Form I-90, Application to Replace Permanent Resident Card Instructions
This form contains 195 fields organized into 24 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Accommodations for Disabilities | ||
| Part 4. Accommodations for Individuals with Disabilities and/or Impairments. (Read the information in the Form I-90 instructions before completing this part.) 1. Are you requesting an accommodation because of a disabilities and/or impairments? Select No | CheckBox |
Select this checkbox if you are not requesting an accommodation due to disabilities and/or impairments.
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| Part 4. Accommodations for Individuals with Disabilities and/or Impairments. (Read the information in the Form I-90 instructions before completing this part.) NOTE: If you need extra space to complete this section, use the space provided in Part 8. Additional Information. 1. Are you requesting an accommodation because of your disabilities and/or impairments? Select Yes | CheckBox |
Select this checkbox if you are requesting an accommodation due to disabilities and/or impairments.
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| Part 4. Accommodations for Individuals with Disabilities and/or Impairments. (Read the information in the Form I-90 instructions before completing this part.) If you answered "Yes," select any applicable boxes. 1. A. Select I am deaf or hard of hearing and request the following accommodation (if you are requesting a sign-language interpreter, indicate for which language (e. g., American Sign Language)) | CheckBox |
Select this checkbox if you are deaf or hard of hearing and request an accommodation. Specify the type of accommodation needed, such as a sign-language interpreter and the language required.
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| Part 4. Accommodations for Individuals With Disabilities and Impairments. (Read the information in the Form I-90 instructions before completing this part.) 1. A. Enter Language | Text |
Enter the language in which you need accommodations for disabilities and impairments.
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| Part 4. Accommodations for Individuals With Disabilities and Impairments. (Read the information in the Form I-90 instructions before completing this part.) If you answered "Yes," select any applicable boxes. 1. B. Select I am blind or have low vision and request the following accommodation | CheckBox |
Select this checkbox if you are blind or have low vision and need accommodations.
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| Part 4. Accommodations for Individuals With Disabilities and Impairments. (Read the information in the Form I-90 instructions before completing this part.) 1. B. Enter Accommodation Requested | Text |
Enter the specific accommodation you are requesting if you are blind or have low vision.
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| Part 4. Accommodations for Individuals With Disabilities and Impairments. (Read the information in the Form I-90 instructions before completing this part.) If you answered "Yes," select any applicable boxes. 1. C. Select I have another type of disability and/or impairment (describe the nature of your disability and/or impairment and the accommodation you are requesting) | CheckBox |
Select this checkbox if you have another type of disability or impairment and need accommodations.
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| Part 4. Accommodations for Individuals With Disabilities and Impairments. (Read the information in the Form I-90 instructions before completing this part.) 1. C. Enter Description of Disability and/or Impairment and the Accommodations Requested | Text |
Describe the nature of your disability or impairment and the specific accommodations you are requesting.
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| Additional Information | ||
| Part 8. Additional Information. 3. D. Enter Additional Information | Text |
Provide any additional information relevant to the application in this field.
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| Part 8. Additional Information. 6. A. Enter Page Number | Text |
Enter the page number of the form where additional information is being referenced.
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| Part 8. Additional Information. 6. B. Enter Part Number | Text |
Enter the part number of the form where additional information is being referenced.
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| Part 8. Additional Information. 6. C. Enter Item Number | Text |
Enter the item number of the form where additional information is being referenced.
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| Part 8. Additional Information. 6. D. Enter Additional Information | Text |
Provide any additional information relevant to the application in this field.
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| Part 8. Additional Information. 5. D. Enter Additional Information | Text |
Provide any additional information relevant to the application in this field.
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| Part 8. Additional Information. 3. A. Enter Page Number | Text |
Enter the page number of the form where additional information is being referenced.
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| Part 8. Additional Information. 3. B. Enter Part Number | Text |
Enter the part number of the form where additional information is being referenced.
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| Part 8. Additional Information. 3. C. Enter Item Number | Text |
Enter the item number of the form where additional information is being referenced.
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| Part 8. Additional Information. 5. A. Enter Page Number | Text |
Enter the page number of the form where the additional information is referenced.
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| Part 8. Additional Information. 5. B. Enter Part Number | Text |
Enter the part number of the form where the additional information is referenced.
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| Part 8. Additional Information. 5. C. Enter Item Number | Text |
Enter the item number of the form where the additional information is referenced.
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| Part 8. Additional Information. 4. A. Enter Page Number | Text |
Enter the page number of the form where the additional information is referenced.
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| Part 8. Additional Information. 4. B. Enter Part Number | Text |
Enter the part number of the form where the additional information is referenced.
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| Part 8. Additional Information. 4. C. Enter Item Number | Text |
Enter the item number of the form where the additional information is referenced.
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| Part 8. Additional Information. 4. D. Enter Additional Information | Text |
Enter any additional information that is relevant to your application.
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| Part 8. Additional Information. 7. A. Enter Page Number | Text |
Enter the page number of the form where the additional information is referenced.
