Instructions For Form I-821 - Application For Temporary Protected Status (Page 10 of 18) in pdf

NOTE: If you are submitting a first-time re-registration with USCIS following an Immigration Judge or Board of

Immigration Appeals decision granting your TPS application, please include a copy of that decision order with your

Form I-821. This will aid USCIS in verifying your grant of TPS and processing your application, as USCIS may not

have received records of your grant of TPS by either the immigration judge or the Board of Immigration Appeals.

2. What documents do you need to provide to prove identity and nationality?

Examples of documents that you can submit include copies of any of the following:

A. Passport;

B. Birth certificate accompanied by photo identification; or

C. Any national identity document from your country of origin bearing your photo and/or fingerprint.

3. What documents do you need to provide to prove date of entry into the United States to meet the continuous

residence requirement for this program?

Examples of documents that you can submit include copies of any of the following:

A. Passport;

B. Form I-94, Arrival-Departure Record; or

C. Documents specified in Item Number 4., below.

4. What documents do you need to provide to prove residence in the United States?

Submit copies of any of the following relevant documents.

A. Employment records (for example, pay stubs; Form W-2, Wage and Tax Statement; certification of the filing of

Federal income tax returns; state verification of the filing of state income tax returns; letters from employers; or, if

you are self-employed, letters from banks and other firms with which you have done business.)

NOTE: In all of these documents, your name and the name of the employer or other interested organization must

appear on the form or letter, as well as relevant dates. Letters from employers must be in affidavit form and the

employer must also sign and attest to the affidavit under penalty of perjury.

Such letters must include:

(1) Your address at the time of employment;

(2) Exact periods of employment;

(3) Periods of layoff; and

(4) Duties with the company.

If the employment records are unavailable, submit an affidavit explaining why you cannot obtain these records.

Your employer must sign and attest to the affidavit under penalty of perjury.

B. Rent receipts, utility bills (for example, gas, electric and phone), and receipts or letters from companies showing

the dates during which you received service.

C. School records (for example, letters, and report cards) from the schools that you or your children have attended in

the United States, showing the names of the schools and periods of school attendance.

D. Hospital or medical records concerning treatment or hospitalization of you or your children, showing the name of

the medical facility or physician, and the dates of the treatment or hospitalization.

Form I-821 Instructions 10/19/17 N

Page 10 of 18

Instructions For Form I-821 - Application For Temporary Protected Status Page 10