Interagency Record of Request -- A, G or NATO Dependent Employment Authorization or Change/Adjustment to/from A, G or NATO Status

• Legal Form Number: I-566
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-566 Edition 12/02/21 Page 1 of 8

Interagency Record of Request -

A, G, or NATO Dependent Employment Authorization or

Change/Adjustment To/From A, G, or NATO Status

Department of Homeland Security

U.S. Citizenship and Immigration Services

A-

►

8. Gender Male Female

7. Country of Citizenship or Nationality

Marital Status9.

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

►

10.

►

U.S. Social Security Number (SSN) (if any)11.

Department of State (DOS) Personal Identification

Number (PID)

12.

13. USCIS Online Account Number (if any)

Other

Marriage AnnulledLegally Separated

MarriedSingle Divorced Widowed

Other Information

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

6. Country of Birth

Provide your relationship to the principal alien

(if applicable).

14.

15.a. Form I-94 Arrival-Departure Record Number (if any)

►

Information About Your Last Arrival into the

United States

Select this box if

Form G-28 is

attached.

Attorney State Bar Number

(if applicable) Attorney or Accredited Representative

USCIS Online Account Number (if any)

Part 1. Information About You

Full Legal Name

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

Street Number

and Name

2.b.

2.d. City or Town

2.e. State 2.f. ZIP Code

2.c. Ste. Flr.Apt.

In Care Of Name (if any)2.a.

U.S. Mailing Address

NOTE: The person requesting employment authorization or

change/adjustment of status provides the requested information.

3. Is your current mailing address the same as your physical

address? Yes No

U.S. Physical Address

Street Number

and Name

4.a.

4.c. City or Town

4.d. State 4.e. ZIP Code

4.b. Ste. Flr.Apt.

To be completed by an

attorney or accredited

representative (if any).

USCIS

Form I-566

OMB No. 1615-0027

Expires 12/31/2023

START HERE - Type or print in black ink.►

A-Number:

(USPS ZIP Code Lookup)

FOR USCIS OFFICE ONLY

Remarks:

NOTE: If you answered “No” to Item Number 3., provide

your physical address in Item Numbers 4.a. - 4.e.