Application for Replacement/Initial Nonimmigrant Arrival-Departure Document

Instructions for Application for Replacement/Initial
Nonimmigrant Arrival-Departure Document
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-102
OMB No. 1615-0079
Expires 02/28/2015

What is the Purpose of This Form?
Use Form I-102, Application for Replacement/Initial Nonimmigrant Arrival-Departure Document, to request a new or
replacement of an incorrect, lost, stolen, or mutilated Nonimmigrant Arrival-Departure Document.

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When Should I Use This Form?
You may file a Form I-102 if you:

1. Were admitted at a port of entry in the United States by air, sea port, or arriving by land/border crossing and you were
not issued an initial Form I-94, I-94W, or I-95 or need to replace your lost, stolen, or mutilated Form I-94, I-94W, or
I-95;
NOTE: If you were admitted at an air or sea port of entry and issued an electronic Form I-94, you should go to the
U.S. Customs and Border Patrol (CBP) Web site at www.cbp.gov/I94 in order to obtain an initial or replacement paper
version of Form I-94. Follow the instructions you received from CBP on how to do this. You may print-out a paper
version of your Form I-94 from this Web site. CBP does not charge a fee for this service. If you are unable to obtain
your Form I-94 from the CBP Web site or do not want to use the CBP Web site, you may use this form (Form I-102)
to obtain a paper Form I-94. However, you must pay the Form I-102 filing fee when submitting this form to USCIS.
2. Would like to replace a lost, stolen, or mutilated Form I-94W or receive an initial Form I-94W, but only if you were
admitted at a land border port of entry, or you were admitted at an air or sea port of entry on or before June 28, 2010;
3. Extended/changed your initial nonimmigrant status with USCIS after you were admitted to the United States, and you
need a replacement of your lost, stolen, or mutilated Form I-94;
4. Were not issued a Form I-94 when you entered as a nonimmigrant member of the military; or
5. Were issued Form I-94, I-94W, or I-95 with incorrect information.

NOTE: If CBP issued you Form I-94, I-94W, or I-95 with incorrect information (for example: misspelled name,
incorrect date of birth, visa classification, or date of admission), you should not file Form I-102. You will need to go
to the nearest CBP port of entry (POE) or the nearest CBP deferred inspection office (DOP), in person, to have the
information corrected. For locations and hours of operation visit the CBP's Web site at www.cbp.gov.

General Instructions
Each application must be properly signed and accompanied by the appropriate fee. (See "What Is the Filing Fee?"
section of these instructions.) A photocopy of a signed application or typewritten name in place of a signature is not
acceptable.
If you are under 14 years of age, your parent or legal guardian may sign the application on your behalf.
Evidence. You must submit all required initial evidence along with all the supporting documentation with your
application at the time of filing.
Copies. Unless specifically required that an original document be filed with an application or petition, an ordinary legible
photocopy may be submitted. Original documents submitted when not required may remain a part of the record, and will
not be automatically returned to you.
Translations. Any document containing a foreign language submitted to USCIS shall be accompanied by a full English
language translation which the translator has certified as complete and accurate, and by the translator's certification that he
or she is competent to translate from the foreign language into English.

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How to Fill Out Form I-102
A separate Form I-102 must be filed for each person seeking the immigration benefit.
1. Type or print legibly in black ink.
2. If extra space is needed to complete any item, attach a continuation sheet, write your name and Alien Registration
Number (A-Number) (if any), at the top of each sheet of paper, indicate the Part and item number to which your
answer refers, and date and sign each sheet.
3. Answer all questions fully and accurately. If an item is not applicable or the answer is none, leave the answer blank.

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Specific Instructions

Form I-102 is divided into Parts 1 through 5. The following information should help you fill out the form.
Part 1.

