I 821D – Fill Out and Use This PDF

The I-821D form is a request for Consideration of Deferred Action for Childhood Arrivals (DACA) submitted to the Department of Homeland Security, U.S. Citizenship and Immigration Services. This form allows eligible individuals to apply for deferred action status, which can provide temporary relief from deportation and opportunities for work authorization. For accurate processing, fill out the form completely and carefully review the instructions provided.

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I 821D PDF Details

Navigating the intricacies of immigration policies and procedures is pivotal for individuals seeking to alter their residency status in the United States. The I-821D form, specifically designed for the Consideration of Deferred Action for Childhood Arrivals (DACA) by the Department of Homeland Security and processed by the U.S. Citizenship and Immigration Services (USCIS), serves as a gateway for eligible individuals dreaming of cementing their stay and working in the U.S. without the immediate fear of deportation. The form caters to both initial and renewal requests, embodying hope for those brought to the U.S. as children. Detailed sections within the form guide applicants through providing personal information, residency and travel history, criminal, national security, and public safety information, culminating in statements, certifications, and signatures that attest to the truthfulness and accuracy of the provided information. Furthermore, it touches on educational achievements and potential military service, reflecting a comprehensive review of an individual's life in and contributions to the United States. The required accompaniment of Forms I-765 and I-765WS for employment authorization indicates the program's holistic approach to integrating individuals fully into societal fabric. With stringent criteria demanding continuous residence since June 15, 2007, clean criminal records, and specific educational milestones, the form underscores the U.S. government's meticulous process in determining who qualifies for deferred action.

Question	Answer
Form Name	I 821D
Form Length	7 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 45 sec
Other names	daca forms, form daca, 821d, form i 821d pdf

Form Preview Example

Consideration of Deferred Action

for Childhood Arrivals

Department of Homeland Security

U.S. Citizenship and Immigration Services

A-

Receipt

For

USCIS

Case ID:

Use

Requestor interviewed

Only

Returned:

Relocated

Received:

Remarks

Resubmitted:

/ /

Sent:

To Be Completed

by an Attorney or

Select this box if Form G-28 is attached to

Accredited Representative, if any.

represent the requestor.

USCIS

Form I-821D

OMB No. 1615-0124

Expires 03/31/2023

Action Block

Attorney State Bar Number (if any):

►START HERE - Type or print in black ink. Read Form I-821D Instructions for information on how to complete this form.

Part 1. Information About You (For Initial and

Renewal Requests)

I am not in immigration detention and I have included Form I-765, Application for Employment Authorization, and Form I-765WS, Form I-765 Worksheet; and

I am requesting:

1.Initial Request - Consideration of Deferred Action for Childhood Arrivals

2.Renewal Request - Consideration of Deferred Action for Childhood Arrivals

AND

For this Renewal request, my most recent period of Deferred Action for Childhood Arrivals expires on

(mm/dd/yyyy) ►

Removal Proceedings Information

5.Are you NOW or have you EVER been in removal proceedings, or do you have a removal order issued in any other context (for example, at the border or within the United States by an immigration agent)?

Yes No

NOTE: The term “removal proceedings” includes exclusion or deportation proceedings initiated before April 1, 1997; an Immigration and Nationality Act (INA) section 240 removal proceeding; expedited removal; reinstatement of a final order of exclusion, deportation, or removal; an INA section 217 removal after admission under the Visa Waiver Program; or removal as a criminal alien under INA section 238.

If you answered "Yes" to Item Number 5., you must select a box below indicating your current status or outcome of your removal proceedings.

Full Legal Name

3.a. Family Name

(Last Name)

3.b. Given Name

(First Name)

3.c. Middle Name

U.S. Mailing Address (Enter the same address on Form I-765)

4.a. In Care Of Name (if applicable)

4.b.	Street Number
	Street Number
	and Name
4.c.	Apt.
4.c.	Apt.	Ste.	Flr.
4.d.	City or Town



4.e.	State		4.f. ZIP Code
4.e.	State		4.f. ZIP Code

Status or outcome:

5.a.	Currently in Proceedings (Active)
5.b.	Currently in Proceedings (Administratively Closed)
5.c.	Terminated
5.d.	Subject to a Final Order
5.e.	Other. Explain in Part 8. Additional Information.

