Form I-485 -U.s. Citizenship Immigration And Service - Department Of Homeland Security
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2OMB No. 1615-0023
Supplement A to Form I-485,
Department of Homeland Security
Adjustment of Status Under Section 245(i)
U.S. Citizenship Immigration and Service
NOTE: Use this form only if you are applying to adjust status to that of a lawful permanent resident under section 245(i) of
the Immigration and Nationality Act.
Part A. Information About You
For USCIS Use Only
Action Block
Last Name
First Name
Middle Name
Address: In Care Of
Street Number and Name
Apt. Number
State
Zip Code
City
Alien Registration Number (A #) if any
Date of Birth (mm/dd/yyyy)
Country of Birth
Country of Citizenship/Nationality
Telephone Number
E-Mail Address, if any
Part B. Eligibility
(Check the correct response)
1. I am filing Supplement A to Form I-485 because:
a.
I am the beneficiary of a visa petition filed on or before January 14, 1998.
b.
I am the beneficiary of a visa petition filed on or after January 15, 1998, and on or before April 30, 2001.
c.
I am the beneficiary of an application for a labor certification filed on or before January 14, 1998.
d.
I am the beneficiary of an application for a labor certification filed on or after January 15, 1998, and on or before April 30,
2001.
If you checked box b or d in Question 1, you must submit evidence demonstrating that you were physically present in the
United States on December 21, 2000.
2. And I fall into one or more of these categories: (Check all that apply to you)
a.
I entered the United States as an alien crewman;
b.
I have accepted employment without authorization;
c.
I am in unlawful immigration status because I entered the United States without inspection or I remained in the United
States past the expiration of the period of my lawful admission;
d.
I have failed (except through no fault of my own or for technical reasons) to maintain, continuously, lawful status;
e.
I was admitted to the United States in transit without a visa;
f.
I was admitted as a nonimmigrant visitor without a visa;
g.
I was admitted to the United States as a nonimmigrant in the S classification; or
h.
I am seeking employment-based adjustment of status and am not in lawful nonimmigrant status.
Part C. Additional Eligibility Information
1. Are you applying to adjust status based on any of the below reasons?
a.
You were granted asylum in the United States;
b. You have continuously resided in the United States since January 1, 1972;
c. You entered as a K-1 fiancé(e) of a U.S. citizen;
d. You have an approved Form I-360, Petition for Amerasian, Widow(er), Battered or Abused Spouse or Child, or Special
Immigrant, and are applying for adjustment as a special immigrant juvenile court dependent or a special immigrant who has
served in the U.S. armed forces, or a battered or abused spouse or child;
Form I-485 Supplement A (Rev. 01/18/11)Y
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