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{
"Application For Employment Authorization": {
"For USCIS Use Only": {
"Free Stamp": "Paroled pursuant to INA 212(d)(5)",
"Action Block": "Employment authorization approved",
"Authorization/Extension Valid Through": "12/31/2026",
"Alien Registration Number": "209456781",
"Remarks": "Applicant eligible for temporary protected status benefits."
},
"To be completed by an attorney or Board of Immigration Appeals (BIA)-accredited representative (if any).": {
"Attorney or Accredited Representative USCIS Online Account Number (if any)": "876543210123",
"Select this box if Form G-28 is attached.": "Yes"
},
"Part 1. Reason for Applying": {
"Other Names Used": {
"Additional Information": {
"2.a. Family Name (Last Name)": "Martinez",
"2.b. Given Name (First Name)": "Elena",
"2.c. Middle Name": "Sofia",
"3.a. Family Name (Last Name)": "Rodriguez",
"3.b. Given Name (First Name)": "Emily",
"3.c. Middle Name": "Rose",
"4.a. Family Name (Last Name)": "Carter"
}
},
"I am applying for (select only one box)": "1.c. Renewal of my permission to accept employment. (Attach a copy of your previous employment authorization document.)"
}
}
}