Form I-485 Supplement A I-485 Supplement A Supplement A to Form I-485, Adjustment of Status Under S

Supplement A to Form I-485,
Adjustment of Status Under Section 245(i)

USCIS
Form I-485

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

OMB No. 1615-0023
Expires 02/28/2026

NOTE: Use Supplement A to Form I-485, Adjustment of Status Under INA Section 245(i) (Supplement A), only if you are applying
to adjust status to that of a lawful permanent resident under the Immigration and Nationality Act (INA) section 245(i). You may file
Supplement A only if you are filing your Form I-485, Application to Register Permanent Residence or Adjust Status, at the same time
or if you previously filed your Form I-485 and it remains pending.

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►START HERE - Type or print in black ink.

Part 1. Information About You
1.

Your Current Legal Name

Family Name (Last Name)

2.

Given Name (First Name)

Middle Name (if applicable)

U.S. Mailing Address

In Care Of Name (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

ZIP Code

(USPS ZIP Code Lookup)

Other Information
3.

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

A-

5.

Date of Birth (mm/dd/yyyy)

6.

Country of Birth

4.

USCIS Online Account Number (if any)
►

7.

Country of Citizenship or Nationality

Part 2. Eligibility
Basis of INA Section 245(i) Eligibility
You claim eligibility to adjust status under INA section 245(i) because (Select only one box):
1.a.

You are or were the principal beneficiary of an immigrant petition or application for permanent labor certification filed on
or before January 14, 1998.

1.b.

You are or were the principal beneficiary of an immigrant petition or application for permanent labor certification filed on
or after January 15, 1998, and on or before April 30, 2001, and you were physically present in the United States on
December 21, 2000.

1.c.

You are or were the derivative beneficiary of an immigrant petition or application for permanent labor certification filed
on or before January 14, 1998.

Form I-485 Supp A Edition 04/01/24

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Part 2. Eligibility (continued)
1.d.

You are or were the derivative beneficiary of an immigrant petition or application for permanent labor certification filed
on or after January 15, 1998, and on or before April 30, 2001, and the principal beneficiary was physically present in the
United States on December 21, 2000.

1.e.

You are currently the spouse applying to accompany or follow-to-join your spouse OR you are a child (unmarried and
under 21 years of age) applying to accompany or follow-to-join your parent described above in Item Numbers 1.a. - 1.d.

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Qualifying Petition or Application

Provide the following information about the immigrant petition or application for permanent labor certification filed on or before April
30, 2001 that qualifies you to adjust status under INA section 245(i).
2.

Receipt Number of Petition (if any)

Information on Principal Beneficiary of Petition or Application
3.

Family Name (Last Name)

4.

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

Given Name (First Name)

Middle Name (if applicable)

Immigrant Category
5.

Type or print the family-based, employment-based, special immigrant, or Diversity Visa immigrant category you selected on
Form I-485, Part 2. Application Type or Filing Category, in Item Numbers 3.a. - 3.g.

Part 3. Bars to Adjustment

You are applying to adjust under INA section 245(i) because one or more of the following bars to adjustment apply to you (Select all
applicable boxes):
1.a.

You last entered the United States without being admitted or paroled after inspection by an immigration officer.

1.b.

You last entered the United States as a nonimmigrant crewman.

1.c.

You are now employed or have ever been employed in the United States without authorization.

1.d.

You are not in lawful immigration status on the date of filing your application for adjustment of status.

1.e.

You have ever failed to continuously maintain a lawful status since entry into the United States, unless your failure to
maintain status was through no fault of your own or for technical reasons.

1.f.

You were last admitted to the United States in transit without a visa.

1.g.

You were last admitted to the United States as a nonimmigrant visitor without a visa under the Guam and Commonwealth
of the Northern Mariana Islands Visa Waiver Program, and you are not a Canadian citizen.

1.h.

You were last admitted to the United States as a nonimmigrant visitor without a visa under the Visa Waiver Program (See
https://travel.state.gov/content/travel/en/us-visas/tourism-visit/visa-waiver-program.html).

1.i.

You are seeking employment-based adjustment of status and you are not maintaining a lawful nonimmigrant status on the
date of filing your application for adjustment of status.

1.j.

You have ever violated the terms of your nonimmigrant status.

Form I-485 Supp A Edition 04/01/24

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Part 4. Applicant's Contact Information, Certification, and Signature
Applicant's Contact Information
Provide your daytime telephone number, mobile telephone number (if any), and email address (if any).
1.

Applicant's Daytime Telephone Number

3.

Applicant's Email Address (if any)

2.

Applicant's Mobile Telephone Number (if any)

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Applicant's Certification and Signature

I certify, under penalty of perjury, that I provided or authorized all of the responses and information contained in and submitted with
my supplement, I read and understand or, if interpreted to me in a language in which I am fluent by the interpreter listed in Part 5.,
understood, all of the responses and information contained in, and submitted with, my supplement, and that all of the responses and
the information are complete, true, and correct. Furthermore, I authorize the release of any information from any and all of my records
that U.S. Citizenship and Immigration Services (USCIS) may need to determine my eligibility for an immigration request and to other
entities and persons where necessary for the administration and enforcement of U.S. immigration law.
4.

Date of Signature (mm/dd/yyyy)

Applicant's Signature

Part 5. Interpreter's Contact Information, Certification, and Signature
Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

2.

Interpreter's Business or Organization Name

Interpreter's Given Name (First Name)

Interpreter's Contact Information
3.

Interpreter's Daytime Telephone Number

5.

Interpreter's Email Address (if any)

4.

Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification and Signature
I certify, under penalty of perjury, that I am fluent in English and

,

and I have interpreted every question on the supplement and Instructions and interpreted the applicant's answers to the questions in
that language, and the applicant informed me that they understood every instruction, question, and answer on the supplement.
6.

Interpreter's Signature

Form I-485 Supp A Edition 04/01/24

Date of Signature (mm/dd/yyyy)

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Part 6. Contact Information, Certification, and Signature of the Person Preparing this Supplement, if
Other Than the Applicant
Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name

Preparer's Given Name (First Name)

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Preparer's Contact Information
3.

Preparer's Daytime Telephone Number

5.

Preparer's Email Address (if any)

4.

Preparer's Mobile Telephone Number (if any)

Preparer's Certification and Signature

I certify, under penalty of perjury, that I prepared this supplement for the applicant at their request and with express consent and that
all of the responses and information contained in and submitted with the supplement are complete, true, and correct and reflects only
information provided by the applicant. The applicant reviewed the responses and information and informed me that they understand
the responses and information in or submitted with the supplement.
6.

Preparer's Signature

Form I-485 Supp A Edition 04/01/24

Date of Signature (mm/dd/yyyy)

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