Application for Replacement/Initial Nonimmigrant Arrival-Departure Document

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 11/30/2021

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.

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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
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.

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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.)

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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.
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

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)
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
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.

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Item Number 2. USCIS Online Account Number. 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.

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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.
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 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.

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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.
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 From 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.

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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.
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;
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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.

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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 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.
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.

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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.

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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?
The filing fee for Form I-102 is $485.
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.
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.

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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.

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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, we may reject your application.
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
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?
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 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.

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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
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.

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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

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
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.

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.
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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
a rejection or 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.

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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.

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