Form I-130A Edition 04/01/24 Page 1 of 6

To be completed by an attorney or accredited representative (if any).

► START HERE - Type or print in black ink.

Part 1. Information About You (Spouse 

Beneficiary)

4.c.

4.f.

4.h.

4.g.

4.d.

4.a.

4.b.

Street Number 

and Name

Apt. Ste. Flr.

City or Town

State 4.e. ZIP Code

Province

Country

Postal Code

Physical Address 1

Address History

Provide your physical addresses for the last five years, whether 

inside or outside the United States. Provide your current 

address first. If you need extra space to complete this section, 

use the space provided in Part 7. Additional Information.

6.c.

6.f.

6.h.

6.g.

6.d.

6.a.

6.b.

Street Number 

and Name

Apt. Ste. Flr.

City or Town

State 6.e. ZIP Code

Province

Country

Postal Code

Physical Address 2

Select this box if 

Form G-28 is 

attached.

Attorney State Bar Number 

(if applicable)

Attorney or Accredited Representative 

USCIS Online Account Number (if any)

7.a. Date From (mm/dd/yyyy)

7.b. Date To (mm/dd/yyyy)

Family Name 

(Last Name) 

Given Name 

(First Name) 

Middle Name

Your Full Name

3.c.

3.b. 

3.a.

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

►

►

A2. USCIS Online Account Number (if any)

5.a. Date From (mm/dd/yyyy)

5.b. Date To (mm/dd/yyyy)

Postal Code

Country

Province

City or Town

Apt. Ste. Flr.

Street Number 

and Name

8.b.

8.a.

8.e.

8.f.

8.d.

8.c.

Provide your last address outside the United States of more than 

one year (even if listed above).

The purpose of this form is to collect additional information for a spouse beneficiary of Form I-130, Petition for Alien Relative. If 

your spouse is a U.S. citizen, lawful permanent resident, or non-citizen U.S. national who is filing Form I-130 on your behalf, you 

must complete and sign Form I-130A, Supplemental Information for Spouse Beneficiary, and submit it with the Form I-130 filed by 

your spouse. If you reside overseas, you still must complete Form I-130A, but you do not need to sign the form.

Volag Number 

(if any) 

Last Physical Address Outside the United States

Supplemental Information for Spouse Beneficiary 

Department of Homeland Security 

U.S. Citizenship and Immigration Services 

USCIS 

Form I-130A 

OMB No. 1615-0012 

Expires 02/28/2027
Form I-130A Edition 04/01/24 Page 2 of 6

9.b. Date To (mm/dd/yyyy)

9.a. Date From (mm/dd/yyyy)

Part 1. Information About You (The Spouse 

Beneficiary)

Full Name of Parent 1

Information About Parent 1

Given Name 

(First Name) 

Middle Name

13. City/Town/Village of Birth 

14.

16. Country of Residence

15. City/Town/Village of Residence

Country of Birth 

11. Date of Birth (mm/dd/yyyy)

Family Name 

(Maiden Name) 

Part 2. Information About Your Employment 

Provide your employment history for the last five years, 

whether inside or outside the United States. Provide your 

current employment first. If you are currently unemployed, 

type or print "Unemployed" in Item Number 1. below. If you 

need extra space to complete this section, use the space 

provided in Part 7. Additional Information.

Employment History

2.c. City or Town

2.f.

2.h.

Province

Country 

2.g. Postal Code 

2.d. State 2.e. ZIP Code

Street Number 

and Name

2.a.

2.b. Apt. Ste. Flr.

Employer 1

1. Name of Employer/Company

18. Date of Birth (mm/dd/yyyy)

Country of Birth 

22. City/Town/Village of Residence

23. Country of Residence

21.

20. City/Town/Village of Birth 

Middle Name

Given Name 

(First Name) 

Information About Parent 2

17.a.

Full Name of Parent 2

Family Name 

(Last Name) 

3. Your Occupation

4.a. Date From (mm/dd/yyyy)

4.b. Date To (mm/dd/yyyy)

6.c. City or Town

6.f.

6.h.

Province

Country 

6.g. Postal Code 

6.d. State 6.e. ZIP Code

Street Number 

and Name

6.a.

6.b. Apt. Ste. Flr.

Employer 2

5. Name of Employer/Company

10.a.

10.b.

10.c.

17.b.

17.c.

12. Sex Male Female

19. Sex Male Female
Form I-130A Edition 04/01/24 Page 3 of 6

Part 2. Information About Your Employment 

(continued)

7. Your Occupation

3.

Provide your last occupation outside the United States if not 

shown above. If you never worked outside the United States, 

provide this information in the space provided in Part 7. 

Additional Information.

Your Occupation

1. Name of Employer/Company

8.a. Date From (mm/dd/yyyy)

8.b. Date To (mm/dd/yyyy)

4.a. Date From (mm/dd/yyyy)

4.b. Date To (mm/dd/yyyy)

Part 3. Information About Your Employment 

Outside the United States

The interpreter named in Part 5. read to me every 

question and instruction on this form and my answer 

to every question in 

1.b.

a language in which I am fluent, and I understood 

everything.

,

2. At my request, the preparer name in Part 6.,

prepared this form for me based only upon 

information I provided or authorized.

,

3. Spouse Beneficiary's Daytime Telephone Number

Spouse Beneficiary's Contact Information

5. Spouse Beneficiary's Email Address (if any)

4. Spouse Beneficiary's Mobile Telephone Number (if any)

Spouse Beneficiary's Certification

Copies of any documents I have submitted are exact photocopies 

of unaltered, original documents, and I understand that USCIS 

may require that I submit original documents to USCIS at a later 

date. Furthermore, I authorize the release of any information 

from any of my records that USCIS may need to determine my 

eligibility for the immigration benefit I seek.

