คํา แนะ นํา สําหรับ Form I-914 โปรแกรมสําหรับภาษาไทย พ.ศ. สถานะ
แบบฟอร์มที่เกี่ยวข้อง
- Form I-914, โปรแกรมสําหรับ Th Nimimigrant สถานะ - โปรแกรมสําหรับ Nonimigrant สถานะ
- Form I-914, Supplement A, โปรแกรมสําหรับสมาชิกครอบครัว T-1 - โปรแกรมสําหรับสมาชิกครอบครัว T-1
- Form I-914, Supplement B, ปฏิญญาการบังคับใช้กฎหมายสําหรับเหยื่อการจราจรในบุคคล - ปฏิญญา ว่า ด้วย การ บังคับ ใช้ กฎหมาย สําหรับ ผู้ ตก เป็น เหยื่อ ของ การ จราจร ติด ตัว
Instructions for Application for T Nonimmigrant Status
USCIS
Form I-914
OMB No. 1615-0099
Expires 12/31/2023
Department of Homeland Security
U.S. Citizenship and Immigration Services
What Is the Purpose of This Form I-914?
You should use Form I-914, Application for T Nonimmigrant Status, to request temporary immigration benefits if you are
a victim of a severe form of trafficking in persons.
Who May File This Form I-914?
Form I-914 should be filed by you, the victim of a severe form of trafficking in persons. You may file Form I-914,
Supplement A, Application for Family Member of T-1 Recipient, with your Form I-914 now or at a later date for your
eligible family members.
1. Principal Applicant. You must demonstrate all of the following:
A. You are or have been a victim of a severe form of trafficking in persons;
B. You are physically present in the United States at the time of filing your application. You can establish physical
presence if you meet one of the criteria below:
(1) You are 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 in persons; or
(2) You were allowed entry into the United States to participate in investigative or judicial processes associated
with an act or a perpetrator of trafficking;
C. You have complied with any reasonable request for assistance from a Federal, state, local, or tribal agency that has
the authority to detect, investigate or prosecute acts of trafficking or the investigating of a crime where the acts of
trafficking are at least one central reason for the commission of that crime, unless:
(1) You are under 18 years of age; or
(2) You are unable to cooperate with a request due to physical or psychological trauma; and
D. You would suffer extreme hardship involving unusual and severe harm upon removal.
2. As the Principal Applicant, you may file for your eligible family member using Form I-914, Supplement A, when you
file your Form I-914. You may also file for your eligible family member while your Form I-914 is pending or when
you are in T-1 nonimmigrant status.
A. If you are under 21 years of age, you may file for the following family members:
(1) Spouse;
(2) Unmarried child(ren) under 21 years of age;
(3) Parent(s); and/or
(4) Unmarried sibling(s) under 18 years of age.
If you filed your Form I-914 when you were under 21 years of age, you may continue to file for these family
members until your application is adjudicated. Your parent or unmarried sibling will remain eligible for a T
visa even if you turn 21 years of age before your application is adjudicated. Similarly, if you have an unmarried
sibling, they will remain eligible even if they are over 18 years of age at the time your application is adjudicated.
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B. If you are over 21 years of age, you may file for the following eligible family members:
(1) Spouse; and/or
(2) Unmarried child(ren) under 21 years of age.
USCIS will continue to consider your unmarried child as an eligible family member if the child was under 21
years of age at the time you filed your Form I-914, even if they turn 21 years of age before your application is
adjudicated.
C. Regardless of your age at the time of filing, if your family member faces a present danger of retaliation, as a result
of your escape from the severe form of trafficking in persons or your cooperation with law enforcement, you may
file for the following eligible family members:
(1) Parent(s);
(2) Unmarried sibling(s) under 18 years of age; and/or
(3) An adult or minor child of your derivative (your grandchild, your spouse’s child, your niece or nephew, or
your sibling).
General Instructions
Fill Out Form I-914, Form I-914, Supplement A, and Form I-914, Supplement B (optional)
1. Type or print legibly in ink.
2. If you need extra space to complete any item within this application, use the space provided in Part 9. Additional
Information or attach a separate sheet of paper. Type or print your name and Alien Registration Number
(A-Number), indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and
date each sheet.
3. Answer all questions fully and accurately, unless instructed to leave a part blank. State that an item is not applicable
with “N/A.” If the answer is none, type or print “None.” If the answer is unknown, type or print “unknown.”
Completing Form I-914
You, as the principal applicant, must file Form I-914 for yourself.
This application is divided into Parts 1. - 9. The following information will help you fill out the application.
Part 1. Purpose for Filing This Application - Select all the appropriate boxes that apply to why you filed this
application. At least one box must be selected. If you are only filing for a T-6 derivative, you should leave Part A. blank.