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| Part 8. Additional Information. 7. B. Enter Part Number | Text |
Enter the part number related to the additional information you are providing.
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| Part 8. Additional Information. 7. C. Enter Item Number | Text |
Enter the item number related to the additional information you are providing.
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| Part 8. Additional Information. 7. D. Enter Additional Information | Text |
Provide any additional information that is relevant to your application.
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| Applicant's Contact Information | ||
| Part 5. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Contact Information. 5. Enter Applicant's Email Address (if any) | Text |
Enter your email address, if you have one.
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| Part 5. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Contact Information. 3. Enter Applicant's Daytime Telephone Number | Text |
Enter your daytime telephone number.
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| Part 5. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Contact Information. 4. Enter Applicant's Mobile Telephone Number (if any) | Text |
Enter your mobile telephone number, if you have one.
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| Applicant's Signature | ||
| Part 5. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Signature. 6. B. Enter Date of Signature. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of your signature in the format MM/DD/YYYY.
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| Part 5. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Signature. 6. A. Applicant's Signature. This signature field can not be signed with a digital signature and the signee's name can not be typewritten into this space. This is a protected field. Print and sign in ink | Text |
Sign your name in ink. This field cannot be signed digitally or typewritten.
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| Applicant's Statement | ||
| Part 5. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Statement. NOTE: Select the box for either Item Number 1. A. or 1. B. If applicable, select the box for Item Number 2. 1. B. Select The interpreter named in Part 6. has read to me every question and instruction on this application and my answer to every question in a language in which I am fluent and I understood everything | CheckBox |
Select this checkbox if an interpreter has read the application to you in a language you understand.
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| Part 5. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Statement. 1. B. Enter Language | Text |
Enter the language in which the interpreter read the application to you.
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| Part 5. Applicant's Statement, Contact Information, Certification, and Signature. NOTE: Read the Penalties section of the Form I-90 instructions before completing this part. Applicant's Statement. NOTE: Select the box for either Item Number 1. A. or 1. B. If applicable, select the box for Item Number 2. 1. A. Select I can read and understand English, and I have read and understand every question and instruction on this application, and my answer to every question | CheckBox |
Select this checkbox if you can read and understand English, and you have read and understand every question and instruction on this application, and your answer to every question.
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| Part 5. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Statement. NOTE: Select the box for either Item Number 1. A. or 1. B. If applicable, select the box for Item Number 2. 2. Select At my request, the preparer named in Part 7. prepared this application for me based only upon information I provided or authorized | CheckBox |
Select this checkbox if the preparer named in Part 7 prepared this application for you based only upon information you provided or authorized.
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| Part 5. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Statement. 2. Enter Name of Preparer | Text |
Enter the name of the preparer who helped you complete this application.
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| Application Type | ||
| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. E. Select My name or other biographic information has been legally changed since issuance of my existing card | CheckBox |
Select this checkbox if your name or other biographic information has been legally changed since the issuance of your existing Permanent Resident Card.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. F. Select My existing card has already expired or will expire within six months | CheckBox |
Select this checkbox if your existing Permanent Resident Card has already expired or will expire within six months.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. G. 1. Select I have reached my 14th birthday and am registering as required. My existing card will expire AFTER my 16th birthday. NOTE: If you are filing this application before your 14th birthday, or more than 30 days after your 14th birthday, you must select reason 2.j. However, if your card has expired, you must select reason 2.f | CheckBox |
Select this checkbox if you have reached your 14th birthday and are registering as required, and your existing card will expire after your 16th birthday. Note: If you are filing this application before your 14th birthday, or more than 30 days after your 14th birthday, you must select reason 2.j. However, if your card has expired, you must select reason 2.f.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. G. 2. Select I have reached my 14th birthday and am registering as required. My existing card will expire BEFORE my 16th birthday. NOTE: If you are filing this application before your 14th birthday, or more than 30 days after your 14th birthday, you must select reason 2. J. However, if your card has expired, you must select reason 2. F | CheckBox |
Select this checkbox if you have reached your 14th birthday and are registering as required, and your existing card will expire before your 16th birthday. Note: If you are filing this application before your 14th birthday, or more than 30 days after your 14th birthday, you must select reason 2.j. However, if your card has expired, you must select reason 2.f.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. D. Select My existing card has incorrect data because of Department of Homeland Security (D H S) error. (Attach your existing card with incorrect data along with this application.) | CheckBox |
Select this checkbox if your existing Permanent Resident Card has incorrect data due to a Department of Homeland Security (DHS) error. Attach your existing card with incorrect data along with this application.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. A. Select My previous card has been lost, stolen, or destroyed | CheckBox |
Select this checkbox if your previous Permanent Resident Card has been lost, stolen, or destroyed.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. B. Select My previous card was issued but never received | CheckBox |
Select this checkbox if your previous Permanent Resident Card was issued but never received.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. C. Select My existing card has been mutilated | CheckBox |
Select this checkbox if your existing Permanent Resident Card has been mutilated.