5.f. Most Recent Date of Proceedings

(mm/dd/yyyy) ►

5.g. Location of Proceedings

Form I-821D Edition 08/31/21

Page 1 of 7

Part 1. Information About You (For Initial and

Renewal Requests) (continued)

Other Information

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

► A-

7.U.S. Social Security Number (if any)

►

Date of Birth

(mm/dd/yyyy) ►

Gender

Male

Female

10.a. City/Town/Village of Birth

10.b. Country of Birth

11.Current Country of Residence

12.Country of Citizenship or Nationality

13.Marital Status

Married Widowed Single Divorced

Other Names Used (If Applicable)

If you need additional space, use Part 8. Additional Information.

14.a. Family Name (Last Name)

14.b. Given Name

(First Name)

14.c. Middle Name

Processing Information

15.Ethnicity (Select only one box)

Hispanic or Latino

Not Hispanic or Latino

16.Race (Select all applicable boxes)

White

Asian

Black or African American

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

17.	Height	Feet		Inches
18.

	Weight		Pounds

19.Eye Color (Select only one box)

Black	Blue	Brown
Gray	Green	Hazel
Maroon	Pink	Unknown/Other

20.Hair Color (Select only one box)

Bald (No hair)	Black	Blond
Brown	Gray	Red
Sandy	White	Unknown/
		Other

Part 2. Residence and Travel Information (For

Initial and Renewal Requests)

1.I have been continuously residing in the U.S. since at least

June 15, 2007, up to the present time.	Yes	No

NOTE: If you departed the United States for some period of time before your 16th birthday and returned to the United States on or after your 16th birthday to begin your current period of continuous residence, and if this is an initial request, submit evidence that you established residence in the United States prior to 16 years of age as set forth in the instructions to this form.

For Initial Requests: List your current address and, to the best of your knowledge, the addresses where you resided since the date of your initial entry into the United States to present.

For Renewal Requests: List only the addresses where you resided since you submitted your last Form I-821D that was approved.

If you require additional space, use Part 8. Additional

Information.

Form I-821D Edition 08/31/21

Page 2 of 7

Part 2. Residence and Travel Information (For

Initial and Renewal Requests) (continued)

Present Address
2.a.	Dates at this residence (mm/dd/yyyy)
	From ►			To ►	Present
2.b.	Street Number
	Street Number
	and Name
2.c.	Apt.
2.c.	Apt.	Ste.	Flr.
2.d.	City or Town



2.e.			2.f. ZIP Code
2.e.	State		2.f. ZIP Code


Address 1
3.a.	Dates at this residence (mm/dd/yyyy)
	From ►			To ►

3.b.	Street Number
	Street Number
	and Name
3.c.	Apt.
3.c.	Apt.	Ste.	Flr.
3.d.	City or Town



3.e.			3.f. ZIP Code
3.e.	State		3.f. ZIP Code


Address 2
4.a.	Dates at this residence (mm/dd/yyyy)
	From ►			To ►

4.b.	Street Number
	Street Number
	and Name
4.c.	Apt.
4.c.	Apt.	Ste.	Flr.
4.d.	City or Town



4.e.			4.f. ZIP Code
4.e.	State		4.f. ZIP Code


Address 3
5.a.	Dates at this residence (mm/dd/yyyy)
	From ►			To ►

5.b.	Street Number
	Street Number
	and Name
5.c.
5.c.	Apt.	Ste.	Flr.
5.d.	City or Town




5.e.	State		5.f. ZIP Code

Travel Information

For Initial Requests: List all of your absences from the United States since June 15, 2007.

For Renewal Requests: List only your absences from the United States since you submitted your last Form I-821D that was approved.

If you require additional space, use Part 8. Additional

Information.

Departure 1
6.a.
6.a.	Departure Date	(mm/dd/yyyy) ►
6.b.

	Return Date	(mm/dd/yyyy) ►
6.c.
6.c.	Reason for Departure


Departure 2
7.a.
7.a.	Departure Date	(mm/dd/yyyy) ►
7.b.

