U visa certification request checklist
A printable from U Visa Certification. Fill it in by hand. Nothing you write is collected by this website.
U visa certification request checklist
Before you send
- I have a lawyer or DOJ accredited representative, or I called a free legal group
- I know which agency handled my case: ______________________
- Report or case number: ______________________
- Date of the crime: ______________________
In the envelope or email
- Supplement B, current edition, my part filled in
- Cover letter naming Penal Code 679.10 and the 30 day (or 7 day) deadline
- Copy of the police report, or the report number
- Note on how I helped (911 call, report, interview, court)
- Stamped envelope with a safe return address
- Safe email and phone for follow up
- "In removal proceedings" or "family member aging out" written at the top, if true
After I send
- Date sent: ____________ Proof kept (receipt, email copy)
- Follow up date (30 or 7 days later): ____________
- Date signed form came back: ____________ File by (6 months later): ____________
Do not write your Social Security number or A number on this sheet if others can see it.
From U Visa Certification. Facts checked October 21, 2026. Free information, not legal or medical advice.