Instructions For Form I-817 - Application For Family Unity Benefits (Page 5 of 14) in pdf

Item Numbers 2.a. - 2.c. Your Full Name. Provide your full legal name as shown on your identity documents. If you

have two last names, include both and use a hyphen (-) between the names, if appropriate.

Item Numbers 3.a. - 4.c. Other Names Used. Provide other names you have used since birth, including your maiden

name, any nicknames, and any names that appear in your documents. If you need extra space to complete this section, use

the space provided in Part 9. Additional Information to provide other names used.

Item Number 5. Date of Birth. Provide your date of birth in mm/dd/yyyy format in the space provided.

Item Number 6. U.S. Social Security Number (if any). Provide your U.S. Social Security number, if any. If you do not

have a U.S. Social Security number, leave this space blank.

Item Number 7. USCIS Online Account Number (if any). If you have previously filed an application, petition, or

request using the USCIS Electronic Immigration System (USCIS ELIS), provide the USCIS Online Account Number you

were issued by the system. The USCIS Online Account Number is not the same as an A-Number. If you were issued a

USCIS Online Account Number, enter it in the space provided.

Item Number 8. Gender. Select male or female.

Item Numbers 9. - 10. Country of Birth and Country of Citizenship or Nationality. Provide the name of the country

of your birth and the name of the country of your citizenship or nationality. Use the current names of the country of your

birth and country of your citizenship or nationality.

Item Numbers 11.a. - 11.f. Mailing Address. Provide your U.S. mailing address, if different from your home address.

Item Numbers 12.a. - 12.e. Physical Address. Provide your physical street address in the United States. This must

include a street number and name or a rural route number. Do not put a Post Office Box (PO Box) number here.

NOTE: Applicants must provide a U.S. address in either the Mailing Address or the Physical Address sections.

Item Numbers 13. - 18. Biographic Information. Provide the biographic information requested. Providing this

information as part of your application may reduce the time you spend at your USCIS ASC appointment as described in

the Biometric Services Appointment section of these Instructions.

Ethnicity and Race. Select the boxes that best describe your ethnicity and race.

Categories and Definitions for Ethnicity and Race

A. Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish

culture or origin, regardless of race. (NOTE: This category is only included under Ethnicity in Part 1., Item

Number 13.)

B. White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

C. Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian

subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine

Islands, Thailand, and Vietnam.

D. Black or African American. A person having origins in any of the black racial groups of Africa.

E. American Indian or Alaska Native. A person having origins in any of the original peoples of North and South

America (including Central America), and who maintains tribal affiliation or community attachment.

F. Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii,

Guam, Samoa, or other Pacific Islands.

Height. Select the values that best match your height in feet and inches. For example, if you are five feet and nine inches,

select “5” for feet and “09” for inches. Do not enter your height in meters or centimeters.

Weight. Enter your weight in pounds. If you do not know your weight, or need to enter a weight under 30 pounds or over

699 pounds, enter “000.” Do not enter your weight in kilograms.

Eye Color. Select the box that best describes the color of your eyes.

Hair Color. Select the box that best describes the color of your hair.

Form I-817 Instructions 12/23/16 N

Page 5 of 14

Instructions For Form I-817 - Application For Family Unity Benefits Page 5

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