Form I-102 - Application For Replacement/initial Nonimmigrant Arrival - Departure Document

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OMB No. 1615-0079; Expires 06/30/07
I-102, Application for Replacement/Initial
Department of Homeland Security
Nonimmigrant Arrival - Departure Document
U.S. Citizenship and Immigration Services
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a separate sheet
(s) of paper. Write your name and Alien Registration Number (A #), if you have one, at the top of each sheet and indicate the number of the
item to which the answer refers. The U.S. Citizenship and Immigration Services (USCIS) is comprised of offices of the former Immigration
and Naturalization Service (INS).
You should use Form I-102 to:
Use Form I-102 to request a new or replacement of an
incorrect, lost, stolen or damaged Nonimmigrant Arrival -
Replace your lost, stolen or mutilated Form I-94, I-94W
Departure Document.
or I-95;
You will need to give us:
Receive an initial Form I-94 if you were not issued one
when you entered as a nonimmigrant, and you are filing
A completed and signed Form I-102
this form with an application for extension of stay or
change of status;
Evidence of eligibility
Receive a corrected Form I-94, I-94W or Form I-95 if you
Filing fee
were issued one with incorrect information when you
See Step 3 for specific filing instructions.
entered as a nonimmigrant or refugee; or to
Receive an initial Form I-94 if you were not issued one
When Should I Use Form I-102?
when you were originally admitted into the United States
As a nonimmigrant visitor to the United States, you should
due to your military membership as described below:
use Form I-102 to apply to the U.S. Citizenship and
A nonimmigrant member of the U.S. armed forces; or
Immigration Services (USCIS) for a new or replacement:
A nonimmigrant member of the North Atlantic Treaty
Form I-94, Nonimmigrant Arrival - Departure Record;
Organization (NATO) armed forces or civilian
Form I-94W, Nonimmigrant Visa Waiver Arrival -
component; or
Departure Record; or
A nonimmigrant member of the Partnership for Peace
military program under the Status of Forces Agreement
Form I-95, Crewman Landing Permit.
How Do I File Form I-102?
ADVISORY: Do not use this form to request an action on a
A separate Form I-102 must be filed for each person seeking
Form I-94 issued by the U.S. Customs and Border Protection
the immigration benefit. Follow the steps below to complete
(CBP). If you are seeking a new Form I-94 based on a Form
your application:
I-94 issued at a port-of-entry or otherwise by CBP, you
should contact the nearest CBP office or port-of-entry and
Step 1 - Reason for Filing Form I-102
inquire about their procedures, or visit the CBP's website at
Step 2 - Fill Out the Form I-102
Step 3 - Submit Your Application
Step 2. Fill Out the Form I-102.
Use black ink. Type or print clearly using capital letters. If
USCIS wants to make sure that you receive the requested
an item does not apply to you, write "N/A." If the answer is
benefit. To do this, we may ask for more evidence, interview
none, write "NONE."
you and/or conduct an investigation. If you give us false
This form is divided into Parts 1 through 5. The following
documents, misrepresent facts or otherwise engage in
information should help you fill out the form.
fraud, USCIS will take appropriate action. This means we
will not only deny your application, you may lose current and
Part 1.
Information about you.
future immigration benefits. You may also face penalties,
including criminal and/or civil prosecution leading to fines
Family Name (Last name) - Give your legal name. If you
and/or imprisonment.
have two last names, include both and use a hyphen (-)
between the names, if appropriate.
Step 1. Reason for Filing Form I-102.
Address - Give your physical street address. This must
include a street number and name or a rural route number.
The following is a brief description of eligibility categories.
Do not put a post office box (P.O. Box) number here.
Check the box in Part 2 of Form I-102 that matches your
A # - This is your immigration file number. If you do not
reason for filing.
have an Alien Registration Number or do not know it, leave
this blank.
After determining which category best applies, you must
submit evidence that proves eligibility. Each category has
U.S. Social Security # - If you do not have a U.S. Social
specific evidence requirements. See Step 3, Submit Your
Security number, leave this blank.
Form I-102, for information on what evidence is required.
Instructions I-102 (Rev. 10/26/05)Y


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