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

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

OMB No. 1615-0007; Expires 09/30/2011

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)

*Date of Birth (mm/dd/yyyy)

A-Number (Copy Number From Alien Card)

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

(City or Post Office)

(Street or Rural Route)

*(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

Date (mm/dd/yyyy)

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

Fingerprint Identification Number (FIN):
Form AR-11 SR (Rev. 10/27/11) N

* Indicates mandatory fields that must be completed.

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 5 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. This form expires September 30, 2011. Do not
mail your application to this address.
Mail Your Form AR-11 SR to the Address Below:
U. S. Department of Homeland Security
Citizenship and Immigration Services
Attn: Change of Address
1344 Pleasants Drive
Harrisonburg, VA 22801