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 03/31/2016

Action Block

Receipt
For
USCIS
Use
Only

DRAFT
NOT FOR
PRODUCTION
09/01/2016

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:
/
/

To be completed by an
attorney or BIA-accredited
representative (if any).

Select this box if
Form G-28 is
attached.

Address in Part 1

Mail To (Re-entry &

U.S. Consulate at:

Refugee Only)

Intl DHS Ofc at:

/

Attorney State Bar Number
(if applicable)

Attorney or Accredited Representative
USCIS Online Account Number (if any)

► Start Here. Type or Print in Black Ink

Part 1. Information About You

Mailing Address

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

3.a. Street Number
and Name

1.c. Middle Name

3.c. City or Town

Other Names Used (if any)
Provide all other names you have ever used , including aliases,
maiden name, and nicknames. If you need extra space to
complete this section, use the space in Part 12. Additional
Information.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name

Form I-131 01/22/16 Y

3.b.

Apt.

3.d. State
3.f.

Ste.

Flr.

4.e. ZIP Code

Province

3.g. Postal Code
3.h. Country

4.

Is your current mailing address the same as your physical
address?
Yes
No

If you answered “No” to Item Number 4., provide your
physical address in Item Numbers 5.a. - 5.i.

Page 1 of 8

Part 1. Information About You (continued)

1.d.

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

1.e.

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

1.f.

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

Physical Address
5.a. In Care of Name

5.b. Street Number
and Name
5.c.

Apt.

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1.g.

Ste.

Flr.

5.d. City or Town
5.e. State
5.g. Province

5.f.

ZIP Code

5.h. Postal Code
5.i.

Country

2.c. Middle Name

Alien Registration Number (A-Number) (if any)
► A-

7.

If you selected Item Number 1.f., provide the following
information about that person in Item Number 2.a.- 5.i. If you
selected Item Number 1.g., provide the following information
about the Principal Entrepreneur in Item Number 2.a. - 2.h.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

Other Information
6.

I am the spouse or a child of an individual who is an
Applicant for Entrepreneur Parole or is already in the
United States as an Entrepreneur Parolee and I am
applying for an Advance Parole Document.

2.d. Date of Birth (mm/dd/yyyy)
2.e. Country of Birth

USCIS Online Account Number (if any)
►

2.f.

USCIS Online Account Number (if any)
►

8.

Country of Birth

9.

Country of Citizenship or Nationality

10.

Gender

11.

Class of Admission

12.

Date of Birth (mm/dd/yyyy)

3.a. Street Number
and Name

13.

U.S. Social Security Number (if any)

3.b.

2.g. Country of Citizenship or Nationality

2.h. Daytime Telephone Number

Male

Female

Mailing Address

►

Part 2. Application Type

Apt.

3.d. State
3.f.

1.b.

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

3.h. Country

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.

Form I-131 01/22/16 Y

Flr.

3.c. City or Town

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

1.a.

Ste.

4.e. ZIP Code

Province

3.g. Postal Code

Page 2 of 8

6.

Part 2. Application Type (continued)
4.

Is your current mailing address the same as your physical
address?
Yes
No
If you answered “No” to Item Number 4., or if you
selected Item Number 1.f. in Part 2, provide your
physical address in Item Numbers 5.a. - 5.i.

5.b. Street Number
and Name

Ste.

5.g. Province

Country

White

Unknown/Other

5.f.

1.

Date of Intended Departure
(mm/dd/yyyy)

2.

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

ZIP Code

3.b. If you answered “Yes” to Item Number 3.a., provide the
name of the DHS office

4.a. Have you ever before been issued a reentry permit or
Refugee Travel Document?
Yes
No

5.h. Postal Code
5.i.

Sandy

Red

Flr.

5.d. City or Town
5.e. State

Gray

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5.a. In Care of Name

Apt.

Brown

Blond

Part 4. Processing Information

Physical Address

5.c.

Hair Color (Select only one box)
Black
Bald (No hair)

If you answered "Yes" to Item Number 4.a., provide the
following information for the last document issued to you.

Part 3. Biographic Information

4.b. Date Issued (mm/dd/yyyy)

1.

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

Ethnicity (Select only one box)
Hispanic or Latino

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.