Information About You

1.a. - 1.c. Your Full Name

Provide your legal name. If you have two last names, include both and use a hyphen (-) between the names, if
appropriate.
2.a. - 2.i. Mailing Address

List your complete mailing address in the spaces provided. If your mail will be sent to someone other than yourself,
please include an "In Care Of Name" as part of your mailing address.
3. Alien Registration Number (A-Number)

This is your immigration file number. If you do not have an Alien Registration Number or do not know it, leave this
blank.
4. Date of Birth

Provide your date of birth (mm/dd/yyyy) in the space provided as it is shown on your birth certificate or other
government-issued identity document.
5. - 6. Country of Birth and Country of Citizenship

Provide the name of the country of your birth and the name of the country of your citizenship. The name of the
country should be the current name of the country.
7. U.S. Social Security Number
Provide your Social Security Number. If you do not have a U.S. Social Security Number, leave this blank.
8. - 9. Date and Place of Last Admission to the United States
Provide the date (mm/dd/yyyy) and location of your last actual entry into the United States.
10. What is your current Nonimmigrant Status?
Provide your current status. If you were granted a change of status, provide a copy of the approval notice noting the
change.
11. Status Expires
Provide the ending date of your authorized stay in the United States.
12. Form I-94, I-94W, or I-95 Arrival-Departure Number
Provide your Form I-94, I-94W, or I-95 Arrival-Departure Number, if you have one. Otherwise, leave it blank.

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Part 2.

Reason for Application

The following is a brief description of eligibility categories. Check the box in Part 2 of Form I-102 that matches your
reason for filing.
After determining which category best applies, you must submit evidence that proves eligibility. Each category has
specific evidence requirements. See section entitled "Submit Your Application," for information on what evidence is
required.

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You should use Form I-102 to:

1. Replace your lost, stolen, or mutilated Form I-94, I-94W, or I-95;

NOTE: If you were issued an electronic Form I-94 by CBP at an air or sea port of entry, you may not need to file
Form I-102. Instead, you may be able to obtain a replacement Form I-94 by going to the CBP Web site at
www.cbp.gov/I94. No fee is charged for this service. See the NOTE in the section entitled, “When Should I Use
This Form” for more information.
2. Receive an initial Form I-94 or I-94W if you were not issued one at admission, or you are filing this Form I-102 with
Form I-539, Application to Extend/Change Nonimmigrant Status.
NOTE: If you were issued an electronic Form I-94 by CBP at an air or sea port of entry, you may not need to file
Form I-102. Instead, you may be able to obtain an initial Form I-94 by going to the CBP Web site at www.cbp.gov/I94.
No fee is charged for this service. See the NOTE in the section entitled, “When Should I Use This Form” for more
information.
3. Receive a corrected Form I-94, I-94W, or I-95 if you were issued one by USCIS with incorrect information.
NOTE: If CBP issued you Form I-94, I-94W, or I-95 with incorrect information (for example: misspelled name,
incorrect date of birth, visa classification, or date of admission), you should not file Form I-102. You will need to go to
the nearest CBP port of entry (POE) or the nearest CBP deferred inspection office (DIO), in person, to have the
information corrected. For locations and hours of operation visit the CBP's Web site at www.cbp.gov.
4. Receive an initial Form I-94 if you were not issued one when you were originally admitted into the United States due
to your military membership as described below:
a. Nonimmigrant member of the U.S. Armed Forces;

b. Nonimmigrant member of the North Atlantic Treaty Organization (NATO) armed forces or civilian component; or
c. Nonimmigrant member of the Partnership for Peace military program under the Status of Forces Agreement (SOFA).
Part 3.

Processing Information

1.a. - 5. Provide all information requested in the spaces provided.
Part 4.

Signature of Applicant

As the applicant, you must sign, date and provide a daytime telephone number on the space provided on the application.
If you do not sign the form, it will be rejected as incomplete.
Part 5.

Signature of Person Preparing Form, If Other than Applicant

If you, the applicant, did not fill out Form I-102, the preparer of the application must also sign, date and provide his or her
name, address, daytime telephone number, and e-mail address in the spaces provided.
Submit Your Application
Your application must include the following items:
1. Your Signed and Completed Form I-102
Each application must be properly signed and filed with the correct fee. If you are under 14 years of age, your parent
or legal guardian may sign the application.

