{
  "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.)"
    }
  }
}