Form I-90, Application to Replace Permanent Resident Card Instructions
This form contains 195 fields organized into 30 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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| Alien and USCIS Account Numbers | ||
| Form Page Identifier (Footer) | Text |
Enter or verify the form page identifier or internal tracking value shown in the page footer, if required.
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| Apt./Ste./Flr. (Mailing Address) | Text |
Enter your apartment, suite, or floor number for your mailing address, or leave this field blank if not applicable. Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
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| USCIS Online Account Number | Text |
Provide your USCIS Online Account Number if you have one; leave blank if you do not have an online account.
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| Alien Registration Number (A-Number) | Text |
Enter your Alien Registration Number exactly as it appears on your permanent resident card (include the 'A' prefix if shown).
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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 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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| Application Type - My Status | ||
| Lawful Permanent Resident | Checkbox |
Check this box if you are a lawful permanent resident (not in commuter status) and are filing this application for that status.
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| Permanent Resident - In Commuter Status | Checkbox |
Check this box if you are a permanent resident who is in commuter status and your application should proceed under Section A.
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| Conditional Permanent Resident | Checkbox |
Check this box if you are a conditional permanent resident (e.g., CR1, CR2, CF1, CF2) and are filing this application as a conditional permanent resident.
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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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| Immigration Admission Details | ||
| U.S. Social Security Number (if any) | Number |
Enter your U.S. Social Security Number if you have been issued one, or leave this field blank if you do not have a SSN.
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| Date of Admission | Date |
Provide the date you were most recently admitted to the United States for the admission shown on this form.
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| Class of Admission | Text |
Enter the admission class code (the short alphanumeric classification shown on your I-94, I-551, or other U.S. admission document) that describes your current status.
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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 | ||
| Internal Use — Control Number | Text |
Enter the internal tracking or control number assigned by the agency for this form (for example, a page, batch, or record number).
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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 (6.a - 6.i) | ||
| In Care Of Name (C/O) | Text |
Enter the full name of the person or organization who should receive mail on your behalf (C/O). Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
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| Street Number and Name | Text |
Enter the street number and street name for your mailing address (for example, 123 Main St). Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
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| City or Town | Text |
Enter the city or town for your mailing address. Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
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| Postal Code | Text |
Enter the postal code for your mailing address (used for non‑U.S. postal systems). Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
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| ZIP Code | Text |
Enter the U.S. ZIP code for your mailing address (5‑digit or ZIP+4 if applicable). Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
|
| State | Combobox |
Enter the U.S. state for your mailing address (use the two‑letter abbreviation or full state name). Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
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
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
|
| Country | Text |
Enter the country name for your mailing address. Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
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| Province / Region | Text |
Enter the province, territory, or region for your mailing address, if applicable. Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
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| Apt. | Checkbox |
Check this box when your mailing address includes an apartment (Apt.) number and you will enter that number in the adjacent field. Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
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| Ste. | Checkbox |
Check this box when your mailing address includes a suite (Ste.) number and you will enter that suite number in the adjacent field. Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
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| Flr. | Checkbox |
Check this box when your mailing address includes a floor (Flr.) designation and you will enter that floor number in the adjacent field. Fill only if 'No (Proceed to Item Numbers 6.a. - 6.i.)', 'N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'No' or 'N/A (I never received my previous card)' is 'Yes' (any).
Depends on:
No (Proceed to Item Numbers 6.a. - 6.i.), N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.)
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| Name Change Question and Current Card Name | ||
| Yes (Proceed to Item Numbers 5.a. - 5.c.) | Checkbox |
Check this box if your name has legally changed since the issuance of your Permanent Resident Card.
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| No (Proceed to Item Numbers 6.a. - 6.i.) | Checkbox |
Check this box if your name has not legally changed since the issuance of your Permanent Resident Card.
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| N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.) | Checkbox |
Check this box if you never received your previous Permanent Resident Card.
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| Current Family Name (Last Name) | Text |
Enter your family/last name exactly as it appears on your current Permanent Resident Card. Fill only if 'Yes (Proceed to Item Numbers 5.a. - 5.c.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'Yes'.
Depends on:
Yes (Proceed to Item Numbers 5.a. - 5.c.)
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| Current Given Name (First Name) | Text |
Enter your given/first name exactly as it appears on your current Permanent Resident Card. Fill only if 'Yes (Proceed to Item Numbers 5.a. - 5.c.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'Yes'.
Depends on:
Yes (Proceed to Item Numbers 5.a. - 5.c.)
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| Current Middle Name | Text |
Enter your middle name exactly as it appears on your current Permanent Resident Card, or leave blank if none. Fill only if 'Yes (Proceed to Item Numbers 5.a. - 5.c.)' Has your name legally changed since the issuance of your Permanent Resident Card? is 'Yes'.
