I-102 Instructions TOC

TABLE OF CHANGES – INSTRUCTIONS

Form I-102, Application for Replacement/ Initial Nonimmigrant Arrival-Departure Document

OMB Number: 1615-0079

05/13/2019

Reason for Revision: Add collections for POE, Class of Admission, Name on I-94, explanation of error, and standard language updates

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 10/31/2019

Edition Date 10/19/2017

Current Page Number and Section	Current Text	Proposed Text
Page 1 What is the Purpose of This Form?	[Page 1] 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.	[Page 1] What is the Purpose of Form I-102? Use this form to request a new or replacement of an incorrect, lost, stolen, or mutilated Nonimmigrant Arrival-Departure Document. This includes Form I-94, Arrival/Departure Record, Form I-94W, Nonimmigrant Visa Waiver Arrival/Departure Record, and From I-95, Crewman’s Landing Permit.
When Should I Use This Form?	When Should I Use This Form? 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/.	When Should I Use Form I-102? 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, Form I-94W, or Form I-95; or B. You need to replace your lost, stolen, or mutilated Form I-94, Form I-94W, or Form I-95. NOTE: If you were admitted to the United States by Customs and Border Protection (CBP) at an airport or seaport after April 30, 2013, CBP may have issued you an electronic Form I-94 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 you cannot obtain your Form I-94 from the CBP website, you may obtain it by filing Form I-102, Application for Replacement/Initial Nonimmigrant Arrival-Departure Record, with USCIS. USCIS does charge a fee for this service. See the USCIS website at www.uscis.gov/I-102 for more information. 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. Were granted an extension of nonimmigrant stay or change of nonimmigrant status after you were initially admitted to the United States, and you need a replacement of your lost, stolen, or mutilated Form I-94; 4. Were not issued Form I-94 when you entered as a nonimmigrant member of the military; or 5. Were issued Form I-94, Form I-94W, or Form I-95 with incorrect information. NOTE: If CBP issued your Form I-94, Form I-94W, or Form 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.
General Instructions	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. [New] 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. [Page 2] 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. 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.	General Instructions USCIS provides forms free of charge through the USCIS website. To view, print, or complete our forms, you should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you do not have internet access, you may order USCIS forms by calling the USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing), call: 1-800-767-1833. Each application must be properly signed and filed. For all signatures on this application, USCIS will not accept a stamped or typewritten name in place of a signature. A legal guardian may also sign for a mentally incompetent person. If the request is not signed or if the requisite signature on the request is not valid, USCIS will reject the request. See 8 CFR 103.2(a)(7)(ii)(A). If USCIS accepts a request for adjudication and determines that it has a deficient signature, USCIS will deny the request. Validity of Signatures. USCIS will consider a photocopied, faxed, or scanned copy of the original handwritten signature valid for filing purposes. The photocopy, fax, or scan must be of the original document containing the handwritten ink signature. Filing Fee. Each application must be accompanied by the appropriate filing fee. (See the What Is the Filing Fee section of these Instructions.) Evidence. At the time of filing, you must submit all evidence and supporting documents listed in the What Evidence Must You Submit and/or Specific Instructions sections of these Instructions. [Page 2] Copies. You should submit legible photocopies of documents requested, unless the Instructions specifically state that you must submit an original document. USCIS may request an original document at the time of filing or at any time during processing of an application or petition. If USCIS requests an original document from you, it will be returned to you after USCIS determines it no longer needs your original. NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be immediately destroyed after we receive them. Translations. If you submit a document with information in a foreign language, you must also submit a full English translation. The translator must sign a certification that the English language translation is complete and accurate, and that he or she is competent to translate from the foreign language into English. The certification must also include the translator’s signature, printed name, the signature date, and the translator’s contact information. How to Fill Out Form I-102 [Deleted] 1. Type or print legibly in black ink. 2. If you need extra space to complete any item within this application, use the space provided in Part 7. Additional Information or 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; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been married and the question asks, “Provide the name of your current spouse”), type or print “N/A” unless otherwise directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many children do you have” or “How many times have you departed the United States”), type or print “None” unless otherwise directed.
Specific Instructions	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. [Page 3] 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. 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. [New] 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/. [Page 4] 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 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: [New] 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. [Page 5] 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. 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.	Specific Instructions Form I-102 is divided into Parts 1. - 7.  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 have previously filed an application or petition using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account Number by logging in to your account and going to the profile page. If you previously filed certain applications or petitions on a paper form through a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice issuing you a USCIS Online Account Number. You may find your USCIS Online Account Number at the top of the notice. The USCIS Online Account Number is not the same as an A-Number. If you were issued a USCIS Online Account Number, enter it in the space provided. Item Numbers 3.a. - 3.c. Your Full Legal Name. Provide your full legal name.  