Not Hispanic or Latino
2.

Race (Select all applicable boxes)
White

Where do you want this travel document sent? (Select one)

Asian

5.

To the U.S. address shown in Part 1. (Item Number
3.a. - 3.h.) of this form.

American Indian or Alaska Native

6.a.

To a U.S. Embassy or consulate at:

Native Hawaiian or Other Pacific Islander

6.b. City or Town

Black or African American

3.

Height

Feet

4.

Weight

5.

Eye Color (Select only one box)
Black
Blue

Inches
Pounds

Gray

Green

Maroon

Pink

6.c. Country
7.a.

To a DHS office overseas at:

7.b. City or Town
Brown
Hazel

7.c. Country

Unknown/Other

Form I-131 01/22/16 Y

Page 3 of 8

Part 4. Processing Information (continued)
If you selected Item Number 6.a. or 7.a. above, where should
the notice to pick up the travel document be sent?
8.a.

To the address show in Part 2 (Item Number 3.a. 3.h.) of this form

8.b.

To the address shown in below (Part 4., Item
Number 9.a. - 9.i.)

Part 6. 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.
2.

9.b. Street Number
and Name
Apt.

Ste.

9.g. Province

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

Flr.

Yes

No

If you answered “Yes” to Item Number 2., provide the
details in Part 12. Additional Information.

9.d. City or Town
9.e. State

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

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9.a. In Care of Name

9.c.

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

9.f.

ZIP Code

9.h. Postal Code
9.i.

Country

10.

Daytime Telephone Number

Part 7. Complete Only If Applying for a Refugee
Travel Document

1.

If you answer “Yes” to any of the following questions, you
must explain in Part 12. Additional Information. Include
your name and A-Number on the top of the page.

2.

Part 5. Information About Your Proposed
Travel

1.a. Purpose of Trip (If you need more space, use the space
provided in Part 12. Additional Information.)

Country From Which You Are a Refugee or Asylee

Do you plan to travel to the country named above?
Yes

No

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

3.a. Returned to the country named above?

Yes

No

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

1.b. List the countries you intend to visit. (If you need more
space, use the space provided in Part 12. Additional
Information.)

No

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

No

Since you were accorded refugee/asylee status, have you, by
any legal procedure or voluntary act:
4.a. Reacquired the nationality of the country named above?

4.b. Acquired a new nationality?

Yes

No

Yes

No

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

Form I-131 01/22/16 Y

No

Page 4 of 8

Part 8. Complete Only If Applying for Advance
Parole
On a separate sheet of paper or in Part 12. Additional
Information, 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.

NOTE: Read the Penalties section of the Form I-131
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 Form I-131.

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For 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 U.S. Consulate or the
DHS overseas office that you want us to notify.
2.a. City or Town

2.b. Country

Part 9. Applicant's Statement, Contact
Information, Declaration, Certification, and
Signature

Applicant's Statement

NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2. If filing as the
spouse or child of an individual who is an Applicant for
Entrepreneur Parole or is already in the United States as an
Entrepreneur Parolee, select the box for Item Number 3.
1.a.

I can read and understand English, and I have read
and understand every question and instruction on this
application and my answer to every question.

1.b.

The interpreter named in Part 10. read to me every
question and instruction on this application and my
answer to every question in

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 (Item Number 3.a. 3.h.)

4.

To the address shown below (Part 8., Item Number
5.a. - 5.i.)

a language in which I am fluent, and I understood
everything.

2.

5.a. In Care of Name

Apt.

3.

Ste.

Flr.

5.d. City or Town
5.e. State

5.f.

ZIP Code

5.g. Province
5.h. Postal Code
5.i.

Country

5.j.

Daytime Telephone Number

Form I-131 01/22/16 Y

At my request, the preparer named in Part 11.,
,

prepared this application for me based only upon
information I provided or authorized.

5.b. Street Number
and Name
5.c.

,

I am the spouse/child of a principal Entrepreneur
Parolee or principal applicant for Entrepreneur Parole
and I understand that the approval of this application
is contingent upon the approval of an application for
Entrepreneur Parole for the principal.

Applicant's Contact Information
4.

Applicant's Daytime Telephone Number

5.

