Form I-566 - Interagency Record Of Request - A, G Or Nato Dependent Employment Authorization Or Change/adjustment To/from A, G Or Nato Status Page 7

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For Official Use Only
Part 9. DOS OFM, DOS Visa Office, NATO/HQ
Part 10. USCIS USE ONLY
SACT, and/or USUN USE ONLY
1.
From
1.
The Department of State, NATO/HQ SACT, and/or USUN
Adjudicator's ID Number
Recommends the request be granted
Recommends the request be denied
USCIS Office
If the recommendation is for denial, provide the
reasons for such a recommendation.
Office Telephone Number (including area code)
A-Number/File Number
2.
To
DOS Protocol
USUN
DOS OFM
NATO/HQ SACT
DOS Visa Office (Subject filed under Section
13. Advise USCIS of findings.)
3.
Adjustment or Change of Status
Granted
Denied
Date of Decision
(mm/dd/yyyy)
If change of status granted, print new status
4.
Request for Employment Authorization
Granted
Denied
Date of Decision (mm/dd/yyyy)
Date Valid Until (mm/dd/yyyy)
Classification
2.
Date of Decision (mm/dd/yyyy)
5.
DOS OFM, USUN, NATO/HQ SACT, or DOS Visa
3.
Telephone Number (including area code)
Office
Office Notified
Yes
No
4.
Office
Date of Notification (mm/dd/yyyy)
DOS Protocol
USUN
DOS OFM
NATO/HQ SACT
DOS Visa
5.
Signature 1
6.
Signature 2
Form I-566 12/07/16 N
Page 7 of 7

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