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| Part 2. Application Type. NOTE: If your conditional permanent resident status (for example: C R 1, C R 2, C F 1, C F 2) is expiring within the next 90 days, then do not file this application. (See the What is the Purpose of This Application section of the Form I-90 Instructions for further information.) My status is (Select only one box). 1. A. Select Lawful Permanent Resident. (Proceed to Section A.) | CheckBox |
Select this checkbox if your status is Lawful Permanent Resident. Proceed to Section A.
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| Part 2. Application Type. My status is (Select only one box). 1. B. Select Permanent Resident - In Commuter Status. (Proceed to Section A.) | CheckBox |
Select this checkbox if your status is Permanent Resident - In Commuter Status. Proceed to Section A.
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| Part 2. Application Type. My status is (Select only one box). 1. C. Select Conditional Permanent Resident. (Proceed to Section B.) | CheckBox |
Select this checkbox if your status is Conditional Permanent Resident. Proceed to Section B.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.). 2. J. Select I have a prior edition of the Alien Registration Card, or I am applying to replace my current Permanent Resident Card for a reason that is not specified above | CheckBox |
Select this checkbox if you have a prior edition of the Alien Registration Card, or you are applying to replace your current Permanent Resident Card for a reason that is not specified above.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. H. 2. Select I am a commuter who is taking up actual residence in the United States | CheckBox |
Select this checkbox if you are a commuter who is taking up actual residence in the United States.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. I. Select I have been automatically converted to lawful permanent resident status | CheckBox |
Select this checkbox if you have been automatically converted to lawful permanent resident status.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. H. 1. Select I am a permanent resident who is taking up commuter status | CheckBox |
Select this checkbox if you are a permanent resident who is taking up commuter status.
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| Part 2. Application Type. Reason for Application (select only one box). Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.) 2. H. 1. A. My Port of Entry (P O E) into the United States will be. Enter City or Town and State | Text |
Enter the city or town and state of your Port of Entry (POE) into the United States.
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| Part 2. Application Type. Reason for Application (select only one box). Section B. (To be used only by a conditional permanent resident.) 3. B. Select My previous card was issued but never received | CheckBox |
Select this option if your previous card was issued but never received.
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| Part 2. Application Type. Reason for Application (select only one box). Section B. (To be used only by a conditional permanent resident.) 3. C. Select My existing card has been mutilated | CheckBox |
Select this option if your existing card has been mutilated.
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| Part 2. Application Type. Reason for Application (select only one box). Section B. (To be used only by a conditional permanent resident.) 3. D. Select My existing card has incorrect data because of Department of Homeland Security (D H S) error. (Attach your existing permanent resident card with incorrect data along with this application.) | CheckBox |
Select this option if your existing card has incorrect data due to a Department of Homeland Security (DHS) error. Attach your existing permanent resident card with incorrect data along with this application.
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| Part 2. Application Type. Reason for Application (select only one box). Section B. (To be used only by a conditional permanent resident.) 3. E. Select My name or other biographical information has legally changed since the issuance of my existing card | CheckBox |
Select this option if your name or other biographical information has legally changed since the issuance of your existing card.
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| Part 2. Application Type. Reason for Application (select only one box). Section B. (To be used only by a conditional permanent resident.) 3. A. Select My previous card has been lost, stolen, or destroyed | CheckBox |
Select this option if your previous card has been lost, stolen, or destroyed.
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| Barcode | ||
| PDF417BarCode1 | Text |
This field contains a barcode for the form. No input is required.
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| PDF417BarCode1 | Text |
This field contains a PDF417 barcode related to the form.
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| Biographic Information | ||
| Part 3. Processing Information. Biographic Information. 8. Height. Feet. Select Number of Feet from List | ComboBox |
Select your height in feet from the list provided.
3
6
2
5
7
4
8
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| Part 3. Processing Information. Biographic Information. 8. Height. Inches. Select Number of Inches from List | ComboBox |
Select your height in inches from the list provided.
3
6
2
5
10
4
11
0
7
1
8
9
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| Part 3. Processing Information. Biographic Information. 9. Weight. Pounds. Enter First Digit of Weight in Pounds | Text |
Enter the first digit of your weight in pounds.
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| Part 3. Processing Information. Biographic Information. 9. Weight. Pounds. Enter Second Digit of Weight in Pounds | Text |
Enter the second digit of your weight in pounds.
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| Part 3. Processing Information. Biographic Information. 9. Weight. Pounds. Enter Third Digit of Weight in Pounds | Text |
Enter the third digit of your weight in pounds.
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| Part 3. Processing Information. Biographic Information. 6. Ethnicity (Select only one box). Select Not Hispanic or Latino | CheckBox |
Select this checkbox if you are not Hispanic or Latino.
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| Part 3. Processing Information. Biographic Information. 6. Ethnicity (Select only one box). Select Hispanic or Latino | CheckBox |
Select this checkbox if you are Hispanic or Latino.
