Form I-130a - Supplemental Information For Spouse Beneficiary
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6Supplemental Information for Spouse Beneficiary
USCIS
Form I-130A
Department of Homeland Security
OMB No. 1615-0012
U.S. Citizenship and Immigration Services
Expires 07/31/2018
To be completed by an attorney or accredited representative (if any).
Volag Number
Attorney State Bar Number
Attorney or Accredited Representative
Select this box if
USCIS Online Account Number (if any)
(if any)
(if applicable)
Form G-28 is
attached.
START HERE - Type or print in black ink.
►
The purpose of this form is to collect additional information for a spouse beneficiary of Form I-130, Petition for Alien Relative. If
your spouse is a U.S. citizen, lawful permanent resident, or non-citizen U.S. national who is filing Form I-130 on your behalf, you
must complete and sign Form I-130A, Supplemental Information for Spouse Beneficiary, and submit it with the Form I-130 filed by
your spouse. If you reside overseas, you still must complete Form I-130A, but you do not need to sign the form.
Part 1. Information About You (Spouse
5.a.
Date From (mm/dd/yyyy)
Beneficiary)
5.b.
Date To (mm/dd/yyyy)
1.
Alien Registration Number (A-Number) (if any)
A-
►
Physical Address 2
2.
USCIS Online Account Number (if any)
6.a.
Street Number
and Name
►
6.b.
Apt.
Ste.
Flr.
Your Full Name
6.c.
City or Town
3.a.
Family Name
(Last Name)
6.d.
State
6.e. ZIP Code
3.b.
Given Name
(First Name)
6.f.
Province
3.c.
Middle Name
6.g.
Postal Code
6.h.
Country
Address History
Provide your physical addresses for the last five years, whether
inside or outside the United States. Provide your current
7.a.
Date From (mm/dd/yyyy)
address first. If you need extra space to complete this section,
use the space provided in Part 7. Additional Information.
7.b.
Date To (mm/dd/yyyy)
Physical Address 1
Last Physical Address Outside the United States
4.a.
Street Number
Provide your last address outside the United States of more than
and Name
one year (even if listed above).
4.b.
Apt.
Ste.
Flr.
8.a.
Street Number
and Name
4.c.
City or Town
8.b.
Apt.
Ste.
Flr.
4.d.
4.e. ZIP Code
State
8.c.
City or Town
4.f.
Province
8.d.
Province
4.g.
Postal Code
8.e.
Postal Code
4.h.
Country
8.f.
Country
Form I-130A 02/27/17 N
Page 1 of 6
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