This form contains 196 fields organized into 53 sections, giving it a Form Complexity Index of 73/100 (complex). Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
A-Number (if any)
A-Number	Text	Enter your Alien Registration Number (A-Number), if you have one. Max length: 9 characters
Accommodation - Deaf/Hard of Hearing (Request and Details)
I am deaf or hard of hearing	Checkbox	Check this box if you are requesting an accommodation because you are deaf or hard of hearing (and will request details such as a sign-language interpreter and language, if applicable). Fill only if 'Yes — Requesting an accommodation due to disability/impairment' is 'Yes'. Depends on: Yes — Requesting an accommodation due to disability/impairment
Requested Sign-Language Interpreter Language	Text	Enter the sign language you need for an interpreter (for example, American Sign Language) or describe the accommodation you are requesting as a person who is deaf or hard of hearing. Fill only if 'I am deaf or hard of hearing' is 'Yes'. Max length: 140 characters Depends on: I am deaf or hard of hearing
Accommodation Request (Blind or Low Vision)
I am blind or have low vision	Checkbox	Check this box if you are blind or have low vision and you are requesting an accommodation. Depends on: Yes — Requesting an accommodation due to disability/impairment
Requested Accommodation (Blind or Low Vision)	Text	Describe the accommodation you are requesting because you are blind or have low vision. Fill only if 'I am blind or have low vision' is 'Yes'. Max length: 140 characters Depends on: I am blind or have low vision
Accommodation Request (Other Disability/Impairment)
I have another type of disability and/or impairment	Checkbox	Check this box if you are requesting an accommodation due to a disability and/or impairment that is not otherwise listed and you will describe the disability/impairment and the accommodation requested. Depends on: Yes — Requesting an accommodation due to disability/impairment
Other Disability/Impairment Accommodation Request Details	Text	Describe the nature of your other disability and/or impairment and the specific accommodation(s) you are requesting. Fill only if 'I have another type of disability and/or impairment' is 'Yes'. Max length: 140 characters Depends on: I have another type of disability and/or impairment
Accommodations Request Due to Disability/Impairment (Yes/No)
No — Not requesting an accommodation due to disability/impairment	Checkbox	Check this box if you are not requesting an accommodation because of disabilities and/or impairments.
Yes — Requesting an accommodation due to disability/impairment	Checkbox	Check this box if you are requesting an accommodation because of your disabilities and/or impairments.
Additional Information Entry 3 (Page/Part/Item and Explanation)
Additional Information Explanation	Text	Provide the full explanation or additional details corresponding to the referenced page, part, and item number. Depends on: Yes, Yes
Page Number (Reference)	Text	Enter the page number of the form that this additional information refers to. Max length: 2 characters
Part Number (Reference)	Text	Enter the part number of the form that this additional information refers to. Max length: 4 characters
Item Number (Reference)	Text	Enter the item number within the referenced part that this additional information addresses. Max length: 4 characters
Additional Information Entry 4 (Page/Part/Item and Explanation)
Page Number (Additional Information Entry 4)	Text	Enter the page number of the form that your additional information refers to. Max length: 2 characters
Part Number (Additional Information Entry 4)	Text	Enter the part number of the form that your additional information refers to. Max length: 4 characters
Item Number (Additional Information Entry 4)	Text	Enter the item number of the form question that your additional information refers to. Max length: 4 characters
Explanation (Additional Information Entry 4)	Text	Provide the additional information or explanation that corresponds to the specified page, part, and item number. Depends on: Yes, Yes
Additional Information Entry 5 (Page/Part/Item and Explanation)
Additional Information Explanation	Text	Provide the detailed additional information or explanation that corresponds to the page, part, and item number entered above. Depends on: Yes, Yes
Page Number	Text	Enter the page number of the form that your additional information refers to. Max length: 2 characters
Part Number	Text	Enter the part number of the form that your additional information refers to. Max length: 4 characters
Item Number	Text	Enter the item number of the form that your additional information refers to. Max length: 4 characters
Additional Information Entry 6 (Page/Part/Item and Explanation)
Page Number (Entry 6)	Text	Enter the page number of the form that the additional information in this entry relates to. Max length: 2 characters