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| Part 3. Processing Information. Biographic Information. 7. Race (Select all applicable boxes). Select Native Hawaiian or Other Pacific Islander | CheckBox |
Select this checkbox if you identify as Native Hawaiian or Other Pacific Islander.
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| Part 3. Processing Information. Biographic Information. 7. Race (Select all applicable boxes). Select American Indian or Alaska Native | CheckBox |
Select this checkbox if you identify as American Indian or Alaska Native.
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| Part 3. Processing Information. Biographic Information. 7. Race (Select all applicable boxes). Select White | CheckBox |
Select this checkbox if you identify as White.
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| Part 3. Processing Information. Biographic Information. 7. Race (Select all applicable boxes). Select Asian | CheckBox |
Select this checkbox if you identify as Asian.
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| Part 3. Processing Information. Biographic Information. 7. Race (Select all applicable boxes). Select Black or African American | CheckBox |
Select this checkbox if you identify as Black or African American.
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| Part 3. Processing Information. Biographic Information. 10. Eye Color (Select only one box). Select Blue | CheckBox |
Select this checkbox if your eye color is blue.
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| Part 3. Processing Information. Biographic Information. 10. Eye Color (Select only one box). Select Green | CheckBox |
Select this checkbox if your eye color is green.
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| Part 3. Processing Information. Biographic Information. 10. Eye Color (Select only one box). Select Hazel | CheckBox |
Select 'Hazel' if your eye color is hazel.
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| Part 3. Processing Information. Biographic Information. 10. Eye Color (Select only one box). Select Pink | CheckBox |
Select 'Pink' if your eye color is pink.
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| Part 3. Processing Information. Biographic Information. 10. Eye Color (Select only one box). Select Maroon | CheckBox |
Select 'Maroon' if your eye color is maroon.
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| Part 3. Processing Information. Biographic Information. 10. Eye Color (Select only one box). Select Brown | CheckBox |
Select 'Brown' if your eye color is brown.
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| Part 3. Processing Information. Biographic Information. 10. Eye Color (Select only one box). Select Black | CheckBox |
Select 'Black' if your eye color is black.
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| Part 3. Processing Information. Biographic Information. 10. Eye Color (Select only one box). Select Unknown / Other | CheckBox |
Select 'Unknown / Other' if your eye color is unknown or does not fit any other category.
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| Part 3. Processing Information. Biographic Information. 10. Eye Color (Select only one box). Select Gray | CheckBox |
Select 'Gray' if your eye color is gray.
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| Part 3. Processing Information. Biographic Information. 11. Hair Color (Select only one box). Select Bald (No hair) | CheckBox |
Select 'Bald (No hair)' if you have no hair.
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| Part 3. Processing Information. Biographic Information. 11. Hair Color (Select only one box). Select Blond | CheckBox |
Select 'Blond' if your hair color is blond.
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| Part 3. Processing Information. Biographic Information. 11. Hair Color (Select only one box). Select Gray | CheckBox |
Select this checkbox if your hair color is gray.
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| Part 3. Processing Information. Biographic Information. 11. Hair Color (Select only one box). Select Sandy | CheckBox |
Select this checkbox if your hair color is sandy.
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| Part 3. Processing Information. Biographic Information. 11. Hair Color (Select only one box). Select Unknown / Other | CheckBox |
Select this checkbox if your hair color is unknown or other.
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| Part 3. Processing Information. Biographic Information. 11. Hair Color (Select only one box). Select White | CheckBox |
Select this checkbox if your hair color is white.
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| Part 3. Processing Information. Biographic Information. 11. Hair Color (Select only one box). Select Red | CheckBox |
Select this checkbox if your hair color is red.
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| Part 3. Processing Information. Biographic Information. 11. Hair Color (Select only one box). Select Brown | CheckBox |
Select this checkbox if your hair color is brown.
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| Part 3. Processing Information. Biographic Information. 11. Hair Color (Select only one box). Select Black | CheckBox |
Select this checkbox if your hair color is black.
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| General Information | ||
| PDF417BarCode1 | Text |
This field contains a barcode that encodes specific information about the form and its version.
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| Internal Processing | ||
| PDF417BarCode1 | Text |
This is a barcode field used for internal processing by USCIS.
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| Internal Use | ||
| PDF417BarCode1 | Text |
This field contains a barcode for internal use by USCIS.
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| PDF417BarCode1 | Text |
This is a barcode field for internal use by USCIS.
