Form I-485 - Supplement A - Adjustment Of Status Under Section 245(I)
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4Supplement A to Form I-485,
Adjustment of Status Under Section 245(i)
USCIS
Form I-485
Department of Homeland Security
OMB No. 1615-0023
U.S. Citizenship and Immigration Services
Expires 06/30/2019
NOTE: Use Supplement A to Form I-485, Adjustment of Status Under INA Section 245(i) (Supplement A), only if you are applying
to adjust status to that of a lawful permanent resident under the Immigration and Nationality Act (INA) section 245(i). You may file
Supplement A only if you are filing your Form I-485, Application to Register Permanent Residence or Adjust Status, at the same time
or if you previously filed your Form I-485 and it remains pending.
►
START HERE - Type or print in black ink.
Part 1. Information About You
Part 2. Eligibility
Your Current Legal Name
Basis of INA Section 245(i) Eligibility
1.a. Family Name
You claim eligibility to adjust status under INA section 245(i)
(Last Name)
because (Select only one box):
1.b.
Given Name
1.a.
You are or were the principal beneficiary of an
(First Name)
immigrant petition or application for permanent labor
1.c.
Middle Name
certification filed on or before January 14, 1998.
1.b.
You are or were the principal beneficiary of an
U.S. Mailing Address
immigrant petition or application for permanent labor
certification filed on or after January 15, 1998, and
2.a. In Care Of Name (if any)
on or before April 30, 2001, and you were physically
present in the United States on December 21, 2000.
2.b.
Street Number
1.c.
You are or were the derivative beneficiary of an
and Name
immigrant petition or application for permanent labor
certification filed on or before January 14, 1998.
2.c.
Apt.
Ste.
Flr.
1.d.
You are or were the derivative beneficiary of an
2.d.
City or Town
immigrant petition or application for permanent labor
certification filed on or after January 15, 1998, and
2.e.
State
2.f.
ZIP Code
on or before April 30, 2001, and the principal
beneficiary was physically present in the United
States on December 21, 2000.
Other Information
You are currently the spouse applying to accompany
1.e.
3.
Alien Registration Number (A-Number) (if any)
or follow-to-join your spouse OR the child
►
A-
(unmarried and under 21 years of age) applying to
accompany or follow-to-join your parent described in
4.
USCIS Online Account Number (if any)
Item Numbers 1.a. - 1.d.
►
Qualifying Petition or Application
5.
Date of Birth (mm/dd/yyyy)
Provide the following information about the immigrant petition
6.
Country of Birth
or application for permanent labor certification filed on or
before April 30, 2001 that qualifies you to adjust status under
INA section 245(i).
7.
Country of Citizenship or Nationality
2.
Receipt Number of Petition (if any)
Page 1 of 4
Form I-485 Supplement A 06/26/17 N
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