Part 2. General Information About You (Person filing this application as a victim)
1. Your Full Legal Name. Provide your legal name, as shown on your birth certificate, passport or other legal
document. If you have two last names, include both names and use a hyphen (-) between the names, if appropriate.
Type or print your last, first, and middle names in each appropriate field.
2. Other Names Used. Provide all the names you have used, including aliases, maiden name, nicknames, aliases, etc.
3. U.S. Physical Address. Give your physical street address. This must include a street number and name or a rural
route number. Do not put a post office box (PO Box) number here.
4. Safe U.S. Mailing Address. If you do not feel secure in receiving correspondence regarding this application at your
home address, you may provide a “safe mailing address” in this space. This address may be a post office box, the
address of a friend, your attorney, a community-based organization that is helping you, or any other address where
you can safely and promptly receive mail.
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5. A-Number. This is your USCIS (former Immigration and Naturalization Service (INS)) file number. If you do not
have an A-Number or do not know it, please leave this blank.
6. U.S. Social Security Number. If you do not have a Social Security Number, please leave this blank.
7. Gender or Sex and Marital Status. Select the appropriate box for each.
8. Date of Birth. Provide eight numbers to show your date of birth (example: May 1, 1979, should be written
(05/01/1979)
9. Place of Birth. Provide the name of the country where you were born. Include the city or town, state or province,
and country.
10. Country of Citizenship or Nationality. Provide the name of the country where you are a citizen. This is not
necessarily the country where you were born.
11. Passport. Give the number of the passport used to enter the United States. Give the location where your passport
was issued. Give the date when your passport was issued, even if the passport is currently expired. If the passport
you used to enter the United States is not available, include an explanation in Part 9.
12. Last Entry Into the United States. Give the date and place where you last entered the United States, regardless of
whether that entry was legal or illegal.
13. Form I-94 Arrival-Departure Record Number. Provide the number on Form I-94 issued at the time of entry.
14. Your Current Immigration Status. Provide your current status, regardless of how you entered the United States
(visitor, student, entry without inspection, etc.).
Part 3. Additional Information About Your Application
You must answer each question. You must explain relevant information about your claim. Attach documents in support
of your claim and the specific facts on which you are relying to support your claim.
Complete Item Number 10. to indicate whether you would like an Employment Authorization Document (EAD). If your
application is approved, you will be authorized to work. USCIS will send you an EAD as evidence of your authorization
to work if you indicate “Yes” for Item Number 10. As the principal applicant you do not need to file a Form I-765,
Application for Employment Authorization Document.
Complete Item Number 11. to indicate whether you are applying for one or more eligible family members at this
time. See the section below entitled “Completing Form I-914 Supplement A, Application for a Family Member T-1
Recipient,” for information on completing an application on behalf of your eligible family member.
Part 4. Processing Information
You must answer each question. If you answer “Yes” to any of the questions, explain in the space provided in Part 9.
Additional Information. Explain if any of the acts or circumstances relate to your having been a victim of a severe form
of trafficking in persons.
Part 5. Information about Your Family Members
Even if you are not applying to bring your family members to the United States, you must provide the requested
information about your spouse and children, if any.
Part 6. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature
Select the appropriate box to indicate whether you read this application yourself or whether you had an interpreter assist you.
If someone assisted you in completing the application, select the box indicating that you used a preparer. Further, you must
sign and date your application and provide a response to fields requesting your daytime telephone number, mobile telephone
number (if any), and email address (if any). You may include a safe daytime phone number such as the number of your
attorney or a community-based agency that is helping you. Every application MUST contain the signature of the applicant
(or parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.
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Part 7. Interpreter’s Contact Information, Certification, and Signature
If you used anyone as an interpreter to read the instructions and questions on this application to you in a language in
which you are fluent, the interpreter must fill out this section; provide his or her name and daytime telephone number. If
applicable, the interpreter should provide the name and address of his or her business or organization (if any), his or her
mobile telephone number (if any), and his or her email address (if any). The interpreter must sign and date the application.
Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than
the Applicant
This section must contain the signature of the person who completed your application, if other than you, the applicant.
If the same individual acted as your interpreter and your preparer, that person should complete both Part 7. and Part 8.
If the person who completed this application is associated with a business or organization, that person should complete
the business or organization name and address information. Anyone who helped you complete this application MUST
sign and date the application. A stamped or typewritten name in place of a signature is not acceptable. If the person
who helped you prepare your application is an attorney or accredited representative, he or she may need to also submit
a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with your
application.
