Instructions For Form I-854 - Inter-Agency Alien Witness And Informant Record (Page 5 of 6) in pdf

Other Information

Employment Authorization

Alien witnesses and/or informants who have received S nonimmigrant classification are eligible to receive an Employment

Authorization Document (EAD) enabling them to seek employment in the United States. Alien witnesses and/or informants

may request an EAD by filing Form I-765, Application for Employment Authorization, under the C21 eligibility category.

Instructions for Form I-765 are available on the USCIS Web site at You may not file Form I-765

with Forms I-854A and I-854B. You must file Form I-765 separately.

Authority for Collecting This Information

You can find the authority that requires you to file Form I-854A, when requesting to classify an alien witness and/or

informant as an S nonimmigrant, at INA section 101(a)(15)(S). You can find the authority to require you to file Form

I-854B, when requesting that an S nonimmigrant is permitted to apply for adjustment of status, under INA section 245(j).

Information you provide on Forms I-854A and I-854B is used to determine eligibility for the requested benefit/authorization

to record the numbers of requests and determinations made on this form, track and monitor the alien, and provide Congress

with a required annual report on the admission of alien witnesses and/or informants.

Failure to provide all information as required may result in the denial or rejection of this form. USCIS, DOS, and DOJ

may also disclose the information you provide to other Federal, state, local, and foreign law enforcement, intelligence, and

regulatory agencies.

USCIS Forms and Information

To ensure you are using the latest versions of these forms, visit the USCIS Web site at

where you can obtain

the latest USCIS forms and immigration-related information. If you do not have Internet access, you may order USCIS

forms by calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by calling the USCIS

National Customer Service Center at 1-800-375-5283. For TDD (deaf or hard of hearing) call: 1-800-767-1833.

Penalties

All statements made in response to questions on this form are declared to be true and correct under penalty of perjury

18 U.S.C. 1546, which provides in part:

Whoever knowingly makes under oath, or as permitted under penalty under 28 U.S.C. 1746, knowingly subscribes

as true, any false statement with respect to a material fact in any application, affidavit, or other document required

by the immigration laws or regulations prescribed thereunder, or knowingly presents any such application, affidavit,

or other document containing any such false statement - shall be fined in accordance with this title or imprisoned

for not more than five years, or both.

The knowing placement of false information on this form may subject the alien and/or the preparer of this form to criminal

penalties under Title 18 U.S.C. 1546(a). The knowing placement of false information on this form may also subject the

alien and/or the preparer to civil penalties under section 274C of the Act, 8 U.S.C. 1324c. Under 8 U.S.C. 1324c, a person

subject to a final order for civil document fraud is removable from the United States and may be subject to fines.

USCIS Privacy Act Statement

AUTHORITIES: 8 U.S.C. section 1101(a)(15)(S) authorizes USCIS to collect the information and the associated

evidence for this application.

PURPOSE: The primary purpose for providing the requested information on these forms are to obtain S nonimmigrant

status after assisting a law enforcement agency as a witness or informant. DHS will use the information you provide to

grant or deny the benefit sought.

Form I-854AB Instructions 07/13/17 N

Page 5 of 6

Instructions For Form I-854 - Inter-Agency Alien Witness And Informant Record Page 5