H-1b Beneficiary Intake Form
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H-1B BENEFICIARY INTAKE FORM
INSTRUCTIONS:
(1) Please submit ALL required forms, supporting documents, and appropriate fees (if applicable) along with this request form to
your hiring department.
(2) Please use the most updated forms available at Old versions are not acceptable.
(3) Processing time at UConn’s Office of the General Counsel is up to two months.
(4) Processing time at the U.S. Citizenship & Immigration Services (USCIS) generally takes four months.
(5) If this request is for a new employment petition for one who is currently in H-1B status with another employer, the
beneficiary must not start working for UConn until UConn receives the official petition receipt notice from USCIS AND the
employment start date at UConn stated the petition becomes current. The beneficiary must not have resigned his/her current
employment position before UConn files this petition with USCIS.
(6) If this request is for an amendment petition, the amended employment must not start until UConn receives the official
petition receipt notice from USCIS AND the amended employment start date stated in the petition becomes current.
(7) Please type. Do not leave any section blank and write “N/A” where appropriate. ALL SIGNATURES MUST BE SIGNED
IN
BLUE
INK.
(8) Please see the beneficiary’s checklist (OGC 425) for additional documents required for this petition.
TYPE OF PETITION
□
New employment (First time working in H-1B status)
□
Current H-1B changing to UConn employment (Holds H-1B with another employer, but UConn will become primary employer
and H-1B sponsor)
□
H-1B extension (Will continue employment at UConn)
□
New concurrent employment (Will continue H-1B with another employer while working simultaneously at UConn)
□
Amendment (Any change made to the previously approved H-1B with UConn)
□
Other (specify):
INFORMATION ABOUT THE BENEFICIARY
A. Personal Information
1. Full Name (as it appears on your immigration documents and passport):
Family Name:
Given Name:
Middle Name: ________________
2. Date of Birth (mm/dd/yyyy):
3. Gender:
Male
Female
4. Marital Status:
Married
Single
5. Social Security Number (if available): ______-______-______
6. Country of Birth:
7. Country of Citizenship:
8. Country of Legal Permanent Residence:
9. Province of Birth:
10. All other Names Used (include maiden name, any secondary last name, and names from all previous marriages):
11. Current Occupation:
OGC 424 H-1B Beneficiary Intake Form
Rev. 3/27/2013
Page 1 of 4
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