Completing Form I-914, Supplement A, Application for Family Member of T-1 Recipient
If you are filing for an eligible family member, you must complete Form I-914, Supplement A, Application for Family
Member of T-1 Recipient. Form I-914, Supplement A, must be submitted for each family member for whom you are filing.
Form I-914, Supplement A, may be filed concurrently with the principal applicant’s initial Form I-914, while the
principal applicant’s Form I-914 is pending, or at any time while the principal is in T nonimmigrant status. However,
any Form I-914, Supplement A, submitted subsequently must have the appropriate boxes selected in Part 1., and must
be accompanied by a copy of the principal applicant’s Form I-914. Evidence submitted with the original application,
however, need not be resubmitted.
This form is divided into Parts 1. - 9. The following information should help you fill out the form.
Part 1. Family Member Relationship to You (the principal)
Select the appropriate box if you are filing for your spouse, child(ren), parent(s), or sibling(s) based on your age. Leave
this field blank if you are only applying for your derivative’s adult or minor child (see Part 2.).
Part 2. Family Member Relationship to Your Derivative
Select the box if you are filing for the adult or minor child of your derivative (your grandchild, your spouse’s child, your
niece or nephew, or your sibling) who faces a present danger of retaliation as a result of your escape from the severe form
of trafficking in persons or your cooperation with law enforcement.
Please select the appropriate box in either Part 1. or Part 2.
Part 3. General Information About You (the principal)
1. Your Full Legal Name. You should provide your legal name, as shown on your birth certificate, passport or other
legal document. If you have two last names, include both and use a hyphen (-) between the names, if appropriate.
Type or print your last, first, and middle names in each appropriate field.
2. Date of Birth. You should use eight numbers to show your date of birth (example: May 1, 1979, should be written
05/01/1979).
3. A-Number. This is your USCIS (former INS) file number. If you do not have an A-Number or do not know it, leave
this blank.
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4. Status of your Form I-914, Application for T Nonimmigrant Status. You must select the appropriate box.
Part 4. Information About Your Family Member (the derivative)
1. Full Legal Name. Provide the name of the family member, as shown on his or her birth certificate or legal change
of name document. If the person has two last names, include both and use a hyphen (-) between the names, if
appropriate. Type or print the person’s last, first, and middle names in each appropriate field.
2. Other Names Used. Provide all the names you have used, including aliases, maiden name, and nicknames, etc.
3. U.S. Physical Address or Intended U.S. Physical Address. Give his or her intended physical street address. This
must include a street number and name or a rural route number. Do not put a post office box (PO Box) number here.
4. Safe U.S. Mailing Address. If your relative does not feel secure in receiving correspondence regarding this
application at his or her home address, you may provide a “safe mailing address” in this space. This address may be a
post office box, the address of a friend, your/his or her attorney, a community-based organization, or any other address
where he or she can safely and punctually receive mail.
5. A-Number. This is your relative’s USCIS (former INS) file number. If he or she does not have an A-Number or you
do not know it, please leave this blank.
6. U.S. Social Security Number. If your relative does not have a U.S. Social Security Number, please leave this blank.
7. Gender or Sex and Marital Status. Select the appropriate box for each.
8. Date of Birth. Provide eight numbers to show his or her date of birth (example: May 1, 1979, should be written
05/01/1979).
9. Place of Birth. Provide the name of the country where he or she was born. Include the city or town, state or
province, and country.
10. Country of Citizenship or Nationality. Provide the name of the country where he or she is a citizen. This is not
necessarily the country where he or she was born.
11. Passport. Give the number of the passport used to enter the United States. Give the location where his or her
passport was issued. Give the date when his or her passport was issued, even if the passport is currently expired. If
the passport you used to enter the United States is not available, include an explanation in Part 9.
12. Last Entry Into the United States. If your relative is currently in the United States, give the date and place where he
or she last entered the United States, regardless of whether that entry was legal or illegal.
13. Form I-94 Arrival-Departure Record Number. If physically present in the United States, give the number on Form
I-94 issued at the time of entry.
14. Current Immigration Status. Provide your relative’s current status, regardless of how you entered the United States
(visitor, student, entry without inspection etc.).
15. Previously Traveled to the United States. Give the following information about your family member if he or she
has previously traveled to the United States, if applicable.
16. Family Member’s Prior Marriage(s) Information. If your family member was previously married, list the names
of his or her prior spouse(s), the dates the previous marriage terminated, the location where and how the marriage(s)
terminated.
17. U.S. Consulate or Inspection Facility Where You Want Notification Sent. If your family member is outside the
United States, indicate the U.S. Consulate or inspection facility you want notified if the Form I-914, Supplement A, is
approved.
