Fillable INS-Form-I-131 Application for Travel Document

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INS-Form-I-131 Application for Travel Document

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Form I-131 12/23/16 N Page 1 of 5
For
USCIS
Use
Only
USCIS
Form I-131
OMB No. 1615-0013
Expires 12/31/2018
Application for Travel Document
Department of Homeland Security
U.S. Citizenship and Immigration Services
Part 1. Information About You
Start Here. Type or Print in Black Ink
►
3.
►
A-
Alien Registration Number (A-Number)
1.b.
1.c.
2.a.
1.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
Physical Address
In Care of Name
ZIP Code
2.f.
State
2.e.
City or Town2.d.
2.h.
2.i.
Province
Country
2.g.
Postal Code
8. ►(mm/dd/yyyy)Date of Birth
Other Information
5. Country of Citizenship
4. Country of Birth
9. U.S. Social Security Number (if any)
►
Class of Admission6.
FemaleMaleGender7.
Street Number
and Name
2.b.
2.c.
Apt.
Flr.Ste.
Address in Part 1
US Consulate at:
Intl DHS Ofc at:
Action Block
Receipt
To Be Completed
by an Attorney/
Representative,
if any.
Fill in box if G-28 is
attached to represent
the applicant.
Attorney State
License Number:
By: Date: / / /
Document Hand Delivered
Document Issued
Re-entry Permit (Update
"Mail To" Section)
Multiple Advance Parole
Valid Until: / / /
Single Advance Parole
Refugee Travel Document
(Update "Mail To" Section)
Mail To
(Re-entry &
Refugee
Only)
1 2 3 4 5 6 7 8 9
SMITH
Jane
1 2 3 4 5 6 7 8 9
K-1
183 Gore Creek Street
Joan
Vail
02/13/1975
81658
CO
Australia
Australia
Form I-131 12/23/16 N Page 2 of 5
Part 2. Application Type
I am a permanent resident or conditional resident of
the United States, and I am applying for a reentry
permit.
1.a.
1.b.
I now hold U.S. refugee or asylee status, and I am
applying for a Refugee Travel Document.
1.c.
I am a permanent resident as a direct result of refugee
or asylee status, and I am applying for a Refugee
Travel Document.
I am applying for an Advance Parole Document to
allow me to return to the United States after
temporary foreign travel.
1.d.
1.f. I am applying for an Advance Parole Document for a
person who is outside the United States.
I am outside the United States, and I am applying for
an Advance Parole Document.
1.e.
2.b.
2.c.
2.a.
1.
2.
3.a.
4.a.
4.c.
4.b.
3.b.
Family Name
(Last Name)
Given Name
(First Name)
Middle Name
2.f. Country of Citizenship
2.e. Country of Birth
2.d.
(mm/dd/yyyy)
►(mm/dd/yyyy)
►
►(mm/dd/yyyy)Date of Birth
Daytime Phone Number2.g.
2.h.
Physical Address (If you checked box 1.f.)
In Care of Name
City or Town2.k.
2.o.
2.p.
Province
Country
2.n.
Postal Code
ZIP Code
2.m.
State
2.l.
Part 3. Processing Information
Date of Intended Departure
Expected Length of Trip (in days)
If you are applying for a non-DACA related Advance Parole Document, skip to Part 7; DACA recipients must complete Part 4
before skipping to Part 7.
If "Yes", Name of DHS office:
Are you, or any person included in this application, now
in exclusion, deportation, removal, or rescission
proceedings?
Have you ever before been issued a reentry permit or
Refugee Travel Document? (If "Yes" give the following
information for the last document issued to you):
Date Issued
Disposition (attached, lost, etc.):
Yes No
Street Number
and Name
2.i.
If you checked box "1.f." provide the following information
about that person in 2.a. through 2.p.
( )
-
2.j.
Apt.
Flr.Ste.
Yes No
21
01/02/2018
Form I-131 12/23/16 N Page 3 of 5
To a DHS office overseas at:
7.
If you checked "6" or "7", where should the notice to pick up
the travel document be sent?
To the address shown in Part 2 (2.h. through 2.p.)
of this form.
2 to 3 years
more than 4 years
3 to 4 years6 months to 1 year
1 to 2 years
8.
7.b.
Country
7.a. City or Town
City or Town6.a.
Country
6.b.
To the address shown in Part 3 (10.a. through 10.i.)
of this form.:
9.
10.a.
1.a.
1.b.
In Care of Name
City or Town10.d.
ZIP Code
10.f.
State
10.e.
10.h.
10.i.
Province
Country
10.g.
Postal Code
Daytime Phone Number10.j.
Part 4. Information About Your Proposed Travel
Purpose of trip. (If you need more space, continue on a
separate sheet of paper.)
List the countries you intend to visit. (If you need more
space, continue on a separate sheet of paper.)
Part 5. Complete Only If Applying for a Re-entry Permit
Since you became a permanent resident of the United
States, have you ever filed a Federal income tax return as
a nonresident or failed to file a Federal income tax return
because you considered yourself to be a nonresident? (If
"Yes" give details on a separate sheet of paper.)
Since becoming a permanent resident of the United States (or
during the past 5 years, whichever is less) how much total time
have you spent outside the United States?
1.a. less than 6 months
1.b.
1.c.
1.d.
1.e.
1.f.
2.
Yes No