I further authorize release of information contained in this form, 

in supporting documents, and in my USCIS records to other 

entities and persons where necessary for the administration and 

enforcement of U.S. immigration laws.

2.c. City or Town

2.f.

2.h.

Province

Country 

2.g. Postal Code 

2.d. State 2.e. ZIP Code

Street Number 

and Name

2.a.

2.b. Apt. Ste. Flr.

I can read and understand English, and I have read 

and understand every question and instruction on this 

form and my answer to every question.

1.a.

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

applicable, select the box for Item Number 2.

Part 4. Spouse Beneficiary's Statement, Contact 

Information, Certification, and Signature

Spouse Beneficiary's Statement

NOTE: Read the Penalties section of the Form I-130 and 

Form I-130A Instructions before completing this part.

I certify, under penalty of perjury, that I provided or authorized 

all of the information in this form, I understand all of the 

information contained in, and submitted with, my form, and that 

all of this information is complete, true, and correct.

Spouse Beneficiary's Signature

6.b. Date of Signature (mm/dd/yyyy)

6.a. Spouse Beneficiary's Signature (sign in ink)

NOTE TO ALL SPOUSE BENEFICIARIES: If you do not 

completely fill out this form or fail to submit required documents 

listed in the Instructions, USCIS may deny the Form I-130 filed 

on your behalf.
Form I-130A Edition 04/01/24 Page 4 of 6

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

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

1.a. Interpreter's Family Name (Last Name)

Interpreter's Full Name

Part 5. Interpreter's Contact Information, 

Certification, and Signature 

Provide the following information about the interpreter you used 

to complete Form I-130A if he or she is different from the 

interpreter used to complete the Form I-130 filed on your behalf.

Interpreter's Mailing Address

3.c. City or Town

3.d. State 3.e. ZIP Code

3.f.

Postal Code

Street Number 

and Name

3.a.

3.b. Apt. Ste. Flr.

3.g.

3.h. Country 

Province

Interpreter's Certification

I am fluent in English and 

which is the same language provided in Part 4., Item Number 

1.b., and I have read to this spouse beneficiary in the identified 

language every question and instruction on this form and his or 

her answer to every question. The spouse beneficiary informed 

me that he or she understands every instruction, question, and 

answer on the form, including the Spouse Beneficiary's 

Certification, and has verified the accuracy of every answer.

I certify, under penalty of perjury, that:

,

Interpreter's Signature

7.b. Date of Signature (mm/dd/yyyy)

7.a. Interpreter's Signature (sign in ink)

Part 6. Contact Information, Declaration, and 

Signature of the Person Preparing this Form, if 

Other Than the Spouse Beneficiary

Provide the following information about the preparer you used 

to complete Form I-130A if he or she is different from the 

preparer used to complete the Form I-130 filed on your behalf.

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

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

Preparer's Full Name

1.a. Preparer's Family Name (Last Name)

Interpreter's Contact Information

4. Interpreter's Daytime Telephone Number

6. Interpreter's Email Address (if any)

5. Interpreter's Mobile Telephone Number (if any) Preparer's Mailing Address

3.c. City or Town

3.d. State 3.e. ZIP Code

3.f.

Postal Code

Street Number 

and Name

3.a.

3.b. Apt. Ste. Flr.

3.g.

3.h. Country 

Province
Form I-130A Edition 04/01/24 Page 5 of 6

Part 6. Contact Information, Declaration, and 

Signature of the Person Preparing this Form, if 

Other Than the Spouse Beneficiary (continued)

Preparer's Contact Information

5. Preparer's Mobile Telephone Number (if any)

4. Preparer's Daytime Telephone Number

6. Preparer's Email Address (if any)

Preparer's Statement

I am not an attorney or accredited representative but 

have prepared this form on behalf of the spouse 

beneficiary and with the spouse beneficiary's consent.

7.a.

NOTE: If you are an attorney or accredited 

representative whose representation extends beyond 

preparation of this form, you may be obliged to submit 

a completed Form G-28, Notice of Entry of 

Appearance as Attorney or Accredited Representative, 

with this form.

I am an attorney or accredited representative and my 

representation of the spouse beneficiary in this case

extends does not extend beyond the preparation

7.b.

of this form.

Preparer's Certification

By my signature, I certify, under penalty of perjury, that I 

prepared this form at the request of the spouse beneficiary. The 

spouse beneficiary then reviewed this completed form and 

informed me that he or she understands all of the information 

contained in, and submitted with, his or her form, including the 

Spouse Beneficiary's Certification, and that all of this 

information is complete, true, and correct. I completed this 

form based only on information that the spouse beneficiary 

provided to me or authorized me to obtain or use.

Preparer's Signature

8.a. Preparer's Signature (sign in ink)

8.b. Date of Signature (mm/dd/yyyy)
Form I-130A Edition 04/01/24 Page 6 of 6

Part 7. Additional Information

If you need extra space to provide any additional information 

within this form, use the space below. If you need more space 

than what is provided, you may make copies of this page to 

complete and file with this form or attach a separate sheet of 

paper. Type or print your name and A-Number (if any) at the 

top of each sheet; indicate the Page Number, Part Number, 

and Item Number to which your answer refers; and sign and 

date each sheet.

A-Number (if any) ► A3.a.

2.

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

3.d.

Page Number Part Number Item Number

5.a. Page Number Part Number Item Number

Page Number

5.b.

Part Number

5.c.

Item Number

5.d.

1.b. 

1.c.

1.a. Family Name 

(Last Name) 

Given Name 

(First Name) 

Middle Name

4.b. 4.c.

4.d.

4.a.

6.d.

6.a. 6.b. 6.c.

Page Number Part Number Item Number

7.d.

7.a. 7.b. 7.c.