Form I-918 Supplement B, U Nonimmigrant Status Certification Page 2
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3Part 3. Criminal Acts (continued)
2. Provide the date(s) on which the criminal activity occurred.
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
3. List the statutory citation(s) for the criminal activity being investigated or prosecuted, or that was investigated or prosecuted.
4. Did the criminal activity occur in the United States, including Indian country and military installations,
Yes
No
or the territories or possessions of the United States?
a. Did the criminal activity violate a Federal extraterritorial jurisdiction statute?
Yes
No
b. If "Yes," provide the statutory citation providing the authority for extraterritorial jurisdiction.
c.
Where did the criminal activity occur?
5. Briefly describe the criminal activity being investigated and/or prosecuted and the involvement of the individual named in Part 1.
Attach copies of all relevant reports and findings.
6. Provide a description of any known or documented injury to the victim. Attach copies of all relevant reports and findings.
Part 4. Helpfulness of the Victim
The victim (or parent, guardian or next friend, if the victim is under the age of 16, incompetent or incapacitated.):
1. Possesses information concerning the criminal activity listed in Part 3.
Yes
No
2. Has been, is being or is likely to be helpful in the investigation and/or prosecution of the
Yes
No
criminal activity detailed above. (Attach an explanation briefly detailing the assistance the
victim has provided.)
3. Has not been requested to provide further assistance in the investigation and/or prosecution.
Yes
No
(Example: prosecution is barred by the statute of limitation.) (Attach an explanation.)
4. Has unreasonably refused to provide assistance in a criminal investigation and/or prosecution
Yes
No
of the crime detailed above. (Attach an explanation.)
Form I-918 Supplement B (01/15/13) Y Page 2
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