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| Interpreter Information | ||
| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 1. B. Enter Interpreter's Given Name (First Name) | Text |
Enter the given name (first name) of the interpreter who is assisting with this application.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Provide the following information about the interpreter. Interpreter's Full Name. 1. A. Enter Interpreter's Family Name (Last Name) | Text |
Enter the family name (last name) of the interpreter who is assisting with this application.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 2. Enter Interpreter's Business or Organization Name (if any) | Text |
Enter the business or organization name of the interpreter, if applicable. This field has a maximum length of 30 characters.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Certification. I certify, under penalty of perjury, that: I am fluent in English and (another language), which is the same language provided in Part 5., Item Number 1. B., and I have read to this applicant in the identified language every question and instruction on this application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question, and answer on the application, including the Applicant's Certification, and has verified the accuracy of every answer. Enter Language | Text |
Enter the language in which the interpreter is fluent, as specified in Part 5, Item Number 1.B.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Signature. 7. B. Enter Date of Signature. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of the interpreter's signature in the format MM/DD/YYYY.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Signature. 7. A. Interpreter's Signature. This signature field can not be signed with a digital signature and the signee's name can not be typewritten into this space. This is a protected field. Print and sign in ink | Text |
The interpreter must print and sign their name in ink. Digital signatures or typewritten names are not allowed.
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| Interpreter Mailing Address | ||
| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. C. Enter City or Town | Text |
Enter the city or town of the interpreter's mailing address. This field has a maximum length of 20 characters.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. A. Enter Street Number and Name | Text |
Enter the street number and name of the interpreter's mailing address. This field has a maximum length of 25 characters.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. B. Enter Apartment, Suite, or Floor Number | Text |
Enter the apartment, suite, or floor number of the interpreter's mailing address. This field has a maximum length of 6 characters.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. F. Enter Province | Text |
Enter the province of the interpreter's mailing address. This field has a maximum length of 20 characters.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. E. Enter ZIP Code | Text |
Enter the ZIP Code of the interpreter's mailing address. This field has a maximum length of 5 characters.
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| Interpreter's Contact Information | ||
| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 6. Enter Interpreter's Email Address, (if any) | Text |
Enter the interpreter's email address, if available. The maximum length is 38 characters.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 4. Enter Interpreter's Daytime Telephone Number | Text |
Enter the interpreter's daytime telephone number. The maximum length is 10 characters.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 5. Enter Interpreter's Mobile Telephone Number (if any) | Text |
Enter the interpreter's mobile telephone number, if available. The maximum length is 10 characters.
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| Interpreter's Mailing Address | ||
| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. D. Select State from List of States | ComboBox |
Select the state from the list of states where the interpreter's mailing address is located.
CT
OK
AR
MH
ID
VT
NV
MS
FM
MA
CO
AK
WA
WI
FL
MT
DC
GU
AP
MD
TN
WY
NM
AS
AL
IL
MP
AA
ND
MN
AE
RI
VA
PA
MI
GA
NH
PW
SD
KS
IN
WV
OH
HI
DE
KY
OR
NC
ME
NY
SC
IA
CA
NE
NJ
PR
VI
MO
TX
UT
AZ
LA
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. H. Enter Country | Text |
Enter the country where the interpreter's mailing address is located.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. G. Enter Postal Code | Text |
Enter the postal code for the interpreter's mailing address. The maximum length is 9 characters.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. B. Select Apartment | CheckBox |
Select this checkbox if the interpreter's mailing address includes an apartment number.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. B. Select Suite | CheckBox |
Select this checkbox if the interpreter's mailing address includes a suite number.
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| Part 6. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. B. Select Floor | CheckBox |
Select this checkbox if the interpreter's mailing address includes a floor number.
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| Mailing Address | ||
| Part 1. Information About You. Mailing Address. 6. A. Enter In Care Of Name | Text |
Enter the name of the person in whose care the mail should be sent, if applicable.
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| Part 1. Information About You. Mailing Address. 6. B. Enter Street Number and Name | Text |
Enter your street number and name for your mailing address.
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| Part 1. Information About You. Mailing Address. 6. C. Enter Apartment, Suite, or Floor Number | Text |
Enter your apartment, suite, or floor number for your mailing address, if applicable.
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| Part 1. Information About You. Mailing Address. 6. D. Enter City or Town | Text |
Enter the city or town for your mailing address.
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| Part 1. Information About You. Mailing Address. 6. H. Enter Postal Code | Text |
Enter the postal code for your mailing address. This should be a 9-digit code.
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| Part 1. Information About You. Mailing Address. 6. F. Enter ZIP Code | Text |
Enter the ZIP code for your mailing address. This should be a 5-digit code.
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| Part 1. Information About You. Mailing Address. 6. E. Select State from List of States | ComboBox |
Select the state for your mailing address from the provided list of states.
CT
OK
AR
MH
ID
VT
NV
MS
FM
MA
CO
AK
WA
WI
FL
MT
DC
GU
AP
MD
TN
WY
NM
AS
AL
IL
MP
AA
ND
MN
AE
RI
VA
PA
MI
GA
NH
PW
SD
KS
IN
WV
OH
HI
DE
KY
OR
NC
ME
NY
SC
IA
CA
NE
NJ
PR
VI
MO
TX
UT
AZ
LA
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| Part 1. Information About You. Mailing Address. 6. I. Enter Country | Text |
Enter the country for your mailing address.
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| Part 1. Information About You. Mailing Address. 6. G. Enter Province | Text |
Enter the province for your mailing address. This can be up to 20 characters long.
