Form I 854 PDF Details

Navigating the complexities of immigration processes can often seem daunting, especially when dealing with specialized forms like the Form I-854, also known as the Inter-Agency Alien Witness and Informant Record. This form plays a crucial role in the legal framework that governs how non-U.S. citizens can assist law enforcement agencies within the United States. Designed for use by these agencies, the Form I-854 enables them to request an S classification for aliens who are willing to provide critical information or testify in situations concerning criminal activities or investigations. The form carefully outlines the specifics of the alien's status, background, and the conditions under which they can assist U.S. law enforcement efforts. Notably, it includes sections dedicated to ensuring the safety of the informant or witness by evaluating any potential dangers they may face, whether in the United States or abroad. Law enforcement agencies must complete detailed information regarding the alien's identity, criminal history, and the legal basis for the S classification request. Additionally, the form addresses security concerns and includes certifications by both the alien and the requesting law enforcement agency to affirm the accuracy and truthfulness of the provided information. With this form, there's a pathway created not just for the administration of justice but also for ensuring the safety and legal compliance of those aliens willing to assist in law enforcement operations, proving to be a critical tool in the intersection of immigration law and criminal justice.

QuestionAnswer
Form NameForm I 854
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesi854 form, form i 854, G-325, 7a

Form Preview Example

OMB No. 1615-0046; Expires 07/31/2015

Department of Homeland Security

U.S. Citizenship and Immigration Services

Form-I-854, Inter-Agency Alien Witness and Informant Record

START HERE - Type or print in black ink.

Part A. To be completed by Law Enforcement Agencies (See instructions for specific information.)

1.Name of LEA/Requestor:

2.Requesting Agent: Address:

Check if applicable:

3.

Alien will be placed in danger in

United States

Alien poses no danger to people or property of the U.S.

Control Agent:

Phone No.(Including Area Code):

Fax No.(Including Area Code):

abroad as a result of providing information, etc.

If the alien poses a danger, the danger posed by the alien is outweighed by the assistance the alien will furnish.

Investigation.

Prosecution.

United States Attorney involvement.

4.Type of Request(s). (Attach legal basis for request.)

S-5

S-6

Consular post at which visa will be sought:

Change of Status - If change of status is requested, current immigration status is

Adjustment of Status (Go to Part F after completing information in items 5, 6 and 7 below.)

Fees attached (when applicable)

Security concerns. State special instructions regarding security precautions.

NOTE: Provide a clear statement of the operations that form the basis of the request (e.g., Grand Jury subpoena), the objective of the request and any bargain the requestor wishes to make or has made with the alien. Attach a complete criminal history, FBI No. and U.S. Social Security Number.

5. Alien's Name (Last Name, First and Middle)

Other Names Used

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Alien's Address (Street Number and Name)

A-Number

I-94 Number

 

 

 

 

 

 

 

 

 

 

 

 

City

 

State or Province

Zip/Postal Code

Current Location of Alien

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Marital Status

Date of Birth

Place of Birth (City or Country)

Citizenship/Nationality

 

Occupation

 

 

(mm/add/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Last Entry into U.S. (mm/dd/yyyy):

 

 

 

Form G-325

 

 

Form FD-258

 

 

 

Photos

 

 

 

 

 

 

 

 

 

 

 

attached

 

 

attached

 

 

 

attached

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.On a separate application, provide all information requested in item 5 above for each beneficiary who seeks derivative status - spouse, parents and all sons and daughters of the alien for whom an S classification is requested. (Attach additional sheets of paper as necessary.)

Form I-854 07/24/13 Y Page 1

7a. The following information must be provided for each alien named in items 5 and 6 above.

Has the alien, while outside of the United States, ever committed, ordered, incited, assisted, or otherwise participated in genocide, torture, or extrajudicial killing or participated in Nazi persecution?

Yes

No

If yes please write a detailed statement below and attach any relevant documents. (Attach additional

sheets of paper as needed.)

 

7b. For the above named alien, I request waiver(s) of the following grounds of inadmissibility. (Check all possible grounds and attach all relevant documents establishing the ground(s) of inadmissibility and why you feel a waiver is appropriate for this alien. This information must be provided for each alien named in items 5 and 6 above. Copy this check list of the grounds of inadmissibility for each derivative.)

Communicable disease

Immigrant visa issued outside numerical limitation Crime involving moral turpitude

International child abduction

Multiple criminal convictions

Engaged in unlawful commercialized vice

Entrance prejudicial to public

Involved in espionage, sabotage or laws relating to technology Coming to overthrow the U.S. Government

Foreign policy exclusion

Unqualified physician

Previously removed - aggravated felony

Stowaway

Nonimmigrant without a valid passport or visa

Previously excluded and deported or removed

Alien smuggler

Physical/mental disorder (dangerous)

Drug abuser or addict

Convicted of law pertaining to controlled substances

Controlled substance trafficker

Prostitute and/or Procurer of Prostitution

Exercised diplomatic immunity to avoid prosecution

Unlawful activity related to National Security

Terrorist activities

Communist Party member

Public charge

Lacking labor certification

Fraud/Misrepresentation

Immigrant without a visa

Draft evader-was immigrant when left U.S.