Part Number (Entry 6)	Text	Enter the part number of the form that the additional information in this entry relates to. Max length: 4 characters
Item Number (Entry 6)	Text	Enter the item number of the form question that the additional information in this entry relates to. Max length: 4 characters
Explanation / Additional Information (Entry 6)	Text	Provide the additional information or explanation that corresponds to the page, part, and item number listed above. Depends on: Yes, Yes
Additional Information Entry 7 (Page/Part/Item and Explanation)
Additional Info 7 Page Number	Text	Enter the page number of the form that this additional information refers to. Max length: 2 characters
Additional Info 7 Part Number	Text	Enter the part number of the form that this additional information refers to. Max length: 4 characters
Additional Info 7 Item Number	Text	Enter the item number of the form question that this additional information refers to. Max length: 4 characters
Additional Info 7 Explanation	Text	Provide the additional information or explanation corresponding to the specified page, part, and item number. Depends on: Yes, Yes
Applicant Contact Information
Email Address	Text	Enter the applicant’s email address, if they have one. Max length: 38 characters
Daytime Telephone Number	Text	Enter the applicant’s daytime telephone number where they can be reached. Max length: 13 characters
Mobile Telephone Number	Text	Enter the applicant’s mobile telephone number, if they have one. Max length: 13 characters
Applicant Signature and Date
Date of Signature	Date	Enter the date on which the applicant signed the form.
Applicant Signature	Text	Enter the applicant’s full legal signature.
Applicant Statement - Interpreter Assistance
Interpreter read application to me	Checkbox	Check this box if the interpreter named in Part 6 read every question and instruction on this application to you in a language you are fluent in, and you understood your answers.
Language Used by Interpreter	Text	Enter the language in which the interpreter read the questions and instructions to you and in which you provided your answers. Fill only if 'Interpreter read application to me' is 'Yes'. Depends on: Interpreter read application to me
Applicant Statement - Preparer Assisted at Applicant Request
At my request, the preparer named in Part 7 prepared this application for me	Checkbox	Check this box if you asked the preparer named in Part 7 to complete this application for you using only the information you provided or authorized.
Preparer Name (at Applicant's Request)	Text	Enter the name of the preparer who completed this application for you at your request (the preparer referenced in Part 7). Fill only if 'At my request, the preparer named in Part 7 prepared this application for me' is 'Yes'. Depends on: At my request, the preparer named in Part 7 prepared this application for me
Applicant Statement - Read and Understand English
I can read and understand English	Checkbox	Check this box if you can read and understand English and you have read and understood every question and instruction on this application.
Application Type - My Status (select one)
Port of Entry (City/Town and State)	Text	Enter the city or town and state of your intended U.S. port of entry if you are a permanent resident taking up commuter status.
Lawful Permanent Resident	Checkbox	Check this box if you are a lawful permanent resident (not in commuter status and not a conditional permanent resident).
Permanent Resident – In Commuter Status	Checkbox	Check this box if you are a permanent resident who lives outside the United States and commutes to the U.S. for work (commuter status).
Conditional Permanent Resident	Checkbox	Check this box if you have conditional permanent resident status (for example, CR1/CR2/CF1/CF2).
Biographic Information - Ethnicity (Select One)
Not Hispanic or Latino	Checkbox	Check this box if your ethnicity is not Hispanic or Latino.
Hispanic or Latino	Checkbox	Check this box if your ethnicity is Hispanic or Latino.
Biographic Information - Eye Color (Select One)
Blue	Checkbox	Check this box if your eye color is blue (select only one eye color).
Green	Checkbox	Check this box if your eye color is green (select only one eye color).
Hazel	Checkbox	Check this box if your eye color is hazel (select only one eye color).
Pink	Checkbox	Check this box if your eye color is pink (select only one eye color).
Maroon	Checkbox	Check this box if your eye color is maroon (select only one eye color).
Brown	Checkbox	Check this box if your eye color is brown (select only one eye color).
Black	Checkbox	Check this box if your eye color is black (select only one eye color).
Unknown/Other	Checkbox	Check this box if your eye color is unknown or not listed (select only one eye color).
Gray	Checkbox	Check this box if your eye color is gray (select only one eye color).
Biographic Information - Hair Color (Select One)
Bald (No hair)	Checkbox	Check this box if you have no hair (are bald).
