Form I-821 - Application For Temporary Protected Status Page 10
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1338.d. Are you NOW the spouse or child of, or are you yourself,
Part 7. Eligibility Standards (continued)
an alien who knowingly aided, abetted, assisted,
conspired, or colluded with a human trafficker?
Have you EVER:
Yes
No
31.a. Served in, been a member of, assisted in, or participated
in any military unit, paramilitary unit, police unit, self-
38.e. Within the previous five years, have you EVER obtained
defense unit, vigilante unit, rebel group, guerrilla group,
any financial or other benefit from the human trafficking
militia, or insurgent organization?
Yes
No
activity of your spouse (including former spouses) or
parents, and you knew, or reasonably should have
31.b. Served or worked in any prison, jail, prison camp,
known, that the financial or other benefit that you
detention facility, labor camp, or any other situation that
received resulted from such human trafficking?
involved detaining persons?
Yes
No
Yes
No
32.
Have you EVER been a member of, assisted in, or
39.a. Are you NOW or have you EVER engaged in money
participated in any group, unit, or organization of any
laundering as described in section 1956 or 1957 of Title
kind in which you or other persons used any type of
18, United States Code?
Yes
No
weapon against any person or threatened to do so?
Yes
No
39.b. Are you NOW or have you EVER been a knowing aider,
abettor, assister, conspirator, or colluder with others in
33.
Have you EVER assisted with or participated in selling or
money laundering?
Yes
No
providing weapons to any person who to your knowledge
used them against another person, or in transporting
40.
Have you EVER been responsible for or directly carried
weapons to any person who to your knowledge used them
out particularly severe violations of religious freedom, as
against another person?
Yes
No
defined in section 3 of the International Religious
Freedom Act of 1998 (22 U.S.C. section 6402) while
34.
Have you EVER received any type of military,
serving as a foreign government official?
paramilitary, or weapons training?
Yes
No
Yes
No
35.
Have you EVER unlawfully voted in a United States
41.
Has an immigration judge or the Board of Immigration
Federal, state, or local election?
Yes
No
Appeals EVER determined that you filed a frivolous
asylum application in the past?
Yes
No
36.
Have you EVER claimed to be a U. S. citizen (in writing
or in any other way)?
Yes
No
Part 8. Applicant's Statement, Contact
37.a. Have you EVER recruited, enlisted, conscripted, or used
Information, Certification, and Signature
any person under 15 years of age to serve in or help an
armed force or group?
Yes
No
NOTE: Read the Penalties section of the Form I-821
Instructions before completing this part. You must file Form
37.b. Have you EVER used any person under 15 years of age
I-821 while in the United States.
to take part in hostilities or to help or provide services to
people in combat?
Applicant's Statement
Yes
No
38.a. Have you EVER committed or conspired to commit
NOTE: Select the box for either Item Number 1.a. or 1.b. If
human trafficking offenses, as defined in the section 103
applicable, select the box for Item Number 2.
of the Victims of Trafficking and Violence Protection Act
1.a.
I can read and understand English, and I have read
of 2000, in the United States or outside the United States?
and understand every question and instruction on this
Yes
No
application and my answer to every question.
38.b. Have you EVER knowingly aided, abetted, assisted,
1.b.
The interpreter named in Part 9. read to me every
conspired, or colluded with a human trafficker?
question and instruction on this application and my
Yes
No
answer to every question in
a language in which I am fluent, and I understood
38.c. Are you NOW the spouse or child of an alien who
everything.
committed or conspired to commit human trafficking
offenses?
2.
At my request, the preparer named in Part 10.,
Yes
No
prepared this application for me based only upon
information I provided or authorized.
Form I-821 10/19/17 N
Page 10 of 13
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