Instructions For Form I-821 - Application For Temporary Protected Status (Page 8 of 18) in pdf

Item Numbers 1.a. - 1.c. and 11.a - 11.c. Former Spouse’s Full Name. Provide your former spouse’s full legal name.

Item Numbers 2. and 12. Former Spouse’s Nationalities. Provide your former spouse’s nationality or nationalities, if

more than one.

Item Numbers 3. and 13. A-Number (if any). Provide your former spouse’s A-Number, if available to you. The

A-Number is the number used to identify your former spouse’s immigration records.

Item Numbers 4. and 14. Date of Birth. Provide the date of your former spouse’s birth in a mm/dd/yyyy format.

Item Numbers 5. and 15. Date of Death (if applicable). Provide the date of your former spouse’s death in a mm/dd/

yyyy format.

Item Numbers 6.a. - 7. and 16.a. - 17. Dates of Marriage and How Marriage Ended.

Item Numbers 8. - 10. and 18. - 20. Your Former Spouse’s TPS. If your former spouse ever had TPS, indicate the

dates of his or her TPS and whether your former spouse’s TPS is still valid, if known. Also indicate if your former spouse

is re-registering for TPS, if that information is available to you.

Part 6. Information About Your Children (if any)

Item Numbers 1.a. - 1.c. and 8.a. - 8.c. Child’s Full Name. Provide the child’s full legal name.

Item Numbers 2. and 9. 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 Numbers 3. and 10. A-Number (if any and available to you). Provide your child’s A-Number, if available to you.

The A-Number is the number used to identify your child’s immigration records. You can find your child’s A-number on

documents from USCIS, U.S. Immigration and Customs Enforcement (ICE), or DOJ Executive Office of Immigration

Review (EOIR) during immigration proceedings in court.

Item Numbers 4. and 11. Date of Birth. Provide the date of your child’s birth in a mm/dd/yyyy format.

Item Numbers 5.a. - 5.h. and 12.a. - 12.h. Your Child’s U.S. Mailing Address. Provide your child’s U.S. mailing

address.

Item Numbers 6.a. - 7. and 13.a. - 14. Your Child’s TPS. If your child ever had TPS, please indicate the dates of his or

her TPS, if known. Also indicate if your child is re-registering for TPS, if that information is available to you.

Part 7. Eligibility Standards

Item Numbers 1.a. - 41. Eligibility Standards. Complete Item Numbers 1.a. - 41. If you select “Yes” to any of Item

Numbers 3. - 41., provide an explanation in Part 11. Additional Information.

Part 8. Applicant’s Statement, Contact Information, Certification, and Signature

Item Numbers 1.a. - 6.b. Select the appropriate box to indicate whether you read this application yourself or whether

you had an interpreter assist you. If someone assisted you in completing the application, select the box indicating that you

used a preparer. Further, you must sign and date your application and provide your daytime telephone number, mobile

telephone number (if any), and email address (if any). Every application MUST contain the signature of the applicant (or

parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.

Form I-821 Instructions 10/19/17 N

Page 8 of 18

Instructions For Form I-821 - Application For Temporary Protected Status Page 8