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| Part 1. Information About You. Mailing Address. 6. C. Select Apartment | CheckBox |
Select this checkbox if your mailing address includes an apartment number.
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| Part 1. Information About You. Mailing Address. 6. C. Select Suite | CheckBox |
Select this checkbox if your mailing address includes a suite number.
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| Part 1. Information About You. Mailing Address. 6. C. Select Floor | CheckBox |
Select this checkbox if your mailing address includes a floor number.
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| Personal Information | ||
| Part 1. Information About You. Your Full Name. NOTE: Your card will be issued in this name. 3. A. Enter Family Name (Last Name) | Text |
Enter your family name (last name) as it should appear on your new Permanent Resident Card.
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| Part 1. Information About You. Your Full Name. 3. B. Enter Given Name (First Name) | Text |
Enter your given name (first name) as it should appear on your new Permanent Resident Card.
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| Part 1. Information About You. Your Full Name. 3. C. Enter Middle Name | Text |
Enter your middle name as it should appear on your new Permanent Resident Card.
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| Part 1. Information About You. Your Full Name. 4. Has your name legally changed since the issuance of your Permanent Resident Card? Select Yes. (Proceed to Item Numbers 5. A. through 5. C.) | CheckBox |
Select this checkbox if your name has legally changed since the issuance of your Permanent Resident Card. Proceed to fill out Item Numbers 5. A. through 5. C.
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| Part 1. Information About You. Your Full Name. 4. Has your name legally changed since the issuance of your Permanent Resident Card? Select No (Proceed to Item Numbers 6. A. through 6. I.) | CheckBox |
Select this checkbox if your name has not legally changed since the issuance of your Permanent Resident Card. Proceed to fill out Item Numbers 6. A. through 6. I.
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| Part 1. Information About You. Your Full Name. 4. Has your name legally changed since the issuance of your Permanent Resident Card? Select Not Applicable - I never received my previous card. (Proceed to Item Numbers 6. A. through 6. I.) | CheckBox |
Select this checkbox if you never received your previous Permanent Resident Card. Proceed to fill out Item Numbers 6. A. through 6. I.
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| Part 1. Information About You. Provide your name exactly as it is printed on your current Permanent Resident Card. NOTE: Attach all evidence of your legal name change with this application. 5. A. Enter Family Name (Last Name) | Text |
Enter your family name (last name) exactly as it is printed on your current Permanent Resident Card. Attach all evidence of your legal name change with this application if applicable.
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| Part 1. Information About You. Provide your name exactly as it is printed on your current Permanent Resident Card. 5. B. Enter Given Name (First Name) | Text |
Enter your given name (first name) exactly as it is printed on your current Permanent Resident Card.
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| Part 1. Information About You. Provide your name exactly as it is printed on your current Permanent Resident Card. 5. C. Enter Middle Name | Text |
Enter your middle name exactly as it is printed on your current Permanent Resident Card.
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| Part 1. Information About You. 2. Enter U S C I S Online Account Number, if any | Text |
Enter your USCIS Online Account Number, if you have one. This number can be up to 12 digits long.
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| Part 1. Information About You. 1. Enter Alien Registration Number. (A. Number) | Text |
Enter your Alien Registration Number (A-Number). This is a unique identifier assigned to you by the USCIS.
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| Part 1. Information About You. Additional Information. 9. Enter Date of Birth. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter your date of birth in the format MM/DD/YYYY.
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| Part 1. Information About You. Additional Information. 10. Enter City / Town / Village of Birth | Text |
Enter the name of the city, town, or village where you were born. Maximum length is 38 characters.
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| Part 1. Information About You. Additional Information. 11. Enter Country of Birth | Text |
Enter the name of the country where you were born.
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| Part 1. Information About You. Additional Information. 16. Enter U. S. Social Security Number, if any | Text |
Enter your U.S. Social Security Number, if you have one. Maximum length is 9 digits.
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| Part 1. Information About You. Additional Information. 15. Enter Date of Admission. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of your admission to the U.S. in the format MM/DD/YYYY.
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| Part 1. Information About You. Additional Information. 14. Enter Class of Admission | Text |
Enter your class of admission, which is the category under which you were admitted to the U.S.
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| Part 1. Information About You. Additional Information. Mother's Name. 12. Enter Given Name (First Name) | Text |
Enter the given name (first name) of your mother.
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| Part 1. Information About You. Additional Information. Father's Name. 13. Enter Given Name (First Name) | Text |
Enter the given name (first name) of your father.
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| Part 1. Information About You. Additional Information. 8. Gender. Select Male | CheckBox |
Select this checkbox if your gender is male.
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| Part 1. Information About You. Additional Information. 8. Gender. Select Female | CheckBox |
Select this checkbox if your gender is female.
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| Part 8. Additional Information. If you need extra space to provide any additional information within this application, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper. Include your name and. A. Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. Your Full Name. 1. A. Family Name (Last Name). This is a read only field. This field pre-populates from page 1 | Text |
This field displays your family name (last name) as pre-populated from page 1. It is read-only.
