I-566, Interagency Record of Request (United States)
This form is to establish eligibility for immigration benefits in the United States. The form provided here is simply a sample of what the actual Form I-566 looks like.
U.S. Department of Homeland Security
Bureau of Citizenship and Immigration Service
I-566, Interagency Record of Request - A, G or NATO Dependent Employment Authorization or Change/Adjustment to/from A, G or NATO Status
START HERE - Please Type or Print in Black Ink.
Part 1. Information about you. ( The person seeking employment authorization or change/adjustment of status.)
1. Family Name _______________________________
Given Name _______________________________
Middle Name _______________________________
2. Home Address - Street Number and Name _______________________________
Apt. # _______________________________
City _______________________________
State _______________________________
Zip Code _______________________________
3. Mailing Address - Street Number and Name _______________________________
Apt. # _______________________________
C/O (in care of): _______________________________
City _______________________________
State _______________________________
Zip Code _______________________________
Daytime Phone # (with area code) _______________________________
4. Date of Birth (mm/dd/yyyy) _______________________________
5. Country of Birth _______________________________
6. Country of Citizenship _______________________________
7. Gender ____ Male ____ Female
8. Marital Status ____ Married ____ Not Married
9. Alien # (if any) _______________________________
10. Social Security # (if any) _______________________________
11. I-94 # (Arrival/Departure Document) _______________________________
12. DOS Personal Identification # (PID) _______________________________
13. Date of Last into U.S. (mm/dd/yyyy) _______________________________
14. Current Immigration Status _______________________________
15. Relationship to Principal (if applicable) _______________________________
Part 2. Information about principal alien.
1. Family Name _______________________________
Given Name _______________________________
Middle Name _______________________________
2. Home Address - Street Number and Name _______________________________
Apt. # _______________________________
City _______________________________
State _______________________________
Zip Code _______________________________
3. Date Tour of Duty Expected to End (mm/dd/yyyy) _______________________________
4. Country of Citizenship _______________________________
5. Marital Status ____ Married ____ Not Married
6. Job Title _______________________________
7. I-94 # (Arrival/Departure Document) _______________________________
8. DOS Personal Identification # (PID) _______________________________
Part 3. Type of request. (See instructions for complete information on the different types of requests.)
1. ____ I am requesting employment authorization as a:
a. ____ spouse.
b. ____ son or daughter, age: ___________, who:
____ is a full-time, post-secondary student.
____ is disabled.
2. I am requesting change/adjustment of status. (Select one.)
a. ____ Change of nonimmigrant status to A, G or NATO nonimmigrant - specifically to:
b. ____ Section 247(a), immigrant to A or G nonimmigrant.
c. ____ Change to other nonimmigrant status from A, G or NATO - specifically to:
d. ____ Adjustment from A, G or NATO nonimmigrant to immigrant.
e. ____ A-1, A-2, G-1 or G-2 nonimmigrant applying under Section 13 of the Act of September 11, 1957.
Part 4. Certification - Submit 2 copies with original signatures - "For Official Use Only" page must also be attached.
I certify under penalty of perjury that the foregoing is true and correct. I understand false information is a basis for denial or termination of the benefit requested and for other penalties provided by law and regulation. If I am requesting employment authorization, I further certify that I do not have a criminal record. I have not violated United States immigration and/or visa laws, I have not worked illegally in the United States, and I have paid Social Security and all applicable taxes on all employment in the United States.
If you checked box b or d in Question 1, you must submit evidence demonstrating that you were physically present in the United States on December 21, 2000.
Signature _______________________________
Date (mm/dd/yyyy) _______________________________
Part 5. Your personal information.
Your Name (family, given, middle) _______________________________
Date of Birth (mm/dd/yyyy) _______________________________
DOS Personal Identification # (PID) _______________________________
For Official Use Only
Part 6. Certification by Diplomatic Mission, International Organization, NATO/HQ SACT or NATO Member State. (Certifying official must have this information and page to complete process.)
