If extra space is needed to complete any item on the form, use the space provided in Part 7. Additional Information
or attach an additional sheet of paper. Type or print the victim’s name and Alien Registration Number (A-Number), if
known, 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.

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3. Answer all questions fully and accurately. State that an item is not applicable with “N/A.” If the answer is none, type
or print “None.” If you do not know the answer to a question, leave the field blank.

Specific Instructions

This form is divided into Parts 1. - 7. The following information will help you fill out the form:
Part 1. Victim Information

1. Full Legal Name. Provide the legal name of the victim, as shown on their birth certificate, passport, or other legal
document. If the victim has two last names, include both and use a hyphen (-) between the names, if appropriate.
Type or print the victim’s last, first, and middle names in each appropriate field.
2. Other Names Used. You should provide all the names the victim has used, including maiden name, nicknames,
aliases, etc.
3. Date of Birth. Use eight numbers to show the victim’s date of birth (example: May 1, 1979, should be written
05/01/1979).
4. Gender. Indicate how the victim identifies.

5. A-Number. Provide the USCIS (former INS) file number if there is one, and if it is known to you.

6. Social Security Number. Provide the Social Security Number if there is one, and if it is known to you.
Part 2. Agency Information
1. Name of Certifying Agency. The certifying agency must be a Federal, State, Tribal, or local, law enforcement
agency, prosecutor, judge, labor agency, children’s protective services agency, adult protective services agency,
or other authority that has the responsibility and authority for the detection, investigation, and/or prosecution of
severe forms of trafficking in persons under any administrative, civil, criminal, or Tribal laws. 8 CFR 214.201.
2. - 4. Name, Title, and Division/Office of Certifying Officia. Give your name, title, and division or office.
5. Agency Mailing Address. Give the agency’s mailing address.
6. - 7. Daytime Telephone Number and Fax Number. Give your phone number and fax number with area code.
8. Agency Type. Select the appropriate box.
9. - 12. Case Information. Provide the case status information and, if applicable, the case identification number, FBI
Universal Control Number (UCN), or State Identification Number (SID).
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Part 3. Statement of Claim
1. In order to qualify for T nonimmigrant status, the applicant must be or have been a victim of a severe form of
trafficking in persons. Select all applicable boxes that describe the applicant’s victimization. It is not necessary for
the victim to actually perform the labor or commercial sex act(s) to be eligible for T nonimmigrant status.
NOTE: Base your analysis on the practices to which the victim was subjected, rather than on the specific violations
charged, the counts on which convictions were obtained, or whether any prosecution resulted in convictions. The
definitions that control this analysis are not the elements of criminal offenses, but are those in 8 CFR 214.201.
A. Sex trafficking where the commercial sex act was induced through the use of force, fraud or coercion. Sex
trafficking is the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person
for the purpose of inducing a commercial sex act.
B. Sex trafficking where the victim was under 18 years of age at the time the acts of trafficking occured. Inducing an
individual under 18 years of age to perform a commercial sex act is considered sex trafficking, regardless of the
use of force, fraud, or coercion.

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C. Labor trafficking: the recruitment, harboring, transportation, provision, or obtaining of a person for labor or
services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude,
peonage, debt bondage, or slavery.
D. Other. If you need extra space to complete this section, use the space provided in Part 7. Additional Information.
2. Describe the victimization on which the applicant’s claim is based and identify the relationship between that
victimization and the crime investigated or prosecuted. If you need extra space to complete this section, use the space
provided in Part 7. Additional Information.
3. Explain if the individual has expressed any fear of retaliation or revenge if they are removed from the United States.
If you need extra space to complete this section, use the space provided in Part 7. Additional Information.
4. Provide the dates on which the acts of trafficking occurred.

5. List the statutory citations that are or were being investigated or prosecuted.
6. Provide the date on which the investigation or prosecution was initiated.