	Return Date	(mm/dd/yyyy) ►
7.c.
7.c.	Reason for Departure

8.Have you left the United States without advance parole on

	or after August 15, 2012?	Yes	No
		Yes	No
9.a.	What country issued your last passport?
9.b.
9.b.	Passport Number
9.c.
9.c.	Passport Expiration Date
	(mm/dd/yyyy) ►

10.Border Crossing Card Number (if any)

Part 3. For Initial Requests Only

1.I initially arrived and established residence in the U.S.

prior to 16 years of age.	Yes	No

2.Date of Initial Entry into the United States (on or about)

(mm/dd/yyyy) ►

3.Place of Initial Entry into the United States

Form I-821D Edition 08/31/21

Page 3 of 7

Part 3. For Initial Requests Only (continued)

4.Immigration Status on June 15, 2012 (e.g., No Lawful Status, Status Expired, Parole Expired)

5.a. Were you EVER issued an Arrival-Departure Record
(Form I-94, I-94W, or I-95)?	Yes	No

5.b. If you answered "Yes" to Item Number 5.a., provide your Form I-94, I-94W, or I-95 number (if available).

►

5.c. If you answered "Yes" to Item Number 5.a., provide the date your authorized stay expired, as shown on Form I-94, I-94W, or I-95 (if available).

(mm/dd/yyyy) ►

Education Information

6.Indicate how you meet the education guideline (e.g., Graduated from high school, Received a general educational development (GED) certificate or equivalent state-authorized exam, Currently in school)

7.Name, City, and State of School Currently Attending or Where Education Received

8.Date of Graduation (e.g., Receipt of a Certificate of Completion, GED certificate, other equivalent state- authorized exam) or, if currently in school, date of last attendance. (mm/dd/yyyy) ►

Military Service Information

9.Were you a member of the U.S. Armed Forces or U.S.

Coast Guard?	Yes	No

If you answered "Yes" to Item Number 9., you must provide responses to Item Numbers 9.a. - 9.d.

9.a. Military Branch

9.b. Service Start Date (mm/dd/yyyy) ►

9.c. Discharge Date (mm/dd/yyyy) ►

9.d. Type of Discharge

Part 4. Criminal, National Security, and Public

Safety Information (For Initial and Renewal

Requests)

If any of the following questions apply to you, use Part 8. Additional Information to describe the circumstances and include a full explanation.

1.Have you EVER been arrested for, charged with, or convicted of a felony or misdemeanor, including incidents handled in juvenile court, in the United States? Do not include minor traffic violations unless they were alcohol-

or drug-related.	Yes	No

If you answered “Yes,” you must include a certified court disposition, arrest record, charging document, sentencing record, etc., for each arrest, unless disclosure is prohibited under state law.

2.Have you EVER been arrested for, charged with, or convicted of a crime in any country other than the United

States?	Yes	No

If you answered "Yes," you must include a certified court disposition, arrest record, charging document, sentencing record, etc., for each arrest.

3.Have you EVER engaged in, do you continue to engage in, or plan to engage in terrorist activities?

Yes No

4.Are you NOW or have you EVER been a member of a

gang?	Yes	No

5.Have you EVER engaged in, ordered, incited, assisted, or otherwise participated in any of the following:

5.a. Acts involving torture, genocide, or human trafficking?

		Yes	No
5.b.	Killing any person?	Yes	No
5.c.	Severely injuring any person?	Yes	No
5.d.	Any kind of sexual contact or relations with any person
	who was being forced or threatened?	Yes	No
		Yes	No

6.Have you EVER recruited, enlisted, conscripted, or used any person to serve in or help an armed force or group

while such person was under age 15?

Yes

7.Have you EVER used any person under age 15 to take part in hostilities, or to help or provide services to people

in combat?

Yes

Form I-821D Edition 08/31/21

Page 4 of 7

Part 5. Statement, Certification, Signature, and Contact Information of the Requestor (For Initial and Renewal Requests)

NOTE: Select the box for either Item Number 1.a. or 1.b.

1.a. I can read and understand English, and have read and understand each and every question and instruction on this form, as well as my answer to each question.

1.b. The interpreter named in Part 6. has read to me each and every question and instruction on this form, as well as my answer to each question, in

a language in which I am fluent. I understand each and every question and instruction on this form as translated to me by my interpreter, and have provided true and correct responses in the language indicated above.

Part 6. Contact Information, Certification, and

Signature of the Interpreter (For Initial and

Renewal Requests)

Interpreter's Full Name

Provide the following information concerning the interpreter: 1.a. Interpreter's Family Name (Last Name)

1.b. Interpreter's Given Name (First Name)

2.Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address

Requestor's Certification

I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct and that copies of documents submitted are exact photocopies of unaltered original documents. I understand that I may be required to submit original documents to U.S. Citizenship and Immigration Services (USCIS) at a later date. I also understand that knowingly and willfully providing materially false information on this form is a federal felony punishable by a fine, imprisonment up to 5 years, or both, under 18 U.S.C. section 1001. Furthermore, I authorize the release of any information from my records that USCIS may need to reach a determination on my deferred action request.

