Form I-918 - Supplement B - U Nonimmigrant Status Certification Page 2
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54.a.
Did the criminal activity occur in the United States
Part 3. Criminal Acts
(including Indian country and military installations) or the
If you need extra space to complete this section, use the space
territories or possessions of the United States?
provided in Part 7. Additional Information.
Yes
No
1.
The petitioner is a victim of criminal activity involving a
4.b.
If you answered "Yes," where did the criminal activity
violation of one of the following Federal, state, or local
occur?
criminal offenses (or any similar activity). (Select all
applicable boxes)
Abduction
Manslaughter
5.a.
Did the criminal activity violate a Federal extraterritorial
Abusive Sexual Contact
Murder
jurisdiction statute?
Yes
No
Attempt to Commit
Obstruction of Justice
Any of the Named
5.b.
If you answered "Yes," provide the statutory citation
Peonage
Crimes
providing the authority for extraterritorial jurisdiction.
Perjury
Being Held Hostage
Prostitution
Blackmail
Rape
Conspiracy to Commit
6.
Briefly describe the criminal activity being investigated
Any of the Named
Sexual Assault
and/or prosecuted and the involvement of the petitioner
Crimes
named in Part 1. Attach copies of all relevant reports and
Sexual Exploitation
Domestic Violence
findings.
Slave Trade
Extortion
Solicitation to
False Imprisonment
Commit Any of the
Felonious Assault
Named Crimes
Female Genital
Stalking
Mutilation
Torture
Fraud in Foreign Labor
Trafficking
Contracting
Unlawful Criminal
Incest
Restraint
Involuntary Servitude
Witness Tampering
Kidnapping
Provide the dates on which the criminal activity occurred.
2.a.
Date (mm/dd/yyyy)
2.b.
Date (mm/dd/yyyy)
7.
Provide a description of any known or documented injury
to the victim. Attach copies of all relevant reports and
2.c. Date (mm/dd/yyyy)
findings.
2.d. Date (mm/dd/yyyy)
List the statutory citations for the criminal activity being
3.
investigated or prosecuted, or that was investigated or
prosecuted.
Form I-918 Supplement B 02/07/17 N
Page 2 of 5
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