Form I-914 Supplement B template
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Form I-914, Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons
- Country USA
- Language English
- Department U.S. Citizenship and Immigration Services
Declaration of Law Enforcement Officer for Victim of Trafficking in Persons
Use this form to request temporary immigration benefits if you are a victim of a severe form of trafficking in persons, also known as human trafficking.
[Form I-914, Supplement B Edition 12/02/21] This form is for Federal, state, local, or tribal law enforcement agencies to complete for victims of trafficking in persons under the Victims of Trafficking and Violence Protection Act (VTVPA). The victim must be a victim of sex trafficking or severe forms of trafficking for labor or services. The form requires information about the victim, including their full legal name, gender, middle name, alien registration number, and any other names used. Part 2 asks for agency information, including the name of the certifying agency, name and title of the certifying official, agency mailing address, daytime telephone number, fax number, and other details. Part 3 requires a statement of claim detailing the victimization and its relationship to the crime investigated or prosecuted. The form also asks if the applicant has expressed fear of retaliation or revenge if removed from the US, and if there are any family members involved in their trafficking. Part 6 requires the certifying officer to attest under penalty of perjury that the individual is or has been a victim of severe forms of trafficking in persons.
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Have you previously filed for T nonimmigrant status?
No, I have not previously filed for T nonimmigrant status.
What is the relationship of your victimization to the crime investigated or prosecuted?
I was a victim of trafficking in persons and my victimization is related to the crime being investigated or prosecuted, specifically for trafficking in persons.
Have you expressed any fear of retaliation or revenge if you are removed from the United States?
No, I have not expressed any fear of retaliation or revenge if I am removed from the United States.
What was the outcome of your request?
The FBI confirmed that they were aware of my situation and would take appropriate action. However, as an AI language model, I do not have access to the specific outcome of the request.
Please provide the name and address of the law enforcement agency that you contacted to request that Form I-914, Supplement B be completed.
I contacted the Federal Bureau of Investigation (FBI) to request that Form I-914, Supplement B be completed.
Have you cooperated with federal, state, local, or tribal law enforcement officials in the investigation or prosecution of the act of trafficking in which you were a victim?
Yes, I have cooperated with federal, state, local, or tribal law enforcement officials in the investigation or prosecution of the acts of trafficking in persons that I was a victim of.
Please provide the dates on which the acts of trafficking occurred.
The acts of trafficking in persons that I was a victim of occurred between May 1, 2022 and June 30, 2022.
List the statutory citations that are or were being investigated or prosecuted.
The acts of trafficking in persons that I was a victim of were investigated under Section 107(g)(8)(A) of the Trafficking Victims Protection Act and prosecuted under 18 U.S.C. § 1595. Additionally, the acts may have been investigated or prosecuted under other relevant federal or state laws.
Have you ever been denied a nonimmigrant visa or classification?
No, I have never been denied a nonimmigrant visa or classification.
Is there any other basis under which you may be eligible for a nonimmigrant visa or classification (e.g., as a performer, artist or journalist) that does not involve trafficking?
No, I am not eligible for any other basis for a nonimmigrant visa or classification.
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