3.a. Street Number

and Name

3.b. Apt. Ste. 3.c. City or Town 3.d. State

3.f. Province

3.g. Postal Code

3.h. Country

Flr.

3.e. ZIP Code

2.a. Requestor's Signature

2.b. Date of Signature (mm/dd/yyyy) ►

Requestor's Contact Information

3.Requestor's Daytime Telephone Number

4.Requestor's Mobile Telephone Number

5.Requestor's Email Address

Interpreter's Contact Information

4.Interpreter's Daytime Telephone Number

5.Interpreter's Email Address

Form I-821D Edition 08/31/21

Page 5 of 7

Part 6. Contact Information, Certification, and Signature of the Interpreter (For Initial and

Preparer's Mailing Address

Renewal Requests) (continued)

Interpreter's Certification

I certify that:
I am fluent in English and	which

is the same language provided in Part 5., Item Number 1.b.;

I have read to this requestor each and every question and instruction on this form, as well as the answer to each question, in the language provided in Part 5., Item Number 1.b.; and

The requestor has informed me that he or she understands each and every instruction and question on the form, as well as the answer to each question.

3.a. Street Number

and Name

3.b. Apt. Ste. 3.c. City or Town 3.d. State

3.f. Province

3.g. Postal Code

3.h. Country

Flr.

3.e. ZIP Code

6.a. Interpreter's Signature

6.b. Date of Signature (mm/dd/yyyy) ►

Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Request, If Other than the Requestor (For Initial and Renewal Requests)

Preparer's Full Name

Provide the following information concerning the preparer: 1.a. Preparer's Family Name (Last Name)

1.b. Preparer's Given Name (First Name)

2.Preparer's Business or Organization Name

Preparer's Contact Information

4.Preparer's Daytime Telephone Number

5.Preparer's Fax Number

6.Preparer's Email Address

Preparer's Declaration

I declare that I prepared this Form I-821D at the requestor's behest, and it is based on all the information of which I have knowledge.

7.a. Preparer's Signature

7.b. Date of Signature (mm/dd/yyyy) ►

NOTE: If you need extra space to complete any item within this request, see the next page for Part 8. Additional

Information.

Form I-821D Edition 08/31/21

Page 6 of 7

Part 8. Additional Information (For Initial and

Renewal Requests)

If you need extra space to complete any item within this request, use the space below. You may also make copies of this page to complete and file with this request. Include your name and A-Number (if any) at the top of each sheet of paper; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.

4.a. Page Number 4.b. Part Number 4.c. Item Number

4.d.

Full Legal Name

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

2.A-Number (if any)

► A-

3.a. Page Number 3.b. Part Number 3.c. Item Number

3.d.

5.a. Page Number 5.b. Part Number 5.c. Item Number

5.d.

Form I-821D Edition 08/31/21

Page 7 of 7

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entering details in daca form renewal step 1

Write down the information in Full Legal Name, a Family Name Last Name b Given, c Middle Name, US Mailing Address Enter the same, In Care Of Name if applicable, Street Number and Name, Apt, Ste, Flr, City or Town, State, ZIP Code, Form ID Edition, Status or outcome, and Currently in Proceedings Active.

You could be required some valuable information if you would like prepare the Part Information About You For, Other Information, Alien Registration Number ANumber, US Social Security Number if any, Date of Birth, mmddyyyy, Gender, Male, Female, a CityTownVillage of Birth, Ethnicity Select only one box, Hispanic or Latino Not Hispanic or, Race Select all applicable boxes, White Asian, and Black or African American box.

You have to place the rights and responsibilities of the sides within the Marital Status, Married, Widowed, Single, Divorced, Other Names Used If Applicable, If you need additional space use, Family Name Last Name Given Name, Middle Name, Bald No hair, Brown Sandy, Black, Gray White, Blond, and Red space.

daca form renewal Marital Status, Married, Widowed, Single, Divorced, Other Names Used If Applicable, If you need additional space use, Family Name Last Name Given Name, Middle Name, Bald No hair, Brown Sandy, Black, Gray White, Blond, and Red blanks to complete

Finish the document by analyzing the next sections: Form ID Edition, and Page of.

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