18. Foreign Address Where You Want Notification Sent. If your family member is outside the United States, indicate
the address where you want notification sent if the Form I-914, Supplement A, is approved.
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19. Immigration History. Indicate whether your family member has any immigration proceedings history. If your
family member has been in immigration proceedings, complete at least one box.
20. Employment Authorization. If the Form I-914, Supplement A, is approved for your family member, he or she is
authorized to work. Select the box to indicate if you are applying for an Employment Authorization Document (EAD)
for your family member. If you indicate “Yes,” each family member must file Form I-765 with the appropriate fee or
Form I-912, Request For Fee Waiver, when the Form I-914, Supplement A is filed, or at a later time. Do not file Form
I-765 for a family member who is living outside of the United States. If your family member is living outside the
United States, he or she is not eligible to receive employment authorization until he or she is lawfully admitted to the
United States.
Part 5. Processing Information
You must answer each question about your family member. If you answer “Yes” to any of the questions, provide an
explanation in the space provided in Part 9. Additional Information.
Part 6. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature
Select the appropriate box to indicate whether you read this application yourself or whether you had an interpreter assist
you. If someone assisted you in completing the application, select the box indicating that you used a preparer. Further,
you must sign and date your application and provide a response to fields requesting your daytime telephone number,
mobile telephone number, and email address. You may include a safe daytime phone number such as the number of
your attorney or a community-based agency that is helping you. Every application MUST contain the signature of
the applicant (or parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not
acceptable.
NOTE: If the family member for whom you are filing is in the United States, he or she must sign and date the
application. If he or she does not sign or date the application, then Form I-914, Supplement A, will be rejected as
incomplete. If the family member for whom you are filing is outside the United States, only you (the principal applicant)
are required to sign and date the form.
Part 7. Interpreter’s Contact Information, Certification, and Signature
If you used anyone as an interpreter to read the instructions and questions on this application to you in a language in
which you are fluent, the interpreter should provide his or her name and daytime telephone number. If applicable, the
interpreter should provide the name and address of his or her business or organization (if any), his or her mobile telephone
number (if any), and his or her email address (if any). The interpreter must sign and date the application.
Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than
the Applicant
This section must contain the signature of the person who completed your application, if other than you, the applicant.
If the same individual acted as your interpreter and your preparer, that person should complete both Part 7. and Part 8.
If the person who completed this application is associated with a business or organization, that person should complete
the business or organization name and address information. Anyone who helped you complete this application MUST
sign and date the application. A stamped or typewritten name in place of a signature is not acceptable. If the person
who helped you prepare your application is an attorney or accredited representative, he or she may be obliged to also
submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with your
application.
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Completing Form I-914, Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking
in Persons
Form I-914, Supplement B, is completed by Federal, state, local, or tribal law enforcement authorities and is then given to
you to submit to USCIS.
You are not required to file Form I-914, Supplement B, to prove your claim. However, the endorsement of a Federal,
state, local, or tribal law enforcement authority that has the authority to detect, investigate or prosecute acts of trafficking
in persons is one form of evidence that you are a victim of a severe form of trafficking in persons and that you have
complied with any reasonable request for assistance in the investigation or prosecution. Follow the additional instructions
on Form I-914, Supplement B. If you do not provide the Form I-914, Supplement B, you may provide other evidence to
show victimization and cooperation with law enforcement or that you qualify for an exception based on age or trauma.
See section “Evidence of Cooperation with Reasonable Requests from Law Enforcement” for additional information.
Initial Evidence
You must submit:
1. A completed and signed Form I-914;
2. A personal narrative statement;
3. Evidence to establish each eligibility requirement (see next section for details); and
If applying for your family member, you must also submit:
1. A completed and signed Form I-914, Supplement A, for each family member for whom you are applying. You may
file Form I-914 Supplement A, at the same time with your initial application or at a later time.
Any Form I-914, Supplement A, submitted subsequent to the principal applicant’s initial filing, however, must be
accompanied by:
A. A new Form I-914, Supplement A, with the appropriate boxes selected in Part 1. and with an original signature in
Part 6.; and
B. A copy of the original Form I-914.
2. Evidence to establish eligibility for each family member (see next section for details).
NOTE: Evidence submitted with the original Form I-914 does not need to be resubmitted.
Evidence to Establish T Nonimmigrant Status
You must file Form I-914 with evidence sufficient to demonstrate that you satisfy each of the eligibility requirements. If
you have in your possession, or have access to, a document showing how you entered the United States, you must submit
a copy of that document with your application.
