L, or local law enforcement agencies should complete this form for victims under the Victims of Trafficking and Violence Protection Act (VTVPA), Public Law 106-386, as amended. PART 1. Victim Information 1. For USCIS Use Only Returned Receipt Date Full Legal Name Family Name (Last Name) OMB No. 1615-0099 Expires 03/31/2027 Date Given Name (First Name) Middle Name (if any) Resubmitted Date 2. Other Names Used Date Provide any other names the victim has used since birth, including alia.
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