Form I 90 – Fill Out and Use This PDF

Your Full Name. Your card will be issued in this name. Has your name legally changed since the issuance of your Permanent Resident Card? Yes (Proceed to Item Numbers 5.a. - 5.c.) No (Proceed to Item Numbers 6.a. - 6.i.) N/A - I never received my previous card. (Proceed to Item Numbers 6.a. - 6.i.) For Item Numbers 5.a. - 5.c., provide your name exactly as it is printed on your current Permanent Resident Card. Attach all evidence of your legal name change with this application.

Physical Address. Provide this information only if different than mailing address.

Additional Information. Enter the Date of Birth (mm/dd/yyyy) and the Date of Admission (mm/dd/yyyy). Enter the U.S. Social Security Number (if any).

My status is (Select only one box): Lawful Permanent Resident (Proceed to Section A.), Permanent Resident - In Commuter Status (Proceed to Section A.) or Conditional Permanent Resident (Proceed to Section B.).

If your conditional permanent resident status (for example: CR1, CR2, CF1, CF2) is expiring within the next 90 days, then do not file this application. (See the What is the Purpose of This Application section of the Form I-90 Instructions for further information.)

Reason for Application (Select only one box): 2.a. My previous card has been lost, stolen, or destroyed. 2.b. My previous card was issued but never received. 2.c. My existing card has been mutilated.

2.d. My existing card has incorrect data because of Department of Homeland Security (DHS) error. (Attach your existing card with incorrect data along with this application.)

2.e. My name or other biographic information has been legally changed since issuance of my existing card.

2.f. My existing card has already expired or will expire within six months.

2.g.1. I have reached my 14th birthday and am registering as required. My existing card will expire AFTER my 16th birthday. 2.g.2. I have reached my 14th birthday and am registering as required. My existing card will expire BEFORE my 16th birthday.

NOTE: If you are filing this application before your 14th birthday, or more than 30 days after your 14th birthday, you must select reason 2.j. However, if your card has expired, you must select reason 2.f.

2.h.1. I am a permanent resident who is taking up commuter status. My Port-of-Entry (POE) into the United States will be: City or Town and State. 2.h.2. I am a commuter who is taking up actual residence in the United States.

2.i. I have been automatically converted to lawful permanent resident status. 2.j. I have a prior edition of the Alien Registration Card, or I am applying to replace my current Permanent Resident Card for a reason that is not specified in 2.a. to 2.i.

Biographic Information. Ethnicity (Select only one box): Not Hispanic or Latino or Hispanic or Latino. Race (Select all applicable boxes). Eye Color (Select only one box). Hair Color (Select only one box).

Part 3. Processing Information. Complete Item Numbers 3.a. and 3.a1. if you entered the United States with an immigrant visa. (If you were granted adjustment of status, proceed to Item Number 4.)

Item Number 4: Have you ever been in exclusion, deportation, or removal proceedings or ordered removed from the United States? Item Number 5: 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? NOTE: If you answered "Yes" to Item Numbers 4. or 5. above, provide a detailed explanation in the space provided in Part 8. Additional Information.

NOTE: If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

Part 4. Accommodations for Individuals with Disabilities and/or Impairments (Read the information in the Form I-90 Instructions before completing this part.) Are you requesting an accommodation because of your disabilities and/or impairments? No or Yes. If you answered "Yes," select any applicable boxes:

I am deaf or hard of hearing and request the following accommodation (If you are requesting a sign-language interpreter, indicate for which language (for example, American Sign Language)): I am blind or have low vision and request the following accommodation: I have another type of disability and/or impairment (Describe the nature of your disability and/or impairment and the accommodation you are requesting):

Part 5. Applicant's Statement, Contact Information, Certification, and Signature. NOTE: Read the Penalties section of the Form I-90 Instructions before completing this part. NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2. 1.a. I can read and understand English, and I have read and understand every question and instruction on this application and my answer to every question.

1.b. The interpreter named in Part 6. read to me every question and instruction on this application and my answer to every question in a language in which I am fluent and I understood everything.

2. At my request, the preparer named in Part 7., prepared this application for me based only upon information I provided or authorized.

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.

Applicant's Certification: "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."

6.b. Date of Signature (mm/dd/yyyy).

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.

Part 6. Interpreter's Contact Information, Certification, and Signature. 7.a. Interpreter's Signature (sign in ink)

Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Provide the following information about the preparer.

7.a. I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent. 7.b. I am an attorney or accredited representative and my representation of the applicant in this case extends or does not extend beyond the preparation of this application. Preparer's Signature (sign in ink).

If you need extra space to provide any additional information within this application, use the space in Part 8. If you need more space than what is provided, you may make copies of the Part 8 page to complete and file with this application or attach a separate sheet of paper. Include your name and A -Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.