Depends on:
Yes (Proceed to Item Numbers 5.a. - 5.c.)
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| Personal Information | ||
| 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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| Personal Information (Additional Information) | ||
| Date of Birth | Date |
Enter your date of birth.
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| City/Town/Village of Birth | Text |
Enter the name of the city, town, or village where you were born.
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| Country of Birth | Text |
Enter the country where you were born.
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| Mother's Given Name (First Name) | Text |
Enter your mother's given (first) name only.
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| Father's Given Name (First Name) | Text |
Enter your father's given (first) name only.
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| Male | Checkbox |
Check this box if your gender is male.
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| Female | Checkbox |
Check this box if your gender is female.
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| Physical Address (7.a - 7.h) | ||
| Street Number and Name | Text |
Enter the full street number and street name of your physical residence (for example, 123 Main St).
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| City or Town | Text |
Enter the city or town where your physical residence is located.
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| ZIP Code | Text |
Enter the ZIP code for your physical address, including any leading zeros if applicable.
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| Apt./Suite/Floor Number | Text |
Enter the apartment, suite, or floor number associated with your physical address, or leave blank if none.
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| Country | Text |
Enter the country in which your physical residence is located.
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| Postal Code | Text |
Enter the international postal code for your physical address if different from a U.S. ZIP code.
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| Province | Text |
Enter the province, state subdivision, or region for your physical address if applicable.
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| Apt. | Checkbox |
Check this box if your physical address includes an apartment number (then enter the apartment number in the adjacent field).
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| Ste. | Checkbox |
Check this box if your physical address is a suite (Suite) and you will enter the suite number in the adjacent field.
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| Flr. | Checkbox |
Check this box if your physical address includes a floor number and you will enter the floor in the adjacent field.
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| State | Combobox |
Enter the U.S. state (abbreviation or full name) for 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.
|
| 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
|
| 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.
|
| 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.
|
| 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.
|
| 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.
|
| 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.
|
| 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.
|
| 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.
|
| 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.
|
| 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.
|
| 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.
|
| 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.
|
| Reason for Application (Section A) - Select only one | ||
| My name or other biographic information has been legally changed since issuance of my existing card. | Checkbox |
Check this box if you have legally changed your name or other biographic information since your card was issued.
|
| My existing card has already expired or will expire within six months. | Checkbox |
Check this box if your current card has already expired or will expire within the next six months.
|
| I have reached my 14th birthday and am registering as required; my existing card will expire AFTER my 16th birthday. | Checkbox |
Check this box if you are registering after turning 14 and your current card will expire after your 16th birthday.
|
| I have reached my 14th birthday and am registering as required; my existing card will expire BEFORE my 16th birthday. | Checkbox |
Check this box if you are registering after turning 14 and your current card will expire before your 16th birthday.
|
| My existing card has incorrect data because of Department of Homeland Security (DHS) error. | Checkbox |
Check this box if your card contains incorrect information due to a DHS error; attach the incorrect card with your application.
|
| My previous card has been lost, stolen, or destroyed. | Checkbox |
Check this box if your previous Permanent Resident Card was lost, stolen, or destroyed and you are applying for a replacement.
|
| My previous card was issued but never received. | Checkbox |
Check this box if USCIS issued your previous card but you never received it.
|
| My existing card has been mutilated. | Checkbox |
Check this box if your current card is physically mutilated or damaged such that it is no longer valid.
|
| 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 |
Check this box if you have an older edition of the Alien Registration Card or are replacing your card for a reason not covered by the other options.
|
| I am a commuter who is taking up actual residence in the United States. | Checkbox |
Check this box if you are a commuter who is now establishing actual residence in the United States.
|
| I have been automatically converted to lawful permanent resident status. | Checkbox |
Check this box if you were automatically converted to lawful permanent resident status.
|
| I am a permanent resident who is taking up commuter status. | Checkbox |
Check this box if you are a permanent resident changing your status to commuter.
|
| Port-of-Entry (City and State) | Text |
Enter the city or town and U.S. state of your port-of-entry — the place where you first entered the United States, as requested for item 2.h.1.a. Fill only if 'I am a permanent resident who is taking up commuter status.' is 'Yes'.
Depends on:
I am a permanent resident who is taking up commuter status.
|
| System Information | ||
| PDF417BarCode1 | Text |
This field contains a barcode that is automatically generated and should not be modified.
|
| Your Full Name (Family, Given, Middle) | ||
| Family Name (Last Name) | Text |
Enter your legal family or last name exactly as you want it to appear on your replacement Permanent Resident Card.
|
| Given Name (First Name) | Text |
Enter your legal given or first name exactly as you want it to appear on your replacement Permanent Resident Card.
|
| Middle Name | Text |
Enter your full middle name as it should appear on your replacement Permanent Resident Card, or leave blank if you have no middle name.
|