To qualify for T-1 nonimmigrant status, you must demonstrate that you:
1. Are or have been a victim of a severe form of trafficking in persons;
2. Are physically present in the United States, American Samoa, or the Commonwealth of the Northern Mariana Islands,
or at a port of entry, as a result of trafficking, including physical presence based on your having been allowed entry
into the United States to participate in investigative or judicial processes associated with an act or a perpetrator of
trafficking;
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3. Have complied with any reasonable request for assistance in a Federal, State, or local law enforcement investigation
or prosecution of acts of trafficking in persons, unless you are under 18 years of age, or you are unable to cooperate
with a request due to physical or psychological trauma; and
4. Would suffer extreme hardship involving unusual and severe harm upon removal from the United States.
To establish that you are or have been a victim of a severe form of trafficking in persons, you must demonstrate that you
have been a victim of either:
1. Sex trafficking: the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person
for the purpose of inducing a commercial sex act through the use of force, fraud, or coercion. Inducing an individual
under 18 years of age to perform a commercial sex act is considered sex trafficking, regardless of the use of force,
fraud, or coercion; or
2. Labor trafficking: the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services
through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt
bondage, or slavery.
NOTE: Human trafficking and human smuggling are distinct crimes under federal law. Human trafficking is a crime
committed against a person, regardless of immigration status, and it does not require crossing a country’s border.
Smuggling is a crime committed against a country’s immigration laws and border, and it involves the willful movement
of a person across a country’s border. USCIS recognizes that in some situations, human smuggling may turn into human
trafficking.
Evidence of Cooperation with Reasonable Requests from Law Enforcement
Form I-914, Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons (optional)
One type of evidence to support your application is Form I-914, Supplement B. That declaration and instructions are
You are not required to file Form I-914, Supplement B, to prove your claim. However, the endorsement of a Federal,
state, local, or tribal law enforcement officer on Form I-914, Supplement B, is one type of evidence that you are a victim
of a severe form of trafficking in persons and that you have complied with any reasonable request from Federal, state,
local, or tribal law enforcement authority for assistance in the investigation or prosecution of the acts of trafficking.
USCIS (not the Federal, state, local, or tribal law enforcement authority) will determine whether you meet the eligibility
requirements for T nonimmigrant status. Your eligibility for T nonimmigrant status is not dependent upon whether the law
enforcement agency pursues an investigation or prosecution.
If you do not provide a completed Form I-914, Supplement B, you must submit credible evidence to establish that you
are or have been a victim of a severe form of trafficking in persons and that you complied with any reasonable request for
assistance from law enforcement. Such evidence may include, but is not limited to: trial transcripts, court documents,
police reports, news articles, copies of reimbursement forms for travel to and from court, affidavits, or any other form of
evidence. Even if you do provide Form I-914, Supplement B, you may submit additional evidence.
Personal Statement
A personal narrative statement is required. Your personal narrative statement should describe, to the best of your
recollection, the circumstances of the trafficking you suffered, including:
1. The circumstances of your entry into the United States;
2. How you became involved in the trafficking situation;
3. When these events took place;
4. Who was responsible;
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5. How long the trafficking situation lasted;
6. How and when you escaped, were rescued, or otherwise became separated from the traffickers;
7. How your continued presence in the United States relates to the original trafficking you suffered;
8. What harm or mistreatment you fear if you are removed from the United States; and
9. Why you fear you would be harmed or mistreated.
Evidence to Establish Derivative T Nonimmigrant Status
You, as the principal applicant or as current T-1 nonimmigrant filing for your family members, must file Form I-914,
Supplement A, with evidence sufficient to demonstrate that your family members satisfy each of the eligibility
requirements.
If you are under 21 years of age, you may file for the following relatives:
1. Spouse;
2. Unmarried child(ren) under 21 years of age;
3. Parent(s); or
4. Unmarried sibling(s) under 18 years of age.
If you are under 21 years of age at the time you file your application, USCIS will continue to consider your parent or
unmarried sibling. You may continue to file for your family members even if you turn 21 years of age before your
application is adjudicated. Your parent or unmarried sibling will remain eligible for a T visa even if you turn 21 years of
age before your application is adjudicated. Similarly, if you have an unmarried sibling, they will remain eligible even if
they are over 18 years of age at the time your application is adjudicated. If you are a principal applicant over 21 years of
age, you may apply for your child if they were under 21 years of age at the time of the principal application. USCIS will
continue to consider a child as an eligible family member if the child was under 21 years of age at the time of the principal
application.
If you are over 21 years of age, you may file for the following family members:
1. Spouse; or
2. Unmarried child(ren) under 21 years of age.
If a family member faces a present danger of retaliation as a result of your escape from the severe form of trafficking in
persons or cooperation with law enforcement, you may file for the following eligible family members, regardless of your
age:
1. Parent(s);
2. Unmarried sibling(s) under 18 years of age; or
3. Adult or minor child of your derivative (your grandchild, your spouse’s child, your neice or nephew, or your sibling).
