Table of Changes Form

Table of Changes

Form I-90 - Form

May 18, 2009

LOCATION	CURRENT VERSION	PROPOSED VERSION
Page 1 FOR USCIS ONLY	FOR USCIS USE ONLY Returned Resubmitted Reloc Sent Reloc Rec’d  Applicant Interviewed Receipt Status as Verified by Class Initials FD-258 forwarded on I-89 forwarded on I-551 seen and returned (initials) Photocopy of I-551 verified (initials) Name Date Sticker # (ten-digit number) Action Block To Be Completed by Attorney or Representative, if any  Fill in box if G-28 is attached to represent the applicant VOLAG# ATTY State License #	FOR USCIS USE ONLY (The receipt box and the Action Block moved to the top of Page 1.) Receipt  Applicant Interviewed Action Block Class of Admission
Page 1, Part 1.	Part 1. Information About You Family Name Given Name Middle Initial U.S. Mailing Address- C/O Street Number and Name Apt. # City State Zip Code Date of Birth (Month/Day/Year) Country of Birth Social Security # A#	Part 1. Information About You 1. Your Current Legal Name (Your card will be issued in this name) Family Name (Last Name) Given Name (First Name) Full Middle Name 2. Has your name legally changed since the issuance of your Permanent Resident Card?  Yes (Proceed to Question 3)  No (Skip to Question 4)  N/A – I never received my previous card. (Skip to Question 4) 3. Your name exactly as reflected on your Permanent Resident Card Family Name (Last Name) Given Name (First Name) Full Middle Name NOTE: Attach all evidence of your legal name change with this application. 4. U.S. Mailing Address C/O Name: Street Number and Name Apt., Suite, or Floor City State Zip Code + 4 5. U.S. Residence Address (if different from above) Street Number and Name Apt., Suite, or Floor City State Zip Code + 4 6. Gender  Male  Female 7. Date of Birth (mm/dd/yyyy) 8. Country of Birth 9. City/Town/Village of Birth 10. Social Security Number 11. A-Number 12. Class of Admission 13. Date of Admission (mm/dd/yyyy)
Page 1, Part 2.	Part 2. Application Type 1. My status is: (check one) a.  Permanent Resident – (Not a Commuter) b.  Permanent Resident – (Commuter) c.  Conditional Permanent Resident 2. Reason for application: (check one) I am a Permanent Resident or Conditional Permanent Resident and: a.  My card was lost, stolen or destroyed. b.  My authorized card was never received. c.  My card is mutilated. d.  My card was issued with incorrect information because of a USCIS administrative error. I have attached the incorrect card and evidence of the correct information. e.  My name or other biographic information has changed since the card was issued. I am a Permanent Resident and: f.  My present card has an expiration date and it is expiring. g.  I have reached my 14th birthday since my card was issued. h.1.  I have taken up Commuter status. h.2.  I was a Commuter and am now taking up residence in the U.S. i.  My status has been automatically converted to permanent resident. j.  I have an old edition of the card.	Part 2. Application Type NOTE: If your conditional status is expiring within the next 90 days, then do not file this form. (See Form I-90 instructions for further information.) 1. My status is (Check only one box):  A. Permanent Resident (Proceed to Section A in next question)  B. Permanent Resident – In Commuter Status (Proceed to Section A in next question)  C. Conditional Permanent Resident (Skip to Section B in next question) 2. Reason for application (Check only one box and see instructions before filling out the reason): Section A. (To be used only by permanent resident or permanent resident in commuter status)  A. My previous card has been lost, stolen, or destroyed.  B. My previous card was issued but never received.  C. My existing card has been mutilated.  D. My existing card has incorrect data because of USCIS error. (Attach existing card with incorrect data along with this application.)  E. My name or other biographic information has been legally changed since issuance of my existing card.  F. My existing card will expire in six months or has already expired.  G1. I have reached my 14th birthday, and my existing card will not expire before my 16th birthday.  G2. I have reached my 14th birthday, and my existing card will expire before my 16th birthday.  H1. I am a permanent resident who is taking up commuter status. My port of entry (POE) into the United States will be __________  H2. I am a commuter who is taking up actual residence in the United States.  I. I have been automatically converted to permanent resident status.  J. I have a prior edition of the Alien Registration Card, or I am applying to replace my current Permanent Resident Card for a reason that is not specified above. Section B. (To be used only by conditional permanent resident)  A. My previous card has been lost, stolen, or destroyed.  B. My previous card was issued but never received.  C. My existing card has been mutilated.  D. My existing card has incorrect data because of USCIS error. (Attach existing card with incorrect data along with this application.)  E. My name or other biographical information has been legally changed since issuance of my existing card.
Page 1, Part 3.	Part. 3. Processing information. Mother’s First Name Father’s First Name City of Residence where you applied for an Immigrant Visa or Adjustment of Status Consulate where Immigrant Visa was issued or USCIS office where status was Adjusted City/Town/Village of Birth Date of Admission as an immigrant or Adjustment of Status Part 3. Processing information. (continued): If you entered the U.S. with an Immigrant Visa, also complete the following: Destination in U.S. at time of Admission Port of Entry where Admitted to U.S. Are you in removal/deportation or recission proceedings?  No  Yes Since you were granted permanent residence, have you ever filed Form I-407, Abandonment by Alien of Status as Lawful Permanent Resident, or otherwise been judged to have abandoned your status”  No  Yes If you answer yes to any of the above questions, explain in detail on a separate piece of paper.	Part. 3. Processing Information 1. Mother’s First Name 2. Father’s First Name 3. City of residence where you applied for an immigrant visa or adjustment of status 4. Consulate where immigrant visa or USCIS office where adjustment of status was granted 5. If you entered the United States with an immigrant visa, also complete the following: (If you were granted adjustment of status, skip this question and proceed to Question 6.) a. Destination in United States at time of admission b. Port of entry where admitted to United States 6. Have you ever been ordered removed from the United States?  No  Yes 7. Since you were granted permanent residence, have you ever filed Form I-407, Abandonment by Alien of Status as Lawful Permanent Resident, or otherwise been judged to have abandoned your status?  No  Yes NOTE: If you answered “Yes” to Question 6 or Question 7 above, provide detailed explanation in Part 7.
Page 2, Part 4.	Part 4. Signature. (Read the information on penalties in the instructions before completing this section. You must file this application while in the United States.) I certify, under the 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. Signature Date Daytime Phone Number 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 4. Accommodations for Individuals With Disabilities Are you requesting an accommodation because of a disability or impairment? (See instructions for examples of accommodations.)  No  Yes If you answered “Yes,” check any applicable boxes:  a. I am deaf or hard of hearing and request the following accommodation (if requesting a sign-language interpreter, indicate for which language (e.g., American Sign Language)):  b. I am blind or sight-impaired and request the following accommodation:  c. I have another type of disability (describe the nature of the disability and accommodation you are requesting):
Page 2, Part 5.	Part 5. 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 Your Name Date Daytime Phone Number Name and Address of Business/Organization (if applicable)___	Part 5. Signature (Read the information on penalties in the instructions before completing this section. You must file this application while in the United States.) I certify, under the 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. Signature Date Daytime Phone Number 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.
		Part 6. 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. NOTE: If you are an attorney or representative, you must submit a completed Form G-28 along with this application. Signature Date Daytime Phone Number Print Your Name Name of Business/Organization (if applicable) Street Number and Name Apt., Suite, or Floor City State Zip Code +4
New Section		A-Number: Part 7. Explanation Page Provide detailed explanation on this page, if you answered “Yes” to Question 6 or Question 7 in Part 3.

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