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| Part 8. Additional Information. Your Full Name. 1. B. Given Name (First Name). This is a read only field. This field pre-populates from page 1 | Text |
This field displays your given name (first name) as pre-populated from page 1. It is read-only.
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| Part 8. Additional Information. Your Full Name. 1. C. Middle Name. This is a read only field. This field pre-populates from page 1 | Text |
This field displays your middle name as pre-populated from page 1. It is read-only.
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| Part 1. Information About You. 1. Enter Alien Registration Number. (A. Number) | Text |
Enter your Alien Registration Number (A-Number), which is a unique identifier assigned to you by USCIS.
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| Physical Address | ||
| Part 1. Information About You. Physical Address. Provide this information only if different than mailing address. 7. A. Enter Street Number and Name | Text |
Enter the street number and name of your physical address. Provide this information only if it is different from your mailing address.
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| Part 1. Information About You. Physical Address. 7. C. Enter City or Town | Text |
Enter the city or town of your physical address.
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| Part 1. Information About You. Physical Address. 7. E. Enter ZIP Code | Text |
Enter the ZIP Code of your physical address.
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| Part 1. Information About You. Physical Address. 7. B. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of your physical address.
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| Part 1. Information About You. Physical Address. 7. H. Enter Country | Text |
Enter the country of your physical address.
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| Part 1. Information About You. Physical Address. 7. G. Enter Postal Code | Text |
Enter the postal code of your physical address.
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| Part 1. Information About You. Physical Address. 7. F. Enter Province | Text |
Enter the province of your physical address.
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| Part 1. Information About You. Physical Address. 7. B. Select Apartment | CheckBox |
Select this checkbox if your physical address includes an apartment number.
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| Part 1. Information About You. Physical Address. 7. B. Select Suite | CheckBox |
Select this checkbox if your physical address includes a suite.
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| Part 1. Information About You. Physical Address. 7. B. Select Floor | CheckBox |
Select this checkbox if your physical address includes a floor.
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| Part 1. Information About You. Physical Address. 7 D. Select State from List of States | ComboBox |
Select the state from the provided list that corresponds to your physical address.
CT
OK
AR
MH
ID
VT
NV
MS
FM
MA
CO
AK
WA
WI
FL
MT
DC
GU
AP
MD
TN
WY
NM
AS
AL
IL
MP
AA
ND
MN
AE
RI
VA
PA
MI
GA
NH
PW
SD
KS
IN
WV
OH
HI
DE
KY
OR
NC
ME
NY
SC
IA
CA
NE
NJ
PR
VI
MO
TX
UT
AZ
LA
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| Preparer Information | ||
| Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Provide the following information about the preparer. Preparer's Full Name. 1. A. Enter Preparer's Family Name (Last Name) | Text |
Enter the preparer's family name (last name).
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Full Name. 1.B. Enter Preparer's Given Name (First Name) | Text |
Enter the preparer's given name (first name).
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Full Name. 2. Enter Preparer's Business or Organization Name (if any) | Text |
Enter the name of the preparer's business or organization, if any.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. C. Enter City or Town | Text |
Enter the city or town of the preparer's mailing address.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. A. Enter Street Number and Name | Text |
Enter the street number and name of the preparer's mailing address.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Signature. 8. A. Preparer's Signature. This signature field can not be signed with a digital signature and the signee's name can not be typewritten into this space. This is a protected field. Print and sign in ink | Text |
This field is for the signature of the person preparing the application if it is not the applicant. The signature must be handwritten in ink and cannot be digital or typewritten.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Signature. 8. B. Enter Date of Signature. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date when the preparer signed the application. Use the format MM/DD/YYYY.
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| Preparer's Contact Information | ||
| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Contact Information. 6. Enter Preparer's Email Address (if any) | Text |
Enter the email address of the person preparing this application, if available.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Contact Information. 4. Enter Preparer's Daytime Telephone Number | Text |
Enter the daytime telephone number of the person preparing this application.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Contact Information. 5. Enter Preparer's Mobile Telephone Number (if any) | Text |
Enter the mobile telephone number of the person preparing this application, if available.
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| Preparer's Mailing Address | ||
| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. B. Enter Apartment, Suite, or Floor Number | Text |
Enter the apartment, suite, or floor number of the preparer's mailing address.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. F. Enter Province | Text |
Enter the province of the preparer's mailing address.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. E. Enter Zip Code | Text |
Enter the ZIP code of the preparer's mailing address.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. D. Select State from List of States | ComboBox |
Select the state from the list of states for the preparer's mailing address.
