Supplement A to Form I-485, Adjustment of Status Under Section 245(i)

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

Form I-485 Supplement A Edition 07/15/22 Page 1 of 4

Supplement A to Form I-485,

Adjustment of Status Under Section 245(i)

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-485

OMB No. 1615-0023

Expires 03/31/2023

1.b.

1.c.

1.a. Family Name

(Last Name)

Given Name

(First Name)

Middle Name

Your Current Legal Name

Part 1. Information About You

U.S. Mailing Address

NOTE: Use Supplement A to Form I-485, Adjustment of Status Under INA Section 245(i) (Supplement A), only if you are applying

to adjust status to that of a lawful permanent resident under the Immigration and Nationality Act (INA) section 245(i). You may file

Supplement A only if you are filing your Form I-485, Application to Register Permanent Residence or Adjust Status, at the same time

or if you previously filed your Form I-485 and it remains pending.

START HERE - Type or print in black ink.►

City or Town2.d.

ZIP Code2.f.State2.e.

Street Number

and Name

2.b.

2.c. Apt. Flr.Ste.

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

►A-

Alien Registration Number (A-Number) (if any)3.

►

4. USCIS Online Account Number (if any)

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

6. Country of Birth

7. Country of Citizenship or Nationality

You are or were the principal beneficiary of an

immigrant petition or application for permanent labor

certification filed on or before January 14, 1998.

1.a.

You are or were the principal beneficiary of an

immigrant petition or application for permanent labor

certification filed on or after January 15, 1998, and

on or before April 30, 2001, and you were physically

present in the United States on December 21, 2000.

1.b.

You are or were the derivative beneficiary of an

immigrant petition or application for permanent labor

certification filed on or before January 14, 1998.

1.c.

You are or were the derivative beneficiary of an

immigrant petition or application for permanent labor

certification filed on or after January 15, 1998, and

on or before April 30, 2001, and the principal

beneficiary was physically present in the United

States on December 21, 2000.

1.d.

You are currently the spouse applying to accompany

or follow-to-join your spouse OR the child

(unmarried and under 21 years of age) applying to

accompany or follow-to-join your parent described in

Item Numbers 1.a. - 1.d.

1.e.

Provide the following information about the immigrant petition

or application for permanent labor certification filed on or

before April 30, 2001 that qualifies you to adjust status under

INA section 245(i).

2. Receipt Number of Petition (if any)

Part 2. Eligibility

You claim eligibility to adjust status under INA section 245(i)

because (Select only one box):

Basis of INA Section 245(i) Eligibility

Qualifying Petition or Application

Other Information

(USPS ZIP Code Lookup)