I-914 Form Table of Changes

I914-002-FRM-TOC-TFinalRule-30Day-07082024.docx

Application for T Nonimmigrant Status; Application for Immediate Family Member of T-1 Recipient; & Declaration of Law Enforcement Officer for Victim of Trafficking in Persons

I-914 Form Table of Changes

OMB: 1615-0099

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TABLE OF CHANGES – FORM

Form I-914, Application for T Nonimmigrant Status

OMB Number: 1615-0099

07/08/2024


Reason for Revision: TFinalRule

Project Phase: 30Day


Legend for Proposed Text:

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Edition Date 04/01/2024



Current Page Number and Section

Current Text

Proposed Text

Page 1,



[Page 1]


For USCIS Use Only


Returned

Date

Date


Resubmitted

Date

Date


Reloc Sent

Date

Date


Reloc Rec’d

Date

Date


Receipt


Validity Dates

From:

To:


Remarks


Conditional Approval

Stamp #

Date


Action Block



To be fully completed by an attorney or accredited representative, if any.

Select this box if Form G-28 is attached.

Attorney State Bar Number

Attorney or Accredited Representative USCIS Online Account Number



START HERE - Type or print in ink.


[Page 1]


For USCIS Use Only


Returned

Date

Date


Resubmitted

Date

Date


Reloc Sent

Date

Date


Reloc Rec’d

Date

Date


Receipt


Validity Dates

From:

To:


Remarks


Waitlisted

Stamp #

Date


Action Block



To be fully completed by an attorney or accredited representative, if any.

Select this box if Form G-28 is attached.

Attorney State Bar Number

Attorney or Accredited Representative USCIS Online Account Number



START HERE - Type or print in ink.


Pages 1-2


Part 2. General Information About You (Person filing this application as a victim)


[Page 1]


Part 2. General Information About You (Person filing this application as a victim)



8. Gender

Male

Femalel.



[Page 1]


Part 2. General Information About You (Person filing this application as a victim)



8. Gender

Male

Female

Another Gender Identity



Pages 2-3,


Part 3. Additional Information About Your Application


[Page 2]


Part 3. Additional Information About Your Application


Answers to the following questions about your claim require explanation and supporting documentation. You should attach documents in support of your claim that you are a victim of a severe form of trafficking in persons and the specific facts on which you are relying to support your claim. You must attach a personal narrative statement addressing the eligibility requirements for T nonimmigrant status as listed in the regulations, including a description of the trafficking you experienced. If you need extra space to complete this section, use the space provided in Part 9. Additional Information.




1. I am or have been a victim of a severe form of trafficking in persons. (Attach evidence to support your claim.)

Yes

No


2.A. I have cooperated with reasonable requests for assistance from law enforcement. Yes

No


B. Due to my age or the trauma I have suffered, I am exempt from the requirement to cooperate with reasonable requests for assistance from law enforcement.

Yes

No



[Page 3]


3. I am physically present in the United States, American Samoa, or the Commonwealth of the Northern Mariana Islands, or at a port of entry, on account of trafficking, or have been allowed entry into the United States to participate in investigative or judicial processes associated with an act or perpetrator of trafficking. (If you selected “Yes,” explain in detail and attach evidence and documents supporting this claim.) Yes

No


4. I fear that I will suffer extreme hardship involving unusual and severe harm upon removal. (If you selected “Yes,” explain in detail and attach evidence and documents supporting this claim.)

Yes

No


5. I have reported the trafficking crime of which I am claiming to be a victim. (If you selected “Yes,” indicate to which law enforcement agency and office you have made the report, the address and phone number of that office, and the case number assigned, if any. If you selected “No,” explain the circumstances.)

Yes

No



Law Enforcement Agency and Office

Street Number and Name

Apt./Ste./Flr. [Number]

City or Town

State

ZIP Code

Daytime Telephone Number

Case Number

Circumstances


6. I am under 18 years of age. (If you selected "Yes," skip to Item Number 8.)

Yes

No


7. I have complied with reasonable requests from Federal, state, local, or tribal law enforcement authorities for assistance in the investigation or prosecution of acts of trafficking, or am unable to cooperate with such requests due to physical or psychological trauma. (If you selected “No,” explain the circumstances.)