____ I certify that the information provided on the first page of this Form I-566 is true and correct to the best of my knowledge and according to our official records.
____ As an applicant for employment authorization, I further certify that his or her eligibility has been verified under the provisions of:
____ A bilateral agreement with: _______________________________
____ A de facto agreement with: _______________________________
Check each of the following that apply:
____ Without a numerical limit.
____ With a numerical limit and this applicant is within the limit; and
____ Schedule B eligibility
____ Based on principal alien's G-4 status
As an applicant for status as a principal alien, I further certify that he or she is being offered the position of: _______________________________
and was notified to the DOS on (date): _______________________________
Signature of Certifying Officer or Official _______________________________
Printed Name _______________________________
Name and Address of Diplomatic Mission, International Organization, NATO/HQ SACT or NATO Member State _______________________________
Duty/Title _______________________________
Phone Number (include area code) _______________________________
Date (mm/dd/yyyy) _______________________________
Official Seal _______________________________
Part 7. DOS, NATO/HQ SACT and/or USUN use only.
1. The Department of State, NATO/HQ SACT and/or USUN:
____ Recommends the request be granted.
____ Recommends the request be denied.
If the recommendation is for denial, provide a reason(s) for such recommendation: _______________________________
2. Date (mm/dd/yyyy) _______________________________
Phone Number (include area code) _______________________________
3. Office: ____ Protocol ____ USUN ____ NATO/HQ SACT ____ Visa
4. Signature 1 _______________________________
Signature 2 _______________________________
Part 8. CIS use only.
1. From:
Adjudicator's Identification # _______________________________
CIS Office _______________________________
Office Phone Number (with area code) _______________________________
A # / File # _______________________________
2. To: ____ Protocol ____ USUN ____ NATO/HQ SACT ____ Visa Office (Subject filed under Section 13. Please advise CIS of your findings.)
3. Adjustment or Change of Status ____ Granted ____ Denied
Date of Decision (mm/dd/yyyy) _______________________________
If change of status granted, give new status: _______________________________
4. Request for Employment Authorization: ____ Granted ____ Denied
Date of Decision (mm/dd/yyyy) _______________________________
Valid to (mm/dd/yyyy) _______________________________
Classification: _______________________________
5. DOS/NATO/HQ SACT/USUN/Visa Office Notified: ____ Yes ____ No
Date of Notification (mm/dd/yyyy) _______________________________
-----------------------------
INSTRUCTIONS FOR FILLING OUT THIS FORM
-----------------------------
NOTE: Please read these instructions carefully. If you need more space to complete an answer, use a separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if you have one, and your Personal Identification Number (PID), if you have one, at the top of each sheet and indicate the number of the item to which the answer refers.
-----------------------------
Use Form I-566 to provide necessary information to DOS, DOD, NATO/HQ SACT and CIS to establish your eligibility to request certain immigration benefits. Such benefits may be available to:
• An eligible dependent of an A, G or NATO nonimmigrant requesting employment authorization.
• An A, G or NATO nonimmigrant requesting a change to another nonimmigrant status; or if you are currently in another nonimmigrant status and have been offered a position that requires you and any dependents to be reclassified as an A, G or NATO nonimmigrant; or
• An A, G or NATO nonimmigrant requesting adjustment to lawful permanent resident.
Form I-566 generally accompanies other forms. There is no filing fee for the I-566.
-----------------------------
When Should I Use Form I-566?
Use Form I-566 to facilitate the application process for various benefits that may be available to you if you are in, or wish to be in, A, G or NATO nonimmigrant status. This form provides information needed to identify you and the person from whom your status is, or will be, derived (the principal alien). Form I-566 assists government agencies and organizations in the exercise of their responsibility to adjudicate applications for immigration benefits, including requests for employment authorization and change or adjustment of status. The government agencies and organizations involved in the process are the:
• Department of State (DOS);
• Department of Defense (DOD);
• North Atlantic Treaty Organization/Headquarters, Supreme Allied Commander Transformation (NATO/HQ SACT); and
• Bureau of Citizenship and Immigration Services (CIS).
