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USCIS Form

Part 1. Information About You

Note: Click on the red circle with a question mark for guidance on where to find certain information.
This number can be found on your physical card. It is also called an A# on older versions. If your card was lost, you can leave this blank.
Code on the card under 'Category', usually 3 characters. Write 'I don’t remember' if you lost it and don't remember the code.
What is the “Resident Since” date printed on your Green Card?

Your Full Name NOTE: Your card will be issued in this name.

 

Has your name legally changed since the issuance of your Permanent Resident Card?

Mailing Address NOTE: USCIS will not mail a Permanent Resident Card to a foreign mailing address, only to a valid U.S. mailing address

Is your physical address the same as your mailing address?

Additional Information

Gender

Date of Birth (mm/dd/yyy)*

Enter only the first names of your parents. If you don't know either of the names just enter N/A.

Part 2. Application Type

Part 3. Processing Information

List the location of the U.S. Embassy, U.S. Consulate, or USCIS office where you filed your application for an immigrant visa or adjustment of status.
List the location of the U.S. Embassy, U.S. Consulate, or USCIS office where you were issued an immigrant visa or granted lawful permanent resident status.
Did you enter the U.S. with an immigrant visa?
Have you ever been in exclusion, deportation, or removal proceedings or ordered removed from the United States?
Since you were granted permanent residence, have you ever filed Form I-407, Abandonment by Alien of Status as Lawful Permanent Resident, or otherwise been determined to have abandoned your status?

Biographic Information

USCIS only provides the following options. If your race doesn’t fit with any of these, select the closest one.

Part 4. Accommodations for Individuals with Disabilities and/or Impairments

If you have a disability and/or impairment, USCIS may provide you with accommodations to help with the application process. Do you have a disability and/or impairment and would like to request an accommodation?

Part 5. Applicant's Statement, Contact Information, and Certification

If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-90, your application will be denied and any other immigration benefit may also be denied. In addition, you will face severe penalties provided by law and may be subject to criminal prosecution.

Applicant's Statement

Can you read and understand English?
Is someone preparing this application for you?

Applicant's Contact Information

Applicant's Certification

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS may need to determine my eligibility for the immigration benefit I seek.

I further authorize release of information contained in this application, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws.

I understand that USCIS will require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that:

  1. I reviewed and provided or authorized all of the information in my application;
  2. I understood all of the information contained in, and submitted with, my application; and
  3. All of this information was complete, true, and correct at the time of filing.

I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in, and submitted with, my application, and that all of this information is complete, true, and correct.

NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, USCIS may deny your application.