Cbp Form 823S PDF Details

Navigating through the process of expedited border crossing between the United States and its neighboring countries has been simplified with the introduction of the CBP Form 823S, a vital document provided by the U.S. Department of Homeland Security's Customs and Border Protection. This form serves as the application for the Secure Electronic Network for Travelers Rapid Inspection (SENTRI), a program designed to facilitate quick and secure border crossings for pre-approved, low-risk travelers. Catering to various applicant types, including first-time applicants, those seeking to renew their pass, or individuals needing a replacement card or vehicle decal, the form covers an extensive range of information. From basic personal and contact data to detailed address and employment history over the last five years, the form ensures thorough vetting. Applicants are required to disclose their citizenship, proof of identification, and any history of legal convictions or customs violations, emphasizing the program's emphasis on security. Additionally, the form extends to gather vehicle information, should the applicant wish to register their car for SENTRI lane usage, though this is optional and restricted to those over 18. Alongside the data collection, applicants must acknowledge the non-refundable fee payment specifics, reinforcing the commitment involved in submitting an application. The certification section demands an understanding and agreement to the program's terms, with a final statement on privacy highlighting the careful handling of applicant information in accordance with various U.S. laws and regulations. Completing and submitting the CBP Form 823S is the first step toward enjoying the benefits of expedited travel, as it ushers applicants into a rigorous yet rewarding system aimed at enhancing the international travel experience for citizens and residents.

QuestionAnswer
Form NameCbp Form 823S
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesapplication sentri get, protection sentri application form, sentri application online, application section sentri

Form Preview Example

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

SENTRI Application

Approved OMB No. 1651-0121 Exp. 8-31-2014

1. Applicant's age is 14 years or younger (check box)

1a. (Check one box only)

 

First time applicant without vehicle

 

 

Applicant renewal

 

Card replacement

1b. SENTRI ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First time applicant with vehicle

 

Add vehicle

 

 

Vehicle decal replacement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION A - PERSONAL INFORMATION

2. Last/Paternal Name

2a. Maternal name

3. First name

4. Middle name (in full)

4a. Suffix

5. Other names used (e.g., maiden name, former name)

 

 

 

 

Nickname

 

 

 

6. Gender

 

 

 

 

 

7. Date of Birth (yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Male

 

 

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

 

 

Place of birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. Citizenship (Check all that apply.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. Residence

 

 

 

 

 

 

 

 

 

 

 

 

Canadian citizen

 

 

 

 

 

 

U.S. citizen

 

 

Mexican citizen

 

 

 

Other (Must Specify)

 

 

 

 

 

 

 

 

 

 

 

 

Canada

 

 

 

 

United States

 

Mexico

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Proof of citizenship/residency/immigration status (Attach copies)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

U.S. Alien Registration No.

 

or

 

Border Crossing Card No.

 

 

 

 

 

 

 

 

 

 

Birth Certificate No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passport No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Country of Issuance

 

 

 

 

 

 

 

 

 

 

 

(Expiration Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

Other Type of Document

 

 

 

 

 

 

 

 

 

 

No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Expiration Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

Drivers license No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Attach Copy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State and Country of Issuance

 

 

 

 

 

 

 

 

 

(Expiration Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(yyyy/mm/dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION B - ADDRESS HISTORY FOR THE LAST 5 YEARS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. Current address

(yyyy/mm)

13. Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apt. No.

14. City

 

 

 

 

 

 

 

 

15. Colonia/Neighborhood

 

 

 

As of what

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

date?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. Country

 

 

 

 

17. State

 

 

 

 

18. Postal/Zip Code

 

19. Home telephone

 

20. Business telephone/Cell phone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ext.

 

 

 

Mailing address if different from residential address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21. Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apt. No.

 

22. City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23. Colonia/Neighborhood

24. Country

25. State

26. Postal/Zip Code

Previous residential addresses if current residence is less than five years (address history continued on page 4).

27.

(yyyy/mm)

(yyyy/mm)

28. Street Address

 

Apt. No.

29. City

 

From:

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

30. Colonia/Neighborhood

 

31. Country

32. State

 

33. Postal/Zip Code

 

 

 

 

 

 

 

 

 

34.

(yyyy/mm)

(yyyy/mm)

35. Street Address

 

Apt. No.

36. City

 

From:

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37. Colonia/Neighborhood

38. Country

39. State

40. Postal/Zip Code

41.(yyyy/mm)

From:

(yyyy/mm) 42. Street Address

To:

Apt. No.

43. City

44. Colonia/Neighborhood

45. Country

46. State

47. Postal/Zip Code

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0121. The estimated average time to complete this application is 40 minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.