Yes

No



8. This is the first time I have entered the United States. (If you selected “No,” list each date, place of entry, and under which status you entered the United States for the past five years, and explain the circumstances of your most recent arrival.) If you need extra space, use the space provided in Part 9. Additional Information.

Yes

No


(1) Date of Entry (mm/dd/yyyy)


(2) Place of Entry

City or Town

State


(3) Status


9. My most recent entry was on account of the trafficking that forms the basis for my claim. (Explain the circumstances of your most recent arrival.)

Yes

No


10. I am requesting an Employment Authorization Document (EAD).

Yes

No



11. I am now applying for one or more eligible family members. (If you selected “Yes,” complete and include a Form I-914, Supplement A, Application for Immediate Family Member of T-1 Recipient, for each family member for whom you are now applying. You may also apply to bring eligible family members to the United States at a later date.)

Yes

No



[Page 2]


Part 3. Additional Information About Your Application


Answers to the following questions about your claim require explanation and supporting documentation. You should attach documents in support of your claim that you are a victim of a severe form of trafficking in persons and the specific facts on which you are relying to support your claim. If you answer “Yes” to Item Numbers 1. - 4., attach evidence and documents to support your claim. You must attach a signed personal narrative statement addressing the eligibility requirements for T nonimmigrant status as listed in the regulations, including a description of the trafficking you experienced. If you need extra space to complete this section, use the space provided in Part 9. Additional Information.


1. I am or have been a victim of a severe form of trafficking in persons.

Yes

No


2.A. I have cooperated with reasonable requests for assistance from law enforcement.

Yes

No



B. Due to my age or the trauma I have suffered, I am exempt from the requirement to cooperate with reasonable requests for assistance from law enforcement.

Yes

No



[Page 3]


3. I am physically present in the United States, American Samoa, or the Commonwealth of the Northern Mariana Islands, or at a port of entry, on account of trafficking, or have been allowed entry into the United States to participate in investigative or judicial processes associated with an act or perpetrator of trafficking.

Yes

No




4. I fear that I will suffer extreme hardship involving unusual and severe harm upon removal.

Yes

No




5. I have reported the trafficking crime of which I am claiming to be a victim. (If you selected “Yes,” indicate to which law enforcement agency and office you have made the report, the address and phone number of that office, and the case number assigned, if any. If you selected “No,” explain the circumstances below.)

Yes

No


Law Enforcement Agency and Office

Street Number and Name

Apt./Ste./Flr. [Number]

City or Town

State

ZIP Code

Daytime Telephone Number

Case Number

Circumstances


6. I was under 18 years of age at the time at least one of the acts of trafficking occurred.

Yes

No


7. I have complied with reasonable requests from Federal, State, Tribal, or local law enforcement authorities for assistance in the investigation or prosecution of acts of trafficking, or am unable to cooperate with such requests due to physical or psychological trauma. (If you selected “No,” and were over 18 years of age at the time one of the acts of trafficking occurred, explain the circumstances.)

Yes

No


8. This is the first time I have entered the United States. (If you selected “No,” list each date, place of entry, and under which status you entered the United States for the past five years, and explain the circumstances of your most recent arrival.) If you need extra space, use the space provided in Part 9. Additional Information.

Yes

No


(1) Date of Entry (mm/dd/yyyy)


(2) Place of Entry

City or Town

State


(3) Status


9. My most recent entry was on account of the trafficking that forms the basis for my claim. (Explain the circumstances of your most recent arrival.)

Yes

No


10. I am requesting an Employment Authorization Document (EAD) when I am granted T nonimmigrant status.

Yes

No


11. I am now applying for one or more eligible family members. (If you selected “Yes,” complete and include a Form I-914, Supplement A, Application for Derivative T Nonimmigrant Status, for each family member for whom you are now applying. You may also apply to bring eligible family members to the United States at a later date.)