You must use this form if:
1. You are applying for employment authorization as an eligible A-1, A-2, G-1, G-3, G-4 or NATO 1-6 dependent. (Definitions and eligibility requirements may be found in 8 CFR 214.2(a), 214.2(g) and 214.2(s)); or
2. You are applying for a change or adjustment of status to, or from, A, G or NATO status.
Definitions
A # - Alien Registration Number assigned to an alien's administrative file.
8 CFR - Title 8, Code of Federal Regulations.
Certifying officer or official: A chief of a diplomatic mission, international organization director or authorized deputy, NATO member state official or NATO/HQ SACT Legal Advisor who is authorized to certify information about an applicant.
PID: Personal Identification Number. This is the number provided to eligible A and G nonimmigrants by the DOS.
Principal alien: A nonimmigrant admitted to work exclusively for a foreign government, international organization, or NATO in A, G or NATO status from whom family members derive their A, G or NATO status.
Statement from prospective employer: A statement on the employer's letterhead identifying the dependent. It must describe the position offered, duties to be performed, the salary offered, hours to be worked and verify that the dependent possesses the qualifications for the position. The statement must include the phone number, name and original signature of the person making the statement.
Statement from school: A statement on the letterhead of the dependent's post-secondary school that identifies the dependent, certifies that he or she is a full-time student, identifies the courses being taken, the credit hours being carried and provides the expected graduation date. The statement must include the phone number, name and original signature of the school official making the statement.
Statement from physician: A statement on the letterhead of the dependent's physician identifying the dependent and the certifying physician. It must identify the dependent's condition, describe the symptoms, provide a prognosis and certify that the dependent is physically/mentally unable to establish, re-establish or maintain a home of his or her own. The statement must include the phone number, name and original signature of the physician making the statement.
DOS Forms
DS-2003, Notification of Appointment of Foreign Diplomatic Officer and Career Consular Officer.
DS-2004, Notification of Appointment of Foreign Government Employee.
CIS Forms
I-94, Arrival/Departure Record, issued to nonimmigrants upon arrival in the United States.
I-129, Petition for a Nonimmigrant Worker.
I-407, Abandonment by Alien of Status as Lawful Permanent Resident.
I-485, Application to Register Permanent Residence or Adjust Status.
I-508, Waiver of Rights, Privileges, Exemptions and Immunities.
I-508F, form used by French nationals in conjunction with the I-508.
I-551, Alien Registration Receipt Card.
I-539, Application to Extend/Change Nonimmigrant Status.
I-765, Application for Employment Authorization.
How Do I File Form I-566?
A separate Form I-566 must be filed for each individual seeking an immigration benefit. Follow these steps to complete your request:
Step 1 -Reason for Filing Form I-566
Step 2 -Fill Out the Form I-566
Step 3 -Submit the Form I-566
Notice
CIS wants to make sure that you receive the requested benefit. To do this, we may ask for more evidence, interview you and/or conduct an investigation. If you give us false documents, misrepresent facts or otherwise engage in fraud, CIS will take appropriate action. This means we will not only deny your request, you may lose current and future immigration benefits. You may also face penalties, including criminal and/or civil prosecution leading to fines and/or imprisonment.
Step 1. Reason for Filing Form I-566.
Dependent Employment Authorization
Your request for employment authorization as an A, G or NATO dependent may be based on either:
1. A formal, written bilateral agreement between the United States and the country which employs the principal alien;
2. A de facto arrangement between the United States and the country which employs the principal alien (employment authorization under a de facto arrangement requires that the principal is a national of the country which employs him/her); or
3. The G-4 dependent employment regulations found in 8 CFR 214.2(g).
If you have a question about which provision may apply to you, contact the diplomatic mission, international organization, NATO/HQ SACT or DOD command that employs the principal alien.
