Application to Register Permanent Residence

or Adjust Status USCIS

Form I-485
Department of Homeland Security OMB No. 1615-0023
U.S. Citizenship and Immigration Services Expires 10/31/2020

For USCIS Use Only

Preference Category: Receipt Action Block

Country Chargeable:

Priority Date:

Date Form I-693 Received:

Section of Law
Applicant Interview
Interviewed Waived INA 209(a) INA 249
Date of INA 209(b) Sec. 13, Act of 9/11/57
Initial Interview: INA 245(a) Cuban Adjustment Act
Lawful Permanent INA 245(i) Other
Resident as of: INA 245(m)

To be completed by an attorney or accredited representative (if any).

Select this box if Volag Number Attorney State Bar Number Attorney or Accredited Representative
Form G-28 is (if any) (if applicable) USCIS Online Account Number (if any)
attached.

► START HERE - Type or print in black ink. A-Number ► A-

NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, U.S. Citizenship and Immigration Services (USCIS) may deny your application.
3.a. Family Name
Part 1. Information About You (individual (Last Name)
applying for lawful permanent residence) 3.b. Given Name
(First Name)
Your Current Legal Name (do not provide a
3.c. Middle Name
nickname)
1.a. Family Name 4.a. Family Name
(Last Name) (Last Name)
1.b. Given Name 4.b. Given Name
(First Name) (First Name)
1.c. Middle Name 4.c. Middle Name

Other Names You Have Used Since Birth (if Other Information About You
applicable)
5. Date of Birth (mm/dd/yyyy)
NOTE: Provide all other names you have ever used, including
your family name at birth, other legal names, nicknames, NOTE: In addition to providing your actual date of birth,
aliases, and assumed names. If you need extra space to include any other dates of birth you have used in
complete this section, use the space provided in Part 14. connection with any legal names or non-legal names in
Additional Information. the space provided in Part 14. Additional Information.
2.a. Family Name 6. Gender Male Female
(Last Name)
2.b. Given Name 7. City or Town of Birth
(First Name)
2.c. Middle Name

Form I-485 Edition 10/15/19 Page 1 of 20

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Part 1. Information About You (Person applying Recent Immigration History

for lawful permanent residence) (continued) Provide the information for Item Numbers 15. - 19. if you last
entered the United States using a passport or travel document.
8. Country of Birth
15. Passport Number Used at Last Arrival

9. Country of Citizenship or Nationality

16. Travel Document Number Used at Last Arrival

10. Alien Registration Number (A-Number) (if any)

► A- 17. Expiration Date of this Passport or Travel Document
(mm/dd/yyyy)
NOTE: If you have EVER used other A-Numbers,
include the additional A-Numbers in the space provided 18. Country that Issued this Passport or Travel Document
in Part 14. Additional Information.
11. USCIS Online Account Number (if any)
19. Nonimmigrant Visa Number from this Passport (if any)
►
12. U.S. Social Security Number (if any)
Place of Last Arrival into the United States
►
20.a. City or Town

U.S. Mailing Address

13.a. In Care Of Name (if any) 20.b. State

21. Date of Last Arrival (mm/dd/yyyy)

13.b. Street Number
and Name When I last arrived in the United States, I:

13.c. Apt. Ste. Flr. 22.a. Was inspected at a port of entry and admitted as (for
example, exchange visitor; visitor, waived through;
13.d. City or Town temporary worker; student):

13.e. State 13.f. ZIP Code

22.b. Was inspected at a port of entry and paroled as (for
(USPS ZIP Code Lookup)
example, humanitarian parole, Cuban parole):
Alternate and/or Safe Mailing Address
If you are applying based on the Violence Against Women Act
22.c. Came into the United States without admission or
(VAWA) or as a special immigrant juvenile, human trafficking parole.
victim (T nonimmigrant), or victim of qualifying criminal
activity (U nonimmigrant) and you do not want USCIS to send 22.d. Other:
notices about this application to your home, you may provide an
alternative and/or safe mailing address.
If you were issued a Form I-94 Arrival-Departure Record Number:
14.a. In Care Of Name (if any)
23.a. Form I-94 Arrival-Departure Record Number
►
14.b. Street Number
and Name 23.b. Expiration Date of Authorized Stay Shown on Form I-94
14.c. Apt. Ste. Flr. (mm/dd/yyyy)

14.d. City or Town 23.c. Status on Form I-94 (for example, class of admission, or
paroled, if paroled)
14.e. State 14.f. ZIP Code

Form I-485 Edition 10/15/19 Page 2 of 20

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Part 1. Information About You (Person applying Employment-based

for lawful permanent residence) (continued) 3.a. Alien worker, Form I-140 (if you select this box, you
must answer Item Number 9.a.)
24. What is your current immigration status (if it has changed
since your arrival)? 3.b. Alien entrepreneur, Form I-526

Special Immigrant
Provide your name exactly as it appears on your Form I-94 (if
4.a. Religious worker, Form I-360
any)
4.b. Special immigrant juvenile, Form I-360
25.a. Family Name
(Last Name) 4.c. Certain Afghan or Iraqi national, Form I-360
25.b. Given Name
(First Name) 4.d. Certain international broadcaster, Form I-360

25.c. Middle Name 4.e. Certain G-4 international organization or family

member or NATO-6 employee or family member,
Form I-360
Part 2. Application Type or Filing Category 4.f. Certain U.S. armed forces members (also known as
the Six and Six program), Form I-360
1. I am filing this Form I-485 as a (select only one box):
4.g. Panama Canal Zone employees, Form I-360
Principal applicant
4.h. Certain Physicians, Form I-360
Derivative applicant
4.i. Certain employee or former employee of the U.S.
NOTE: Attach a copy of the Form I-797 receipt or approval Government abroad, Form I-360
notice for the underlying petition or application, as appropriate.
I am applying as a principal or derivative applicant to register Asylee or Refugee
lawful permanent residence or adjust status to that of a lawful
5.a. Asylum status (INA section 208), Form I-589 or
permanent resident based on the following immigrant category
Form I-730
(select only one category). (See the Form I-485 Instructions for
more information, including any Additional Instructions that 5.b. Refugee status (INA section 207), Form I-590 or
relate to the immigrant category you select.): Form I-730

