Form I-131 Application for Travel Document

Application for Travel Document
USCIS
Form I-131

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

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

Action Block

Receipt

To Be Completed
by an Attorney/
Representative,
if any.

For
USCIS
Use
Only

DRAFT
Not for
Production
11/09/12

Fill in box if G-28 is
attached to represent
the applicant.

Document Hand Delivered
By:

Date:

/

/

/

Document Issued
Re-entry Permit (Update
"Mail To" Section)

Refugee Travel Document
(Update "Mail To" Section)

Single Advance Parole

Multiple Advance Parole
Valid Until:
/
/

Mail To

(Re-entry &
Refugee
Only)
/

Address in Part 1

Attorney State
License Number:

US Consulate at:
Intl DHS Ofc at:

► Start Here. Type or Print in Black Ink

Part 1. Information About You
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

Other Information

3.

► A-

1.c. Middle Name

Physical Address
2.a. In Care of Name

2.b. Street Number
and Name
2.c. Apt.

Ste.

2.g. Postal Code

4.

Country of Birth

5.

Country of Citizenship

6.

Class of Admission

7.

Gender

8.

Date of Birth

9.

U.S. Social Security Number (if any)

Flr.

2.d. City or Town
2.e. State

Alien Registration Number (A-Number)

2.f.

Zip Code

Male

Female
(mm/dd/yyyy) ►

►
2.h. Province
2.i.

Country

Form I-131 11/09/12 N

Page 1 of 5

Part 2. Application Type
1.a.

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

1.b.

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

1.c.

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

1.d.

1.e.
1.f.

2.e. Country of Birth

2.f.

Country of Citizenship

2.g. Daytime Phone Number

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2.h. In Care of Name

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

2.i.

I am applying for an Advance Parole Document for a
person who is outside the United States.

Street Number
and Name

2.j.

Apt.

If you checked box "1.f." provide the following information
about that person in 2.a. through 2.p.

2.c. Middle Name
2.d. Date of Birth

)

-

Physical Address (If you checked box 1.f.)

I am applying for an Advance Parole Document to
allow me to return to the United States after
temporary foreign travel.

2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

(

Ste.

Flr.

2.k. City or Town
2.l.

State

2.m. Zip Code

2.n. Postal Code
2.o. Province

(mm/dd/yyyy) ►

2.p. Country

Part 3. Processing Information
1.

Date of Intended Departure

(mm/dd/yyyy) ►
2.

4.a. Have you ever before been issued a reentry permit or
Refugee Travel Document? (If "Yes" give the following
information for the last document issued to you):

Expected Length of Trip (in days)

3.a. Are you, or any person included in this application, now
in exclusion, deportation, removal, or rescission
proceedings?
Yes
No

4.b. Date Issued

Yes

No

(mm/dd/yyyy) ►

4.c. Disposition (attached, lost, etc.):

3.b. If "Yes", Name of DHS office:

If you are applying for a non-DACA related Advance Parole Document, skip to Part 7; DACA recipients must complete Part 4
before skipping to Part 7.

Form I-131 11/09/12 N

Page 2 of 5

Part 3. Processing Information (continued)
Where do you want this travel document sent? (Check one)
5.
6.

To the U.S. address shown in Part 1 (2.a through
2.i.) of this form.
To a U.S. Embassy or consulate at:

7.

7.b. Country

Ste.

Flr.

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10.d. City or Town
10.e. State

To a DHS office overseas at:

7.a. City or Town

10.b. Street Number
and Name
10.c. Apt.

6.a. City or Town
6.b. Country

10.a. In Care of Name

10.f. Zip Code

10.g. Postal Code
10.h. Province

If you checked "6" or "7", where should the notice to pick up
the travel document be sent?

10.i. Country

8.

To the address shown in Part 2 (2.h. through 2.p.)
of this form.

10.j. Daytime Phone Number

9.

