Instructions For Supplement B, Declaration Of Law Enforcement Officer For Victim Of Trafficking In Persons (Form I-914b) (Page 2 of 4) in pdf

These qualifying elements may be established without submitting Form I-914, Supplement B, but submission of

Supplement B is one piece of evidence. USCIS (not the certifying Federal, State, or local law enforcement official) makes

the determination on whether the evidence is sufficient and whether the applicant meets each eligibility requirement.

General Instructions

1. Type or print legibly in black ink.

2. If extra space is needed to complete any item, attach an additional sheet of paper. Write the victim’s name and A-

Number, if known, at the top of each sheet of paper and indicate the part and number of the item to which the answer

refers.

3. Answer all questions fully and accurately. State that an item is not applicable with “N/A.” If the answer is none, write

“None.”

This form is divided into Parts A. - F. The following information will help you fill out the form:

Part A. Victim Information

1. Full Name. Provide the legal name of the victim, as shown on his or her birth certificate or legal name change

document. If the victim has two last names, include both and use a hyphen (-) between the names, if appropriate.

Write the victim’s last, first and middle names in each appropriate field.

2. Other Names Used. Provide all the names the victim has used that you are aware of, including maiden name if

applicable, married names, nicknames, etc.

3. Date of Birth. Use eight numbers to show the victim’s date of birth (example: May 1, 1979, should be written

05/01/1979).

4. Gender. Check the appropriate box.

5. A-Number. Provide the USCIS (former INS) file number if there is one, and if it is known to you.

6. Social Security Number. Provide the Social Security Number if there is one, and if it is known to you.

Part B. Agency Information

1. Name of Certifying Agency. The certifying agency must be a Federal, State, or local law enforcement agency;

prosecutor or authority; or Federal or State judge that has responsibility for the investigation or prosecution,

conviction, or sentencing of the trafficking in persons of which the applicant was a victim.

2. Name of Certifying Official. Give your name, title, and division or office.

3. Agency Address. Give the agency’s mailing address.

4. Daytime Phone Number and Fax Number. Give your phone number and fax number with area code.

5. Agency Type. Mark the appropriate box.

6. Case Information. Provide the case status information and case identification number, if applicable.

Part C. Statement of Claim

7. In order to qualify for T nonimmigrant benefits, the individual must be or have been a victim of a severe form of

trafficking in persons. Mark the box that describes the individual’s victimization.

A. Sex trafficking in which a commercial sex act was induced by force, fraud, or coercion.

B. Sex trafficking and the victim is under 18 years of age.

C. Recruiting, harboring, transporting, providing, or obtaining of a person for labor or services through the use of

force, fraud, or coercion for subjection to involuntary servitude, peonage, debt bondage, or slavery.

Form I-914, Supplement B Instructions 02/27/17 Y

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Instructions For Supplement B, Declaration Of Law Enforcement Officer For Victim Of Trafficking In Persons (Form I-914b) Page 2