I-102: Application For Replacement/initial Nonimmigrant Arrival (Page 2 of 2) in pdf

OMB No. 1115>0079

U.S. Department of Justice

Application for Replacement /Initial

Nonimmigrant Arrival > Departure Document

Immigration and Naturalization Service

Purpose Of This Form.

If you are elsewhere in the U.S., mail this application to: USINS Northern

Service Center, 100 Centennial Mall North, Room B-26, Lincoln, NE

This form is for a nonimmigrant to apply for a new or replacement Form

68508.

I-94 or Form I-95 Nonimmigrant Arrival-Departure Document.

Fee.

Who May File.

If you are a nonimmigrant in the U.S., file this application:

The fee for this application is $65.00. The fee must be submitted in the

•

to replace your lost or stolen Form I-94 or Form I-95;

exact amount. It cannot be refunded. DO NOT MAIL CASH.

•

to replace your mutilated Form I-94 or Form I-95; or

All checks and money orders must be drawn on a bank or other institution

•

if you were not issued a Form I-94 when you entered as a

located in the United States and must be payable in United States

nonimmigrant, and are filing this application with an application

currency. The check or money order should be made payable to the

for extension of stay or change of status.

Immigration and Naturalization Service, except that:

General Filing Instructions.

•

If you are in Guam, and are filing this application in Guam, make

your check or money order payable to the "Treasurer, Guam."

Please answer all questions by typing or clearly printing in black ink.

Indicate that an item is not applicable with "N/A". If an answer is "none,"

•

If you are in the Virgin Islands, and are filing this application in

write "none". If you need extra space to answer any item, attach a sheet

the Virgin Islands, make your check or money order payable to

of paper with your name and your alien registration number (A#), if any,

the "Commissioner of Finance of the Virgin Islands."

and indicate the number of the item to which the answer refers. You must

file your application with the required Initial Evidence. Every application

Checks are accepted subject to collection.

An uncollected check will

must be properly signed and filed with the correct fee. If you are under 14

render the application and any document issued invalid. A charge of $5.00

years of age, your parent or guardian may sign the application.

will be imposed if a check in payment of a fee is not honored by the bank

on which it is drawn.

Initial Evidence.

Processing Information.

Lost or Stolen Form. If you are applying to replace a lost or stolen Form

Acceptance. Any application that is not signed or is not accompanied by

I-94 or Form I-95, submit a copy of the original Form I-94 or submit a copy

the proper fee will be rejected with a notice that the application is deficient.

of the biographic page from your passport and a copy of the page

You may correct the deficiency and resubmit the application. However, an

indicating admission as claimed, or other evidence of your admission. If

application is not considered properly filed until it is accepted by the

you are unable to submit this evidence, submit a full explanation of why you

Service.

cannot provide any of the above evidence along with a copy of evidence of

your identity and copies of any evidence in your possession to substantiate

Initial processing.

Once the application has been accepted, it will be

your claim.

checked for completeness, including submission of the required initial

evidence.

If you do not completely fill out the form, or file it without

Mutilated Form. If you are applying to replace a mutilated Form I-94 or

required initial evidence, you will not establish a basis for eligibility, and we

Form I-95, attach the original form.

may deny your application.

First Form I-94. If you were not issued a Form I-94 at admission, have not

Decision. You will be notified in writing of the decision on your application.

since been issued a Form I-94, and now require an Form I-94 for another

If the application is approved, a new Form I-94, or Form I-95 will be sent to

application you are filing, submit a copy of any evidence in your possession

you.

to substantiate your claimed admission.

Translations. Any foreign language document must be accompanied by a

Penalties.

full English translation which the translator has certified as complete and

If you knowingly and willfully falsify or conceal a material fact or submit a

correct, and by the translator's certification that he or she is competent to

false document with this request, we will deny the benefit you are filing for,

translate from the foreign language into English.

and may deny any other immigration benefit. In addition, you will face

Copies. If these instructions state that a copy of a document may be filed

severe penalties provided by law, and may be subject to criminal

with this application, and you choose to send us the original, we may keep

prosecution.

that original for our records.

Privacy Act Notice.

Where To File.

We ask for the information on this form, and associated evidence, to

If you are filing to replace a Form I-95, file this application at the local INS

determine if you have established eligibility for the immigration benefit you

office having jurisdiction over where you are temporarily located.

are filing for. Our legal right to ask for this information is in 8 USC 1304.

If you were not issued a Form I-94 at admission, or are filing this

We may provide this information to other government agencies. Failure to

application with an application for extension of stay or change of status, file

provide this information, and any requested evidence, may delay a final

this application where you are filing the accompanying extension of stay or

decision or result in denial of your request.

change of status application.

In all other instances, file your application as follows:

Paperwork Reduction Act Notice.

We try to create forms and instructions that are accurate, can be easily

If you are in Connecticut, Delaware, District of Columbia, Maine, Maryland,

understood, and which impose the least possible burden on you to provide

Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania,

us with information. Often this is difficult because some immigration laws

Puerto Rico, Rhode Island, Vermont, the Virgin Islands, Virginia, or West

are very complex. The estimated average time to complete and file this

Virginia, mail this application to: USINS Eastern Service Center, 75 Lower

application is as follows: (1) 5 minutes to learn about the law and form; (2)

Welden Street, St. Albans, VT 05479-0001.

5 minutes to complete the form; and (3) 15 minutes to assemble and file

If you are in Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana,

the application; for a total estimated average of 25 minutes per application.

Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina,

If you have comments regarding the accuracy of this estimate, or

Tennessee, or Texas, mail this application to: USINS Southern Service

suggestions for making this form simpler, you can write to both the

Center, P.O. Box 152122, Department A, Irving, TX 75015-2122.

Immigration and Naturalization Service, 425 I Street, N.W., Room 5304,

If you are in Arizona, California, Guam, Hawaii, or Nevada, mail this

Washington, D.C. 20536; and the Office of Management and Budget,

application to: USINS Western Service Center, P.O. Box 30040, Laguna

Paperwork Reduction Project, OMB No. 1115-0079, Washington, D.C.

Niguel, CA 92607-0040.

20503.

Form I-102 (Rev. 06/13/95) N

I-102: Application For Replacement/initial Nonimmigrant Arrival Page 2

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