If you have two last names, provide both. Only add a hyphen (-) between your last names if it is included as part of your legal last name. Item Numbers 4.a. – 4.c. Other Names Used. If you have used any other names or aliases, provide them in this section. If you need extra space to complete this section, use the space provided in Part 7. Additional Information. Item Numbers 5.a. - 6. 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 7.a. - 7.f. U.S. Physical Address. Provide your physical address if this address is different from your U.S. mailing address. Item Number 8. 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 9. - 10. 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 11. 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 12. - 13. 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 14. Class of Admission at Last Entry into the United States. Provide the class of admission at your last entry into the United States. Item Number 15. Type of Port-of-Entry. Indicate whether you last entered the United States at a land border, airport, or seaport. Item Number 16. 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. [Page 3] Item Number 17. Date Status Expires. Provide the date (mm/dd/yyyy) your authorized period of stay in the United States expires or expired. Item Number 18.a. Form I-94, Form I-94W, or Form I-95 Arrival-Departure Number. Provide your Form I-94, Form I-94W, or Form I-95 Arrival-Departure Number, if you have one. Otherwise, leave this field blank. The Form I-94 Arrival-Departure number is on the Form I-94, which may be noted as the Departure Number on some versions.  If CBP did not provide you with a paper Form I-94 upon arrival/admission to the United States, you may print out a paper version of 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 Numbers 18.b. - 18.c. Passport and Travel Document Numbers. If you used a passport or travel document to travel to the United States, enter either the passport or travel document information in the appropriate space on the application, even if the passport or travel document is currently expired. [Deleted] Item Number 18.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 18.b. or 18.c. Item Number 18.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 18.b. or 18.c. Item Numbers 19.a. – 19.c. Provide your name exactly as it appears on Form I-94, Form I-94W, or Form I-95. If your name on Form I-94, Form I-94W, or Form I-95 appears different than your current legal name, provide evidence of the name change. This evidence may include, but is not limited to, a birth certificate registered with civil authorities, a marriage certificate registered with civil authorities, a divorce decree registered with civil authorities, a death certificate registered with civil authorities, an adoption decree, a court order, or other legal document at the time of admission or issuance of Form I-94.  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, Form I-94W, or Form I-95. Select Item Numbers 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 Form I-102? section of these Instructions for more information. 2. Receive an initial Form I-94 or Form 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 Form I-94W at admission. Select Item Number 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 Form I-102? section of these Instructions for more information. 3. Receive a corrected Form I-94, Form I-94W, or Form I-95 if you were issued one by USCIS with incorrect information. Select Item Number 1.f. in Part 2. NOTE: If CBP issued you Form I-94, Form I-94W, or Form 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. [Page 4] 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 Item Number 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. – 2.b. Provide all information requested in the spaces provided. Part 4. Applicant’s Statement, Contact Information, Certification, and Signature Item Numbers 1.a. - 6.b. Select the appropriate box to indicate whether you read this application yourself or whether you had an interpreter assist you. If someone assisted you in completing the application, select the box indicating that you used a preparer. Further, you must sign and date your application and provide your daytime telephone number, mobile telephone number (if any), and email address (if any). Every application MUST contain the signature of the applicant (or parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable. Part 5. Interpreter’s Contact Information, Certification, and Signature Item Numbers 1.a. - 7.b. If you used anyone as an interpreter to read the Instructions and questions on this application to you in a language in which you are fluent, the interpreter must fill out this section; provide his or her name, the name and address of his or her business or organization (if any), his or her daytime telephone number, his or her mobile telephone number (if any), and his or her email address (if any). The interpreter must sign and date the application. Part 6. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant Item Numbers 1.a. - 8.b. This section must contain the signature of the person who completed your application, if other than you, the applicant. If the same individual acted as your interpreter and your preparer, that person should complete both Part 5. and Part 6. If the person who completed this application is associated with a business or organization, that person should complete the business or organization name and address information. Anyone who helped you complete this application MUST sign and date the application. A stamped or typewritten name in place of a signature is not acceptable. If the person who helped you prepare your application is an attorney or accredited representative, he or she may also need to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with your application. Part 7. Additional Information Item Numbers 1.a - 7.d. If you need extra space to provide any additional information within this application, use the space provided in Part 7. Additional Information. If you need more space than what is provided in Part 7., you may make copies of Part 7. to complete and file with your 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. We recommend that you print or save a copy of your completed application to review in the future and for your records. [Deleted] What Evidence Must You Submit? You must submit all evidence requested in these Instructions with your application. If you fail to submit required evidence, USCIS may reject or deny your application for failure to submit requested evidence or supporting documents in accordance with 8 CFR 103.2(b)(1) and these Instructions. 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 Evidence Requirements. You must file your application with a copy of a government-issued ID verifying your legal name and date of birth. You must also submit the required initial evidence listed below for your reason for filing.  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. A. Lost or Stolen Form I-94, Form I-94W, or Form I-95.  If you are applying to replace a lost or stolen Form I-94, Form I-94W, or Form 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, Form I-94W, or Form 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. [Page 5] B. Mutilated Form I-94, Form I-94W, or Form I-95. If you are applying to replace a mutilated Form I-94, Form I-94W, or Form I-95, attach the original damaged form. C. 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 Form I-102 section of these Instructions. D. Correct Inaccurate Information. If you want USCIS to correct inaccurate information that USCIS issued on your Form I-94, Form I-94W, or Form I-95, attach your Form I-94, Form I-94W, or Form I-95 to your application. Also attach a statement dated and signed by you, citing specifically what information on your Form I-94, Form I-94W, or Form I-95 requires correction. You must also attach evidence verifying the validity of the information submitted for correction purposes. 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.
