Form I-333 Obligor Change of Address

DEPARTMENT OF HOMELAND SECURITY

U.S. Immigration and Customs Enforcement
OBLIGOR CHANGE OF ADDRESS

OMB No. 1653-0042
Expiration 10/31/2019

INSTRUCTIONS:
In order to assist in the management of your bond please file this form for each bond for which you are the obligor.
This form may be presented in person and upon presentation a signed copy will be returned to you indicating receipt of
the change of address. However, you may mail this form to the Enforcement and Removal Office in which you posted
your bond (www.ice.gov/contact/ero/).
In addition the law requires that all non-United States citizens (i.e., bonded aliens) present in the U.S. for more than 29
days present a notice of a change of address (Alien's Change of Address Card, Form AR-11).
Today's Date:
TYPE OR PRINT THIS FORM
File Number:

Name of Alien:

Bond Receipt Number:

Alien's Current Physical Address
Number/Street/Apt.:

Obligor's Name:

City:

Obligor's New Address
Number/Street/Apt.:

State/ZIP Code:
Alien's Telephone Number:

City:
State/ZIP Code:
Telephone Number:
Obligor's Signature (Sign in ink):

X
DHS Official Receiving Change of Address
Name:
Title:
Location:
Signature (Sign in ink):

X

Privacy Act Statement
Authority and Purpose: The Immigration and Nationality Act, as amended, (8 U.S.C. 1103, 1183, 1226, 1229c, and 1363) authorizes the
collection of this information to provide for the posting, maintenance, cancellation, and breach of an immigration surety bond, and for
associated financial management activities. ICE needs to maintain current obligor address information so that it can communicate with the
obligor, and make payments of interest and principal owed to the obligor.
Disclosure: Furnishing this information is voluntary; however, failure to provide it may result in your failure to receive communications
from ICE pertinent to the immigration bond, and could also interfere with timely payments of interest and principal.
Routine Uses: This information will be used by and disclosed to DHS personnel and contractors or other agents who need the information
to support the enforcement of immigration laws and the provision of immigration benefits. DHS may share this information with the U.S.
Treasury Department to report interest paid to an obligor, and to facilitate payments to or collection of monies owed by an obligor. DHS
may also share this information with the U.S. Justice Department and other Federal and State agencies for collection, enforcement,
investigatory, or litigation purposes, or as otherwise authorized pursuant to its published Privacy Act system of records notice.
3 Copies: Original - A File, Obligor, Burlington Finance Center
ICE Form I-333 (7/15)

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Public Reporting Burden. The U.S. Immigration and Customs Enforcement is collecting this information as a part of its agency mission
under the Department of Homeland Security. The estimated average time to review the instructions, search existing data sources, gather
and maintain the data needed and completing and reviewing this collection of information is 15 minutes (.25 hours) per response. An
agency may not conduct or sponsor, and a person is not required to respond to, an information collection unless it displays a currently
valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to the Department of Homeland Security, U.S. Immigration and Customs Enforcement, 801 I Street,
NW, Washington, D.C. 20536-5800. OMB No. 1653-0042. (Do not mail your completed application to this address.)

ICE Form I-333 (7/15)

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