You must include:
1. A completed Form I-914, Supplement A, for each eligible family member you want included on your application.
2. Credible documentation of the claimed relationship. Documents acceptable for this purpose are listed below.
A. Husband or Wife. Submit a copy of your marriage certificate issued by a civil authority.
If either you or your spouse were married before, you must submit documents to show all previous marriages
were legally terminated. (Example: a divorce decree or death certificate.)
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B. Child, and you are the mother. Submit a copy of the child’s birth certificate showing your name and the name
of the child issued by a civil authority.
C. Child, and you are the father. Submit a copy of the child’s birth certificate issued by a civil authority showing
both parents’ names and your marriage certificate. If the child was born out of wedlock, give proof that a parent-
child relationship exists or existed. (Example: the child’s birth certificate showing your name and evidence that
you have financially supported the child. In some cases, a blood test may be necessary.)
D. Mother. Submit a copy of your birth certificate issued by a civil authority showing your name and your mother’s
name.
E. Father. Submit a copy of your birth certificate showing the names of both parents, your parents’ marriage
certificate establishing that your father was married to your mother before you were born, and copies of
documents showing that any prior marriages of either your father or mother were legally terminated. If you were
born out of wedlock, provide proof of legitimation, or additional proof that a parent - child relationship exists or
existed. See Item C. above. If you are filing for a stepparent or adoptive parent, see Items G. and H. below.
F. Brother or Sister. Submit a copy of your birth certificate and a copy of your brother’s or sister’s birth certificate
showing that you have at least one common parent. If you and your brother or sister have a common father but
different mothers, submit copies of the marriage certificates of the father to each mother and copies of documents
showing that any prior marriages of either your father or mother were legally terminated. If you and your brother
or sister are related through adoption or through a stepparent, or if you have a common father and either of you
were not legitimated before your 18th birthday, see also G and H.
G. Stepparent/Stepchild. If your application is based on a stepparent-stepchild relationship, you must file your
application with a copy of the marriage certificate of the stepparent to the child’s natural parent showing that the
marriage occurred before the child’s 18th birthday, and copies of documents showing that any prior marriages
were legally terminated.
H. Adoptive parent or adopted child. If you and the person you are filing for are related by adoption, you must
submit a copy of the adoption decree(s) showing that the adoption took place before the child reached 16 years of
age (unless a sibling exception applies).
If the relationship was created by the adoption of the sibling of a child already adopted, then you must submit
a copy of the adoption decree(s) showing that the adoption of the sibling took place before the child became 18
years of age.
In either case, you also must submit copies of evidence showing that each child was in the legal custody of and
jointly resided with the parent(s) who adopted him or her for some time within two years before or after the
adoption. Legal custody may only be granted by a court or recognized government entity and is usually granted
at the time the adoption is finalized. However, if legal custody is granted by a court or recognized government
agency prior to the adoption, that time may count to fulfill the two-year legal custody requirement.
I. Your unmarried sibling under 18 years of age. Submit a certified copy of your birth certificate and a copy of
your brother’s or sister’s birth certificate showing that you have at least one common parent.
3. If you are filing for your parents, unmarried siblings under 18 years of age, and/or the adult minor child of another
derivative because of a present danger of retaliation based on your escape from the severe form of trafficking in
persons or cooperation with law enforcement, you should include the following:
A. A description of the danger the family member faces and how the danger is linked to your escape or cooperation
with law enforcement;
B. Documentation of a previous grant of advance parole to a family member, if available; and
C. Any other credible evidence describing the danger of retaliation, including a signed statement from a law
enforcement official, trial transcripts, court documents, police reports, news articles, copies of reimbursement
forms for travel to and from court, and affidavits from other individuals.
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Unavailable Documents
If a required document is not available, you may give USCIS the following secondary evidence instead:
NOTE: USCIS may require a statement from the appropriate civil authority certifying that the necessary document is
unavailable.
1. Church record: A certificate under the seal where the baptism, dedication, or comparable rite occurred within two
months after the birth, showing the date and place of the child’s birth, date of the religious ceremony, and the names
of the child’s parents.
2. School record: A letter from the authority of the school attended (preferably the first school) showing dates of
admission to the school, child’s date and place of birth, and the names and birthplaces of both parents if shown in the
school records.
3. Census records: Federal or state census records showing the names place of birth and date of birth or age of the
person listed.