What Is the Filing Fee?	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. [New] [Page 6] 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.	What Is the Filing Fee? The filing fee for Form I-102 is $445. NOTE: The filing fee is not refundable, regardless of any action USCIS takes on this application. DO NOT MAIL CASH. You must submit all fees in the exact amounts. [Deleted] 1. You do not need to pay the fee to request USCIS to correct your Form I-94, Form 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, you must pay the fee. 2. You do not need to pay the fee if you are a nonimmigrant military member in the U.S. Armed Forces, or if 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. Payments by Check or Money Order Use the following guidelines when you prepare your check or money order for the Form I-102 filing fee: 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 USCIS a check, we 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. Payments by Credit Card If you are filing your application at a USCIS Lockbox facility, you can pay your filing fee using a credit card. Please see Form G-1450, Authorization for Credit Card Transactions, at www.uscis.gov/G-1450 for more information. [Page 6] 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. Visit the USCIS Contact Center at www.uscis.gov/contactcenter to get answers to your questions and connect with a live USCIS representative. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Where to File?	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.	Where to File? Please see our website at www.uscis.gov/I-102 or visit the USCIS Contact Center at www.uscis.gov/contactcenter to connect with a USCIS representative for the most current information about where to file this application. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Address Changes	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.	Address Change An applicant who is not a U.S. citizen must notify USCIS of his or her new address within 10 days of moving from his or her previous residence. For information on filing a change of address, go to the USCIS website at www.uscis.gov/addresschange or contact the USCIS Contact Center at www.uscis.gov/contactcenter for help. The USCIS Contact Center provides information in English and Spanish. 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 the Lockbox does not process change of address requests.
Processing Information	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.	Processing Information [Deleted] You must have a United States address to file this application. Initial Processing. Once USCIS accepts your application, we will check it for completeness. If you do not completely fill out this application, you will not establish a basis for your eligibility and USCIS may reject or deny your application. Requests for More Information. USCIS may request that you provide more information or evidence to support your application. We may also request that you provide the originals of any copies you submit. If we request an original document from you, it will be returned to you after USCIS determines it no longer needs your original. Requests for Interview. We may request that you appear at a USCIS office for an interview based on your application. At the time of any interview or other appearance at a USCIS office, we may require that you provide your biometrics to verify your identity and/or update background and security checks. Decision. The decision on Form I-102 involves a determination of whether you have established eligibility for the immigration benefit you are seeking. USCIS will notify you of the decision in writing.
USCIS Forms and Information	[Page 7] 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.	[Page 7] USCIS Forms and Information To ensure you are using the latest version of this application, 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 the USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center offers services in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833. Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at www.uscis.gov. Select “Tools,” then under “Self Service Tools,” select “Appointments” and follow the screen prompts to set up your appointment. Once you finish scheduling an appointment, the system will generate an appointment notice for you.
Penalties	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.	Penalties If you knowingly and willfully falsify or conceal a material fact or submit a false document with your 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	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.	DHS Privacy Notice AUTHORITIES: The information requested on this application, 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 information requested on this application is to request a new or replacement Form I-94, Arrival-Departure Record, Form I-94W, Nonimmigrant Visa Waiver Arrival/Departure Record, or Form I-95, Crewman’s Landing Permit. 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, including your Social Security number (if applicable), and any requested evidence, may delay a final decision or result in denial of your application. ROUTINE USES: DHS may share the information you provide on this application and any additional requested evidence 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/ICE/CBP-001 - Alien File, Index, and National File Tracking System, DHS/USCIS-007 Benefits Information System, and DHS/USCIS-018 Immigration Biometric and Background Check] and published privacy impact assessments [DHS/USCIS/PIA-016(a) Computer Linked Application Information Management System (CLAIMS 3) and Associated Systems], which can be found at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the interest of national security.
Paperwork Reduction Act	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.	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 Office of Management and Budget (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, gathering the required documentation and information, completing the application. 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.

2