Family-based Human Trafficking Victim or Victim of Qualifying

2.a. Immediate relative spouse of a U.S. citizen, parent of Criminal Activity
a U.S. citizen if the U.S. citizen is 21 years of age or
6.a. Human trafficking victim (T Nonimmigrant), Form
older, and unmarried child under 21 years of age of a
I-914 or derivative family member, Form I-914A
U.S. citizen, Form I-130
6.b. Victim of Qualifying Criminal Activity (U
2.b. Other relative of a U.S. citizen or relative of a lawful
Nonimmigrant), Form I-918, derivative family
permanent resident under the family-based preference
member, Form I-918A, or qualifying family member,
categories, Form I-130
Form I-929
2.c. Individual admitted to the United States as a fiancé(e)
or child of a fiancé(e) of a U.S. citizen, Form I-129F
(K-1/K-2 Nonimmigrant)
2.d. Widow or widower of a U.S. citizen, Form I-360
2.e. VAWA self-petitioner, Form I-360
2.f. Spouse, child, or parent of a deceased U.S. active
duty service member in the armed forces under the
National Defense Authorization Act (NDAA), Form
I-130 or Form I-360

Form I-485 Edition 10/15/19 Page 3 of 20

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If you answered "Yes" to Item Number 9.a., answer

Part 2. Application Type or Filing Category
Item Numbers 9.b. - 9.c. If you answered "No," skip to
(continued) Item Number 10.
9.b. How is your relative related to you?
Special Programs Based on Certain Public Laws
Brother or sister
7.a. Applicant adjusting under the Cuban Adjustment Act
Husband, wife, father, mother, child, adult son, or
7.b. Applicant adjusting under the Cuban Adjustment Act adult daughter
for battered spouses and children
9.c. This relative is a:
7.c. Applicant adjusting based on dependent status under
U.S. citizen
the Haitian Refugee Immigrant Fairness Act
U.S. national
7.d. Applicant adjusting based on dependent status under
the Haitian Refugee Immigrant Fairness Act for Lawful permanent resident
battered spouses and children
None of the above
7.e. Lautenberg Parolees
10. Regardless of the immigrant category you are adjusting
7.f. Diplomats or high ranking officials unable to return under, do you hold:
home (Section 13 of the Act of September 11, 1957)
VAWA self-petitioner status Yes No
7.g. Applicant adjusting under the Indochinese Parole
Adjustment Act of 2000 Victim of Qualifying Criminal Activity (U nonimmigrant)
status
7.h. Applicant adjusting under the Amerasian Act Yes No
(October 22, 1982), Form I-360
Human trafficking victim (T nonimmigrant) status
Additional Options Yes No

8.a. Diversity Visa program

INA Section 245(i)
8.b. Continuous residence in the United States since
before January 1, 1972 ("Registry") 11. Are you applying for adjustment based on the
Immigration and Nationality Act (INA) section 245(i)?
8.c. Individual born in the United States under diplomatic
status Yes No

8.d. S nonimmigrants and qualifying family members NOTE: If you answered "Yes" to Item Number 11., you
(only law enforcement agencies can file Form I-485 must have selected a family-based, employment-based,
for someone in this category.) special immigrant, or Diversity Visa immigrant category
listed above in Item Numbers 2.a. - 8.e. as the basis for
8.e. Other eligibility (see the Form I-485 Instructions,
your application for adjustment of status. Fill out the rest
Who May Form I-485, Item Number 3. Other
of this application AND Supplement A to Form I-485,
Immigrant Categories for examples)
Adjustment of Status Under Section 245(i) (Supplement
A). For detailed filing instructions, read the Form I-485
Instructions (including any Additional Instructions that
Additional Alien Worker Information relate to the immigrant category that you selected in Item
Numbers 2.a. - 8.e.) and Supplement A Instructions.
Answer Item Number 9.a. only if you selected Item Number
3.a. “Alien worker, Form I-140.” Information About Your Immigrant Category
9.a. Did a relative file the associated Form I-140 for you or If you are the principal applicant, provide the following
does a relative have a significant ownership interest (five information.
percent or more) in the business that filed Form I-140 for
you? (The relative must be your husband, wife, father, 12. Receipt Number of Underlying Petition (if any)
mother, child, adult son, adult daughter, brother, or sister.)
Yes No
13. Priority Date from Underlying Petition (if any)
(mm/dd/yyyy)

Form I-485 Edition 10/15/19 Page 4 of 20

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Part 2. Application Type or Filing Category Address History

(continued) Provide physical addresses for everywhere you have lived
during the last five years, whether inside or outside the United
If you are a derivative applicant (the spouse or unmarried
States. Provide your current address first. If you need extra
child under 21 years of age of a principal applicant), provide the
space to complete this section, use the space provided in
following information for the principal applicant.
Part 14. Additional Information.
Principal Applicant's Name
Physical Address 1 (current address)
14.a. Family Name
(Last Name) 5.a. Street Number
and Name
14.b. Given Name
(First Name) 5.b. Apt. Ste. Flr.
14.c. Middle Name
5.c. City or Town
15. Principal Applicant's A-Number (if any)
5.d. State 5.e. ZIP Code
► A-

16. Principal Applicant's Date of Birth (mm/dd/yyyy) 5.f. Province

5.g. Postal Code

17. Receipt Number of Principal's Underlying Petition (if any)
5.h. Country
►

18. Priority Date of Principal Applicant's Underlying Petition

(if any) (mm/dd/yyyy) Dates of Residence

6.a. From (mm/dd/yyyy)

Part 3. Additional Information About You 6.b. To (mm/dd/yyyy)

