f Binh entered the.oligibility category(e)(3)(C) in Item Number 27., provideithe information requestedinitemNtitithers 28.a 28m. njermation About YourEligibilittedtegory 19.0 Cou ofBirth 20. Date ofairthOun/eldfioyy) Aforn7alion:4tout Your Last Arditallathr UstitedStapif ;1.a. Form I-94.Arrival bepatinreatoordNu