4. Affidavits: Written statements sworn to or affirmed by two persons who were living at the time and who have
personal knowledge of the event you are trying to prove. (Example: the date and place of birth, marriage, divorce, or
death.) The persons making the affidavits need not be citizens of the United States. Each affidavit should contain the
following information:
A. The relationship, if any, between you and the affiant;
B. Full information concerning the event; and
C. Complete details concerning how the person acquired knowledge of the event.
NOTE: In a case where you or your relative’s name has changed from what is shown on the supporting document,
submit the legal document authorizing such name change. (Example: marriage certificate, adoption decree, court
order, etc.)
Waiver of Ground(s) of Inadmissibility
To be eligible for T nonimmigrant status, you must be admissible to the United States. If you or your eligible family
member(s) answered “Yes” to one or more of the questions in Part 4. of Form I-914 or Form I-914, Supplement A, you or
your eligible family member(s) may be inadmissible. USCIS may waive the ground of inadmissibility if:
5. The acts or circumstances were caused by or related to you having been a victim of a severe form of human
trafficking, or
6. USCIS finds that it is in the national and public interest to exercise discretion.
If you and/or your eligible family member(s) is or becomes inadmissible under section 212(a) of the Immigration and
Nationality Act, you and/or your family member(s) will not be eligible for T nonimmigrant status unless USCIS waives
the ground of inadmissibility.
Applicants seeking a waiver of inadmissibility must submit Form I-192, Application for Advance Permission to Enter
as a Nonimmigrant (Pursuant to Section 212(d)(3) or (d)(13) of the Immigration and Nationality Act). A separate fee or
request for fee waiver must be filed with Form I-192. Form I-192 should be filed concurrently with Form I-914. USCIS,
in its discretion, will decide eligibility for the waiver.
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Where to File?
Mail your complete application to the following address:
USCIS
Vermont Service Center
38 River Road
Essex Junction, VT 05479-0001
What Is the Filing Fee?
There is no filing fee for any Form I-914.
Address Changes
If you have changed your address, you must inform USCIS of your new address. For information on filing a change of
address visit the USCIS website at www.uscis.gov/addresschange or contact the USCIS Contact Center at
1-800-375-5283.
Processing Information
Any Form I-914 that is not signed will be rejected with a notice that Form I-914 is deficient. You may correct the
deficiency and resubmit Form I-914. An application is not considered properly filed until accepted by USCIS.
Initial Processing
Once Form I-914 has been accepted, it will be checked for completeness, including submission of the required initial
evidence. If you do not completely fill out the form or file it without required initial evidence, you will not establish a
basis for eligibility, and we may deny your Form I-914.
Requests For More Information or Interview
We may request more information or evidence, or we may request that you and/or your family member appear at a USCIS
office for an interview. We may also request that you submit the originals of any copy.
Employment Authorization
If your application is approved, you will be authorized to work. If you are the principal applicant, USCIS will send an
Employment Authorization Document (EAD) as evidence of your authorization to work if you indicate “Yes” for Form
I-914, Item Number 10. in Part 3. As the principal applicant, you do not need to file Form I-765, Application for
Employment Authorization Document. Your family members may apply for employment authorization if Form I-914,
Supplement A, is approved. If your derivative family member wants to apply for employment authorization, he or she
must file Form I-765 with the appropriate fee or Form I-912, Request For Fee Waiver. Form I-765 can be filed with Form
I-914, Supplement A, or at a later time. If your family member is living outside the United States, he or she is not eligible
to receive employment authorization until he or she is lawfully admitted to the United States. Do not file Form I-765 for a
family member who is living outside of the United States.
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Travel While Your Form I-914 Is Pending
Filing of an application for T nonimmigrant status does not grant you permission to travel outside the United States.
Departing from the United States while your application is pending could impact your ability to establish eligibility for T
nonimmigrant status. Additionally, departing from the United States while your application is pending could impact your
ability to return to the United States unless you or your family member have another status which permits travel.
Travel After Your Form I-914 is Approved
For a T-1 nonimmigrant to depart the United States and return to the United States in T-1 nonimmigrant status, they must
file a Form I-131, Application for Travel Document, and obtain advance parole prior to departure.
A T-1 nonimmigrant who departs the United States and returns through means other than an advance parole document
issued prior to departure or admission at a designated port of entry with a T nonimmigrant visa does not resume T
nonimmigrant status and may have to reapply for such status.
For a T-2, T-3, T-4, T-5, or T-6 nonimmigrant to depart the United States and return to the United States in T nonimmigrant
status, they must either:
7. File a Form I-131, Application for Travel Document, and obtain advance parole prior to departure, or
8. Apply for and receive a T nonimmigrant visa from the Department of State and seek admission as a T nonimmigrant
at a designated port of entry.