1. Have you ever applied for an immigrant visa to obtain

Physical Address 2
permanent resident status at a U.S. Embassy or U.S.
Consulate abroad? Yes No 7.a. Street Number
and Name
If you answered "Yes" to Item Number 1., complete 7.b. Apt. Ste. Flr.
Item Numbers 2.a. - 4. below. If you need extra space to
complete this section, use the space provided in Part 14. 7.c. City or Town
Additional Information.
Location of U.S. Embassy or U.S. Consulate 7.d. State 7.e. ZIP Code

2.a. City 7.f. Province

2.b. Country 7.g. Postal Code

7.h. Country
3. Decision (for example, approved, refused, denied,
withdrawn)

4. Date of Decision (mm/dd/yyyy)

Form I-485 Edition 10/15/19 Page 5 of 20

 A-Number ► A-

Address of Employer or Company

Part 3. Additional Information About You
(continued) 12.a. Street Number
and Name
Dates of Residence 12.b. Apt. Ste. Flr.
8.a. From (mm/dd/yyyy)
12.c. City or Town
8.b. To (mm/dd/yyyy)
12.d. State 12.e. ZIP Code
Provide your most recent address outside the United States
where you lived for more than one year (if not already listed 12.f. Province
above).
12.g. Postal Code
9.a. Street Number
and Name 12.h. Country
9.b. Apt. Ste. Flr.

9.c. City or Town 13. Your Occupation

9.d. State 9.e. ZIP Code

Dates of Employment
9.f. Province
14.a. From (mm/dd/yyyy)
9.g. Postal Code
14.b. To (mm/dd/yyyy)
9.h. Country
Employer 2
15. Name of Employer or Company
Dates of Residence

10.a. From (mm/dd/yyyy)

Address of Employer or Company
10.b. To (mm/dd/yyyy) 16.a. Street Number
and Name
Employment History 16.b. Apt. Ste. Flr.
Provide your employment history for the last five years, 16.c. City or Town
whether inside or outside the United States. Provide the most
recent employment first. If you need extra space to complete 16.d. State 16.e. ZIP Code
this section, use the space provided in Part 14. Additional
Information. 16.f. Province
Employer 1 (current or most recent)
16.g. Postal Code
11. Name of Employer or Company
16.h. Country

17. Your Occupation

Dates of Employment

18.a. From (mm/dd/yyyy)

18.b. To (mm/dd/yyyy)

Form I-485 Edition 10/15/19 Page 6 of 20

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Part 3. Additional Information About You 3. Date of Birth (mm/dd/yyyy)

(continued)
4. Gender Male Female
Provide your most recent employment outside of the United 5. City or Town of Birth
States (if not already listed above).
19. Name of Employer or Company
6. Country of Birth

Address of Employer or Company

7. Current City or Town of Residence (if living)
20.a. Street Number
and Name
20.b. Apt. Ste. Flr. 8. Current Country of Residence (if living)

20.c. City or Town

20.d. State 20.e. ZIP Code Information About Your Parent 2

20.f. Province Parent 2's Legal Name
9.a. Family Name
20.g. Postal Code (Last Name)
9.b. Given Name
20.h. Country (First Name)
9.c. Middle Name
21. Your Occupation
Parent 2's Name at Birth (if different than above)
10.a. Family Name
Dates of Employment (Last Name)
10.b. Given Name
22.a. From (mm/dd/yyyy) (First Name)
10.c. Middle Name
22.b. To (mm/dd/yyyy)
11. Date of Birth (mm/dd/yyyy)
Part 4. Information About Your Parents 12. Gender Male Female
Information About Your Parent 1 13. City or Town of Birth
Parent 1's Legal Name
1.a. Family Name 14. Country of Birth
(Last Name)
1.b. Given Name
(First Name) 15. Current City or Town of Residence (if living)
1.c. Middle Name

Parent 1's Name at Birth (if different than above) 16. Current Country of Residence (if living)
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name

Form I-485 Edition 10/15/19 Page 7 of 20

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Part 5. Information About Your Marital History Place of Marriage to Current Spouse
9.a. City or Town
1. What is your current marital status?
Single, Never Married Married Divorced
9.b. State or Province
Widowed Marriage Annulled
Legally Separated
9.c. Country
2. If you are married, is your spouse a current member of the
U.S. armed forces or U.S. Coast Guard?
N/A Yes No 10. Is your current spouse applying with you?
3. How many times have you been married (including Yes No
annulled marriages and marriages to the same individual)?
Information About Prior Marriages (if any)
If you have been married before, whether in the United States or
Information About Your Current Marriage in any other country, provide the following information about
(including if you are legally separated) your prior spouse. If you have had more than one previous
marriage, use the space provided in Part 14. Additional
If you are currently married, provide the following information
Information to provide the information below.
about your current spouse.
Prior Spouse's Legal Name (provide family name before
Current Spouse's Legal Name
marriage)
4.a. Family Name
(Last Name) 11.a. Family Name
(Last Name)
4.b. Given Name
(First Name) 11.b. Given Name
(First Name)
4.c. Middle Name
11.c. Middle Name
5. A-Number (if any)
12. Prior Spouse's Date of Birth (mm/dd/yyyy)
► A-

6. Current Spouse's Date of Birth (mm/dd/yyyy)

13. Date of Marriage to Prior Spouse (mm/dd/yyyy)

7. Date of Marriage to Current Spouse (mm/dd/yyyy)

Place of Marriage to Prior Spouse
14.a. City or Town
Current Spouse's Place of Birth
8.a. City or Town
14.b. State or Province

8.b. State or Province

14.c. Country

8.c. Country
15. Date Marriage with Prior Spouse Legally Ended
(mm/dd/yyyy)

Form I-485 Edition 10/15/19 Page 8 of 20

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Child 2
Part 5. Information About Your Marital History
(continued) Current Legal Name
7.a. Family Name
Place Where Marriage with Prior Spouse Legally Ended (Last Name)
16.a. City or Town 7.b. Given Name
(First Name)
7.c. Middle Name
16.b. State or Province
8. A-Number (if any)
► A-
16.c. Country
9. Date of Birth (mm/dd/yyyy)