Yes

No


Pages 4-7


Part 4. Processing Information

[Page 4]


Part 4. Processing Information



D. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individual or to cause substantial damage to property?

Yes

No



(4) The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individual or to cause substantial damage to property?

Yes

No



8. Have you EVER been present or nearby when any person was:


A. Intentionally killed, tortured, beaten, or injured?

Yes

No


B. Displaced or moved from his or her residence by force, compulsion, or duress?

Yes

No


[Page 4]


Part 4. Processing Information



D. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property?

Yes

No



(4) The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property?

Yes

No



8. Have you EVER been present or nearby when any person was:


A. Intentionally killed, tortured, beaten, or injured?

Yes

No


B. Displaced or moved from their residence by force, compulsion, or duress?

Yes

No




Pages 7-8


Part 5. Information About Your Family Members


[Page 7]


Part 5. Information About Your Family Members


Provide the following information about your spouse and all of your children, if applicable. If you need extra space to complete this section, use the space provided in Part 9. Additional Information.


1. Your Spouse’s Legal Name

Family Name (Last Name)

Given Name (First Name)

Middle Name (if any)



2. Date of Birth (mm/dd/yyyy)


3. Country of Birth


4. Current Location

City or Town of Residence

Country of Residence


5. Information About Your Children


A. Child 1

Family Name (Last Name)

Given Name (First Name)

Middle Name (if any)


Date of Birth (mm/dd/yyyy)


Country of Birth


Relationship


Current Location

City or Town

State

Country


B. Child 2

Family Name (Last Name)

Given Name (First Name)

Middle Name (if any)


Date of Birth (mm/dd/yyyy)


Country of Birth


Relationship


Current Location

City or Town

State

Country




[Page 8]


C. Child 3

Family Name (Last Name)

Given Name (First Name)

Middle Name (if any)


Date of Birth (mm/dd/yyyy)


Country of Birth


Relationship


Current Location

City or Town

State

Country


Complete Form I-914, Supplement A, Application for Family Member of T-1 Recipient, for each family member listed above for whom you are now applying for derivative T nonimmigrant status, and attach it to this application.


[Page 7]


Part 5. Information About Your Family Members


Provide the following information about your spouse and all of your children, if applicable. If you need extra space to complete this section, use the space provided in Part 9. Additional Information.


1. Information About your Spouse

A. Your Spouse’s Legal Name

Family Name (Last Name)

Given Name (First Name)

Middle Name (if any)


B. Date of Birth (mm/dd/yyyy)


C. Country of Birth


D. Current Location

City or Town of Residence

Country of Residence


2. Information About Your Children


A. Child 1

Family Name (Last Name)

Given Name (First Name)

Middle Name (if any)


Date of Birth (mm/dd/yyyy)


Country of Birth


[deleted]


Current Location

City or Town

State

Country


B. Child 2

Family Name (Last Name)

Given Name (First Name)

Middle Name (if any)


Date of Birth (mm/dd/yyyy)


Country of Birth


[deleted]


Current Location

City or Town

State

Country




[Page 8]


C. Child 3

Family Name (Last Name)

Given Name (First Name)

Middle Name (if any)


Date of Birth (mm/dd/yyyy)


Country of Birth


[deleted]


Current Location

City or Town

State

Country


[deleted]

Pages 8-9


Part 6. Applicant's Statement, Contact Information, Declaration, Certification, and Signature


[Page 8]


Part 6. Applicant's Statement, Contact Information, Declaration, Certification, and Signature


NOTE: Read the Penalties section of the Form I-914 Instructions before completing this section.


Applicant'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. Applicant's Statement Regarding the Interpreter


A. I can read and understand English, and I have read and understand every question and instruction on this application and my answer to every question.


B. The interpreter named in Part 7. read to me every question and instruction on this application and my answer to every question in [Fillable Field], a language in which I am fluent, and I understood everything.


2. Applicant's Statement Regarding the Preparer


At my request, the preparer named in Part 8., [Fillable Field], prepared this application for me based only upon information I provided or authorized.


