Instructions For Form I-821 - Application For Temporary Protected Status Page 5

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Item Number 8. USCIS Online Account Number (if any). If you have previously filed an application, petition, or
request using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)),
provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account
Number by logging in to your account and going to the profile page. If you previously filed certain applications, petitions,
or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice
issuing you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account Number can be
found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The
USCIS Online Account Number is not the same as an A-Number.
Item Number 9. U.S. Social Security Number (if any). Provide your U.S. Social Security number. If you do not have a
U.S. Social Security number, type or print “N/A.”
Item Number 10. Date of Birth. Provide your date of birth in month/day/year (mm/dd/yyyy) format.
Item Numbers 11.a. - 11.b. Other Dates of Birth Used. Provide all other dates of birth used in mm/dd/yyyy format.
Item Number 12. Gender. Indicate your gender.
Item Number 13. City/Town/Village of Birth. Provide the city/town/village where you were born in the space provided.
Item Number 14. Country of Birth. Provide your country of birth in the space provided.
Item Numbers 15.a. - 15.d. Countries of Residence/You Entered (Before Entering the United States). List all of the
countries you entered while traveling to the United States, including any countries where you resided as well as those
where you transited through. Use Part 11. Additional Information to provide the dates when you were in those countries
and any immigration status you may have had while in those countries. If you have ever been offered an immigration
status in another country that you did not accept, please describe that status offer as well and why you did not accept it in
Part 11. Additional Information.
Item Numbers 16.a. - 16.d. Country or Countries of Citizenship or Nationality (if any) (List all countries that apply.)
Provide the name of EACH country of which you are a citizen or where you have nationality. This is not necessarily
the country where you were born. If you do not have citizenship in any country, type or print “stateless” and provide an
explanation in Part 11. Additional Information.
Item Number 17. Marital Status. Select the appropriate category to indicate your current marital status. If you are
uncertain of your marital status or have additional relevant information about your marital status, please use Part 11.
Additional Information.
Item Number 18. Date of Current Marriage (if currently married). Provide the date of your current marriage (if
cuurently married) in mm/dd/yyyy format.
Item Number 19. Date of Last Entry into the United States. Provide the date and place where you last entered the
United States in mm/dd/yyyy format.
Item Number 20. Immigration Status (or Lack of Status) When You Last Entered the United States. Provide your
immigration status, if any, at the time when you last entered the United States. For example, visitor, student, visa overstay.
If you entered without inspection or admission or parole, type or print “No Status” as your immigration status.
Item Numbers 21.a. - 22.b. Place of Last Entry into the United States. Provide the U.S. Port of Entry (if any), city or
town and state where you last entered into the United States.
Item Number 23. Form I-94 Arrival-Departure Record. If U.S. Customs and Border Protection (CBP) or USCIS
issued you a Form I-94, Arrival-Departure Record, provide your Form I-94 number and date that your authorized period
of stay expires or expired (as shown on Form I-94). The Form I-94 number also is known as the Departure Number on
some versions of Form I-94.
Form I-821 Instructions 10/19/17 N
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