7. Provide the date on which the investigation or prosecution was completed, if any.
Part 4. Cooperation of Victim

In order to qualify for T nonimmigrant status, the applicant must show that they have complied with any reasonable
requests from Federal, State, Tribal, or local law enforcement in the investigation or prosecution of the acts of trafficking
of which they were a victim (unless they were under 18 years of age at the time the acts of trafficking occurred or they are
unable to cooperate with the request due to physical or psychological trauma). It is not necessary for you to demonstrate
that the cooperation of the victim led to a formal investigation, arrest, or prosecution. If the applicant is unable to
cooperate with law enforcement’s reasonable request due to physical or psychological trauma or age, the applicant must
provide evidence to this effect.
Select the boxes that describe the individual’s cooperation with the investigation or prosecution of the acts of trafficking
and provide an explanation. If you need extra space to complete this section, use the space provided in Part 7. Additional
Information.
Part 5. Family Members Implicated in Trafficking
List whether any of the victim’s family members are believed to have been involved in the trafficking in persons.

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NOTE: A victim cannot apply for derivative T nonimmigrant status for a family member who participated in the acts
of trafficking that established the victim’s eligibility for T nonimmigrant status, and USCIS will not grant an immigration
benefit to a family member who committed trafficking.
Part 6. Attestation
You, the certifying Federal, State, Tribal, or local law enforcement official filling out this form (identified in Part 2. of
Supplement B), must sign and date the form in this section. Further, your supervisor must provide their name and sign
and date this supplement.
Supplement B must have an original signature. A photocopy of a signed declaration or a typewritten name in place of a
signature is not acceptable.
Part 7. Additional Information

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Item Numbers 1. - 7. If you need extra space to provide any additional information in this form, use the space provided
in Part 7. Additional Information. If you need more space than what is provided in Part 7., you may make copies of
Part 7. to complete and file with your supplement, or attach a separate sheet of paper. Type or print the victim’s name and
A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your
answer refers; and sign and date each sheet.

How Can I Provide Further Information at a Later Date?

An agency can provide further information to USCIS or formally withdraw or disavow Form I-914, Supplement B, at a
later date, even after this form is submitted to USCIS, if there is new information or if the victim is no longer cooperating
with a reasonable request for assistance in an investigation or prosecution. Send any written statement to USCIS at:
USCIS
Vermont Service Center
38 River Road
Essex Junction, VT 05479-0001

An agency should send a letter on official agency letterhead to USCIS at the address above describing the reasons for
providing further information or the reasons for withdrawing or disavowing the declaration. Include the victim’s name,
date of birth, and A-Number (if available) on all correspondence. USCIS will allow the victim to rebut this information.

DHS Privacy Notice
AUTHORITIES: The information requested on this application, and the associated evidence, is collected under Public
Law106-386 sections 107(e) and 1513(c) and 8 USC 1101(a)(15)(T).
PURPOSE: The primary purpose for providing the requested information on this application is to determine if the
applicant has established eligibility for temporary immigration benefits for which the applicant is filing. Department of
Homeland Security (DHS) uses the information you provide to grant or deny the immigration benefit the applicant is
seeking.
CONFIDENTIALITY: Information concerning principal applicants for T nonimmigrant status and the family members
they apply for is protected under 8 U.S.C. Section 1367.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information,
including the applicant’s Social Security number (if applicable), and any requested evidence, may delay a final decision or
result in denial of the application.
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ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, including 8 U.S.C. Section 1367,
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 and DHS/USCIS-007 - Benefits Information System] and published the privacy impact assessment [DHS/USCIS/
PIA-016(a) Computer Linked Application Information Management System and Associated Systems], which you can find
at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the
interest of national security.

Paperwork Reduction Act

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USCIS may not conduct or sponsor an information collection, and you are not required to respond to a collection of
information unless it displays a currently valid OMB control number. The public reporting burden for law enforcement
agencies for this collection of information is estimated at 3.58 hours per response, including the time for reviewing
instructions and completing and submitting the form. The public burden for the Form I-914 respondents who will take
the action of contacting a law enforcement agency to request that Form I-914, Supplement B, be completed is estimated
to require 15 minutes to make such a request to the agency. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to: 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. OMB No. 1615-0099. Do not mail your completed Form I-914,
Supplement B to this address

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