Information Collection

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

IC 218034 under ICR 201703-1615-001 · OMB 1615-0023.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0023 can be found here:

Documents and Forms

Document Name Document Type
Form Form I-485 Supplem Supplement A to Form I-485, Adjustment of Status Under Section 245(i) Form
I485-INS-SUPP A-30 Day-07082016.pdf Instruction
I485-INS-SUPP A-Comp+AC21+FR(062617-N)-11212016.pdf Instruction
Form I-485 Supplem Supplement A to Form I-485, Adjustment of Status Under S I485-FRM-SUPP A-30 Day-07252016.pdf www.uscis.gov/I-485 Form
I-485 Supplement A Supplement A to Form I-485, Adjustment of Status Under S I485-FRM-SUPP A-Comp+AC21+FR(062617-N)-11212016.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supplement A to Form I-485, Adjustment of Status Under Section 245(i)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form I-485 Supplement A	Supplement A to Form I-485, Adjustment of Status Under Section 245(i)	I485-FRM-SUPP A-30 Day-07252016.pdf	www.uscis.gov/I-485	Yes	No	Fillable Printable
Instruction			I485-INS-SUPP A-30 Day-07082016.pdf		Yes	No	Printable Only
Form	I-485 Supplement A	Supplement A to Form I-485, Adjustment of Status Under Section 245(i)	I485-FRM-SUPP A-Comp+AC21+FR(062617-N)-11212016.pdf		Yes	No	Fillable Printable
Instruction			I485-INS-SUPP A-Comp+AC21+FR(062617-N)-11212016.pdf		Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title: USCIS Benefits Information System	FR Citation: 73 FR 56596

Number of Respondents: 36,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	36,000	36,000
Annual IC Time Burden (Hours)	45,000	45,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.