Alien accompanying helpless inadmissible alien

Violator of section 274C

Ordered, incited, assisted or otherwise participated in the commission of the acts of torture or extra judicial killing.

Engaged in conduct relating to severe violations of religious freedoms

Weapons charges, domestic violence, and money laundering

Other

No waivers are requested/needed

Form I-854 07/24/13 Y Page 2

Part B. Certifications

1.Alien Certification (S classification request)

I certify under penalty of perjury that I have reviewed with the LEA all the information in Part A, disclosed all information to the best of my ability, and disclosed all reasons for which I may be removed from the United States; that I shall report at least every three months my whereabouts and activities as the above LEA shall require; that I understand I am subject to removal for any grounds of inadmissibility (conduct or condition) not disclosed at this time or for conduct committed after admission to the United States; that I shall abide by all conditions, limitations and restrictions imposed upon my entry; that the classification I seek is temporary and will terminate within three (3) years; that I am restricted by the terms of my admission to very specific means by which I will be able to remain permanently in the United States; that I will pay Social Security and all applicable taxes on all employment in the United States; and that I hereby waive my right to a removal hearing and to contest, other than on the basis of an application for withholding of removal, any action for deportation instituted against me.

Certification: I certify that I have read and understand all the questions and statements on this form. If I do not understand English, I further acknowledge that this has been read to me in a language I do understand. The answers I have furnished are true and correct to the best of my knowledge and belief.

Signature

 

 

 

Date (mm/dd/yyyy)

 

 

 

 

 

LEA Witness

 

Title

 

Date (mm/dd/yyyy)

 

 

 

 

 

Translator

 

Language Used

 

Date (mm/dd/yyyy)

2.LEA Certification

I certify the above information is true and correct to the best of my knowledge; that I may make, have made, and will make no promises regarding the above alien's ability to adjust status or stay permanently in the United States other than those that comport with section 101(a)(15)(S) of the Act; that I will collect quarterly reports detailing the above alien's whereabouts and activities and forward required information to the Criminal Division; that I will immediately report to U.S. Immigration and Customs Enforcement, DHS if this alien fails to report quarterly or fails to comply or to cooperate with the terms and conditions of admission or if the alien commits any removable activity after the date of admission. I further certify that I assume complete law enforcement responsibility for control and continued stay in lawful status of the alien, including necessary monitoring, travel arrangements for arrival and departure, safety precautions and specified conditions of stay or departure; that I have provided a sworn declaration as to the basis of this application and checked all available database information on the above alien, and that I have carefully reviewed the above statements with the alien to ensure that all terms and conditions are understood.

Translation (This serves to verify the alien's certification of translation. See Page 2, Part B.1. of this form.)

Signature of HQ Chief of LEA

Title of Certifier

Date (mm/dd/yyyy)

 

 

 

 

Name of Agency Contact

 

 

Phone Number (Including Area Code)

Form I-854 07/24/13 Y Page 3

3.For United States Attorney Use Only (if applicable)

Because the alien's presence is essential to the success of a Federal or State investigation or prosecution, the United States Attorney recommends the above request be granted and further certifies that there has not been and will not be any promises at all regarding the above alien's ability to adjust status or stay permanently in the United States, other than those that comport with section 101(a) (15)(S) of the Act.

Signature

Office

4.For U.S. Department of State/Rewards Committee - S6 Classification use only

After checking all information, the U.S. Department of State:

Certifies the alien is eligible to receive an award under 22 U.S.C 2708(a).

Certifies the alien is not eligible for such award.

Date (mm/dd/yyyy)

Phone Number (Including Area Code)

Date (mm/dd/yyyy)

Signature

Date (mm/dd/yyyy)

Phone Number (Including Area Code)

 

 

 

 

Title

 

Office

Part C. For Department of Justice, Criminal Division Use Only

After checking and evaluating all waiver and other information available, the Department of Homeland Security, U.S. Immigration and Customs Enforcement and Department of Justice, Criminal Division:

Certify that, pursuant to section 101(a)(15)(S) of the Act and the request of the above LEA, the above alien is recommended for the S classification requested, that the above request(s) for waivers of inadmissibility appear to warrant approval, that all conditions and limitations of the request for classification are attached, that this request falls within the numerical limitation for an S visa and that, therefore, this request is forwarded to the Assistant Secretary of Immigration and Customs Enforcement for approval.

Deny request

Signature

Date (mm/dd/yyyy)

Phone Number (Including Area Code)

 

 

 

 

Title

 

Office

Form I-854 07/24/13 Y Page 4

Part D. For U.S. Immigration and Customs Enforcement Use Only

Fee Received (If applicable)

Request Denied

Waiver(s) of Grounds of Inadmissibility

Note all grounds waived and conditions attached thereto.