If one of the provisions in 1, 2 or 3 applies to you, you must also show that you are an eligible dependent of a principal alien. Eligible dependents are the:
• Spouse or unmarried child under age 21; or
• Dependent unmarried son or daughter who is a full-time, post-secondary student between age 21 and 23 years (or between age 21 and 25 under certain bilateral agreements); or the
• Dependent unmarried son or daughter who is mentally or physically unable to care for him or herself and cannot establish his or her own household.
If you meet one of these conditions and believe you are eligible to apply for employment authorization, complete Parts 1, 2, 3 (Check Box "1a" or "1b"), 4 and 5 on Form I-566.
Evidence requirements
• If you are filing as the spouse or unmarried child under age 21:
- Bilateral agreement - submit documentation as specified in the applicable agreement.
- De facto arrangement or G-4 regulations - submit a statement from your prospective employer.
• If you are filing as the dependent unmarried son or daughter who is a full-time, post-secondary student between ages 21 and 23 years (or between ages 21 and 25 under certain bilateral agreements):
- Bilateral agreement - submit documentation as specified in the applicable agreement and a statement from your school.
- De facto arrangement or G-4 regulations - submit a statement from your prospective employer and school.
• If you are filing as the dependent unmarried son or daughter who is mentally or physically unable to care for yourself and cannot establish your own household:
- Bilateral agreement - submit documentation as specified in the applicable agreement and a statement from your physician.
- De facto arrangement or G-4 regulations - submit a statement from your prospective employer and physician.
• If you are requesting an extension of your employment authorization, submit the above noted required documents and any other documents required by the principal alien's sponsoring agency.
Change to/from Nonimmigrant A, G or NATO Status or Adjustment of Status
• Change of nonimmigrant status to A, G or NATO nonimmigrant.
Complete Form I-566, Parts 1, 3 (check Box "2a"), 4 and 5. Complete Part 2 if you are not applying to be the principal alien. Attach the required supporting documents:
- Your Form I-94 and Form I-539.
- A DS-2003 or DS-2004 form, as appropriate, if you are applying to be the principal alien.
• Section 247(a), immigrant to A or G nonimmigrant.
Complete Form I-566, Parts 1, 3 (check Box "2b"), 4 and 5. Complete Part 2 if you are not applying to be the principal alien. Attach the required supporting documents:
- A DS-2003 or DS-2004 form, as appropriate, if you are applying to be the principal alien.
NOTE: If you are a permanent resident who wishes to be employed by an A or G mission or organization while retaining your permanent resident status, contact the CIS district office having jurisdiction over your residence for instructions. (See section 247(b) of the Immigration and Nationality Act for more information.)
• Change to other nonimmigrant status from A, G or NATO.
Complete Form I-566, Parts 1, 3 (check Box "2c"), 4 and
5. Complete Part 2 if you are not applying to be the principal alien.
• Adjustment from A, G or NATO nonimmigrant to immigrant status.
Complete Form I-566, Parts 1, 3 (check Box "2d"), 4 and
5. Complete Part 2 if you are not applying to be the principal alien. Attach these required supporting documents:
- Your Form I-94 and Form I-485 package;
- Your Form I-508;
- If you are a French National, a Form I-508F; and
- All documentation required to establish eligibility for the status you are requesting.
1. A-1, A-2, G-1 or G-2 nonimmigrant applying under Section 13 of the Act of September 11, 1957.
Complete Form I-566, Parts 1, 3 (check Box "2e"), 4 and 5. Complete Part 2 if you are not applying to be the principal alien. Attach these required supporting documents:
- Your Form I-94 and Form I-485 package;
- Your Form I-508;
- If you are a French National, a Form I-508F; and
- All documentation required to establish eligibility for the status you are requesting.
Step 2. Fill Out the Form I-566.
