Instructions For Application For Replacement/initial Nonimmigrant Arrival-Departure Document (Form I-102) Page 7


USCIS Forms and Information
To ensure you are using the latest version of this form, visit the USCIS website at
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 our toll-free number at 1-800-870-3676. You may also obtain forms and information by calling the
USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
As an alternative to waiting in line for assistance at your local USCIS office, you can now schedule an appointment
through the USCIS Internet-based system, InfoPass. To access the system, visit the USCIS website at Use the InfoPass appointment scheduler and follow the screen prompts to set up your appointment.
InfoPass generates an electronic appointment notice that appears on the screen.
If you knowingly and willfully falsify or conceal a material fact or submit a false document with 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.
USCIS Privacy Act Statement
AUTHORITIES: The information requested on this form, 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 requested information on this form is to request for a new or
replacement Form I-94 or I-95 Nonimmigrant Arrival-Departure Document. DHS will use the information you provide to
grant or deny the immigration benefit you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and
any requested evidence, may delay a final decision in your case or result in denial of your form.
ROUTINE USES: DHS may share the information you provide on this form 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-007 - Benefits Information System and DHS/USCIS/ICE/CBP-001
Alien File, Index, and National File Tracking System of Records DHS may also share the
information, as appropriate, for law enforcement purposes or in the interest of national security.
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 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 and submitting the
form. 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.
Form I-102 Instructions 10/19/17 N
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