10. Country of Birth

Part 6. Information About Your Children
1. Indicate the total number of ALL living children 11. Is this child applying with you? Yes No
(including adult sons and daughters) that you have.
NOTE: The term “children” includes all biological or Child 3
legally adopted children, as well as current stepchildren,
Current Legal Name
of any age, whether born in the United States or other
countries, married or unmarried, living with you or 12.a. Family Name
elsewhere and includes any missing children and those (Last Name)
born to you outside of marriage. 12.b. Given Name
(First Name)
Provide the following information for each of your children. 12.c. Middle Name
If you have more than three children, use the space provided in
13. A-Number (if any)
Part 14. Additional Information.
► A-
Child 1
Current Legal Name 14. Date of Birth (mm/dd/yyyy)
2.a. Family Name 15. Country of Birth
(Last Name)
2.b. Given Name
(First Name)
16. Is this child applying with you? Yes No
2.c. Middle Name
3. A-Number (if any) Part 7. Biographic Information
► A-
1. Ethnicity (Select only one box)
4. Date of Birth (mm/dd/yyyy) Hispanic or Latino
5. Country of Birth Not Hispanic or Latino
2. Race (Select all applicable boxes)

6. Is this child applying with you? Yes No White

Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

Form I-485 Edition 10/15/19 Page 9 of 20

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Part 7. Biographic Information (continued) Dates of Membership or Dates of Involvement

5.a. From (mm/dd/yyyy)

3. Height Feet Inches
5.b. To (mm/dd/yyyy)
4. Weight Pounds

5. Eye Color (Select only one box) Organization 2

Black Blue Brown 6. Name of Organization
Gray Green Hazel
Maroon Pink Unknown/Other 7.a. City or Town
6. Hair Color (Select only one box)
Bald (No hair) Black Blond 7.b. State or Province
Brown Gray Red
Sandy White Unknown/Other 7.c. Country

Part 8. General Eligibility and Inadmissibility 8. Nature of Group

Grounds
1. Have you EVER been a member of, involved in, or in Dates of Membership or Dates of Involvement
any way associated with any organization, association,
fund, foundation, party, club, society, or similar group in 9.a. From (mm/dd/yyyy)
the United States or in any other location in the world
including any military service? 9.b. To (mm/dd/yyyy)
Yes No

If you answered "Yes" to Item Number 1., complete Item Organization 3

Numbers 2. - 13.b. below. If you need extra space to complete
10. Name of Organization
this section, use the space provided in Part 14. Additional
Information. If you answered "No," but are unsure of your
answer, provide an explanation of the events and circumstances
11.a. City or Town
in the space provided in Part 14. Additional Information.
Organization 1
11.b. State or Province
2. Name of Organization

11.c. Country
3.a. City or Town

12. Nature of Group

3.b. State or Province

Dates of Membership or Dates of Involvement

3.c. Country
13.a. From (mm/dd/yyyy)

4. Nature of Group 13.b. To (mm/dd/yyyy)

Form I-485 Edition 10/15/19 Page 10 of 20

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Part 8. General Eligibility and Inadmissibility Criminal Acts and Violations

Grounds (continued) For Item Numbers 25. - 45., you must answer "Yes" to any
question that applies to you, even if your records were sealed or
Answer Item Numbers 14. - 80.b. Choose the answer that you
otherwise cleared, or even if anyone, including a judge, law
think is correct. If you answer “Yes” to any questions (or if
enforcement officer, or attorney, told you that you no longer
you answer "No," but are unsure of your answer), provide
have a record. You must also answer "Yes" to the following
an explanation of the events and circumstances in the space
questions whether the action or offense occurred here in the
provided in Part 14. Additional Information.
United States or anywhere else in the world. If you answer
14. Have you EVER been denied admission to the United "Yes" to Item Numbers 25. - 45., use the space provided in
States? Yes No Part 14. Additional Information to provide an explanation
that includes why you were arrested, cited, detained, or charged;
15. Have you EVER been denied a visa to the United States? where you were arrested, cited, detained, or charged; when
Yes No (date) the event occurred; and the outcome or disposition (for
example, no charges filed, charges dismissed, jail, probation,
16. Have you EVER worked in the United States without community service).
authorization? Yes No 25. Have you EVER been arrested, cited, charged, or
detained for any reason by any law enforcement official
17. Have you EVER violated the terms or conditions of your
(including but not limited to any U.S. immigration
nonimmigrant status? Yes No official or any official of the U.S. armed forces or U.S.
Coast Guard)? Yes No
18. Are you presently or have you EVER been in removal,
exclusion, rescission, or deportation proceedings?
26. Have you EVER committed a crime of any kind (even if
Yes No you were not arrested, cited, charged with, or tried for that
crime)? Yes No
19. Have you EVER been issued a final order of exclusion,
deportation, or removal? Yes No 27. Have you EVER pled guilty to or been convicted of a
crime or offense (even if the violation was subsequently
20. Have you EVER had a prior final order of exclusion,
expunged or sealed by a court, or if you were granted a
deportation, or removal reinstated? Yes No pardon, amnesty, a rehabilitation decree, or other act of
clemency)? Yes No
21. Have you EVER held lawful permanent resident status
which was later rescinded? Yes No NOTE: If you were the beneficiary of a pardon, amnesty,
22. Have you EVER been granted voluntary departure by an a rehabilitation decree, or other act of clemency, provide
immigration officer or an immigration judge but failed to documentation of that post-conviction action.
depart within the allotted time? Yes No 28. Have you EVER been ordered punished by a judge or had
conditions imposed on you that restrained your liberty
23. Have you EVER applied for any kind of relief or (such as a prison sentence, suspended sentence, house
protection from removal, exclusion, or deportation? arrest, parole, alternative sentencing, drug or alcohol
Yes No treatment, rehabilitative programs or classes, probation, or
community service)? Yes No
24.a. Have you EVER been a J nonimmigrant exchange visitor
who was subject to the two-year foreign residence 29. Have you EVER been a defendant or the accused in a
requirement? Yes No criminal proceeding (including pre-trial diversion,
deferred prosecution, deferred adjudication, or any
If you answered "Yes" to Item Number 24.a., complete Item withheld adjudication)? Yes No
Numbers 24.b. - 24.c. If you answered "No" to Item Number
24.a., skip to Item Number 25. 30. Have you EVER violated (or attempted or conspired to
violate) any controlled substance law or regulation of a
24.b. Have you complied with the foreign residence
state, the United States, or a foreign country?
requirement? Yes No
Yes No
24.c. Have you been granted a waiver or has Department of
State issued a favorable waiver recommendation letter
for you? Yes No