CT
OK
AR
MH
ID
VT
NV
MS
FM
MA
CO
AK
WA
WI
FL
MT
DC
GU
AP
MD
TN
WY
NM
AS
AL
IL
MP
AA
ND
MN
AE
RI
VA
PA
MI
GA
NH
PW
SD
KS
IN
WV
OH
HI
DE
KY
OR
NC
ME
NY
SC
IA
CA
NE
NJ
PR
VI
MO
TX
UT
AZ
LA
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. H. Enter Country | Text |
Enter the country of the preparer's mailing address.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. G. Enter Postal Code | Text |
Enter the postal code of the preparer's mailing address.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. B. Select Apartment | CheckBox |
Select this checkbox if the preparer's mailing address includes an apartment.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. B. Select Suite | CheckBox |
Select this checkbox if the preparer's mailing address includes a suite.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Mailing Address. 3. B. Select Floor | CheckBox |
Select the floor number of the preparer's mailing address.
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| Preparer's Statement | ||
| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Statement. 7. A. Select I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent | CheckBox |
Select this option if you are not an attorney or accredited representative but have prepared this application on behalf of the applicant with their consent.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Statement. 7. B. Select I am an attorney or accredited representative and my representation of the applicant in this case extends / does not extend beyond the preparation of this application. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application | CheckBox |
Select this option if you are an attorney or accredited representative and your representation of the applicant extends or does not extend beyond the preparation of this application. Note: You may need to submit Form G-28 if your representation extends beyond preparation.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Statement. 7. B. Select I am an attorney or accredited representative and my representation of the applicant in this case extends beyond the preparation of this application | CheckBox |
Select this option if you are an attorney or accredited representative and your representation of the applicant extends beyond the preparation of this application.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other Than the Applicant. Preparer's Statement. 7. B. Select I am an attorney or accredited representative and my representation of the applicant in this case does not extend beyond the preparation of this application | CheckBox |
Select this option if you are an attorney or accredited representative and your representation of the applicant does not extend beyond the preparation of this application.
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| Processing Information | ||
| Part 3. Processing Information. 1. Enter Location where you applied for an immigrant visa or adjustment of status | Text |
Enter the location where you applied for an immigrant visa or adjustment of status.
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| Part 3. Processing Information. 2. Enter Location where your immigrant visa was issued or U S C I S office where you were granted adjustment of status | Text |
Enter the location where your immigrant visa was issued or the USCIS office where you were granted adjustment of status.
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| Part 3. Processing Information. Complete Item Numbers 3. A. and 3. A. 1. if you entered the United States with an immigrant visa. (If you were granted adjustment of status, proceed to Item Number 4.) 4. Have you ever been in exclusion, deportation, or removal proceedings or ordered removed from the United States? Select No | CheckBox |
Select this checkbox if you have never been in exclusion, deportation, or removal proceedings or ordered removed from the United States.
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| Part 3. Processing Information. Complete Item Numbers 3. A. and 3. A. 1. if you entered the United States with an immigrant visa. (If you were granted adjustment of status, proceed to Item Number 4.) 4. Have you ever been in exclusion, deportation, or removal proceedings or ordered removed from the United States? Select Yes. NOTE: If you answered "Yes" to Item Numbers 4. or 5. above, provide a detailed explanation in the space provided in Part 8. Additional Information | CheckBox |
Select this checkbox if you have been in exclusion, deportation, or removal proceedings or ordered removed from the United States. If you select 'Yes', provide a detailed explanation in Part 8. Additional Information.
|
| Part 3. Processing Information. 5. Since you were granted permanent residence, have you ever filed Form I-4 07, Abandonment by Alien of Status as Lawful Permanent Resident, or otherwise been judged to have abandoned your status? Select No | CheckBox |
Indicate whether you have ever filed Form I-407 or have been judged to have abandoned your status as a lawful permanent resident. Select 'No' if this does not apply to you.
|
| Part 3. Processing Information. 5. Since you were granted permanent residence, have you ever filed Form I-4 07, Abandonment by Alien of Status as Lawful Permanent Resident, or otherwise been judged to have abandoned your status? Select Yes. NOTE: If you answered "Yes" to Item Numbers 4. or 5. above, provide a detailed explanation in the space provided in Part 8. Additional Information | CheckBox |
Indicate whether you have ever filed Form I-407 or have been judged to have abandoned your status as a lawful permanent resident. Select 'Yes' if this applies to you. If you select 'Yes', provide a detailed explanation in Part 8.
|
| Part 3. Processing Information. Complete Item Numbers 3. A. and 3. A. 1. if you entered the United States with an immigrant visa. (If you were granted adjustment of status, proceed to Item Number 4.) 3. A. 1. Port of Entry where admitted to the United States. Enter City or Town and State | Text |
Enter the city or town and state of the port of entry where you were admitted to the United States if you entered with an immigrant visa.
|
| Part 3. Processing Information. Complete Item Numbers 3. A. and 3. A. 1. if you entered the United States with an immigrant visa. (If you were granted adjustment of status, proceed to Item Number 4.) 3. A. Enter Destination in the United States at time of admission | Text |
Enter the destination in the United States at the time of your admission if you entered with an immigrant visa.
|
| System Information | ||
| PDF417BarCode1 | Text |
This field contains a barcode that is automatically generated and should not be modified.
|