Signature

Title

Request Granted

Date (mm/dd/yyyy) Phone Number (Including Area Code)

Office

Part E. For U.S. Citizenship and Immigration Services Use Only

LEA Request:

Granted

Forward to DOS/VO

 

Change of Classification Granted

Signature

Title

Denied

Denied

Date (mm/dd/yyyy) Phone Number (Including Area Code)

Office

Part F. For Department of State/Visa Office Use Only

Forwarded to Consul by VO for Visa Approval

Not Forwarded

 

Signature

Date (mm/dd/yyyy)

Phone Number (Including Area Code)

 

 

 

 

 

 

 

 

Title

 

Office

 

 

 

 

 

 

 

Visa Granted

 

 

 

 

 

 

 

 

 

 

 

 

Visa Denied

Signature

 

 

 

Date (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

Office

Form I-854 07/24/13 Y Page 5

Part G. Request to allow an S Nonimmigrant to file for adjustment of status to permanent resident

(For Department of Justice, Criminal Division Use Only)

(Please attach all relevant documentation establishing (1) the information certified below; (2) the recommendations and reasons for the certified recommendations.)

1. Name of LEA:

 

 

 

submitting request to allow an S nonimmigrant to

 

 

 

 

file for adjustment of status.

Date Submitted (mm/dd/yyyy):

 

 

 

 

 

 

2.Criminal Division (Assistant Attorney General) Certifications.

I certify that

 

has -

(Alien's Name)

If S-5:

Supplied the information that formed the basis of entry;

If S-6:

The information substantially contributed to the success of an authorized criminal investigation or the prosecution of an individual as per terms of entry.

Supplied the information that formed the basis of entry;

The information substantially contributed to the prevention or frustration of an act of terrorism against a U.S. person or property or the success of an authorized criminal investigation of, or the prosecution of, an individual involved in such an act of terrorism.

If S-5 or S-6:

Has received a reward under section 36(a) of the State Department Basic Authorities Act of 1956;

 

 

Has abided by all the terms, conditions and specific 22 U.S.C. 2708(a) limitations of the S classification.

Other Comments:

Signature

Date (mm/dd/yyyy)

Phone Number (Including Area Code)

 

 

 

 

Title

 

Office

 

 

 

3. For U.S. Citizenship and Immigration Services Use Only

 

 

Adjustment

Other Action

Signature

Date (mm/dd/yyyy)

Phone Number (Including Area Code)

 

 

 

 

Title

 

Office

Form I-854 07/24/13 Y Page 6

How to Edit Form I 854 Online for Free

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As for the blank fields of this precise PDF, this is what you should know:

1. When submitting the DHS, be sure to incorporate all necessary blanks within its corresponding part. This will help to expedite the work, allowing your details to be processed quickly and properly.

Guidelines on how to prepare inadmissibility portion 1

2. Soon after this section is filled out, go to type in the suitable information in these - Adjustment of Status Go to Part F, Fees attached when applicable, Security concerns State special, NOTE Provide a clear statement of, request and any bargain the, Aliens Name Last Name First and, Other Names Used, Aliens Address Street Number and, ANumber, I Number, City, State or Province, ZipPostal Code Current Location of, Marital Status, and Date of Birth mmaddyyyy.

Writing segment 2 of inadmissibility

Concerning ANumber and City, make sure that you get them right in this current part. The two of these are surely the most important fields in the document.

3. This third part is generally straightforward - fill out all of the fields in Has the alien while outside of the, Yes, If yes please write a detailed, b For the above named alien I, attach all relevant documents, Communicable disease, and Controlled substance trafficker to conclude the current step.

inadmissibility conclusion process detailed (step 3)

4. To go forward, this fourth form section will require filling in a couple of form blanks. These comprise of Immigrant visa issued outside, Prostitute andor Procurer of, Crime involving moral turpitude, Exercised diplomatic immunity to, International child abduction, Multiple criminal convictions, Unlawful activity related to, Terrorist activities, Engaged in unlawful commercialized, Communist Party member, Entrance prejudicial to public, Public charge, Involved in espionage sabotage or, Lacking labor certification, and Coming to overthrow the US, which are fundamental to moving forward with this particular form.

Engaged in unlawful commercialized, Prostitute andor Procurer of, and Public charge of inadmissibility

5. This form has to be wrapped up by going through this segment. Further you will find a comprehensive list of fields that must be filled out with accurate details to allow your form usage to be accomplished: Physicalmental disorder dangerous, Drug abuser or addict, Convicted of law pertaining to, Engaged in conduct relating to, Weapons charges domestic violence, Other, No waivers are requestedneeded, and Form I Y Page.

Best ways to fill in inadmissibility part 5

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