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2. General Requirements
a. Initial Evidence. You must file your application with the required initial evidence. Attach copies, showing the front
and back of the documents you need to support your application. Do not send original documents unless
instructed to do so.
b. Lost or Stolen Form I-94, I-94W, or I-95. If you are applying to replace a lost or stolen Form I-94, I-94W, or
I-95, submit a copy of the original or submit a copy of the biographic page from your passport and a copy of the
page indicating admission as claimed, or other evidence of your admission. If you are unable to provide this
evidence, submit a full explanation stating why you cannot give any of the above evidence, along with a copy of
evidence of your identity and copies of any evidence in your possession to substantiate your claim. If your Form
I-94, I-94W, or I-95 was stolen, submit a copy of the police report relating to the theft.

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c. Mutilated Form I-94, I-94W, or I-95. If you are applying to replace a mutilated Form I-94, I-94W, or I-95, attach
the original damaged form.
d. First Form I-94. If you were not issued Form I-94 at admission and have not since been issued Form I-94, but
now require Form I-94 for another application you are filing, submit a copy of any evidence in your possession to
substantiate your claimed admission.
e. Nonimmigrant Military Member. If you are filing as a nonimmigrant military member in the U.S. Armed
Forces, NATO, or the Partnership for Peace program and you are requesting an initial Form I-94, contact your
foreign commander or his or her designee in the United States for filing information.
f. Correct Inaccurate Information. If you want USCIS to correct inaccurate information on your Form I-94,
I-94W, or I-95, attach your Form I-94, I-94W, or I-95 to your application. If you check box "1.f." in Part 2,
Reason for Application, attach a statement dated and signed by you, citing specifically what information on your
Form I-94, I-94W, or I-95 requires correction. You must also attach evidence verifying the validity of the
information submitted for correction purposes.
g. Not Issued Form I-94/Extension-Status Change. If you were not issued Form I-94 at admission or are filing this
application with a Form I-539, Application to Extend/Change Nonimmigrant Status. Check box "1.e." in Part 2,
Reason for Application, and file this form in accordance with Form I-539 filing instructions.

What Is the Filing Fee?

The filing fee for Form I-102 is $330.

1. The fee must be submitted in the exact amount. The fee for this form cannot be waived, and is nonrefundable. Do not
mail cash.
2. You do not need to pay the fee to request USCIS to correct your Form I-94, I-94W, or Form I-95 if the error(s) on
your document was made by USCIS, through no fault of your own. If, however, the error(s) was made because of
information you provided or failed to provide to USCIS or the U.S. Department of State (DOS), you must pay the fee.
3. You do not need to pay the fee if you are a nonimmigrant military member in the U.S. Armed Forces or you are
participating in a NATO or Partnership for Peace military program under the SOFA, and you are requesting an initial
Form I-94. Check Box "1.g." in Part 2, Reason for Application, if this applies to you.
Use the following guidelines when you prepare your check or money order:
1. The check or money order must be drawn on a bank or other financial institution located in the United States and must
be payable in U.S. currency; and
2. Make the check or money order payable to U.S. Department of Homeland Security.
NOTE: Spell out U.S. Department of Homeland Security; do not use the initials "USDHS" or "DHS."
3. If you live outside the United States, contact the nearest U.S. Embassy or consulate for instructions on the method of
payment.

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Notice to Those Making Payment by Check
If you send us a check, it will be converted into an electronic funds transfer (EFT). This means we will copy your check
and use the account information on it to electronically debit your account for the amount of the check. The debit from
your account will usually take 24 hours and will be shown on your regular account statement.
You will not receive your original check back. We will destroy your original check, but we will keep a copy of it. If the
EFT cannot be processed for technical reasons, you authorize us to process the copy in place of your original check. If the
EFT cannot be completed because of insufficient funds, we may try to make the transfer up to two times.