Blond	Checkbox	Check this box if your hair color is blond.
Gray	Checkbox	Check this box if your hair color is gray.
Sandy	Checkbox	Check this box if your hair color is sandy.
Unknown/Other	Checkbox	Check this box if your hair color is unknown or not listed.
White	Checkbox	Check this box if your hair color is white.
Red	Checkbox	Check this box if your hair color is red.
Brown	Checkbox	Check this box if your hair color is brown.
Black	Checkbox	Check this box if your hair color is black.
Biographic Information - Height
Height (Feet)	Combobox	Enter your height in whole feet. 3 6 2 5 7 4 8
Height (Inches)	Combobox	Enter the remaining inches of your height after the feet value. 3 6 2 5 10 4 11 0 7 1 8 9
Biographic Information - Race (Select All That Apply)
Native Hawaiian or Other Pacific Islander	Checkbox	Check this box if you identify your race as Native Hawaiian or Other Pacific Islander.
American Indian or Alaska Native	Checkbox	Check this box if you identify your race as American Indian or Alaska Native.
White	Checkbox	Check this box if you identify your race as White.
Asian	Checkbox	Check this box if you identify your race as Asian.
Black or African American	Checkbox	Check this box if you identify your race as Black or African American.
Biographic Information - Weight
Weight (Pounds)	Number	Enter your current body weight in pounds. Max length: 3 characters
Birth Information
Date of Birth	Date	Enter your date of birth.
City/Town/Village of Birth	Text	Enter the name of the city, town, or village where you were born. Max length: 38 characters
Country of Birth	Text	Enter the country where you were born.
Class and Date of Admission
Date of Admission	Date	Enter the date you were admitted to the United States in the class of admission listed above.
Class of Admission	Text	Enter your immigration class of admission as shown on your official immigration document.
Conditional Permanent Resident Application Type (Section B) Reason
Previous card issued but never received	Checkbox	Check this box if USCIS/DHS issued your previous card but you never received it. Depends on: Conditional Permanent Resident
Existing card mutilated	Checkbox	Check this box if your current Permanent Resident Card has been mutilated or physically damaged. Depends on: Conditional Permanent Resident
Incorrect data due to DHS error	Checkbox	Check this box if your current card has incorrect information because of a DHS error (attach the card with incorrect data). Depends on: Conditional Permanent Resident
Name or biographic information legally changed	Checkbox	Check this box if your name or other biographic information has legally changed since your current card was issued. Depends on: Conditional Permanent Resident
Previous card lost, stolen, or destroyed	Checkbox	Check this box if your previous Permanent Resident Card was lost, stolen, or destroyed. Depends on: Conditional Permanent Resident
Current Legal Name
Family Name (Last Name)	Text	Enter your current legal family name (last name) as it should appear on your Permanent Resident Card.
Given Name (First Name)	Text	Enter your current legal given name (first name) as it should appear on your Permanent Resident Card.
Middle Name	Text	Enter your current legal middle name as it should appear on your Permanent Resident Card.
Gender
Male	Checkbox	Check this box if your gender is male.
Female	Checkbox	Check this box if your gender is female.
General
Page Footer Tracking Field	Text	Enter the tracking or identifier text (if any) provided for this page in the form’s footer.
	Text	Max length: 1 characters
	Text	Max length: 1 characters
	Text	Max length: 1 characters
Unlabeled field (bottom of page)	Text	Enter the text value requested in the unlabeled field located at the bottom of the page. Depends on: Yes — Requesting an accommodation due to disability/impairment
A-Number (Alien Registration Number)	Text	Enter the applicant’s Alien Registration Number (A-Number), if any, to identify this page of the form.