Use black ink. Type or print clearly using capital letters. If an item does not apply to you, write "N/A." If the answer is none, write "NONE."
If you need extra space to answer any item, attach a sheet of paper and at the top of each sheet, write your name, A # (if any) and PID (if available). Indicate the item number to which the answer refers.
NOTE: If you are filling out this form by hand, only complete Page 1 and 2. When you are done, make a photocopy of these pages. If you are filling out this form electronically, input your information on the first two pages, pages 3 and 4 will be automatically populated. When you print the form, you will get 2 completed copies. No matter how you fill out the form, both copies must have an original signature.
This form is divided into Parts 1 through 8. The following information should help you fill out the form.
Part 1. Information about you. ( The person seeking employment authorization or change/adjustment of status.)
. Family Name (Last name) -Give your legal name. If you have two last names, include both and use a hyphen (-) between the names, if appropriate.
. Home Address - Give your physical street address in the United States. This must include a street number and name or a rural route number. Do not put a post office box (P.O. Box) number here.
. Mailing Address - Give your mailing address, if different from your home address.
. Daytime Phone Number (include area code) - Give a phone number in the United States where you may be reached during the day.
. Marital Status - Check the appropriate box. If you are divorced or widowed, mark "Not Married."
. A # -This is your file number. If you do not have an A number or do not know it, leave this blank.
. Social Security # - Give your U.S. Social Security number. If you do not have one, leave this blank.
• I-94 # -Give the number on the Form I-94, Arrival/Departure Document, you received upon your most recent admission into the United States.
• DOS Personal Identification # (PID) -This is the number provided to eligible A and G nonimmigrants by the DOS.
• Date of Last Entry into the U.S. -Give the date you last entered the United States.
• Current Immigration Status -Give your current status. If you changed status after admission to the United States, give your new status.
Part 2 - Information about principal alien.
• If you are a dependent family member filing for employment authorization or change/adjustment of status to or from an A, G or NATO nonimmigrant status, complete this part.
Part 3 - Type of request.
• Check and fill in any boxes that apply to your request.
Part 4 - Certification.
• Sign and date the Form I-566 (both copies). If both copies of the form are not signed, your request will be returned as incomplete. A parent or guardian may sign, if appropriate.
Part 5 - Your personal information.
• You, the person making the request, must complete this part to assist the agencies involved in responding to your request.
Parts 6, 7 and 8 are for official use only.
• This page, with only Part 5 filled in, must be submitted with your request. You, the requester, do not fill in any of Parts 6, 7 and 8.
Step 3. Submitting the Form I-566.
Your Form I-566 must include the following items.
• Your signed and completed Form I-566. Two (2) copies of both pages of the form must be submitted. Both copies must have an original signature in Part 4.
NOTE: If your request is urgent, you may so indicate by attaching a written request. Every effort will be made to expedite processing.
• Filing fee. There is no fee for filing Form I-566. However, there may be a filing fee for the associated petition or application. If the petition or application is submitted with this request, read the instructions on the associated form for fee information.
• Evidence. Attach copies of the front and back of the documents you need to support your request. See Step 1, Reason for Filing Form I-566, for detailed document requirements. Do not send original documents unless instructed to do so.
NOTE: Documents not in English must have a full English translation. The translator must provide a statement that the translation is complete and correct and that he or she is competent to translate the foreign language into English.
Submit your Form I-566. See the following to determine how your I-566 is to be submitted.
If You Are Requesting Employment
NOTE: A completed and signed Form I-765 must be attached to the Form I-566, and include all required documentation. See Form I-765 instructions for additional information.
Submit your request as follows:
- A and G Dependents: Submit your complete Form I-566 package, including the Form I-765, to the DOS office in Washington, D.C. through your diplomatic mission or international organization. In New York City, the United Nations (UN) and UN missions should submit the package to the U.S. Mission to the UN (USUN).
The DOS or USUN will forward favorably endorsed requests directly to the CIS. If your Form I-765 application is approved, the CIS will transmit your employment authorization in accordance with current procedures.