Form I-485 Edition 10/15/19 Page 11 of 20

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42. Have you EVER trafficked a person into involuntary

Part 8. General Eligibility and Inadmissibility servitude, peonage, debt bondage, or slavery? Trafficking
Grounds (continued) includes recruiting, harboring, transporting, providing, or
obtaining a person for labor or services through the use of
31. Have you EVER been convicted of two or more offenses
force, fraud, or coercion. Yes No
(other than purely political offenses) for which the
combined sentences to confinement were five years or
43. Have you EVER knowingly aided, abetted, assisted,
more? Yes No conspired, or colluded with others in trafficking persons
for commercial sex acts or involuntary servitude,
32. Have you EVER illicitly (illegally) trafficked or benefited
peonage, debt bondage, or slavery? Yes No
from the trafficking of any controlled substances, such as
chemicals, illegal drugs, or narcotics? Yes No 44. Are you the spouse, son or daughter of a foreign national
who engaged in the trafficking of persons and have
33. Have you EVER knowingly aided, abetted, assisted,
received or obtained, within the last five years, any
conspired, or colluded in the illicit trafficking of any
financial or other benefits from the illicit activity of your
illegal narcotic or other controlled substances?
spouse or your parent, although you knew or reasonably
Yes No should have known that this benefit resulted from the illicit
activity of your spouse or parent? Yes No
34. Are you the spouse, son, or daughter of a foreign national
who illicitly trafficked or aided (or otherwise abetted,
45. Have you EVER engaged in money laundering or have
assisted, conspired, or colluded) in the illicit trafficking of
you EVER knowingly aided, assisted, conspired, or
a controlled substance, such as chemicals, illegal drugs, or
colluded with others in money laundering or do you seek
narcotics and you obtained, within the last five years, any
to enter the United States to engage in such activity?
financial or other benefit from the illegal activity of your
spouse or parent, although you knew or reasonably should Yes No
have known that the financial or other benefit resulted
from the illicit activity of your spouse or parent? Security and Related
Yes No
Do you intend to:
35. Have you EVER engaged in prostitution or are you
46.a. Engage in any activity that violates or evades any law
coming to the United States to engage in prostitution?
relating to espionage (including spying) or sabotage in the
Yes No United States? Yes No
36. Have you EVER directly or indirectly procured (or
46.b. Engage in any activity in the United States that violates or
attempted to procure) or imported prostitutes or persons
evades any law prohibiting the export from the United
for the purpose of prostitution? Yes No States of goods, technology, or sensitive information?
37. Have you EVER received any proceeds or money from Yes No
prostitution? Yes No 46.c. Engage in any activity whose purpose includes opposing,
controlling, or overthrowing the U.S. Government by
38. Do you intend to engage in illegal gambling or any other
force, violence, or other unlawful means while in the
form of commercialized vice, such as prostitution,
United States? Yes No
bootlegging, or the sale of child pornography, while in the
United States? Yes No 46.d. Engage in any activity that could endanger the welfare,
safety, or security of the United States?
39. Have you EVER exercised immunity (diplomatic or
otherwise) to avoid being prosecuted for a criminal Yes No
offense in the United States? Yes No
46.e. Engage in any other unlawful activity? Yes No
40. Have you EVER, while serving as a foreign government
47. Are you engaged in or, upon your entry into the United
official, been responsible for or directly carried out
States, do you intend to engage in any activity that could
violations of religious freedoms? Yes No have potentially serious adverse foreign policy
consequences for the United States? Yes No
41. Have you EVER induced by force, fraud, or coercion (or
otherwise been involved in) the trafficking of persons for
commercial sex acts? Yes No