CBP Form 823S (10/10)

SECTION C - EMPLOYMENT HISTORY FOR THE LAST 5 YEARS (if applicable)

48.

Current employer

(yyyy/mm)

(yyyy/mm)

49. Employer's name

 

 

 

 

 

 

 

 

From:

 

 

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50.

Street Address

 

 

 

 

 

 

Apt. No.

51. City

 

52. Colonia/Neighborhood

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

53. Country

 

 

 

 

 

54. State

 

55. Postal/Zip Code

 

56. Telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ext.

57. Occupation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Previous Employer name and address if current employer is less than five years (employment history continued on page 4).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

58.

(yyyy/mm)

 

(yyyy/mm)

59. Employer's name

 

 

 

 

60. Street Address

 

Apt. No.

 

From:

 

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

61. City

62. Colonia/Neighborhood

63. Country

64. State

65. Postal/Zip Code

SECTION D - ADDITIONAL INFORMATION

66.

Have you ever been convicted of an offense in any country?

What country were you convicted in?

Have you ever received a waiver of inadmissibility to the U.S. from CBP (former USINS)?

Have you ever been found in violation of customs or immigration laws?

If you have answered YES, please give details:

N o

No

No

Yes

Yes

Yes

SECTION E – UNITED STATES CONTACT INFORMATION

Note: If U.S. contact information is not completed, Customs and Border Protection (CBP) will attempt to contact applicant via telephone for U.S. contact information. Application will not be accepted, if no U.S. contact information is available.

67.Full Name

68.Street Address

69. U.S. City

U.S. State

Postal/Zip Code

SECTION F – VEHICLE DATA

Note: An applicant does not have to provide vehicle data to enroll in SENTRI (i.e. carpool). However, if an applicant wishes to utilize their vehicle in the SENTRI lane, he or she must provide the vehicle data. Vehicle can only be registered for those persons age 18 and over.

70.

Make

 

 

 

 

71.

Model

 

 

 

 

72.

Year

 

 

 

 

73.

Color

 

 

 

 

74.

VIN No.

 

 

 

 

75.

License Plate No.

 

 

 

 

76.

Country

77. State

 

 

 

 

Registered Owner Information

78.Last/Paternal Name

79.First name

78a. Maternal name

79a. Middle name (in full)

79b. Suffix

 

 

80.Gender Male

Female

81. Date of Birth (yyyy/mm/dd)

CBP Form 823S (10/10)

SECTION G - FEE PAYMENT (non-refundable)

82.

 

 

 

 

 

 

Please submit the amount below in US currency only.

 

 

 

 

 

 

 

All credit card fees will be processed as U.S. funds

 

VISA

 

 

MasterCard

 

 

 

 

 

 

 

 

 

 

 

I am enclosing a certified check or money order payment

 

 

 

 

$

 

 

 

 

 

 

 

 

 

Discover

 

 

American Express

 

 

 

 

 

 

 

 

 

 

 

 

Once an application has been processed, absolutely no refunds will be granted. No exceptions.

 

 

 

 

Card no.

 

 

Expiration Date (yyyy/mm)

 

 

 

 

 

 

 

 

Card holder's name (please print)

Card holder's signature

SECTION H - CERTIFICATION

83.

I certify that all information given on this application, and in support of this application, was provided voluntarily and is true and complete. I understand that any information on this application, including any supporting documentation, background information, and biometric data may be shared among Customs and Immigration authorities in both Mexico and the U.S. and among law enforcement and other government agencies in accordance with applicable laws. I certify that I have read, understood, and agree to abide by all conditions required for use of the SENTRI program, including all instructions and notices accompanying this application.

Applicant

Name (please print)

Signature

Date (yyyy/mm/dd)

U.S. PRIVACY ACT STATEMENT

The authority to collect the information on this application, any supporting documentation, fingerprints, and other requested information is contained in Titles 8 and 19 of the U.S. Code and corresponding regulations. Furnishing the information on this form is voluntary; however, failure to provide all the requested information may result in the delay of a final decision or denial of your application. The information collected will be used to make a determination on your application. It may also be provided to other government agencies (Federal, state, local, and/or foreign) as permitted under the Privacy Act of 1974, 5 U.S.C. § 552a (2002), and other applicable law. All applicants are subject to a check of criminal information databases and other immigration and customs databases in order to determine eligibility for this program.

Please mail or take your completed application along with application fee to the nearest SENTRI Enrollment Center. Locations and addresses of SENTRI Enrollment Centers can be found at www.SENTRI.gov.