Decision
The decision on Form I-914 involves a determination of whether you have established eligibility for T nonimmigrant
status. You will be notified of the decision in writing.
Confidentiality
Information concerning principal applicants for T nonimmigrant status and the family members they apply for is
protected under 8 U.S.C. Section 1367. The disclosure of information relating to an individual with a pending or approved
application for T nonimmigrant status is prohibited except in certain limited circumstances. These circumstances may
include, but are not limited to, disclosure of information to law enforcement agencies with the authority to detect,
investigate, or prosecute severe forms of trafficking in persons; non-governmental victims’ service providers for the sole
purpose of assisting victims in obtaining victim services from programs with expertise working with immigrant victims;
and for purposes of national security.
USCIS Forms and Information
To ensure you are using the latest version of this application, visit the USCIS website at www.uscis.gov where you can
obtain the latest USCIS forms and immigration-related information. If you do not have internet access, you may call
the USCIS Contact Center at 1-800-375-5283 and ask that we mail a form to you. The USCIS Contact Center provides
information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Please visit us at www.uscis.gov/contactcenter to get basic information about immigration services and ask questions
about a pending case. Through our digital self-help tools and live assistance, the USCIS Contact Center provides a
pathway for you to get consistent, accurate information and answers to immigration case questions.
Penalties
If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-914, USCIS
will deny Form I-914 and may deny any other immigration benefit you apply for. In addition, you will face severe
penalties provided by law and may be subject to criminal prosecution.
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DHS Privacy Notice
AUTHORITIES: The information requested on this application, and the associated evidence, is collected under Public
Law106-386 sections 107(e) and 1513(c) and 8 USC 1101(a)(15)(T).
PURPOSE: The primary purpose for providing the requested information on this application is to determine whether you
have established eligibility for the temporary immigration benefit you are applying for. DHS uses the information you
provide to grant or deny the immigration benefit you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information,
including your Social Security number (if applicable), and any requested evidence, may delay a final decision or result in
a rejection or denial of your application.
ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you
provide on this application and any additional requested evidence with other Federal, state, local, and foreign government
agencies and authorized organizations. DHS follows approved routine uses described in the associated published system
of records notices [DHS/USCIS-001 - Alien File, Index, and National File Tracking System and DHS/USCIS-007 -
Benefits Information System] and published the privacy impact assessment [DHS/USCIS/PIA-016(a) Computer Linked
Application Information Management System and Associated Systems], which you can find at www.dhs.gov/privacy.
DHS may also share this information, as appropriate, for law enforcement purposes or in the interest of national security.
Paperwork Reduction Act
An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection
of information unless it displays a currently valid OMB control number. The public reporting burden for Form I-914 is
estimated at 2.63 hours per response, and an estimated 1.17 hours for biometrics processing. The public reporting burden
for Form I-914, Supplement A, is estimated to be 1.08 hours per response, including the time for reviewing instructions,
completing and submitting the form. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Office of
Policy and Strategy, Regulatory Coordination Division, 5900 Capital Gateway Drive, Mail Stop #2140, Camp Springs,
MD 20588-0009. OMB No. 1615-0099. Do not mail your completed Form I-914 and Form I-914, Supplement A to
this address.
Checklist
Fill out the checkboxes. This will ensure that you have completed the form properly.
1. I completely filled out and signed the form.
2. I have attached evidence that:
A. I am or have been a victim of a severe form of trafficking;
B. 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 I have been allowed entry into
the United States to participate in investigative or judicial processes associated with the an act or
perpetrator of trafficking;
C. I am cooperating with Federal, state, local, or tribal law enforcement authorities in the investigation
or prosecution of the trafficker(s) (unless under 18 years of age or I am unable to cooperate with such
requests due to physical or psychological trauma); and
Form I-914 Instructions 12/02/21
Page 14 of 15
D. I would suffer extreme hardship involving unusual and severe harm upon removal from the United
States.
3. I have included a personal narrative statement.
If I am applying for one or more family members:
1. I have completed Form I-914, Supplement A for each family member for whom I am now applying and, if he or
she is in the United States, each family member has signed that Form I-914, Supplement A.
2. I have submitted the required evidence, including evidence of:
A. My relationship to the family member for whom I am applying;
B. My age, if I am applying for my parent or unmarried sibling under 18 years of age;
C. My child’s age, if I am applying for my child;
D. My sibling’s age, if I am applying for my unmarried sibling; and
E. If applicable, present danger of retaliation my relative faces as a result of my escape from trafficking or
my cooperation with law enforcement.
3. I will or have filed Form I-765 with the appropriate fee or request for fee waiver, for each family member
requesting an Employment Authorization Document (EAD).
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