Form I-914, Supplement B, Declaration of Law Enforcement Officer for Victim of Trafficking in Persons

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.