Additional Information	Text	Enter any additional information or explanations you want to provide for this application. Depends on: Yes, Yes
Interpreter Address Unit Type and Number (Apt/Ste/Flr)
Unit Number (Apt/Ste/Flr)	Text	Enter the interpreter’s apartment, suite, or floor number for the mailing address. Max length: 6 characters Depends on: Interpreter read application to me
Apt.	Checkbox	Check this box if the interpreter’s mailing address unit type is an apartment. Depends on: Interpreter read application to me
Ste.	Checkbox	Check this box if the interpreter’s mailing address unit type is a suite. Depends on: Interpreter read application to me
Flr.	Checkbox	Check this box if the interpreter’s mailing address unit type is a floor. Depends on: Interpreter read application to me
Interpreter Certification (Language)
Language Interpreted	Text	Enter the language (other than English) that the interpreter used to translate for the applicant. Max length: 18 characters Depends on: Interpreter read application to me
Interpreter Contact Information
Interpreter Email Address	Text	Enter the interpreter's email address, if any. Max length: 38 characters Depends on: Interpreter read application to me
Interpreter Daytime Telephone Number	Text	Enter the interpreter's daytime telephone number. Max length: 10 characters Depends on: Interpreter read application to me
Interpreter Mobile Telephone Number	Text	Enter the interpreter's mobile telephone number, if any. Max length: 10 characters Depends on: Interpreter read application to me
Interpreter Full Name
Interpreter Given Name (First Name)	Text	Enter the interpreter’s given name (first name). Depends on: Interpreter read application to me
Interpreter Family Name (Last Name)	Text	Enter the interpreter’s family name (last name). Depends on: Interpreter read application to me
Interpreter Business or Organization Name	Text	Enter the name of the interpreter’s business or organization, if any. Max length: 30 characters Depends on: Interpreter read application to me
Interpreter Mailing Address (Street/City/State/Zip/Province/Postal/Country)
City or Town	Text	Enter the city or town for the interpreter's mailing address. Max length: 20 characters Depends on: Interpreter read application to me
Street Number and Name	Text	Enter the interpreter's street number and street name for their mailing address. Max length: 25 characters Depends on: Interpreter read application to me
Province	Text	Enter the province for the interpreter's mailing address, if applicable. Max length: 20 characters Depends on: Interpreter read application to me
ZIP Code	Text	Enter the ZIP code for the interpreter's mailing address. Max length: 5 characters Depends on: Interpreter read application to me
State	Combobox	Enter the state for the interpreter'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
Country	Text	Enter the country for the interpreter's mailing address. Depends on: Interpreter read application to me
Postal Code	Text	Enter the postal code for the interpreter's mailing address, if applicable. Max length: 9 characters Depends on: Interpreter read application to me
Interpreter Signature and Date
Date of Signature	Date	Enter the date the interpreter signed this form. Depends on: Interpreter read application to me
Interpreter Signature	Text	Enter the interpreter’s signature. Max length: 1 characters Depends on: Interpreter read application to me
Mailing Address
In Care Of Name	Text	Enter the name of the person or organization who should receive mail at this address, if applicable. Max length: 34 characters
Street Number and Name	Text	Enter the street number and street name for your mailing address. Max length: 25 characters
Apartment/Suite/Floor	Text	Enter your apartment, suite, or floor identifier for the mailing address, if applicable. Max length: 6 characters
City or Town	Text	Enter the city or town for your mailing address. Max length: 20 characters
Postal Code	Text	Enter the postal code for your mailing address, if applicable. Max length: 9 characters
ZIP Code	Text	Enter the ZIP Code for your mailing address. Max length: 5 characters
State	Combobox	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
Country	Text	Enter the country for your mailing address.
Province	Text	Enter the province for your mailing address, if applicable. Max length: 20 characters
Apt.	Checkbox	Check this box if the mailing address is an apartment number.
Ste.	Checkbox	Check this box if the mailing address includes a suite number.
Flr.	Checkbox	Check this box if the mailing address includes a floor number.
Name as Printed on Current Permanent Resident Card
Current Card Last Name	Text	Enter your family name (last name) exactly as it appears on your current Permanent Resident Card. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Current Card First Name	Text	Enter your given name (first name) exactly as it appears on your current Permanent Resident Card. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Current Card Middle Name	Text	Enter your middle name exactly as it appears on your current Permanent Resident Card. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Name Change Since Card Issued (Select One)
Yes	Checkbox	Check this box if your name has legally changed since your Permanent Resident Card was issued.
No	Checkbox	Check this box if your name has not legally changed since your Permanent Resident Card was issued.
N/A - I never received my previous card	Checkbox	Check this box if you never received your previous Permanent Resident Card, so you cannot compare the name on it.
