Supplement B, Delaration of Law Enforcement Officer for

Supplement B, Delaration of Law Enforcement Officer for Victim of Trafficking in Persons Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-914 OMB No. 1M 5-0099 Expires 12/31/2023 START HERE - Type or print in ink. This form should be completed by Federal, state, local, or tribal law enforcement agencies for victims under the Victims of Trafficking and Violence Protection Act (VTVPA). Public Law 106-386, as amended. PART 1. Victim Information 1. Full Legal Name (First Name) Middle Name (if any) 2. Provide any other names you have used since birth, including aliases, maiden names, and nicknames. If you need extra space to complete this section, use the space provided in Part 9. Additional Information. 3. 5. 6. Family Name (Last Name) Given Name (First Name) Middle Name (if any) ada Date of Birth ddimm/ (A-Number) 4. (if any) Gender or Sex El Male El Female El Other Alien Registration P. A- U.S. Social Number Secu