Applicant's Mobile Telephone Number (if any)

6.

Applicant's Email Address (if any)

Page 5 of 8

Part 9. Applicant's Statement, Contact
Information, Declaration, Certification, and
Signature (continued)
Applicant's Declaration and Certification
Copies of any documents I have submitted are exact
photocopies of unaltered, original documents, and I understand
that USCIS may require that I submit original documents to
USCIS at a later date. Furthermore, I authorize the release of
any information from any and all of my records that USCIS
may need to determine my eligibility for the immigration
benefit that I seek.

Part 10. Interpreter's Contact Information,
Certification, and Signature
Provide the following information about the interpreter.

Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)

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I furthermore authorize release of information contained in this
application, in supporting documents, and in my USCIS
records, to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
I understand that USCIS may require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and understood all of the information
contained in, and submitted with, my application; and
2) All of this information was complete, true, and
correct at the time of filing.

I certify, under penalty of perjury, that all of the information in
my application and any document submitted with it were
provided or authorized by me, that I reviewed and understand
all of the information contained in, and submitted with, my
application and that all of this information is complete, true, and
correct.

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

2.

Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address

3.a. Street Number
and Name
3.b.

Apt.

Ste.

Flr.

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

3.e. ZIP Code

Province

3.g. Postal Code
3.h. Country

Applicant's Signature

Interpreter's Contact Information

7.a. Applicant's Signature

4.

Interpreter's Daytime Telephone Number

7.b. Date of Signature (mm/dd/yyyy)

5.

Interpreter's Mobile Telephone Number (if any)

NOTE TO ALL APPLICANTS: If you do not completely fill
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.

6.

Interpreter's Email Address (if any)

Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
,
which is the same language specified in Part 9., Item Number
1.b., and I have read to this applicant in the identified language
every question and instruction on this application and his or her
answer to every question. The applicant informed me that he or
she understands every instruction, question, and answer on the
application, including the Applicant's Declaration and
Certification, and has verified the accuracy of every answer.
Form I-131 01/22/16 Y

Page 6 of 8

Part 10. Interpreter's Contact Information,
Certification, and Signature (continued)

Preparer's Statement
7.a.

I am not an attorney or accredited representative but
have prepared this application on behalf of the
applicant and with the applicant's consent.

7.b.

I am an attorney or accredited representative and my
representation of the applicant in this case
extends
does not extend beyond the
preparation of this application.

Interpreter's Signature
7.a. Interpreter's Signature

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7.b. Date of Signature (mm/dd/yyyy)

Part 11. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
Provide the following information about the preparer.

Preparer's Full Name

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

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

2.

Preparer's Business or Organization Name (if any)

NOTE: If you are an attorney or accredited representative, you
must submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative, with this
application.

Preparer's Certification

By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
applicant then reviewed this completed application and
informed me that he or she understands all of the information
contained in, and submitted with, his or her application,
including the Applicant's Declaration and Certification, and
that all of this information is complete, true, and correct. I
completed this application based only on information that the
applicant provided to me or authorized me to obtain or use.

Preparer's Signature

Preparer's Mailing Address
3.a. Street Number
and Name
3.b.

Apt.

8.a. Preparer's Signature

8.b. Date of Signature (mm/dd/yyyy)

Ste.

Flr.

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

3.e. ZIP Code

Province

3.g. Postal Code
3.h. Country

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

5.

Preparer's Mobile Telephone Number (if any)

6.

Preparer's Email Address (if any)

Form I-131 01/22/16 Y

Page 7 of 8

5.a. Page Number

Part 12. Additional Information
If you need extra space to provide any additional information
within this application, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this application or attach a separate
sheet of paper. Type or print your name and A-Number (if any)
at the top of each sheet; indicate the Page Number, Part
Number, and Item Number to which your answer refers; and
sign and date each sheet.

5.b. Part Number

5.c. Item Number

5.d.

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

1.c. Middle Name
2.

A-Number (if any) ► A-

3.a. Page Number

3.d.

4.a. Page Number

4.d.

Form I-131 01/22/16 Y

3.b. Part Number

3.c. Item Number

6.a. Page Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

6.d.

4.b. Part Number

4.c. Item Number

7.a. Page Number

7.d.

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