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 10/31/2017

What is the Purpose of This Form?
Use this form to request a new or replacement of an incorrect, lost, stolen, or mutilated Nonimmigrant Arrival-Departure
Document.

When Should I Use This Form?

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You may file a Form I-102 if you:

1. Were admitted at a port-of-entry (POE) in the United States (whether at a land border, an airport, or a seaport) and:
A. You were not issued an initial Form I-94, I-94W, or I-95; or

B. You need to replace your lost, stolen, or mutilated Form I-94, I-94W, or I-95.

NOTE: If you were admitted to the United States by CBP at an airport or seaport after April 30, 2013, you may have
been issued an electronic Form I-94 by CBP, instead of a paper Form I-94. You may visit the CBP website at
www.cbp.gov/I94 to obtain a paper version of an electronic Form I-94. CBP does not charge a fee for this service.
Some travelers admitted to the United States at a land border, airport, or seaport, after April 30, 2013 with a passport or
travel document, who were issued a paper Form I-94 by CBP, may also be able to obtain a replacement Form I-94 from
the CBP website without charge. If your Form I-94 cannot be obtained from the CBP website, it may be obtained by
filing Form I-102 with USCIS. USCIS does charge a fee for this service.
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 POE at a land border, or you were admitted at a POE at an airport or seaport 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 POE or the nearest CBP deferred inspection office, in person, to have the information corrected.
For locations and hours of operation visit the CBP's website at www.cbp.gov/xp/cgov/toolbox/contacts/.

General Instructions
USCIS provides forms free of charge through the USCIS website. In order to view, print, or fill out our forms, you should
use the latest version of Adobe Reader, which can be downloaded for free at http://get.adobe.com/reader/.
Each application must be properly signed and filed. A photocopy of a signed application or a 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.
Each application must be accompanied by the appropriate filing fee. (See the What Is the Filing Fee section of these
instructions for more information.)
Evidence. You must submit all required initial evidence and supporting documentation with your application at the time
of filing.

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Copies. You may submit a legible photocopy of the documents requested, unless the instructions specifically state that
you must submit an original document. Original documents submitted when not required may remain a part of the record,
and USCIS will not automatically return them to you.
Translations. Any document you submit to USCIS with information in a foreign language must have a full English
translation. The translator must certify that the English language translation is complete and accurate, and that he or she is
competent to translate from the foreign language into English.
How to Fill Out Form I-102
You must file a separate Form I-102 for each person seeking the immigration benefit.

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1. Type or print legibly in black ink.

2. If you need extra space to complete any item, attach a separate sheet of paper; type or print your name and Alien
Registration Number (A-Number) (if any) at the top of each sheet of paper; indicate the Page Number, Part
Number, 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," type or print "N/A,"
unless otherwise directed.

Specific Instructions

Form I-102 is divided into Parts 1. - 6. The following information should help you fill out the form.
Part 1. Information About You

Item Number 1. 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.
Item Number 2. USCIS Online Account Number (if any). If you previously filed any USCIS form using USCIS,
provide the USCIS Account Number you were issued. The USCIS Account Number is not the same as an A-Number. If
you were issued a USCIS Account Number, enter it in the space provided.
Item Numbers 3.a. - 3.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.
Item Numbers 4.a. - 5. U.S. Mailing Address. Provide your complete U.S. mailing address in the spaces provided. If
your mail is sent to someone other than yourself, include an "In Care Of Name" as part of your mailing address.
Item Numbers 6.a. - 6.f. U.S. Physical Address. Provide your physical address if this address is different from your
U.S. mailing address.
Item Number 7. 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.
Item Numbers 8. - 9. 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. Use the current names of the country of your birth and country of your
citizenship.
Item Number 10. U.S. Social Security Number. Provide your U.S. Social Security Number. If you do not have a U.S.
Social Security Number, leave this field blank.
Item Numbers 11. - 12. Date and Place of Last Entry into the United States. Provide the date (mm/dd/yyyy) and
location of your last actual entry into the United States.
Item Number 13. 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.