Parents' Given Names
Mother's Given Name	Text	Enter your mother's given (first) name.
Father's Given Name	Text	Enter your father's given (first) name.
Physical Address (If Different From Mailing)
Physical Address Street	Text	Enter the street number and street name for your physical address (if different from your mailing address). Max length: 25 characters
Physical Address City or Town	Text	Enter the city or town for your physical address (if different from your mailing address). Max length: 20 characters
Physical Address ZIP Code	Text	Enter the ZIP code for your physical address (if different from your mailing address). Max length: 5 characters
Physical Address Apartment/Suite/Floor	Text	Enter your apartment, suite, or floor number for your physical address, if applicable. Max length: 6 characters
Physical Address Country	Text	Enter the country for your physical address (if different from your mailing address).
Physical Address Postal Code	Text	Enter the postal code for your physical address (if different from your mailing address). Max length: 9 characters
Physical Address Province	Text	Enter the province for your physical address (if different from your mailing address). Max length: 20 characters
Apt.	Checkbox	Check this box if your physical address includes an apartment number.
Ste.	Checkbox	Check this box if your physical address includes a suite number.
Flr.	Checkbox	Check this box if your physical address includes a floor number.
State	Combobox	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
Port-of-Entry City/Town/State (if taking up commuter status)
Port-of-Entry City/Town and State	Text	Enter the city or town and state where you will enter the United States as a commuter. Fill only if 'Permanent resident taking up commuter status' is 'Yes'. Max length: 25 characters Depends on: Permanent resident taking up commuter status
Preparer Address Unit Type and Number (Apt/Ste/Flr)
Unit Number (Apt/Ste/Flr)	Text	Enter the apartment, suite, or floor number for the preparer’s mailing address, if applicable. Max length: 6 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Apt.	Checkbox	Check this box if the preparer’s mailing address includes an apartment (Apt.) number in the unit number field. Depends on: At my request, the preparer named in Part 7 prepared this application for me
Ste.	Checkbox	Check this box if the preparer’s mailing address includes a suite (Ste.) number in the unit number field. Depends on: At my request, the preparer named in Part 7 prepared this application for me
Flr.	Checkbox	Check this box if the preparer’s mailing address includes a floor (Flr.) designation in the unit number field. Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Contact Information
Preparer Email Address	Text	Enter the preparer’s email address, if they have one. Max length: 38 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Daytime Telephone Number	Text	Enter the preparer’s daytime telephone number where they can be reached. Max length: 10 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Mobile Telephone Number	Text	Enter the preparer’s mobile telephone number, if they have one. Max length: 10 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Full Name
Preparer Family Name (Last Name)	Text	Enter the preparer’s family name (last name). Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Given Name (First Name)	Text	Enter the preparer’s given name (first name). Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Business or Organization Name	Text	Enter the name of the preparer’s business or organization, if any. Max length: 34 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Mailing Address (Street/City/State/Zip/Province/Postal/Country)
Preparer City or Town	Text	Enter the city or town for the preparer’s mailing address. Max length: 20 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Street Address	Text	Enter the preparer’s street number and street name. Max length: 25 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Province	Text	Enter the province for the preparer’s mailing address, if applicable. Max length: 20 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer ZIP Code	Text	Enter the ZIP code for the preparer’s mailing address. Max length: 5 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer State	Combobox	Enter the state 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
Preparer Country	Text	Enter the country for the preparer’s mailing address. Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Postal Code	Text	Enter the postal code for the preparer’s mailing address, if applicable. Max length: 9 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer's Signature
Preparer Signature (Additional Line)	Text	Enter the preparer’s signature text if a typed signature is required in this space. Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer Signature	Text	Enter the signature of the person who prepared this application (if other than the applicant). Max length: 1 characters Depends on: At my request, the preparer named in Part 7 prepared this application for me
Date of Signature	Date	Enter the date the preparer signed this application. Depends on: At my request, the preparer named in Part 7 prepared this application for me
Preparer's Statement
Not an attorney/accredited representative	Checkbox	Check this box if you prepared this application for the applicant with the applicant’s consent and you are not an attorney or accredited representative. Depends on: At my request, the preparer named in Part 7 prepared this application for me
Attorney or accredited representative	Checkbox	Check this box if you are an attorney or accredited representative representing the applicant in this case. Depends on: At my request, the preparer named in Part 7 prepared this application for me
Representation extends beyond preparation	Checkbox	Check this box if your representation of the applicant extends beyond preparing this application. Fill only if 'Attorney or accredited representative' is 'Yes'. Depends on: Attorney or accredited representative
Representation does not extend beyond preparation	Checkbox	Check this box if your representation of the applicant does not extend beyond preparing this application. Fill only if 'Attorney or accredited representative' is 'Yes'. Depends on: Attorney or accredited representative
Processing Information - Exclusion/Deportation/Removal Proceedings (Yes/No)
No	Checkbox	Check this box if you have never been in exclusion, deportation, or removal proceedings and have not been ordered removed from the United States.