Form I-485 Edition 10/15/19 Page 12 of 20

 A-Number ► A-

51.d. Provided money, a thing of value, services or labor, or

Part 8. General Eligibility and Inadmissibility
any other assistance or support for any of the activities
Grounds (continued) described in Item Number 51.a.? Yes No
Have you EVER:
51.e. Provided money, a thing of value, services or labor, or
48.a. Committed, threatened to commit, attempted to commit, any other assistance or support to an individual, group, or
conspired to commit, incited, endorsed, advocated, organization who did any of the activities described in
planned, or prepared any of the following: hijacking, Item Number 51.a.? Yes No
sabotage, kidnapping, political assassination, or use of a
weapon or explosive to harm another individual or cause 51.f. Received any type of military, paramilitary, or weapons
substantial damage to property? Yes No training from a group or organization that did any of the
activities described in Item Number 51.a.?
48.b. Participated in, or been a member of, a group or Yes No
organization that did any of the activities described in
Item Number 48.a.? Yes No NOTE: If you answered “Yes” to any part of Item Number
51., explain the relationship and what occurred, including the
48.c. Recruited members or asked for money or things of value dates and location of the circumstances, in the space provided
for a group or organization that did any of the activities in Part 14. Additional Information.
described in Item Number 48.a.? Yes No 52. Have you EVER assisted or participated in selling,
providing, or transporting weapons to any person who,
48.d. Provided money, a thing of value, services or labor, or
to your knowledge, used them against another person?
any other assistance or support for any of the activities
described in Item Number 48.a.? Yes No
Yes No
53. Have you EVER worked, volunteered, or otherwise
48.e. Provided money, a thing of value, services or labor, or
served in any prison, jail, prison camp, detention facility,
any other assistance or support for an individual, group,
labor camp, or any other situation that involved detaining
or organization who did any of the activities described in
persons? Yes No
Item Number 48.a.? Yes No
54. Have you EVER been a member of, assisted, or
49. Have you EVER received any type of military,
participated in any group, unit, or organization of any
paramilitary, or weapons training? Yes No kind in which you or other persons used any type of
weapon against any person or threatened to do so?
50. Do you intend to engage in any of the activities listed in
any part of Item Numbers 48.a. - 49.? Yes No
Yes No
55. Have you EVER served in, been a member of, assisted,
NOTE: If you answered “Yes” to any part of Item Numbers or participated in any military unit, paramilitary unit,
46.a. - 50., explain what you did, including the dates and police unit, self-defense unit, vigilante unit, rebel group,
location of the circumstances, or what you intend to do in the guerilla group, militia, insurgent organization, or any
space provided in Part 14. Additional Information. other armed group? Yes No
Are you the spouse or child of an individual who EVER:
56. Have you EVER been a member of, or in any way
51.a. Committed, threatened to commit, attempted to commit, affiliated with, the Communist Party or any other
conspired to commit, incited, endorsed, advocated, totalitarian party (in the United States or abroad)?
planned, or prepared any of the following: hijacking,
sabotage, kidnapping, political assassination, or use of a Yes No
weapon or explosive to harm another individual or cause 57. During the period from March 23, 1933 to May 8, 1945,
substantial damage to property? Yes No did you ever order, incite, assist, or otherwise participate
in the persecution of any person because of race, religion,
51.b. Participated in, or been a member or a representative of a national origin, or political opinion, in association with
group or organization that did any of the activities either the Nazi government of Germany or any
described in Item Number 51.a.? Yes No organization or government associated or allied with the
Nazi government of Germany? Yes No
51.c. Recruited members, or asked for money or things of value,
for a group or organization that did any of the activities
described in Item Number 51.a.? Yes No

Form I-485 Edition 10/15/19 Page 13 of 20

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Part 8. General Eligibility and Inadmissibility Affidavit of Support Under Section 213A of the
Grounds (continued) INA (Form I-864)
You may need to file Form I-864. For more information, read
Have you EVER ordered, incited, called for, committed, assisted,
the Form I-485 Instructions, What Evidence Must You
helped with, or otherwise participated in any of the following:
Submit, Item Number 9. Public Charge: Declaration of Self-
58.a. Acts involving torture or genocide? Yes No Sufficiency (Form I-944) and Affidavit of Support Under
INA section 213A (Form I-864).
58.b. Killing any person? Yes No I am EXEMPT from filing Form I-864 because:
58.c. Intentionally and severely injuring any person? 62.a. I have earned or can receive credit for 40 qualifying
Yes No quarters (credits) of work in the United States (as
defined by the Social Security Act (SSA). (Attach
58.d. Engaging in any kind of sexual contact or relations with your SSA earnings statements. Do not count any
any person who did not consent or was unable to consent, quarters during which you received a means-tested
or was being forced or threatened? Yes No public benefit).
62.b. I am under 18 years of age, unmarried, immigrating
58.e. Limiting or denying any person's ability to exercise
as the child of a U.S. citizen, and will automatically
religious beliefs? Yes No become a U.S. citizen under the Child Citizenship
Act of 2000 upon my admission to the United States.
59. Have you EVER recruited, enlisted, conscripted, or used
any person under 15 years of age to serve in or help an 62.c. I am applying under the widow or widower of a U.S.
armed force or group? Yes No citizen (Form I-360) immigrant category.

60. Have you EVER used any person under 15 years of age 62.d. I am applying under an alien worker (Form I-140)
to take part in hostilities, or to help or provide services to employment-based preference immigrant category
people in combat? and both of the following apply:
Yes No
(1) I am not a relative of the Form I-140 petitioner;
NOTE: If you answered “Yes” to any part of Item Numbers and
52. - 60., explain what occurred, including the dates and
(2) I do not have a relative with a significant
location of the circumstances, in the space provided in Part 14.
ownership interest (at least five percent) in the
Additional Information.
business that filed Form I-140.

Public Charge 62.e. I am applying under the alien entrepreneur (Form

I-526) immigrant category.
Those who are subject to the public charge ground of
62.f. I am applying under the human trafficking victim
inadmissibility under INA section 212(a)(4) must complete
(T nonimmigrant) immigrant category (INA section
Form I-944, Declaration of Self-Sufficiency, and may also have
245(l)).
to submit Form I-864, Affidavit of Support Under Section 213A
of the INA. Answer the questions below to determine whether 62.g. I am applying under a category other than the human
you need to submit these forms together with this Form I-485. trafficking victim (T nonimmigrant) category (INA
section 245(l)), or as an alien worker under the
Declaration of Self-Sufficiency (Form I-944) employment-based preference categories where a
relative filed Form I-140 for me or has a five percent
61. Are you exempt from the public charge ground of
inadmissibility? or more ownership interest in the business that filed
Yes No Form I-140, and I either have a pending application
for T nonimmigrant status or I am an individual who
To determine if you are exempt from the public charge ground
is in valid T nonimmigrant status.
of inadmissibility, and therefore exempt from filing Form I-944,
read the Form I-485 Instructions, What Evidence Must You NOTE: If, when USCIS adjudicates your adjustment
Submit, Item Number 9. Public Charge: Declaration of Self- application, your Form I-914 is no longer pending a decision or
Sufficiency (Form I-944) and Affidavit of Support Under you are no longer in valid T nonimmigrant status, you may have
Section 213A of the INA (Form I-864). If you answered to submit a Form I-944 and Form I-864.
“Yes” to Item Number 61., proceed to Item Number 63.a. If
62.h. I am applying under the victim of qualifying criminal
you answered “No,” complete Form I-944 and include it with
activity (U nonimmigrant) immigrant category (INA
your Form I-485 filing, and proceed to Item Number 62.a.
section 245(m)).

