Alien'S Change Of Address Card Ar-11 Sr (Department Of Homeland Security)
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1Department of Homeland Security
OMB No. 1615-0007; Expires 12/31/2014
AR-11 SR, Alien's Change of Address Card
U.S. Citizenship and Immigration Services
I am in the United States as a:
*(First Name)
(Middle Name)
*Name (Last in CAPS)
Permanent Resident
Visitor
(Specify)
Student
Other
A-Number (Copy Number From Alien Card)
*Date of Birth (mm/dd/yyyy)
Country of Citizenship
A-
*(Zip Code)
*(City or Post Office)
*(State)
*Present Address (Street or Rural Route)
Years
Months
(If the above address is temporary) I expect to remain there
(City or Post Office)
(State)
(Zip Code)
Last Address
(Street or Rural Route)
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.
If not a Permanent Resident,
Date of Entry Into U.S. (mm/dd/yyyy)
my stay in the U.S. expires on:
(Date - mm/dd/yyyy)
*Signature
Date (mm/dd/yyyy)
Fingerprint Identification Number (FIN):
Form AR-11 SR (Rev. 12/11/11) Y
* Indicates mandatory fields that must be completed.
Special Registration
AR-11 SR, 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.
ADVISORY: This card is not evidence of identity, age, or status claimed.
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.
Mail Your Form AR-11 SR to the Address Below:
U. S. Department of Homeland Security
Citizenship and Immigration Services
Attn: Change of Address
1344 Pleasants Drive
Harrisonburg, VA 22801
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