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Alien's Change of Address Card (United States)

This form is to change address of a U.S. alien. The form provided here is simply a sample of what the actual form AR-11 looks like.

Department of Homeland Security
U.S. Citizenship and Immigration Services

AR-11, Alien's Change of Address Card


Name (Last in CAPS) ___________________________________

(First Name) ___________________________________

(Middle Name) ___________________________________

I am in the United States as a:

____ Visitor ____ Student ____ Permanent ____ Resident ____ Other (Specify) _____________________

Country of Citizenship ___________________________________

Date of Birth (mm/dd/yyyy) ___________________________________

Copy Number From Alien Card A___________________________________

Present Address (Street or Rural Route) ___________________________________

(City or Post Office) ___________________________________

(State) ___________________________________

(Zip Code) ___________________________________

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

Last Address (Street or Rural Route) ___________________________________

(City or Post Office) ___________________________________

(State) ___________________________________

(Zip Code) ___________________________________

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

___________________________________

(Street Address or Rural Route) ___________________________________

(City or Post Office) ___________________________________

(State) ___________________________________

(Zip Code) ___________________________________

Port of Entry Into U.S. ___________________________________

Date of Entry Into U.S. (mm/dd/yyyy) ___________________________________

If not a Permanent Resident, my stay in the U.S. expires on:

(Date - mm/dd/yyyy) ___________________________________

Signature ___________________________________

Date (mm/dd/yyyy) ___________________________________


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INSTRUCTIONS FOR FILLING OUT THIS FORM
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This card is to be used by all aliens to report a change of address within ten 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 issued 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.

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

Public Reporting Burden. Under the Paperwork Reduction Act, an agency may not conduct or sponsor an information collection and a person is not required to respond to an information collection unless it displays a currently valid OMB control number. We try to create forms and instructions that are accurate, can be easily understood and that impose the least possible burden on you to provide us with information. Often this is difficult because some immigration laws are very complex. This collection of information is estimated to average five minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including reducing this burden to: U.S. Citizenship and Immigration Services, Regulatory Management Division, 111 Massachusetts Ave. N.W., Washington, D.C. 20529. Do not mail your completed form to this Washington, D.C. address.

Mail Your Form to the Address Shown Below:

Department of Homeland Security
U.S. Citizenship and Immigration Services
Change of Address1084-I South Laurel Road
London, KY 40742-7134

For commercial overnight or fast freight

Department of Homeland Security
U.S. Citizenship and Immigration Services
Change of Address
P.O. Box 7134
London, KY 40742-7134

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