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I-131, Application for Travel Document (United States)

This form is to apply for a reentry permit, refugee travel document, or advance parole travel document to the United States. The form provided here is simply a sample of what the actual Form I-131 looks like.

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

I-131, Application for Travel Document

DO NOT WRITE IN THIS BLOCK, FOR USCIS USE ONLY (except G-28 block below)

Document Issued
____ Reentry Permit
____ Refugee Travel Document
____ Single Advance Parole
____ Multiple Advance Parole Valid to: _______________________________
If Reentry Permit or Refugee Travel Document, mail to:
____ Address in Part 1
____ American embassy/consulate at: _______________________________
____ Overseas DHS office at: _______________________________

Action Block


Receipt

____ Document Hand Delivered

On _______________________________

By _______________________________


To be completed by Attorney/Representative, if any.

Attorney State License # _______________________________

____ Check box if G-28 is attached.

Part 1. Information about you. (Please type or print in black ink.)

1. A # _______________________________

2. Date of Birth (mm/dd/yyyy) _______________________________

3. Class of Admission _______________________________

4. Gender Male ____ Female ____

5. Name (Family name in capital letters) ________________________

(First) _______________________________

(Middle) _______________________________

6. Address (Number and Street) _______________________________

Apt. # _______________________________

City _______________________________

State or Province _______________________________

Zip/Postal Code _______________________________

Country _______________________________

7. Country of Birth _______________________________

8. Country of Citizenship _______________________________

9. Social Security # (if any) _______________________________

Part 2. Application type (check one).

a. ____ I am a permanent resident or conditional resident of the United States and I am applying for a reentry permit.

b. ____ I now hold U.S. refugee or asylee status and I am applying for a refugee travel document.

c. ____ I am a permanent resident as a direct result of refugee or asylee status and I am applying for a refugee travel document.

d. ____ I am applying for an advance parole document to allow me to return to the United States after temporary foreign travel.

e. ____ I am outside the United States and I am applying for an advance parole document.

f. ____ I am applying for an advance parole document for a person who is outside the United States.
If you checked box "f", provide the following information about that person:

1. Name (Family name in capital letters) _______________________________

(First) _______________________________

(Middle) _______________________________

2. Date of Birth (mm/dd/yyyy) _______________________________

3. Country of Birth _______________________________

4. Country of Citizenship _______________________________

5. Address (Number and Street) _______________________________

Apt. # _______________________________

Daytime Telephone # (area/country code) ________________________

City _______________________________

State or Province _______________________________

Zip/Postal Code _______________________________

Country _______________________________

Part 3. Processing information.

1. Date of Intended Departure (mm/dd/yyyy) _______________________

2. Expected Length of Trip _______________________________

3. Are you, or any person included in this application, now in exclusion, deportation, removal or rescission proceedings?

____ No ____ Yes (Name of DHS office) _______________________________

If you are applying for an Advance Parole Document, skip to Part 7.

4. Have you ever before been issued a reentry permit or refugee travel for the last document issued to you):

____ No ____Yes (Give the following information)

Date Issued (mm/dd/yyyy): _______________________________

Disposition (attached, lost, etc.): _______________________________

5. Where do you want this travel document sent? (Check one)

a. ____ To the U.S. address shown in Part 1 on the first page of this form.

b. ____ To an American embassy or consulate at:

City _______________________________

Country _______________________________

c. ____ To a DHS office overseas at:

City _______________________________

Country _______________________________

d. If you checked "b" or "c", where should the notice to pick up the travel document be sent?

____ To the address shown in Part 2 on the first page of tis form.

____ To the address shown below:

Address (Number and Street) _______________________________

Apt. # _______________________________

Daytime Telephone # (area/country code) _________________________

City _______________________________

State or Province _______________________________

Zip/Postal Code _______________________________

Country _______________________________

Part 4. Information about your proposed travel.

Purpose of trip. If you need more room, continue on a separate sheet(s) of paper.

_______________________________

List the countries you intend to visit.

_______________________________

Part 5. Complete only if applying for a reentry permit.

Since becoming a permanent resident of the United States (or during the past five years, whichever is less) how much total time have you spent outside the United States?

____ less than six months
____ six months to one year
____ one to two years
____ two to three years
____ three to four years
____ more than four years

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(s) of paper.)

____ Yes ____ No

Part 6. Complete only if applying for a refugee travel document.

1. Country from which you are a refugee or asylee: _______________________________

If you answer "Yes" to any of the following questions, you must explain on a separate sheet(s) of paper.

2. Do you plan to travel to the above named country? ____ Yes ____ No

3. Since you were accorded refugee/asylee status, have you ever:

a. returned to the above named country? ____ Yes ____ No

b. applied for and/or obtained a national passport, passport renewal or entry permit of that country? ____ Yes ____ No

c. applied for and/or received any benefit from such country (for example, health insurance benefits). ____ Yes ____ No

4. Since you were accorded refugee/asylee status, have you, by any legal procedure or voluntary act:

a. reacquired the nationality of the above named country? ____ Yes ____ No

b. acquired a new nationality? ____ Yes ____ No

c. been granted refugee or asylee status in any other country? ____ Yes ____ No

Part 7. Complete only if applying for advance parole.

On a separate sheet(s) of paper, please 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.)

1. For how many trips do you intend to use this document? ____ One trip ____ More than one trip

2. If the person intended to receive an advance parole document is outside the United States, provide the location (city and country) of the American embassy or consulate or the DHS overseas office that you want us to notify.

City _______________________________

Country _______________________________

3. 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 on the first page of this form.

____ To the address shown below:

Address (Number and Street) _______________________________

Apt. # _______________________________

Daytime Telephone # (area/country code) _______________________________

City _______________________________

State or Province _______________________________

Zip/Postal Code _______________________________

Country _______________________________

Part 8. Signature. Read the information on penalties in the instructions before completing this section. If you are filing for a reentry permit or refugee travel document, you must be in the United States to file this application.

I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with it are all true and correct. I authorize the release of any information from my records that the U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking.

Signature _______________________________

Date (mm/dd/yyyy) _______________________________

Daytime Telephone Number (with area code) _________________________

Please Note: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you cannot be found eligible for the requested document and this application may be denied.

Part 9. Signature of person preparing form, if other than above. (Sign below)

I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.

Signature _______________________________

Print or Type Your Name _______________________________

Firm Name _______________________________

Firm Address (Street Number and Name or P.O. Box, City, State, Zip Code) _______________________

Daytime Telephone Number (with area code) ____________________

Fax Number (if any) _______________________________

Date (mm/dd/yyyy) _______________________________

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