Form G-325A Biographic Information

G-325A, Biographic Information (for Deferred Action)
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form G-325A
OMB No. 1615-0008
Expires 08/31/2025

Part 1. Information About You
1.

Full Legal Name (Do not provide a nickname)
Family Name (Last Name)

2.

Given Name (First Name)

Current Physical Address
Street Number and Name

Apt. Ste. Flr. Number

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City or Town

State

Date From (mm/yyyy)
3.

Middle Name (if applicable)

ZIP Code

Date To (mm/yyyy)

Current Mailing Address or Safe Address (if applicable)
In Care Of Name (if any)

4.

6.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Date of Birth (mm/dd/yyyy)

USCIS Online Account Number (if any)

►
8.

5.

Gender
Male

7.

Female

ZIP Code

Another Gender Identity

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

All Other Names Used (include names by previous marriages)

NOTE: Provide all other names you have ever used, including family name at birth, other legal names, nicknames, aliases, and
assumed names. If extra space is needed to complete this section, use the space provided in Part 8. Additional Information.
Family Name (Last Name)

9.

City or Town of Birth

11.

Country of Citizenship or Nationality

Form G-325A Edition 10/25/23

Given Name (First Name)

10.

Country of Birth

Middle Name

Part 1. Information About You (continued)
Your Prior Residences
12.

Please list your previous addresses for the last five years excluding your current physical address.
Street Name and Number

City

Province or State

ZIP Code/
Postal Code

From
Month
Year

Country

To
Month

Year

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Your Most Recent Entry into the United States

Please provide the following information regarding your most recent entry into the United States.
13.a. Date You Entered the United States, On or About (mm/dd/yyyy)
13.b. Location at Which You Last Entered the United States

13.c. Immigration Status at the Time of Entry into the United States (for example, H-2 temporary worker, H-1B temporary
worker, no status)

13.d. Date Status Expires/Expired (mm/dd/yyyy)

If you were issued a Form I-94 Arrival-Departure Record Number:
14.a. Form I-94 Arrival-Departure Record Number

14.b. Expiration Date of Authorized Stay Shown on Form I-94
(mm/dd/yyyy)

Information About Your Parent 1
15.

Family Name (Last Name)

Given Name (First Name)

17.

City or Town of Birth (if known)

18.

Country of Birth (if known)

19.

Current City or Town of Residence (if living)

20.

Current Country of Residence (if living)

16.

Date of Birth (mm/dd/yyyy)

Information About Your Parent 2
21.

Family Name (Last Name)

Given Name (First Name)

22.

Date of Birth (mm/dd/yyyy)

23.

City or Town of Birth (if known)

24.

Country of Birth (if known)

25.

Current City or Town of Residence (if living)

26.

Current Country of Residence (if living)

Information About Your Current Spouse (If none, type or print “none”)
27.

Family Name (Last Name)

Form G-325A Edition 10/25/23

Given Name (First Name)

28.

Date of Birth (mm/dd/yyyy)

Part 1. Information About You (continued)
Place of Birth
29.b. Country

29.a. City or Town

Place of Marriage
30.a. City or Town

31.

30.b. State or Province

30.c Country

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Date of Marriage

Part 2. Deferred Action Request
1.

Please select the request type:
Initial Request

Subsequent Request

2.

Please select the filing type for your deferred action request:
A.
B.
C.
D.
E.
F.
G.
H.

3.

Labor Investigation-Based (LIB DA)

Special Immigrant Juvenile (SIJ DA)

Spouse, Widow(er), Parent, Son, or Daughter of Active Duty Service Member of U.S. Armed Forces or Individual in
the Selected Reserve of the Ready Reserve (MIL DA)
Spouse, Widow(er), Parent, Son, or Daughter of Individual (Whether Living or Deceased) who Previously Served on
Active Duty or in the Selected Reserve of the Ready Reserve (and was not Dishonorably Discharged) (MIL DA)
Medical or Humanitarian

Statelessness

Government Referral (Other than a Labor Agency)

Other (Please review the form instructions before completing this field)

Supporting Statement
In addition to submitting evidence required to support your request for deferred action, please provide a brief statement as to
why your request for deferred action should be considered and why you warrant deferred action as a matter of discretion. If
extra space is needed to complete this section, use the space provided in Part 8. Additional Information.

Part 3. Employment Authorization
1.

I am requesting an Employment Authorization Document (EAD) upon being granted deferred action:

Form G-325A Edition 10/25/23

Yes

No

Part 3. Employment Authorization (continued)
If “Yes,” please provide the following information regarding your economic necessity for employment (this information is not
required if you are requesting the SIJ DA filing type):
2.a. My current annual income is:

2.b. My current annual expenses are:

2.c. The total current value of my assets is:

2.d. If you would like to provide an explanation regarding your current financial information or your economic need for employment
authorization, please use this space below. If you need extra space to complete this section, use the space provided in Part 8.
Additional Information.

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Part 4. Social Security Card

If you select “Yes” on Part 3. Employment Authorization, Item Number 1., please complete the following questions to
receive a Social Security card through this process. If the below questions and questions in Part 1. are not completed, you
will not receive a Social Security card through this process.
1.

Do you want the Social Security Administration (SSA) to issue you an original or replacement Social Security card?
Yes (Complete Item Numbers 2. - 3.)
No (Go to Part 5.)

2.

Provide your Social Security Number (SSN) (if any).

►
3.

Consent for Disclosure: I authorize disclosure of information from this application and USCIS systems to
the SSA as required for the purpose of assigning me an SSN and issuing me an original or replacement
Social Security card.

Yes

No

NOTE: If you answered “Yes” to Item Number 1., you must also answer “Yes” to Item Number 3., Consent for Disclosure, to receive a card.

Part 5. Requestor's Contact Information, Certification, and Signature
Requestor's Contact Information
Provide your daytime telephone number, mobile telephone number (if any), and email address (if any).
1.

Requestor's Daytime Telephone Number

3.

Requestor's Email Address (if any)

2.

Requestor's Mobile Telephone Number (if any)

Requestor'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 request, I read and understand or, if interpreted to me in a language in which I am fluent by the interpreter listed in Part 6.,
understood, all of the responses and information contained in, and submitted with, my request, 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 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.

Requestor's Signature

Form G-325A Edition 10/25/23

Date of Signature (mm/dd/yyyy)

Part 6. 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 (if any)

Interpreter's Given Name (First Name)

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

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Part 7. Contact Information, Certification, and Signature of the Person Preparing this Request, if Other
Than the Requestor
Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name

Preparer's Given Name (First Name)

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 request for the requestor at their request and with express consent and that all of
the responses and information contained in and submitted with the request are complete, true, and correct and reflects only
information provided by the requestor. The requestor reviewed the responses and information and informed me that they understand
the responses and information in or submitted with the request.
6.

Preparer's Signature

Form G-325A Edition 10/25/23

Date of Signature (mm/dd/yyyy)

Part 8. 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.
1.

Family Name (Last Name)

2.

A-Number (if any) ►A-

3.

Page Number

Part Number Item Number

4.

Page Number

Part Number Item Number

5.

Page Number

Part Number Item Number

6.

Page Number

Part Number Item Number

Given Name (First Name)

Middle Name

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Form G-325A Edition 10/25/23