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Item Number 14. Date Status Expires. Provide the date (mm/dd/yyyy) your authorized period of stay in the United
States expires or expired.
Item Number 15.a. 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 this field blank. The I-94 number is on the Form I-94
Arrival-Departure Record, which may be noted as the Departure Number on some versions. If CBP did not provide you
with a Form I-94 upon arrival/admission to the United States, you may print out a paper version of the Form I-94 from the
CBP website at www.cbp.gov/I94 according to the instructions provided by CBP at the time of admission.
Item Number 15.b. Passport Number. Enter the passport number of the passport you used at your last entry into the
United States, even if that passport has expired. Skip Item Number 15.c. if you provided your passport number in this
box.

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Item Number 15.c. Travel Document Number. If you do not have your passport number, enter the travel document
number of the travel document you used at your last entry into the United States, even if that travel document has expired.
Item Number 15.d. Country of Issuance for Passport or Travel Document. Enter the country that issued the passport
or travel document number you provided in Item Numbers 15.b. or 15.c.
Item Number 15.e. Expiration Date for Passport or Travel Document. Enter the expiration date (mm/dd/yyyy) of the
passport or travel document number you provided in Item Numbers 15.b. or 15.c.
Part 2. Reason for Application

The following is a brief description of eligibility categories. Select only one 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 the Submit Your Application section of these instructions for
information on what evidence is required.
You should use Form I-102 to:

1. Replace your lost, stolen, or mutilated Form I-94, I-94W, or I-95. Select box "1.a.," "1.b.," "1.c.," or "1.d." in Part 2.
NOTE: If you were issued an electronic Form I-94 by CBP at a POE at an airport or seaport, you may not need to file
Form I-102 to receive your Form I-94 in paper format. Instead, you may be able to obtain your Form I-94 in paper
format by going to the CBP website at www.cbp.gov/I94 and following the instructions on the website. No fee is
charged for this service. See the NOTE in the When Should I Use This Form section of these instructions for more
information.
2. Receive an initial Form I-94 or I-94W if you were admitted to the United States at a POE (whether at a land border,
airport, or seaport) and you were not issued an initial Form I-94 or I-94W at admission. Select box “1.e.” in Part 2.
NOTE: If you were issued an electronic Form I-94 by CBP at a POE at an airport or seaport, you may not need to file
Form I-102 to receive your Form I-94 in paper format. Instead, you may be able to obtain your Form I-94 in paper
format by going to the CBP website at www.cbp.gov/I94 and following the instructions on the website. No fee is
charged for this service. See the NOTE in the When Should I Use This Form section of these instructions 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. Select
box "1.f." in Part 2.
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 POE or the nearest CBP deferred inspection office, in person, to have the information corrected.
For locations and hours of operation visit the CBP's website at www.cbp.gov/xp/cgov/toolbox/contacts/.

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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 (Select box "1.g." in Part 2.):
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
Item Numbers 1.a. - 5. Provide all information requested in the spaces provided.
Part 4. Statement, Certification, Signature and Contact Information of the Applicant

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Select the box that indicates if you filled out this form or if someone interpreted this form for you. If applicable, select the
box that indicates if someone filled out this form for you. Every application must contain the original signature of the
applicant. A photocopy of a signed application or a 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. Sign and date the form and
provide your daytime telephone number, mobile telephone number, and e-mail address.
Part 5. Contact Information, Certification, and Signature of Interpreter

If you used an interpreter to read the instructions and complete the questions on this form, the interpreter must fill out this
section, provide the name of his or her business/organization, the business/organization's address, his or her daytime
telephone number, and his or her e-mail address. The interpreter must also sign and date the form.
Part 6. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other than
Applicant
This section must contain the original signature of the person who completed this form, if other than the person named in
Part 4. If the person who completed this form is associated with a business or organization, the prepare should provide
the name of his or her business/organization name and address. If the person completing this form is an attorney or
accredited representative, he or she must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or
Accredited Representative, along with this application.
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.
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 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, if available. If a police report is unavailable or was not
made, submit an explanation describing the circumstances of the theft and why the police report is unavailable or
was not made.