Yes	Checkbox	Check this box if you have ever been in exclusion, deportation, or removal proceedings, or have been ordered removed from the United States.
Processing Information - Filed Form I-407 or Abandoned Status (Yes/No)
No	Checkbox	Check this box if you have never filed Form I-407 and have not abandoned, and have not been determined to have abandoned, your lawful permanent resident status.
Yes	Checkbox	Check this box if you have ever filed Form I-407, abandoned your lawful permanent resident status, or otherwise been determined to have abandoned your status.
Processing Information - Locations and Entry Details
Application Location	Text	Enter the location where you applied for an immigrant visa or for adjustment of status. Max length: 38 characters
Visa Issuance or USCIS Office Location	Text	Enter the location where your immigrant visa was issued or the USCIS office where you were granted adjustment of status. Max length: 38 characters
Port of Entry (City/Town and State)	Text	Enter the city or town and state of the U.S. port of entry where you were admitted. Max length: 25 characters
U.S. Destination at Admission	Text	Enter your destination in the United States at the time you were admitted.
Reason for Application (select one)
Name/biographic information legally changed	Checkbox	Check this box if your name or other biographic information has been legally changed since your existing card was issued.
Card expired or will expire within six months	Checkbox	Check this box if your existing card has already expired or will expire within the next six months.
Reached age 14; card expires after 16th birthday	Checkbox	Check this box if you have reached your 14th birthday and are registering as required and your existing card will expire after your 16th birthday.
Reached age 14; card expires before 16th birthday	Checkbox	Check this box if you have reached your 14th birthday and are registering as required and your existing card will expire before your 16th birthday.
Incorrect data due to DHS error	Checkbox	Check this box if your existing card contains incorrect information because of a Department of Homeland Security (DHS) error.
Previous card lost, stolen, or destroyed	Checkbox	Check this box if your previous Permanent Resident Card was lost, stolen, or destroyed.
Previous card issued but never received	Checkbox	Check this box if USCIS/DHS issued your previous card but you never received it.
Existing card mutilated	Checkbox	Check this box if your current Permanent Resident Card has been mutilated/damaged.
Prior edition card / other replacement reason not listed	Checkbox	Check this box if you have a prior edition of the Alien Registration Card, or you are replacing your current Permanent Resident Card for a reason not specified above.
Commuter taking up actual residence in the United States	Checkbox	Check this box if you are a commuter who is taking up actual residence in the United States.
Automatically converted to lawful permanent resident status	Checkbox	Check this box if you have been automatically converted to lawful permanent resident status.
Permanent resident taking up commuter status	Checkbox	Check this box if you are a permanent resident who is taking up commuter status.
U.S. Social Security Number (if any)
U.S. Social Security Number	Number	Enter your U.S. Social Security Number, if you have one. Max length: 9 characters
USCIS Account and A-Number
Alien Registration Number (A-Number) (additional entry)	Text	Re-enter your Alien Registration Number (A-Number) in this additional field if it is required by the form.
USCIS Online Account Number	Text	Enter your USCIS online account number, if you have one. Max length: 12 characters
Alien Registration Number (A-Number)	Text	Enter your Alien Registration Number (A-Number). Max length: 9 characters
Your Full Name
Family Name (Last Name)	Text	Enter your family name (last name/surname).
Given Name (First Name)	Text	Enter your given name (first name).
Middle Name	Text	Enter your middle name, if you have one.

Form I-90, Application to Replace Permanent Resident Card Instructions