To the U.S. address shown in Part 1 (2.a through
2.i.) of this form.
Where do you want this travel document sent? (Check one)
6. To a U.S. Embassy or consulate at:
5.
Part 3. Processing Information (continued)
Street Number
and Name
10.b.
10.c.
Apt.
Flr.Ste.
( )
-
Visit my mother and father in
Australia. My US Citizen husband will
be joining me on this trip. Plan to
visit additional times in early 2018.
Australia
Form I-131 12/23/16 N Page 4 of 5
Applied for and/or obtained a national passport, passport
renewal, or entry permit of that country?
Applied for and/or received any benefit from such country
(for example, health insurance benefits)?
Since you were accorded refugee/asylee status, have you, by
any legal procedure or voluntary act:
Been granted refugee or asylee status
in any other country?
Acquired a new nationality?
Reacquired the nationality of the
country named above?
3.b.
3.c.
1.
4.a.
4.c.
4.b.
No
Yes
One Trip
No
Yes
NoYes
No
Yes
No
More than one trip
Yes
If the travel document will be delivered to an overseas office,
where should the notice to pick up the document be sent?:
To the address shown in Part 2 (2.h. through 2.p.)
of this form.
To the address shown in Part 7 (4.a. through 4.i.)
of this form.
How many trips do you intend to use this document?
If the person intended to receive an Advance Parole Document
is outside the United States, provide the location (City or Town
and Country) of the U.S. Embassy or consulate or the DHS
overseas office that you want us to notify.
On a separate sheet of paper, explain how you qualify for an
Advance Parole Document, and what circumstances warrant
issuance of advance parole. Include copies of any documents
you wish considered. (See instructions.)
Part 7. Complete Only If Applying for Advance Parole
3.
4.
City or Town2.a.
Country 2.b.
4.a. In Care of Name
City or Town4.d.
ZIP Code
4.f.
State
4.e.
4.h.
4.i.
Province
Country
4.g.
Postal Code
Daytime Phone Number4.j.
1.
2.
3.a.
No
Yes No
Yes
Part 6. Complete Only If Applying for a Refugee Travel Document
Do you plan to travel to the country
named above?
If you answer "Yes" to any of the following questions, you
must explain on a separate sheet of paper. Include your
Name and A-Number on the top of each sheet.
Country from which you are a refugee or asylee:
Returned to the country named
above?
Since you were accorded refugee/asylee status, have you ever:
Street Number
and Name
4.b.
4.c.
Apt.
Ste. Flr.
( )
-
Form I-131 12/23/16 N Page 5 of 5
To be completed by all preparers, including attorneys and
authorized representatives: I declare that I prepared this benefit
request at the request of the applicant, that it is based on all the
information of which I have knowledge, and that the
information is true to the best of my knowledge.
Declaration
NOTE: If you require more space to provide any additional
information, use a separate sheet of paper. You must include
your Name and A-Number on the top of each sheet.
Part 9. Information About Person Who Prepared This Application, If Other Than the Applicant
Preparer's Full Name
Provide the following information concerning the preparer:
1.a. Preparer's Family Name (Last Name)
1.b. Preparer's Given Name (First Name)
2. Preparer's Business or Organization Name
3.d. State 3.e. ZIP Code
3.f. Postal Code
3.g. Province
3.h. Country
Preparer's Contact Information
4. Preparer's Daytime Phone Number Extension
5. Preparer's E-mail Address (if any)
NOTE: If you are an attorney or representative, you must
submit a completed Form G-28, Notice of Entry of Appearance
as Attorney or Accredited Representative, along with this
application.
Preparer's Mailing Address
3.c. City or Town
6.a. Signature
of Preparer
6.b. Date of Signature (mm/dd/yyyy) ►
I certify, under penalty of perjury under the laws of the
United States of America, that this application and the
evidence submitted with it is all true and correct. I
authorize the release of any information from my records
that U.S. Citizenship and Immigration Services needs
to determine eligibility for the benefit I am seeking.
Part 8. Signature of Applicant (Read the information on penalties in the Form instructions before completing
this Part.) If you are filing for a Re-entry Permit or Refugee Travel Document, you must be in the United States
to file this application.
NOTE: If you do not completely fill out this form or fail to
submit required documents listed in the instructions, your
application may be denied.
1.a.
Signature of Applicant
1.b. Date of Signature (mm/dd/yyyy) ►
2. Daytime Phone Number
Street Number
and Name
3.a.
( )
-
( )
-
3.b.
Apt.
Flr.Ste.
Don't forget to sign!
2 2 2
3 3 3
4 4 4 4
09/17/2017
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Completed 3 July 2020

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