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How to Check if the Fees Are Correct

The fee on this Form I-102 is current as of the edition date appearing in the lower left corner of this page. However,
because USCIS fees change periodically, you can verify if the fee is correct by following one of the steps below:
1. Visit the USCIS Web site at www.uscis.gov, select "FORMS," and check the appropriate fee; or

2. Telephone the USCIS National Customer Service Center at 1-800-375-5283 and ask for the fee information. For TDD
(hearing impaired) call: 1-800767-1833.

Where to File?

Please see our Web site at www.uscis.gov/I-102 or call our National Customer Service Center at 1-800-375-5283 for the
most current information about where to file this benefit request. For TDD (hearing impaired) call: 1-800767-1833.

Address Changes

If you changed your address, you must inform USCIS of your new address. For information on filing a change of address
go to the USCIS Web site at www.uscis.gov/addresschange or contact the National Customer Service Center at
1-800-375-5283. For TDD (hearing impaired) call: 1-800-767-1833.
NOTE: Do not submit a change of address request to USCIS Lockbox facilities because USCIS Lockbox facilities do
not process change of address requests.

Processing Information

Our goal at USCIS is to process all applications fairly. The processing time will vary, depending on the specific
circumstances of each case. We may deny an application if you do not give us the requested information or do not go to
a scheduled interview.
Acceptance
Any Form I-102 that is not signed or accompanied by the correct fee will be rejected with a notice that Form I-102 is
deficient. You may correct the deficiency and resubmit the application. However, an application is not considered
properly filed until it is accepted by USCIS.
Initial Processing
Once Form I-102 has been accepted, it will be checked for completeness, including submission of the required initial
evidence. If you do not completely fill out the form or file it without the required initial evidence, you will not establish
a basis for eligibility, and we may deny your Form I-102.
Requests For More Information or Interview
We may request more information or evidence, or we may request that you appear at a USCIS office for an interview.
We may also request that you submit the originals of any copy. We will return these originals when they are no longer
required.

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Decision
You will be notified in writing of the decision on your application. If the application is approved, a new Form I-94, Form
I-94W or Form I-95 will be issued to you.

USCIS Forms and Information

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To ensure you are using the latest version of this form, visit the USCIS Web site at www.uscis.gov where you can obtain
the latest USCIS forms and immigration-related information. If you do not have internet access, you may order USICS
forms by calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by calling our
USCIS National Customer Service Center at 1-800-375-5283. For TDD (hearing impaired) call: 1-800-767-1833.
As an alternative to waiting in line for assistance at your local USCIS office, you can now schedule an appointment
through the USCIS Internet-based system, InfoPass. To access the system, visit the USCIS Web site. Use the InfoPass
appointment scheduler and follow the screen prompts to set up your appointment. InfoPass generates an electronic
appointment notice that appears on the screen.

Penalties

If you knowingly and willfully falsify or conceal a material fact or submit a false document with Form I-102, we will
deny your Form I-102 and may deny any other immigration benefit.
In addition, you will face severe penalties provided by law and may be subject to criminal prosecution.

USCIS Privacy Act Statement

AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Immigration
and Nationality Act, section 101, et seq.
PURPOSE: The primary purpose for providing the requested information on this form is to determine if you have
established eligibility for the immigration benefit for which you are filing. The information you provide will be used to
grant or deny the benefit sought.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and
any requested evidence, may delay a final decision or result in denial of your form.
ROUTINE USES: The information you provide on this form may be shared with other Federal, State, local, and foreign
government agencies and authorized organizations following approved routine uses described in the associated published
system of records notices [DHS-USCIS-007 - Benefits Information System and DHS-USCIS-001 - Alien File, Index,
and National File Tracking System of Records, which can be found at www.dhs.gov/privacy]. The information may
also be made available, as appropriate, for law enforcement purposes or in the interest of national security.

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 25 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 Coordination
Division, Office of Policy and Strategy, 20 Massachusetts Ave., NW, Washington, DC 20529-2140; OMB No.
1615-0079. Do not mail your completed Form I-102 application to this address.

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