Application for Temporary Protected StatusFile Online

• Legal Form Number: I-821
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-821 07/03/19 E Page 1 of 13

Application for Temporary Protected Status

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-821

OMB No. 1615-0043

Expires 08/31/2025

For USCIS Use Only

Remarks

Receipt

Resubmitted:

Returned:

Sent:

Received:

Case ID:

A-Number:

Relocated:

Action Block

To be completed

by an Attorney

or Accredited

Representative (if any).

Select this box if

Form G-28 or

G-28I is

attached.

Attorney State Bar Number

(if applicable) Attorney or Accredited Representative

USCIS Online Account Number (if any)

►START HERE - Type or print in black ink.

Part 1. Type of Application (select one)

NOTE: Select the box for Item Number 1.a., 1.b., or 2. If

applicable, select the box for Item Number 3.a. or 3.b. For

Item Number 4., enter the name of the designated TPS country.

1.a. This is my initial (first time) application for

Temporary Protected Status (TPS). I do not currently

have TPS.

1.b. This is my re-registration application for TPS. I

currently have TPS, and am applying to re-register.

2. If you selected Item Number 1.b., please indicate who

granted you TPS.

USCIS

Immigration Judge/Board of Immigration Appeals

Are you also filing a request for employment authorization?

3.a. Yes, I am requesting an Employment Authorization

Document (EAD), and I am filing Form I-765,

Application for Employment Authorization, together

with my Form I-821.

3.b. No, I am not currently requesting an EAD.

Part 2. Information About You

Your Full Name

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

NOTE: If you have previously applied or have a

pending application for TPS, but do not currently

have TPS, select Item Number 1.a. and describe

each time that you previously applied, including the

receipt number (if available) and the outcome (if any)

of each application. If you currently have a pending

TPS application, please also describe when you filed

it and the application receipt number (if available) in

Part 11. Additional Information. If you do not

recall or have incomplete information on your prior

TPS applications, please provide the information you

can, even if incomplete.

Name of designated TPS country under which you are

applying.

4.