Form I-131 Application for Travel Document

OMB No. 1615-0013; Expires 03/31/2012

Department of Homeland Security
U. S. Citizenship and Immigration Services

I-131, Application for Travel Document

DO NOT WRITE IN THIS BLOCK

FOR USCIS USE ONLY (except G-28 block below)

Document Issued
Action Block
Reentry Permit
Refugee Travel Document
Single Advance Parole
Multiple Advance Parole
Valid to:
If Reentry Permit or Refugee Travel
Document, mail to:
Address in Part 1
U.S. Embassy/consulate
at:
Overseas DHS office
at:

Part 1.

Receipt

Document Hand Delivered
On
By
To be completed by Attorney/Representative, if any.

Attorney State License #
Check box if G-28 is attached.

Information About You (Type or print in black ink)

1. A Number

2. Date of Birth (mm/dd/yyyy)

3. Class of Admission

4. Gender
Male

5. Name (Family name in capital letters)

(First)

(Middle)

6. Address (Number and Street)
City
7. Country of Birth

Part 2.

Female

Apt. Number
State or Province

Zip/Postal Code

Country

8. Country of Citizenship

9. Social Security # (if any)

Application Type (Check one)

a.

I am a permanent resident or conditional resident of the United States, and I am applying for a reentry permit.

b.

I now hold U.S. refugee or asylee status, and I am applying for a Refugee Travel Document.

c.

I am a permanent resident as a direct result of refugee or asylee status, and I am applying for a Refugee Travel Document.

d.

I am applying for an advance parole document to allow me to return to the United States after temporary foreign travel.

e.

I am outside the United States, and I am applying for an Advance Parole Document.

f.

I am applying for an Advance Parole Document for a person who is outside the United States. If you checked box "f,"
provide the following information about that person:

1. Name (Family name in capital letters)

2. Date of Birth (mm/dd/yyyy)

(First)

3. Country of Birth

5. Address (Number and Street)

City

(Middle)

4. Country of Citizenship

Apt. #

State or Province

Daytime Telephone # (area/country code)

Zip/Postal Code

Country

Form I-131 (Rev. 11/23/10)Y

Part 3. Processing Information
2. Expected Length of Trip

1. Date of Intended Departure (mm/dd/yyyy)

3. Are you, or any person included in this application, now in
No (Name of DHS office):
Yes
exclusion, deportation, removal, or rescission proceedings?
If you are applying for an Advance Parole Document, skip to Part 7.
4. Have you ever before been issued a reentry permit or Refugee Travel Document?
Yes (If "Yes," give the following information for the last document issued to you):
No
Date Issued (mm/dd/yyyy):

Disposition (attached, lost, etc.):

5. Where do you want this travel document sent? (Check one)
a.
To the U.S. address shown in Part 1 on the first page of this form.
b.

To a U.S. Embassy or consulate at:

City:

Country:

c.

To a DHS office overseas at:

City:

Country:

d. If you checked "b" or "c," where should the notice to pick up the travel document be sent?
To the address shown in Part 2 on the first page of this form.
To the address shown below:
Address (Number and Street)
City

Apt. #

State or Province

Daytime Telephone # (area/country code)
Zip/Postal Code

Country

Part 4. Information About Your Proposed Travel
Purpose of trip. (If you need more room, continue on a separate sheet of paper.)

List the countries you intend to visit.

Part 5. Complete Only If Applying for a Reentry Permit
Since becoming a permanent resident of the United States (or during the
past five years, whichever is less) how much total time have you spent
outside the United States?

less than six months
six months to one year
one to two years

Since you became a permanent resident of the United States, have you ever filed a Federal income tax
return as a nonresident or failed to file a Federal income tax return because you considered yourself to be a
nonresident? (If "Yes," give details on a separate sheet of paper.)

two to three years
three to four years
more than four years

Yes

No

2. Do you plan to travel to the country named above?

Yes

No

3. Since you were accorded refugee/asylee status, have you ever:
a. Returned to the country named above?
b. Applied for and/or obtained a national passport, passport renewal, or entry permit of that country?
c. Applied for and/or received any benefit from such country (for example, health insurance benefits).

Yes
Yes
Yes

No
No
No

4. Since you were accorded refugee/asylee status, have you, by any legal procedure or voluntary act:
a. Reacquired the nationality of the country named above?
b. Acquired a new nationality?
c. Been granted refugee or asylee status in any other country?

Yes
Yes
Yes

No
No
No

Part 6. Complete Only If Applying for a Refugee Travel Document
1. Country from which you are a refugee or asylee:
If you answer "Yes" to any of the following questions, you must explain on a separate sheet of paper.

Form I-131 (Rev. 11/23/10)Y Page 2

Part 7. Complete Only If Applying for Advance Parole
On a separate sheet of paper, explain how you qualify for an Advance Parole Document, and what circumstances warrant issuance of
advance parole. Include copies of any documents you wish considered. (See instructions.)
One Trip

1. How many trips do you intend to use this document?

More than one trip

2. If the person intended to receive an Advance Parole Document is outside the United States, provide the location (city and country)
of the U.S. Embassy or consulate or the DHS overseas office that you want us to notify.
City

Country

3. If the travel document will be delivered to an overseas office, where should the notice to pick up the document be sent?:
To the address shown in Part 2 on the first page of this form.
To the address shown below:
Address (Number and Street)

City

Apt. #

State or Province

Daytime Telephone # (area/country code)

Zip/Postal Code

Country

Read the information on penalties in the instructions before completing this section. If you are filing

Part 8. Signature for a reentry permit or Refugee Travel Document, you must be in the United States to file this application.
I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with
it are all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services
needs to determine eligibility for the benefit I am seeking.
Signature

Date (mm/dd/yyyy)

Daytime Telephone Number (with area code)

Note: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be
found eligible for the requested document and this application may be denied.

Part 9. Signature of Person Preparing Form, If Other Than the Applicant (Sign below)
I declare that I prepared this application at the request of the applicant, and it is based on all information of which I have knowledge.
Signature

Print or Type Your Name

Firm Name and Address

Daytime Telephone Number (with area code)

Fax Number (if any)

Date (mm/dd/yyyy)

Form I-131 (Rev. 11/23/10)Y Page 3