Following is a sample I-94 form available for download. I-94 form or I-94 card is a USCIS form for the arrival departure record of non-immigrants during travel to USA. Starting from April 30, 2013 CBP has started a new paperless I-94 process where visitors will no longer have to fill out a paper I-94 Form. They can print out their electronically from CBP's website. Below sample shows the electronic copy of I-94 Form.

The sample is for reference purpose only. The appearance, color, or content of this form is subject to change by the issuing authorities.



Electronic I-94 Arrival/Departure Record Form

Sample electronic I-94

Form I-94 Arrival/Departure Record: Front Page
(Paper-based I-94 Form)

Sample I-94

Form I-94 Arrival/Departure Record: Back Page
(Paper-based I-94 Form)


How to fill form I94?

The information requested on the Form I-94, Arrival Record, upper portion, requires information about the passesnger entering into USA includes:

  • Family Name
  • First Name
  • Date of Birth
  • Country of Citizenship
  • Sex (Male or Female)
  • Passport Number
  • Airline and Flight Number (if applicable)
  • Country Where You Live – Lawful Permanent Residence
  • City Where You Boarded (if applicable)
  • City Where Visa was Issued (if applicable)
  • Date Issued (Day/Mo/Yr) (if applicable)
  • Address While in the United States (Number and Street)
  • City and State

The information requested on the lower part of Form I-94 includes:

  • Family Name
  • First Name
  • Date of Birth
  • Country of Citizenship

After the successful completion of processing the applicant, a CBP officer stamps the applicant's CBP Form I-94, Arrival and Departure Records, and the passport. The CBP Declaration, used at air and sea ports of entry, may also be stamped by the CBP officer. The CBP officer retains the arrival portion of the CBP Form I-94 and returns the departure portion of the CBP Form I-94 and passport to the applicant.

The departure portion of CBP Form I-94 and passport is to be in the applicant's possession at all times until the applicant departs the United States.


Related information: What is I-94 form?

Disclaimer: This sample is provided for your convenience and reference purpose only.