My NEW address is:
(“In care of” other person, if any)
(Number, Street, Apartment)
(City, State and ZIP Code)
(Country, if other than U.S.)
(New Telephone Number)
My OLD address was:
(“In care of” other person, if any)
(Number, Street, Apartment)
(City, State and ZIP Code)
(Country, if other than U.S.)
Name: Alien Number: A
OMB# 1125-0004
Alien’s Change of Address Form/
Immigration Court
U.S. Department of Justice
Executive Office for Immigration Review
Immigration Court
If you move or change your phone number, the law requires you to file this Change of Address Form with the Immigration Court. You must file this
form within five (5) working days of a change in your address or phone number. You will only receive notification as to the time, date, and place of
hearing or other official correspondence at the address which you provide. Changes in address or telephone numbers communicated through any means
except this form, e.g., pleadings, motion papers, correspondence, telephone calls, applications for relief, etc. will not be recognized and the address
information and record will remain unchanged.
Failure to appear at any hearing before an Immigration Judge, when notice of that hearing or other official correspondence was served on
you or sent to the address you provided, may result in one or more of the following actions:
l
If you are not already detained, you may be taken into custody by the Department of Homeland Security (DHS) and held for further action; and
If you are in removal proceedings:
Your hearing may be held in your absence
under Section 240 of the Immigration
and Nationality Act (INA), and an order
of removal may be entered against you.
Furthermore, you may become ineligible for
the following forms of relief from removal
for a period of 10 years after the date of the
entry of the final order:
1. Voluntary Departure as provided for
in Section 240B of the INA;
2. Cancellation of Removal as provided
for in Section 240A of the INA;
3. Adjustment of Status or Change of
Status as provided for in Section(s)
245, 248, or 249 of the INA.
If you are in deportation proceedings:
Your hearing may be held in your absence
under Section 242B of the Immigration and
Nationality Act (INA) (1995), and an order
of deportation may be entered against you.
Furthermore, you may become ineligible for
the following forms of relief from deporta-
tion for a period of 5 years after the date of
the entry of the final order:
1. Voluntary Departure as provided for
in Section 242(b) of the INA (1995);
2. Suspension of Deportation or Vol-
untary Departure as provided for in
Section 244 of the INA (1995);
3. Adjustment of Status or Change of
Status as provided for in Section(s)
245, 248, or 249 of the INA (1995).
If you are in exclusion proceedings:
Your application for admission to the United
States may be considered withdrawn, and
your hearing may be held in your absence
and an order of exclusion and deportation
entered against you.
PROOF OF SERVICE (You Must Complete This)
I mailed or delivered a copy of this Change of Address Form on
to the Office of the Chief Counsel for the DHS (U.S. Immigration and Customs Enforcement-ICE) at
- SIGN HERE
Signature Date
X
- SIGN HERE
Signature
X
(Name)
(Date)
(Number and Street, City, State, Zip Code)
Form EOIR - 33/IC
Revised October 2013
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
