Form I-90 - Application To Replace Permanent Resident Card Page 3
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7Part 2. Application Type (continued)
Biographic Information
Section B. (To be used only by a conditional permanent resident.)
6.
Ethnicity (Select only one box)
Hispanic or Latino
3.a.
My previous card has been lost, stolen, or destroyed.
Not Hispanic or Latino
3.b.
My previous card was issued but never received.
7.
Race (Select all applicable boxes)
3.c.
My existing card has been mutilated.
White
3.d.
My existing card has incorrect data because of DHS
Asian
error. (Attach your existing permanent resident card
Black or African American
with incorrect data along with this application.)
American Indian or Alaska Native
3.e.
My name or other biographic information has legally
Native Hawaiian or Other Pacific Islander
changed since the issuance of my existing card.
8.
Height
Feet
Inches
Part 3. Processing Information
9.
Weight
Pounds
1.
Location where you applied for an immigrant visa or
adjustment of status:
10.
Eye Color (Select only one box)
Black
Blue
Brown
Gray
Green
Hazel
2.
Location where your immigrant visa was issued or USCIS
office where you were granted adjustment of status:
Maroon
Pink
Unknown/Other
11.
Hair Color (Select only one box)
Complete Item Numbers 3.a. and 3.a1. if you entered the
Bald (No hair)
Black
Blond
United States with an immigrant visa. (If you were granted
Brown
Gray
Red
adjustment of status, proceed to Item Number 4.)
Sandy
White
Unknown/Other
3.a. Destination in the United States at time of admission
Part 4. Accommodations for Individuals with
Disabilities and/or Impairments (Read the
3.a.1.
Port-of-Entry where admitted to the United States:
information in the Form I-90 Instructions before
City or Town and State
completing this part.)
NOTE: If you need extra space to complete this section, use
4.
Have you ever been in exclusion, deportation, or removal
the space provided in Part 8. Additional Information.
proceedings or ordered removed from the United States?
1.
Are you requesting an accommodation because of your
Yes
No
disabilities and/or impairments?
Yes
No
5.
Since you were granted permanent residence, have you
If you answered "Yes," select any applicable boxes:
ever filed Form I-407, Abandonment by Alien of Status as
Lawful Permanent Resident, or otherwise been determined
1.a.
I am deaf or hard of hearing and request the
to have abandoned your status?
Yes
No
following accommodation (If you are requesting a
sign-language interpreter, indicate for which
NOTE: If you answered "Yes" to Item Numbers 4. or 5.
language (for example, American Sign Language)):
above, provide a detailed explanation in the space provided in
Part 8. Additional Information.
Form I-90 02/27/17 N
Page 3 of 7
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