CBP Form 823S (10/10)

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

SENTRI Application - Continuation Sheet

Approved OMB No. 0651-0121 Exp. 10-31-2010

1b. SENTRI ID

SECTION A - PERSONAL INFORMATION

2. Last/Paternal Name

2a. Maternal name

3.

First name

 

4. Middle name (in full)

 

 

 

4a. Suffix

 

 

 

 

 

 

 

 

 

 

 

5.

Other names used (e.g., maiden name, former name)

Nickname

 

6. Gender

 

 

7. Date of Birth (yyyy/mm/dd)

 

 

 

 

 

 

Male

 

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION B - ADDRESS HISTORY FOR THE LAST 5 YEARS - continued

Previous residential addresses if current residence is less than five years (address history continued from page 1).

1.(yyyy/mm)

From:

(yyyy/mm)

To:

2. Street Address

Apt. No.

3. City

4. Colonia/Neighborhood

5. Country

6. State

7. Postal/Zip Code

8.(yyyy/mm)

From:

(yyyy/mm) 9. Street Address

To:

Apt. No.

10. City

11. Colonia/Neighborhood

12. Country

13. State

14. Postal/Zip Code

15.(yyyy/mm)

From:

(yyyy/mm) 16. Street Address

To:

Apt. No.

17. City

18. Colonia/Neighborhood

19. Country

20. State

21. Postal/Zip Code

22.(yyyy/mm)

From:

(yyyy/mm)

To:

23. Street Address

Apt. No.

24. City

25. Colonia/Neighborhood

26. Country

27. State

28. Postal/Zip Code

SECTION C - EMPLOYMENT HISTORY FOR THE LAST 5 YEARS - continued

Previous Employer name and address if current employer is less than five years (employment history continued from page 2).

1.

(yyyy/mm)

(yyyy/mm)

2. Employer's name

3. Street Address

From:

 

To:

 

 

 

 

 

 

 

Apt. No.

4. City

 

 

5. Colonia/Neighborhood

6. Country

7. State

8. Postal/Zip Code

 

 

 

 

 

 

 

 

 

 

9.

(yyyy/mm)

 

(yyyy/mm)

10. Employer's name

 

 

11. Street Address

 

Apt. No.

From:

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. City

 

 

13. Colonia/Neighborhood

14. Country

15. State

16. Postal/Zip Code

 

 

 

 

 

 

 

 

 

 

17.(yyyy/mm)

From:

(yyyy/mm) 18. Employer's name

To:

19. Street Address

Apt. No.

20. City

21. Colonia/Neighborhood

22. Country

23. State

24. Postal/Zip Code

25.

(yyyy/mm)

 

(yyyy/mm)

26. Employer's name

 

 

27. Street Address

 

Apt. No.

From:

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

28. City

 

 

29. Colonia/Neighborhood

30. Country

31. State

32. Postal/Zip Code

 

 

 

 

 

 

 

 

 

 

33.

(yyyy/mm)

 

(yyyy/mm)

34. Employer's name

 

 

35. Street Address

 

Apt. No.

From:

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36. City

 

 

37. Colonia/Neighborhood

38. Country

39. State

40. Postal/Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CBP Form 823S (10/10)

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sentri application online writing process described (part 1)

2. Now that the last segment is finished, you're ready add the essential details in Other Type of Document, Drivers license No, Attach Copy, State and Country of Issuance, yyyymmdd, Expiration Date, yyyymmdd, Expiration Date, yyyymmdd, SECTION B ADDRESS HISTORY FOR THE, Street Address, yyyymm, Apt No, City, and ColoniaNeighborhood allowing you to move on further.

Step # 2 for filling out sentri application online

3. This next step will be simple - fill in every one of the form fields in ColoniaNeighborhood, Country, State, PostalZip Code, From, yyyymm, yyyymm Street Address, Apt No, City, ColoniaNeighborhood, Country, State, PostalZip Code, From, and yyyymm to complete the current step.

sentri application online completion process explained (portion 3)

4. To go forward, this next form section will require filling out several empty form fields. These include SECTION C EMPLOYMENT HISTORY FOR, yyyymm Employers name, yyyymm, From, Street Address, Apt No, City, ColoniaNeighborhood, Country, State, PostalZip Code, Telephone number, Occupation, Ext, and Previous Employer name and address, which are vital to moving forward with this form.

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5. When you reach the completion of this file, you'll notice a couple extra requirements that should be met. In particular, Full Name, Street Address, US City, US State, PostalZip Code, SECTION F VEHICLE DATA, Note An applicant does not have to, Make, Model, Year, Color, VIN No, License Plate No, Country, and Registered Owner Information must all be done.

Full Name, License Plate No, and Make inside sentri application online

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