Form I-485 Edition 10/15/19 Page 14 of 20

 A-Number ► A-

63.b. If your answer to Item Number 63.a. is "Yes," do you

Part 8. General Eligibility and Inadmissibility believe you had reasonable cause?
Grounds (continued) Yes No

63.c. If your answer to Item Number 63.b. is "Yes," attach a

62.i. I am applying under a category other than the victim written statement explaining why you had reasonable
of qualifying criminal activity (U nonimmigrant) cause.
category under INA section 245(m) or as an alien
worker under the employment-based preference 64. Have you EVER submitted fraudulent or counterfeit
categories where a relative filed Form I-140 for me or documentation to any U.S. Government official to obtain
has a five percent or more ownership interest in the or attempt to obtain any immigration benefit, including a
business that filed Form I-140, but I either have a visa or entry into the United States? Yes No
pending petition for U nonimmigrant status or I am 65. Have you EVER lied about, concealed, or misrepresented
an individual who is granted U nonimmigrant status. any information on an application or petition to obtain a
NOTE: If, at the time of the adjudication of the Form I-485, visa, other documentation required for entry into the
your Form I-918 is no longer pending a decision or you are no United States, admission to the United States, or any other
longer in valid U nonimmigrant status, you may be required to kind of immigration benefit? Yes No
submit Form I-944 and Form I-864.
66. Have you EVER falsely claimed to be a U.S. citizen (in
62.j. I am applying under the diplomat or high ranking writing or any other way)? Yes No
official unable to return home (Section 13 of the Act
of September 11, 1957) immigrant category. 67. Have you EVER been a stowaway on a vessel or aircraft
I am a law enforcement officer filing this Form I-485 arriving in the United States? Yes No
62.k.
for an S nonimmigrant immigrant (or a qualifying
68. Have you EVER knowingly encouraged, induced,
family member).
assisted, abetted, or aided any foreign national to enter or
62.l. I am applying under the Diversity Visa program to try to enter the United States illegally (alien
immigrant category. smuggling)? Yes No
62.m. I am applying under one of the following special
69. Are you under a final order of civil penalty for violating
immigrant categories (select one):
INA section 274C for use of fraudulent documents?
Armed forces (also known as the Six and Six Yes No
program)
Panama Canal Zone Removal, Unlawful Presence, or Illegal Reentry
Certain broadcasters After Previous Immigration Violations
G-4 or NATO-6 employees and their family 70. Have you EVER been excluded, deported, or removed
members from the United States or have you ever departed the
United States on your own after having been ordered
International employees of the U.S. Government
excluded, deported, or removed from the United States?
abroad
Yes No
Religious workers
71. Have you EVER entered the United States without being
Certain physicians
inspected and admitted or paroled? Yes No
Employed by or on behalf of the U.S.
Government Since April 1, 1997, have you been unlawfully present in the
I am applying under the Amerasian Act (October 22, United States:
62.n.
1982) 72.a. For more than 180 days but less than a year, and then
departed the United States? Yes No
Illegal Entries and Other Immigration Violations
72.b. For one year or more and then departed the United States?
63.a. Have you EVER failed or refused to attend or to remain Yes No
in attendance at any removal proceeding filed against you
on or after April 1, 1997? Yes No NOTE: You were unlawfully present in the United States if
you entered the United States without being inspected and
admitted or inspected and paroled, or if you legally entered the
United States but you stayed longer than permitted.

Form I-485 Edition 10/15/19 Page 15 of 20

 A-Number ► A-

Part 8. General Eligibility and Inadmissibility 80.a. Have you EVER left or remained outside the United
Grounds (continued) States to avoid or evade training or service in the U.S.
armed forces in time of war or a period declared by the
Since April 1, 1997, have you EVER reentered or attempted to President to be a national emergency? Yes No
reenter the United States without being inspected and admitted
80.b. If your answer to Item Number 80.a. is “Yes,” what was
or paroled after:
your nationality or immigration status immediately before
73.a. Having been unlawfully present in the United States for you left (for example, U.S. citizen or national, lawful
more than one year in the aggregate? Yes No permanent resident, nonimmigrant, parolee, present
without admission or parole, or any other status)?
73.b. Having been deported, excluded, or removed from the
United States? Yes No

Part 9. Accommodations for Individuals With

Miscellaneous Conduct Disabilities and/or Impairments
74. Do you plan to practice polygamy in the United States?
NOTE: Read the information in the Form I-485 Instructions
Yes No before completing this part.
75. Are you accompanying another foreign national who 1. Are you requesting an accommodation because of your
requires your protection or guardianship but who is disabilities and/or impairments? Yes No
inadmissible after being certified by a medical officer as
being helpless from sickness, physical or mental If you answered "Yes" to Item Number 1., select any
disability, or infancy, as described in INA section 232(c)? applicable box in Item Numbers 2.a. - 2.c. and provide
Yes No an answer.
2.a. I am deaf or hard of hearing and request the
76. Have you EVER assisted in detaining, retaining, or
following accommodation. (If you are requesting a
withholding custody of a U.S. citizen child outside the
sign-language interpreter, indicate for which
United States from a U.S. citizen who has been granted
language (for example, American Sign Language).):
custody of the child? Yes No

77. Have you EVER voted in violation of any Federal, state,

or local constitutional provision, statute, ordinance, or
regulation in the United States? Yes No 2.b. I am blind or have low vision and request the
following accommodation:
78. Have you EVER renounced U.S. citizenship to avoid
being taxed by the United States? Yes No

Have you EVER:

2.c. I have another type of disability and/or impairment.
79.a. Applied for exemption or discharge from training or (Describe the nature of your disability and/or
service in the U.S. armed forces or in the U.S. National impairment and the accommodation you are
Security Training Corps on the ground that you are a requesting.)
foreign national? Yes No

79.b. Been relieved or discharged from such training or service

on the ground that you are a foreign national?
Yes No
Part 10. Applicant's Statement, Contact
79.c. Been convicted of desertion from the U.S. armed forces? Information, Certification, and Signature
Yes No
NOTE: Read the Penalties section of the Form I-485
Instructions before completing this part. You must file Form
I-485 while in the United States.

