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E. My name or other biographic information has

Accommodations vary with the disability(ies) and/or

legally changed since issuance of my existing card -

impairment(s) and involve modifications to practices or

Check this reason if your biographical information has

procedures. For example, if you are:

changed since the issuance of your card. You may also

1. Unable to use your hands, you may be permitted to take a

select this reason if your card has incorrect data, and the

test orally rather than in writing;

error was not caused by USCIS. Submit a copy of the

original court order reflecting your new name or a copy

2. Hearing-impaired, you may be provided with a sign-

of your original marriage certificate, divorce decree,

language interpreter for a USCIS-sponsored training

birth certificate, adoption decree, passport or applicable

session; or

court documents, etc. Marriage certificate or court

documents submitted as evidence of name change must

3. Unable to travel to a designated USCIS location for an

have been registered with the proper civil authority.

interview, you may be visited at your home or a hospital.

You must include the application fee and biometric

fee with this application if filing using reason "E."

If you believe that you need us to accommodate your

disability and/or impairment, check the "Yes" box and then

Part 3. Processing Information

check any applicable box that describes the nature of your

1. Mother's First Name - List your mother's given name.

disability(ies) and/or impairment(s). Also, write the type(s) of

accommodation(s) you are requesting on the line(s) provided.

2. Father's First Name - List your father's given name.

If you are requesting a sign-language interpreter, be sure to

indicate which language. If you need more space, use a

3. City of residence where you applied for an immigrant

separate sheet of paper.

visa or adjustment of status - List the location of the U.S.

Embassy or consulate or USCIS office where you filed your

NOTE: All domestic USCIS facilities meet the Accessibility

application for an immigrant visa or adjustment of status.

Guidelines of the Americans with Disabilities Act, so you do

not need to contact us to request an accommodation for

4. Consulate where immigrant visa was issued or USCIS

physical access to a domestic USCIS office.

office where status was adjusted - List location of the

U.S. Embassy or consulate or USCIS office where you

USCIS considers requests for accommodations on a case-by-

became a permanent resident

case basis. Asking for an accommodation will not affect your

5. If you entered the United States with an immigrant visa

eligibility for the benefit.

also complete the following - If you entered the United

States with an immigrant visa, you must answer this

Part 5. Signature

question. List your destination in the United States at time

of admission and port of entry where admitted to United

Every application must contain the original signature of the

States in the space provided. If you were granted

applicant. A photocopy of a signed application is not

adjustment of status at a USCIS office in the Unites States,

acceptable. If you are under 14 years of age, your parent or

then skip this question and proceed to Question 6.

guardian may sign the application on your behalf.

6. Have you ever been ordered removed from the United

Include a valid phone number where you may be reached.

States? - Check the appropriate box. If the answer is

“Yes,” you must provide a detailed explanation in Part 7.

Part 6. Signature of Person Preparing Form, If

Other Than Above

7. Since you were granted permanent residence, have you

ever filed Form I-407, Abandonment by Alien of Status

This section must contain the original signature of the person

as Lawful Permanent Resident, or otherwise been

completing this form, if other than the person in Part 5. If the

determined to have abandoned your status? - Check the

person completing this form is associated with a business or

appropriate box. If the answer is “Yes,” you must provide a

organization, complete the business/organization name and

detailed explanation in Part 7.

address section. If the person completing this form is an

Part 4. Accommodations for Individuals With

attorney or representative, submit a completed Form G-28

along with this application.

Disabilities and Impairments

USCIS is committed to providing reasonable accommodations

Include a valid phone number where the person completing

for individuals with disabilities and impairments.

this form may be reached.

Form I-90 Instructions (Rev. 11/23/10) Y Page 5

Instructions For Form I-90 - Application To Replace Permanent Resident Card - Department Of Homeland Security Page 5

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