Uscis Form I-94 - Arrival/departure Record (With Instructions)
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2U.S Department of Justice
OMB No. 1115-0077
Immigration and Naturalization Service
Welcome to the United States
Admission Number
I-94 Arrival/Departure Record - Instructions
This form must be completed by all persons except U.S.Citizens, returning resident
aliens, aliens with immigrant visas, and Canadian Citizens visiting or in transit.
Type or print legibly with pen in ALL CAPITAL LETTERS. Use English. Do not write
on the back of this form.
This form is in two parts. Please complete both the Arrival Record (Items 1 through 13)
and the Departure Record (Items 14 through 17).
When all items are completed, present this form to the U.S. Immigration and
Naturalization Service Inspector.
Item 7 - If you are entering the United States by land, enter LAND in this space. If you
are entering the United States by ship, enter SEA in this space.
Form I-94 (04/06/00)Y
OMB No. 1115-0077
Admission Number
I-94
Arrival Record
1. Family Name
2. First (Given) Name
3. Birth Date (Day/Mo/Yr)
4. Country of Citizenship
5. Sex (Male or Female)
6. Passport Number
7. Airline and Flight Number
8. Country Where You Live
9. City Where You Boarded
10. City Where Visa was Issued
11. Date Issued (Day/Mo/Yr)
12. Address While in the United States (Number and Street)
13. City and State
Authority
The authority to collect this information is contained in Title 8 of the United States Code.
Paperwork Reduction Act Notice. A person is not required to respond to a
collection of information unless it displays a currently valid OMB control number.
The estimated average time to complete and file this application is 4 minutes per
application. If you have comments regarding this form, you can write to the
Immigration and Naturalization Service, HQPDI, 425 I Street N.W., Room 4307r,
Washington DC 20536; OMB No. 1115-0077. DO NOT MAIL YOUR COMPLETED
APPLICATION TO THIS ADDRESS.
OMB No. 1115-0077
Departure Number
I-94
Departure Record
14. Family Name
15. First (Given) Name
16. Birth Date (Day/Mo/Yr)
17. Country of Citizenship
STAPLE HERE
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