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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. Not Issued Form I-94 at Admission. If you were not issued Form I-94 at admission to the United States at a POE
(whether at a land border, airport, or seaport), attach a copy of your passport with the admission stamp issued by
CBP. If you were issued an electronic Form I-94 by CBP upon your admission at a POE at an airport or seaport,
you may be able to obtain your Form I-94 in paper format by accessing the CBP website at www.cbp.gov/I94.
This service is free. See the NOTE in the When Should I Use This Form section of these instructions.
E. Correct Inaccurate Information. If you want USCIS to correct inaccurate information that USCIS issued on your
Form I-94, I-94W, or I-95, attach your Form I-94, I-94W, or I-95 to your application. Also 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.

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F. 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.

What Is the Filing Fee?

The filing fee for Form I-102 is $445.

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 on your
document was made by USCIS, through no fault of your own. If, however, the error 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. Select box "1.g." in Part 2. 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 U.S. Consulate for instructions on the
method of payment.

Notice to Those Making Payment by Check. If you send us a check, USCIS will convert it 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 your bank will show it
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
USCIS cannot process the EFT for technical reasons, you authorize us to process the copy in place of your original check.
If your check is returned as unpayable, USCIS will re-submit the payment to the financial institution one time. If the
check is returned as unpayable a second time, we will reject your application and charge you a returned check fee.

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How to Check If the Fees Are Correct
Form I-102's filing fee is current as of the edition date in the lower left corner of this page. However, because USCIS fees
change periodically, you can verify that the fee is correct by following one of the steps below.
1.

Visit the USCIS website at www.uscis.gov, select "FORMS," and check the appropriate fee; or

2.

Call the USCIS National Customer Service Center at 1-800-375-5283 and ask for the fee information. For TTY (deaf
or hard of hearing) call: 1-800-767-1833.

Where to File?
Please see our website 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 TTY (deaf or hard of hearing) call:
1-800-767-1833.

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Address Changes

You must inform USCIS if you change your address. For information on filing a change of address go to the USCIS
website at www.uscis.gov/addresschange or contact the USCIS National Customer Service Center at 1-800-375-5283.
For TTY (deaf or hard of hearing) 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

USCIS will reject any Form I-102 that is not signed or accompanied by the correct fee 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 USCIS accepts your application, we will check it for completeness, including any 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 application.
Requests for More Information or Interview
We may request more information or evidence from you, 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 needed.
Decision
The decision on Form I-102 involves a determination of whether you have established eligibility for the requested benefit.
USCIS will notify you of the decision in writing. If the application is approved, USCIS will issue you a new Form I-94,
I-94W, or I-95.

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USCIS Forms and Information
To ensure you are using the latest version of this form, visit the USCIS website 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 USCIS
forms by calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by calling the
USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) 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 website at
infopass.uscis.gov/. 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

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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 264 and 8 CFR 264.6.
PURPOSE: The primary purpose for providing the requested information on this form is to request for a new or
replacement Form I-94 or I-95 Nonimmigrant Arrival-Departure Document. DHS will use the information you provide to
grant or deny the immigration benefit you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and
any requested evidence, may delay a final decision in your case or result in denial of your form.
ROUTINE USES: DHS may share the information you provide on this form with other Federal, state, local, and foreign
government agencies and authorized organizations. DHS follows approved routine uses described in the associated
published system of records notices [DHS/USCIS-007 - Benefits Information System and DHS/USCIS/ICE/CBP-001
Alien File, Index, and National File Tracking System of Records www.dhs.gov/privacy]. DHS may also share the
information, 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 45 minutes per response, including the time for reviewing instructions 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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