AR-11SR Alien's Change of Address Card

OMB No. 1615-0007

Department of Homeland Security
U.S. Citizenship and Immigration Services
Name (Last in CAPS)

AR-11 SR, Alien's Change of Address Card

(First Name)

Country of Citizenship

I am in the United States as a:
Permanent Resident
Visitor
(Specify)
Other
Student

(Middle Name)

Copy Number From Alien Card

Date of Birth (mm/dd/yyyy)

A
Present Address

(City or Post Office)

(Street or Rural Route)

Years

(If the above address is temporary) I expect to remain there
Last Address

(Street or Rural Route)

(City or Post Office)

(State)

(Zip Code)

(State)

(Zip Code)

(State)

(Zip Code)

Months

I work for or attend school at: (Employer's Name or Name of School)

(Street Address or Rural Route)

(City or Post Office)

Port of Entry Into U.S.

Date of Entry Into U.S. (mm/dd/yyyy)

Signature

If not a Permanent Resident,
my stay in the U.S. expires on:
(Date - mm/dd/yyyy)

Date (mm/dd/yyyy)

Fingerprint Identification Number (FIN):
Form AR-11 SR (Rev. 01/25/11) N

Special Registration

AR-11 SR, Alien's Change of Address Card
This card is to be used by all aliens to report a change of address within 10 days of such change.
The collection of this information is required by Section 265 of the Immigration and Nationality Act (8 U.S.C. 1305). The data is
used by U.S. Citizenship and Immigration Services for statistical and record purposes and may be furnished to federal, state, local
and foreign law enforcement officials. Failure to report a change of address is punishable by fine or imprisonment and/or removal.
ADVISORY: This card is not evidence of identity, age, or status claimed.

Paperwork Reduction Act
An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. The public reporting burden for this collection of information
is estimated at five minutes per response, including the time for reviewing instructions and completing and submitting the form.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory Products Division, Office of the Executive
Secretariat, 20 Massachusetts Avenue, N.W., Washington, DC 20529-2020. OMB No. 1615-0007; Expires September 30, 2011. Do
not mail your application to this address.
Mail Your Form to the Address Shown Below:
U. S. Department of Homeland Security
Citizenship and Immigration Services
Attn: Change of Address
1344 Pleasants Drive
Harrisonburg, VA 22801