Form I-485 Edition 10/15/19 Page 16 of 20

 A-Number ► A-

I understand that USCIS may require me to appear for an

Part 10. Applicant's Statement, Contact
appointment to take my biometrics (fingerprints, photograph,
Information, Certification, and Signature and/or signature) and, at that time, if I am required to provide
(continued) biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and understood all of the information
Applicant's Statement contained in, and submitted with, my application;
and
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2. 2) All of this information was complete, true, and
correct at the time of filing.
1.a. I can read and understand English, and I have read
and understand every question and instruction on this I certify, under penalty of perjury, that all of the information in
application and my answer to every question. my application and any document submitted with it were
provided or authorized by me, that I reviewed and understand
1.b. The interpreter named in Part 11. read to me every
all of the information contained in, and submitted with, my
question and instruction on this application and my
application and that all of this information is complete, true,
answer to every question in
and correct.
,
a language in which I am fluent, and I understood Applicant's Signature
everything.
2. At my request, the preparer named in Part 12., 6.a. Applicant's Signature (sign in ink)

,
prepared this application for me based only upon 6.b. Date of Signature (mm/dd/yyyy)
information I provided or authorized.
NOTE TO ALL APPLICANTS: If you do not completely fill
Applicant's Contact Information out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.
3. Applicant's Daytime Telephone Number

4. Applicant's Mobile Telephone Number (if any)

Part 11. Interpreter's Contact Information,
Certification, and Signature
Provide the following information about the interpreter.
5. Applicant's Email Address (if any)

Interpreter's Full Name

Applicant's Certification 1.a. Interpreter's Family Name (Last Name)

Copies of any documents I have submitted are exact photocopies

of unaltered, original documents, and I understand that USCIS 1.b. Interpreter's Given Name (First Name)
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 2. Interpreter's Business or Organization Name (if any)
determine my eligibility for the immigration benefit that I seek.
I understand that if I am a male who is 18 to 26 years of age,
submitting this application will automatically register me with
the Selective Service System as required by the Military
Selective Service Act.
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.

Form I-485 Edition 10/15/19 Page 17 of 20

 A-Number ► A-

Part 11. Interpreter's Contact Information, Part 12. Contact Information, Declaration, and
Certification, and Signature (continued) Signature of the Person Preparing this
Application, if Other Than the Applicant
Interpreter's Mailing Address
Provide the following information about the preparer.
3.a. Street Number
and Name
Preparer's Full Name
3.b. Apt. Ste. Flr.
1.a. Preparer's Family Name (Last Name)
3.c. City or Town

3.d. State 3.e. ZIP Code 1.b. Preparer's Given Name (First Name)

3.f. Province
2. Preparer's Business or Organization Name (if any)
3.g. Postal Code

3.h. Country
Preparer's Mailing Address
3.a. Street Number
and Name
Interpreter's Contact Information
3.b. Apt. Ste. Flr.
4. Interpreter's Daytime Telephone Number
3.c. City or Town

5. Interpreter's Mobile Telephone Number (if any) 3.d. State 3.e. ZIP Code

3.f. Province
6. Interpreter's Email Address (if any)
3.g. Postal Code

3.h. Country
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and , Preparer's Contact Information
which is the same language specified in Part 10., Item
4. Preparer's Daytime Telephone Number
Number 1.b., 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
5. Preparer's Mobile Telephone Number (if any)
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. 6. Preparer's Email Address (if any)

Interpreter's Signature
7.a. Interpreter's Signature (sign in ink)

7.b. Date of Signature (mm/dd/yyyy)

Form I-485 Edition 10/15/19 Page 18 of 20

 A-Number ► A-

Part 12. Contact Information, Declaration, and NOTE: Do not complete Part 13. until the USCIS Officer
Signature of the Person Preparing this instructs you to do so at the interview.
Application, if Other Than the Applicant
(continued) Part 13. Signature at Interview

Preparer's Statement I swear (affirm) and certify under penalty of perjury under the
laws of the United States of America that I know that the
7.a. I am not an attorney or accredited representative but contents of this Form I-485, Application to Register Permanent
have prepared this application on behalf of the Residence or Adjust Status, subscribed by me, including the
applicant and with the applicant's consent. corrections made to this application, numbered
7.b. I am an attorney or accredited representative and my through , are complete, true, and correct. All
representation of the applicant in this case
extends does not extend beyond the additional pages submitted by me with this Form I-485, on
preparation of this application. numbered pages through are complete,
NOTE: If you are an attorney or accredited true, and correct. All documents submitted at this interview
representative, you may be obliged to submit a were provided by me and are complete, true, and correct.
completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Subscribed to and sworn to (affirmed) before me
Representative, with this application.
USCIS Officer's Printed Name or Stamp

Preparer's Certification
By my signature, I certify, under penalty of perjury, that I Date of Signature (mm/dd/yyyy)
prepared this application at the request of the applicant. The
Applicant's Signature (sign in ink)
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,
USCIS Officer's Signature (sign in ink)
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.

Preparer's Signature
8.a. Preparer's Signature (sign in ink)

8.b. Date of Signature (mm/dd/yyyy)

Form I-485 Edition 10/15/19 Page 19 of 20

 A-Number ► A-

Part 14. Additional Information 5.a. Page Number 5.b. Part Number 5.c. Item Number

If you need extra space to provide any additional information

within this application, use the space below. If you need more 5.d.
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.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name 6.a. Page Number 6.b. Part Number 6.c. Item Number

2. A-Number (if any) ► A-

6.d.
3.a. Page Number 3.b. Part Number 3.c. Item Number

3.d.

7.a. Page Number 7.b. Part Number 7.c. Item Number

7.d.

4.a. Page Number 4.b. Part Number 4.c. Item Number

4.d.

Form I-485 Edition 10/15/19 Page 20 of 20