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USCIS 1-765, Application for Employment Authorization

3EforeYou Begin

Complete Agency
Form

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Confi rmation

U.S. Citizenship
and Immigration
Services
USCIS 1-90, Application to Replace Permanent Resident Card

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USCIS Refund Policy

Sy oompleting this tra.nsa:ction. yoo agree i:ha1 youhaw paid for a government sa\'Ce and &..3! th:e � iee, biometric
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Tradring Information

Agency Tracking ID: 120039443842
Form Name: USCIS I-90, Application for Employment Authorization
Application Name: USCIS I-90 Payment Form
Payment Information
Payment Type: Debit or credit card
Payment Amount: $540.00
Transaction Date: 12/03/2018 02:21:08 PM EST
Payment Date: 12/03/2018
Office Location: WAS - Fairfax Field Office

Account Information

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Pay.gov Tracking ID: 3FPEDBJT

Need Help?

1-.l:0-375-5233

notification@qa.pay.gov
Pay.gov TEST Payment Confirmation: USCIS I-90 Payment Form

Ill§ An official email of the United States government

THIS IS A TEST TRANSACTION
USCIS Refund Policy By completing this transaction, you agree that you have paid for a government service and
that the filing fee, biometric service fee and all related financial transactions are final and not refundable,
regardless of any action USCIS takes on an application, petition or request. You must submit all fees in the exact
amounts. Please refer to the form(s) you are filing for additional information, or you may call the USCIS Customer
Contact number at 1-800-375-5283. For TTY (deaf or hard of hearing) call 1-800-767-1833.
Application Name: USCIS 1-90 Payment Form
Pay.gov Tracking ID: 3FPEDBJT
Agency Tracking ID: 120039443842
Transaction Type: Sale
Transaction Date: 12/03/2018 02:21:08 PM EST
Account Holder Name: Scott Smithtest
Transaction Amount: $540.00
Card Type: Visa
Card Number. •••••••••�•1111

Office Location: WAS - Fairfax Field Office
Applicant Last name: Smithtest
Applicant First name: Scott
THIS IS AN AUTOMATED MESSAGE. PLEASE DO NOT REPLY.