Applicant's Contact Information

3. Applicant's Daytime Telephone Number

4. Applicant's Safe Daytime Telephone Number

5. Applicant's Email Address (if any)




[Page 9]


Applicant's Declaration and Certification

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


I authorize the release of any information from my record that USCIS needs to determine eligibility for the benefit I am seeking to investigate my claim, and to investigate fraudulent claims. I further authorize USCIS to release information to law enforcement agencies and prosecutors investigating crimes of trafficking or related crimes. I further authorize USCIS to release information to Federal, State, and local public and private agencies providing benefits, to be used solely in making determinations of eligibility for benefits pursuant to 8 USC 1641(c).


I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law.




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, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:


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


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


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


Applicant's Signature

6. Applicant's Signature

Date of Signature (mm/dd/yyyy)


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


[Page 8]


Part 6. Applicant's Statement, Contact Information, Declaration, Certification, and Signature


NOTE: Read the Penalties section of the Form I-914 Instructions before completing this section.


Applicant'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. Applicant's Statement Regarding the Interpreter


A. I can read and understand English, and I have read and understand every question and instruction on this application and my answer to every question.


B. The interpreter named in Part 7. read to me every question and instruction on this application and my answer to every question in [Fillable Field], a language in which I am fluent, and I understood everything.


2. Applicant's Statement Regarding the Preparer


At my request, the preparer named in Part 8., [Fillable Field], prepared this application for me based only upon information I provided or authorized.


Applicant's Contact Information

3. Applicant's Daytime Telephone Number

4. Applicant's Safe Daytime Telephone Number

5. Applicant's Email Address (if any)




[Page 9]


Applicant's Declaration and Certification

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


I authorize the release of any information from my record that USCIS needs to determine eligibility for the benefit I am seeking to investigate my claim, and to investigate fraudulent claims. I further authorize USCIS to release information to law enforcement agencies and prosecutors investigating crimes of trafficking or related crimes. I further authorize USCIS to release information to Federal, State, and local public and private agencies providing benefits, to be used solely in making determinations of eligibility for benefits pursuant to 8 U.S.C. 1641(c).


I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law. Any disclosure will be in accordance with the confidentiality provisions at 8 U.S.C. section 1367 and 8 CFR 214.216.


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, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:


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


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


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



Applicant's Signature

6. Applicant's Signature

Date of Signature (mm/dd/yyyy)


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


Pages 9-10


Part 7. Interpreter's Contact Information, Certification, and Signature (if any)


[Page 9]


Part 7. Interpreter's Contact Information, Certification, and Signature (if any)



Interpreter's Certification


I certify, under penalty of perjury, that:


I am fluent in English and [Fillable Field], which is the same language specified in Part 6., Item B. in Item Number 1., 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 Declaration and Certification, and has verified the accuracy of every answer.


Interpreter's Signature

7. Interpreter's Signature

Date of Signature (mm/dd/yyyy)


[Page 9]


Part 7. Interpreter's Contact Information, Certification, and Signature (if any)



Interpreter's Certification


I certify, under penalty of perjury, that:


I am fluent in English and [Fillable Field], which is the same language specified in Part 6., Item B. in Item Number 1., and I have read to this applicant in the identified language every question and instruction on this application and their answer to every question. The applicant informed me that they understand every instruction, question, and answer on the application, including the Applicant's Declaration and Certification, and has verified the accuracy of every answer.


Interpreter's Signature

7. Interpreter's Signature

Date of Signature (mm/dd/yyyy)


Pages 10-11


Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant


[Page 10]


Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant



Preparer's Certification


By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted with, his or her application, including the Applicant's Declaration and 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.


Preparer's Signature

8. Preparer's Signature

Date of Signature (mm/dd/yyyy)



[Page 10]


Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant



Preparer's Certification


By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then reviewed this completed application and informed me that they understand all the information contained in, and submitted with, their application, including the Applicant's Declaration and 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.


Preparer's Signature

8. Preparer's Signature

Date of Signature (mm/dd/yyyy)


Page 12,


Part 9. Additional Information


[Page 12]


Part 9. Additional Information


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





[Page 12]


Part 9. Additional Information


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



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