Application to Register Permanent Residence or Adjust Status

• Legal Form Number: I-485
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-485 Edition 07/15/22 Page 1 of 18

1.b.

1.c.

1.a. Family Name

(Last Name)

Given Name

(First Name)

Middle Name

Your Current Legal Name (do not provide a

nickname)

Application to Register Permanent Residence

or Adjust Status

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-485

OMB No. 1615-0023

Expires 03/31/2023

Priority Date:

Country Chargeable:

INA 209(a) INA 249

Section of Law

INA 245(a)

INA 245(i)

INA 245(m)

Sec. 13, Act of 9/11/57

Cuban Adjustment Act

Other

Lawful Permanent

Resident as of:

Date of

Initial Interview:

Action BlockReceipt

Interview

Waived

Applicant

Interviewed

Date Form I-693 Received:

Attorney State Bar Number

(if applicable)

Select this box if

Form G-28 is

attached.

Volag Number

(if any) Attorney or Accredited Representative

USCIS Online Account Number (if any)

To be completed by an attorney or accredited representative (if any).

For USCIS Use Only

START HERE - Type or print in black ink.►

NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the

Instructions, U.S. Citizenship and Immigration Services (USCIS) may deny your application.

Part 1. Information About You (Person applying

for lawful permanent residence)

►A-

A-Number

NOTE: Provide all other names you have ever used, including

your family name at birth, other legal names, nicknames,

aliases, and assumed names. If you need extra space to

complete this section, use the space provided in Part 14.

Additional Information.

Other Names You Have Used Since Birth (if

applicable)

2.b.

2.c.

2.a. Family Name

(Last Name)

Given Name

(First Name)

Middle Name

3.b.

3.c.

3.a. Family Name

(Last Name)

Given Name

(First Name)

Middle Name

5. Date of Birth (mm/dd/yyyy)

NOTE: In addition to providing your actual date of birth,

include any other dates of birth you have used in

connection with any legal names or non-legal names in

the space provided in Part 14. Additional Information.

FemaleMaleSex6.

INA 209(b)

4.b.

4.c.

4.a. Family Name

(Last Name)

Given Name

(First Name)

Middle Name

Preference Category:

Other Information About You

City or Town of Birth7.

Form I-485 Edition 07/15/22 Page 2 of 18

►A-

A-Number

Country of Birth8.

Country of Citizenship or Nationality9.

Part 1. Information About You (Person applying

for lawful permanent residence) (continued)

►A-

Alien Registration Number (A-Number) (if any)10.

NOTE: If you have EVER used other A-Numbers,

include the additional A-Numbers in the space provided

in Part 14. Additional Information.

►

11. USCIS Online Account Number (if any)

U.S. Mailing Address

City or Town12.d.

ZIP Code

12.f.

State

12.e.

Street Number

and Name

12.b.

12.c. Apt. Flr.Ste.

12.a. In Care Of Name (if any)

City or Town13.d.

ZIP Code

13.f.

State

13.e.

Street Number

and Name

13.b.

13.c. Apt. Flr.Ste.

13.a. In Care Of Name (if any)

Alternate and/or Safe Mailing Address

If you are applying based on the Violence Against Women Act

(VAWA) or as a special immigrant juvenile, human trafficking

victim (T nonimmigrant), or victim of a qualifying crime (U

nonimmigrant) and you do not want USCIS to send notices

about this application to your home, you may provide an

alternative and/or safe mailing address.

(USPS ZIP Code Lookup)

Social Security Card

14. Has the Social Security Administration (SSA) ever

officially issued a Social Security card to you?

NoYes

If you answered “Yes,” provide the information requested

in Item Number 15.

Provide your U.S. Social Security Number (SSN). 15.

►

Do you want the SSA to issue you a Social Security card?

(You must also answer “Yes” to Item Number 17.

Consent for Disclosure, to receive a card).

16.

NoYes

Consent for Disclosure: I authorize disclosure of

information from this application to the SSA as required

for the purpose of assigning me an SSN and issuing me a

Social Security Card.

17.

NoYes

Passport Number Used at Last Arrival18.

Travel Document Number Used at Last Arrival19.

Recent Immigration History

20. Expiration Date of this Passport or Travel Document

(mm/dd/yyyy)

Country that Issued this Passport or Travel Document21.

Nonimmigrant Visa Number from this Passport (if any)22.

23.a.

Place of Last Arrival into the United States

City or Town

23.b. State

Provide the information for Item Numbers 18. - 24. if you last

entered the United States using a passport or travel document.

Date of Last Arrival (mm/dd/yyyy)

24.

Form I-485 Edition 07/15/22 Page 3 of 18

►A-

A-Number

Part 1. Information About You (Person applying

for lawful permanent residence) (continued)

When I last arrived in the United States, I:

Was inspected at a port of entry and admitted as (for

example, exchange visitor; visitor, waived through;

temporary worker; student):

25.a.

Was inspected at a port of entry and paroled as (for

example, humanitarian parole, Cuban parole):

25.b.

Came into the United States without admission or

parole.

25.c.

Other:

25.d.

If you were issued a Form I-94 Arrival-Departure Record Number:

Expiration Date of Authorized Stay Shown on Form I-9426.b.

(mm/dd/yyyy)

26.c. Status on Form I-94 (for example, class of admission, or

paroled, if paroled)

Form I-94 Arrival-Departure Record Number 26.a.

►

Provide your name exactly as it appears on your Form I-94 (if

any)

28.b.

28.c.

28.a. Family Name

(Last Name)

Given Name

(First Name)

Middle Name

Part 2. Application Type or Filing Category

NOTE: Attach a copy of the Form I-797 receipt or approval

notice for the underlying petition or application, as appropriate.

I am applying to register lawful permanent residence or adjust

status to that of a lawful permanent resident based on the

following immigrant category (select only one box). (See the

Form I-485 Instructions for more information, including any

Additional Instructions that relate to the immigrant category

you select.):

1.a. Family-based

Immediate relative of a U.S. citizen, Form I-130

Other relative of a U.S. citizen or relative of a lawful

permanent resident under the family-based preference

categories, Form I-130

Person admitted to the United States as a fiancé(e) or

child of a fiancé(e) of a U.S. citizen, Form I-129F

(K-1/K-2 Nonimmigrant)

Widow or widower of a U.S. citizen, Form I-360

VAWA self-petitioner, Form I-360

Alien worker, Form I-140

Alien entrepreneur, Form I-526

Employment-based 1.b.

Special Immigrant

Special immigrant juvenile, Form I-360

Certain Afghan or Iraqi National, Form I-360 or

Form DS-157

Religious worker, Form I-360

Certain international broadcaster, Form I-360

Certain G-4 international organization or family

member or NATO-6 employee or family member,

Form I-360

1.c.

What is your current immigration status (if it has changed

since your arrival)?

27.

Asylee or Refugee

Asylum status (INA section 208), Form I-589 or

Form I-730

Refugee status (INA section 207), Form I-590 or

Form I-730

1.d.

Human Trafficking Victim or Crime Victim

Crime victim (U Nonimmigrant), Form I-918,

derivative family member, Form I-918A, or

qualifying family member, Form I-929

Human trafficking victim (T Nonimmigrant), Form

I-914 or derivative family member, Form I-914A

1.e.