- NATO Dependents: Submit your complete Form I-566 package, including the Form I-765, to NATO/HQ SACT Legal Affairs, 7857 Blandy Road, Suite 100, Norfolk, VA 23551-2490. Questions regarding the process or document requirements may be directed to HQ SACT by telephoning (757) 445-3640.
If a bilateral dependent employment agreement contains a numerical limitation on the number of dependents authorized to work, NATO/HQ SACT or DOD will consult with DOS to determine whether this numerical limitation has been reached. NATO/HQ SACT or DOD will forward favorably endorsed requests directly to the CIS.
If your Form I-765 application is approved, the CIS will transmit your employment authorization in accordance with current procedures.
If You Are Requesting a Change/Adjustment of Status - Submit your request as follows:
- Submit the following requests to your diplomatic mission, international organization or NATO/HQ SACT.
• Change of nonimmigrant status to A, G or NATO status.
The diplomatic mission, international organization or NATO/HQ SACT will forward your Form I-566 and Form I-539 application package to the DOS/Visa Office or USUN. The DOS/Visa Office or USUN will forward favorable endorsements to the CIS
• Section 247(a), immigrant to A or G nonimmigrant.
Upon receipt of your Form I-566 with a favorable DOS endorsement, submit both copies of it, your Permanent Resident Card (Form I-551) and Form I-407 to the CIS office having jurisdiction (see instructions on Form I-407).
- Submit the following request directly to DOS/Visa Office or USUN.
• Change to other nonimmigrant status from A, G or NATO.
Upon receipt of a favorable endorsement from the DOS/Visa Office or USUN, submit both copies of the Form I-566, your Form I-94, Form I-539 or Form I-129 (as appropriate), and all documentation required to establish eligibility for the requested status to the CIS office having jurisdiction (see instructions on Forms I-539 or I-129).
Submit the following request directly to the CIS office having jurisdiction (see instructions on Form I-485.)
• Adjustment from A, G or NATO nonimmigrant to immigrant.
• A-1, A-2, G-1 or G-2 nonimmigrant applying under Section 13 of the Act of September 11, 1957.
The CIS will forward this request to the DOS/Visa Office or USUN, as appropriate. The DOS/Visa Office or USUN will advise the CIS of its official position, the date of onset and termination of status, and whether there are any objections to the requested adjustment under Section 13.
Processing Information.
Our goal at CIS is to process all requests fairly. The processing time will vary depending on the specific circumstances of each case. We may reject an incomplete request. We may deny your request if you do not give us the required information or do not go to a scheduled interview.
CIS Forms and Information. To request CIS forms, call our toll-free forms line at 1-800-870-3676. You may also obtain CIS forms and information about immigration laws and regulations by calling 1-800-375-5283 or from the CIS internet website at www.uscis.gov.
Privacy Act Notice. The CIS will use the information on Form I-566 to determine eligibility for the requested immigration benefit. We may provide information on your request to other government agencies.
Paperwork Reduction Act Notice. You are not required to respond to this form unless it displays a currently valid OMB control number. We try to create forms and instructions that are accurate, can be easily understood and impose the least possible burden on you to provide us with information. Often this is difficult because some immigration laws are very complex. The estimated average time to complete and file this form is 15 minutes. If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you may write to the Bureau of Citizenship and Immigration Services, HQRFS, 425 "I" Street, N.W., Room 4034, Washington, D.C. 20536. Do not mail your request to this address.
Check List
• If you filled out the Form I-566 by hand, did you:
____ Completely fill out the form;
____ Make 2 copies; and
____ Sign both copies?
• If you filled out the Form I-566 electronically, did you:
____ Completely fill out the form; and
____ Sign both copies?
• AND:
____ Are both copies of the "Official Use Form attached?"
____ Did you attach all other required documents?
For your records, you should keep copies of your Form I-566 package.