Fillable Printable Immigration Address Change Form

Immigration Address Change Form

Department of Homeland Security

U.S. Citizenship and Immigration Services

OMB No. 1615-0007; Expires 12/31/2014

AR-11, Alien's Change of Address Card

*Name (Last in CAPS) *(First Name) (Middle Name) I am in the United States as a:

A-Number (Copy Number From Alien Card)*Date of Birth (mm/dd/yyyy)

Country of Citizenship

*(City or Post Office)

*Present Address (Street or Rural Route)

(City or Post Office)Last Address (Street or Rural Route)

(Street Address or Rural Route)

I work for or attend school at: (Employer's Name or Name of School)

*(State) *(Zip Code)

(If the above address is temporary) I expect to remain there

Years Months

(Zip Code)(State)

(Zip Code)(State)(City or Post Office)

Date of Entry Into U.S.

(mm/dd/yyyy)

Port of Entry Into U.S.

Date (mm/dd/yyyy)

*Signature

If not a Permanent Resident,

my stay in the U.S. expires on:

(Date - mm/dd/yyyy)

Form AR-11 (Rev. 12/11/11) Y

AR-11, Alien's Change of Address Card

This card is to be used by all aliens 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). The data is used by U.S. Citizenship and

Immigration Services for statistical and record purposes and may be furnished to Federal, State, local and foreign law enforcement

officials. Failure to report a change of address is punishable by fine or imprisonment and/or removal.

Mail Your Form AR-11 to the Address Below:

Paperwork Reduction Act

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

5 minutes per response, including the time for reviewing instructions and completing and submitting the form. 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 Products Division, Office of the Executive Secretariat, 20 Massachusetts

Avenue, N.W., Washington, DC 20529-2020. OMB No. 1615-0007. Do not mail your application to this address.

U.S. Department of Homeland Security

Citizenship and Immigration Services

Attn: Change of Address

1344 Pleasants Drive

Harrisonburg, VA 22801

Visitor

Permanent Resident

Student

Other

(Specify)

ADVISORY: This card is not evidence of identity, age, or status claimed.

* Indicates mandatory fields that must be completed.

A-