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Application for Travel Document Form
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Application for Travel Document Form  |  Application for Travel Document Form

Text Version of Application for Travel Document Form

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Department of Homeland Security OMB No. 1615-0013; Expires 03/31/2012

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 Action Block Receipt
Reentry Permit

Refugee Travel Document
Single Advance Parole
Multiple Advance Parole
Valid to:
If Reentry Permit or Refugee Travel Document Hand Delivered
Document, mail to: On By
Address in Part 1
U.S. Embassy/consulate To be completed by Attorney/Representative, if any.
at:

Attorney State License #
Overseas DHS office
at: Check box if G-28 is attached.

Part 1. Information About You (Type or print in black ink)
1. A Number 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. Number

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

FORMI-131REV11-05-11Y Form I-131 (11/05/11) Y

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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? Yes No (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 Document?
No Yes (If “Yes,” give the following information for the last document issued to you):

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 a U.S. 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 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 4. Information About Your Proposed Travel

Purpose of trip. (If you need more room, continue on a separate sheet 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 less than six months two to three years
past five years, whichever is less) how much total time have you spent six months to one year three to four years
outside the United States? one to two 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 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 of paper.

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

3. Since you were accorded refugee/asylee status, have you ever:
a. Returned to the country named above? 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:
Yes No
a. Reacquired the nationality of the country named above?
b. Acquired a new nationality? Yes No
c. Been granted refugee or asylee status in any other country? Yes No

Form I-131 (11/05/11) Y Page 2

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Part 7. Complete Only If Applying for Advance Parole

On a separate sheet of paper, 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. 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 U.S. 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

Read the information on penalties in the instructions before completing this section. If you are filing
Part 8. Signature
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 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)

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

Part 9. Signature of Person Preparing Form, If Other Than the Applicant (Sign below)

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

Signature Print or Type Your Name

Firm Name and Address Daytime Telephone Number (with area code)

Fax Number (if any) Date (mm/dd/yyyy)

Form I-131 (11/05/11) Y Page 3

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