Fillable Printable Ar 11
Fillable Printable Ar 11
Ar 11
Form AR-11 08/31/15 N Page 1 of 2
Alien's Change of Address Card
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form AR-11
OMB No. 1615-0007
Expires 08/31/2018
*Family Name (Last Name) *Given Name (First Name) Middle Name (if applicable)
I am in the United States as a: Visitor Student Permanent Resident Other (Specify)
Alien Registration Number (A-Number) (if any)
*Date of Birth (mm/dd/yyyy)
Country of Citizenship
*Present Physical Address (No PO Boxes)
Ste. NumberFlr.Apt.
*Street Number and Name
*ZIP Code*State
*City or Town
Ste. NumberFlr.Apt.
Street Number and Name
ZIP CodeState
City or Town
Information About You
Information About Your Address
►
A-
Your Signature
*Your Signature Date of Signature (mm/dd/yyyy)
NOTE: An asterisk (*) indicates a mandatory field that must be completed.
Ste. NumberFlr.Apt.
Street Number and Name
ZIP CodeState
City or Town
Mailing Address (optional)
Previous Physical Address
Form AR-11 08/31/15 N Page 2 of 2
Paperwork Reduction Act
USCIS Privacy Act Statement
An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection of information,
unless it displays a currently valid OMB control number. The public reporting burden for this collection of information is estimated at
12 minutes per response in paper format and 6 minutes when submitted electronically, including the time for reviewing instructions,
gathering the required documentation and information, completing the request, attaching necessary documentation, and submitting the
request. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy,
20 Massachusetts Ave NW, Washington, DC 20529-2140; OMB No. 1615-0007. Do not mail your completed Form AR-11 to this
address.
AUTHORITIES: USCIS collects this information under Section 265 of the Immigration and Nationality Act (INA), as amended,
8 U.S.C. section 1305.
PURPOSE: The primary purpose for providing the requested information on this form is to report a change of address within 10 days
of the change.
DISCLOSURE: Failure to report a change of address may result in a fine, imprisonment and/or removal.
8 U.S.C. sections 1227(a)(3), 1306. Failure to comply may also jeopardize your ability to obtain a future visa or other immigration
benefits.
ROUTINE USES: USCIS may share the information you provide on this form with other Federal, state, local, and foreign
government agencies and authorized organizations in accordance with the approved routine uses described in the associated published
system of records notices [DHS-USCIS-007 - Benefits Information System which can be found at www.dhs.gov/privacy]. The
information may also be made available, as appropriate, for law enforcement purposes or in the interest of national security.
All aliens subject to registration requirements must use this form to report a change of address within 10 days of such change. The
collection of this information is required by Section 265 of the Immigration and Nationality Act (8 U.S.C. 1305). U.S. Citizenship
and Immigration Services (USCIS) uses the data collected on this form for statistical and record-keeping purposes, and may share this
information with other Federal, state, local, and foreign law enforcement officials. Failure to report a change of address is punishable
by fine or imprisonment and/or removal from the United States.
NOTE: This form is not evidence of identity, age, or status claimed.
Address Change Information and Instructions
Mail your completed Form AR-11 to:
U.S. Department of Homeland
Security
Citizenship and Immigration Services
Attn: Change of Address
1344 Pleasants Drive
Harrisonburg, VA 22801
Instructions
Complete all fields on this form, sign and date the form, and mail it to the address below.