To the address shown in Part 3 (10.a. through 10.i.)
of this form.:

(

)

-

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

1.b. List the countries you intend to visit. (If you need more
space, continue on a separate sheet of paper.)

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

less than 6 months
6 months to 1 year
1 to 2 years

Form I-131 11/09/12 N

1.d.
1.e.
1.f.

2 to 3 years
3 to 4 years
more than 4 years

2.

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.)
Yes

No

Page 3 of 5

Part 6. Complete Only If Applying for a Refugee Travel Document
1.

3.c. Applied for and/or received any benefit from such country
(for example, health insurance benefits)?

Country from which you are a refugee or asylee:

Yes
If you answer "Yes" to any of the following questions, you
must explain on a separate sheet of paper. Include your
Name and A-Number on the top of each sheet.
2.

Do you plan to travel to the country
named above?

Yes

No

No

Since you were accorded refugee/asylee status, have you, by
any legal procedure or voluntary act:

DRAFT
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11/09/12

4.a. Reacquired the nationality of the
country named above?

Yes

No

Since you were accorded refugee/asylee status, have you ever:

4.b. Acquired a new nationality?

Yes

No

3.a. Returned to the country named
above?

4.c. Been granted refugee or asylee status
in any other country?

Yes

No

Yes

No

3.b. Applied for and/or obtained a national passport, passport
renewal, or entry permit of that country?
Yes

No

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.)
1.

How many trips do you intend to use this document?
One Trip
More than one trip

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

4.a. In Care of Name

4.b. Street Number
and Name

4.c. Apt.

Ste.

Flr.

4.d. City or Town
4.e. State

4.f.

Zip Code

4.g. Postal Code
4.h. Province

2.b. Country

If the travel document will be delivered to an overseas office,
where should the notice to pick up the document be sent?:
3.

To the address shown in Part 2 (2.h. through 2.p.)
of this form.

4.

To the address shown in Part 7 (4.a. through 4.i.)
of this form.

Form I-131 11/09/12 N

4.i.

Country

4.j.

Daytime Phone Number

(

)

-

Page 4 of 5

Part 8. Signature of Applicant (Read the information on penalties in the Form instructions before completing
this Part.) If you are filing for a Re-entry Permit or Refugee Travel Document, you must be in the United States
to file this application.
1.a. I certify, under penalty of perjury under the laws of the
United States of America, that this application and the
evidence submitted with it is 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.

1.b. Date of Signature (mm/dd/yyyy) ►
2.

Daytime Phone Number

(

DRAFT
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Signature of Applicant

)

-

NOTE: If you do not completely fill out this form or fail to
submit required documents listed in the instructions, your
application may be denied.

Part 9. Information About Person Who Prepared This Application, If Other Than the Applicant
NOTE: If you are an attorney or representative, you must
submit a completed Form G-28, Notice of Entry of Appearance
as Attorney or Accredited Representative, along with this
application.

Preparer's Contact Information

4.

(

Preparer's Full Name

Provide the following information concerning the preparer:

Preparer's Daytime Phone Number

5.

)

Extension

-

Preparer's E-mail Address (if any)

1.a. Preparer's Family Name (Last Name)

Declaration

1.b. Preparer's Given Name (First Name)

2.

Preparer's Business or Organization Name

To be completed by all preparers, including attorneys and
authorized representatives: I declare that I prepared this benefit
request at the request of the applicant, that it is based on all the
information of which I have knowledge, and that the
information is true to the best of my knowledge.

Preparer's Mailing Address

6.a. Signature
of Preparer

3.a. Street Number
and Name

6.b. Date of Signature (mm/dd/yyyy) ►

3.b. Apt.

Ste.

Flr.

NOTE: If you require more space to provide any additional
information, use a separate sheet of paper. You must include
your Name and A-Number on the top of each sheet.

3.c. City or Town
3.d. State
3.f.

3.e. Zip Code

Postal Code

3.g. Province
3.h. Country

Form I-131 11/09/12 N

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