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Guiding You Through Citizenship, Green Card and Visas Applications

Application for Travel Document
I-131
Prepared for

Ragnagnewende Jean De Dieu SALAMBERE

Last Printed On 03/17/2015

24/7 Customer Care Hotline: 1-800-814-1555 or email us at cs@us-immigration.com and we'll respond within 24 hours

Next Steps

1. Read and Follow the Application Filing Instructions.
2. Sign and Date Your Printed Application.
3. Prepare Supporting Documents, as Instructed.*
4. Prepare Filing Fee, if Necessary.*
5. Attach Supporting Documents and Payment.
6. Photocopy Your Signed Application, Supporting Documents and Payment, and Keep the
Copies for Your Records.
7. Send Your Original Signed Application, Supporting Documents, and Payment to USCIS
(Formerly the INS) at the Address Listed in the Filing Instructions.
8. Do Not Send This Cover Page or Your Filing Instructions.

*You may or may not have to send photographs, supporting documents, or a filing fee. Your
Forms Filing Instructions will specify everything that is required.

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Guiding You Through Citizenship, Green Card and Visas Applications

Congratulations, Ragnagnewende! you have reached the final stage of the application process! Following are step-by-step instructions for completing your application and submitting it to U.S.
Citizenship and Immigration Services (USCIS). These instructions have been customized for you based on the answers you gave on your questionnaire.
Note: Be sure to make a copy of your final application and supporting documents before

you send it to USCIS. You will be reminded to do this again later in these instructions.

FINAL STEPS
Step 1 - Review, sign and date your application
Step 2 - Prepare photographs
Step 3 - Prepare supporting documents
Step 4 - Prepare payment
Step 5 - Photocopy your signed application, photographs, supporting documents, and payment
Step 6 - Send completed application and attachments to USCIS
Step 7 - Next steps

Note: Please read all instructions carefully. Any mistakes or omissions will result in a delay

and may cause your application to be rejected If you have any questions about these instructions, please contact 1-800-814-1555, or email cs@us-immigration.com

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Guiding You Through Citizenship, Green Card and Visas Applications

STEP 1 - REVIEW, SIGN AND DATE YOUR APPLICATION
Lets begin! For this step you will need a printed copy of your form I-131, Application for
Travel Document. If you have not already done so, please print the application on paper measuring 8 1/2 inches x 11 inches.
Please take a careful look at your printed application to ensure that each response reflects the information that you intend to communicate to USCIS (formerly the INS). Make sure that all appropriate fields are filled-out completely and accurately. Please note that reviewing the completed I-131 application is solely the responsibility of the user. American
Immigration Center cannot accept liability for the rejection or denial of an application due to the users failure to review the completed application.
Once you have reviewed the completed I-131 application and found it satisfactory, you should sign and date the application as follows:
Find Part 8 of your application.
Sign your full name (no abbreviations or initials) in the box labeled "Signature of
Applicant".

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Guiding You Through Citizenship, Green Card and Visas Applications

Write the date in the box labeled "Date (mm/dd/yyyy)" using the Month/Day/Year format. For example: If you are signing your application on April 25, 2014, then you would write
4/25/2014 in the box.
If you have not already done so, please sign and date Part 8 now.
Note: If you do not sign your application, it will be returned. Please be sure to sign your

application before continuing.
In addition to the Form I-131, you have also printed Form G-1145, E-Notification of
Application/Petition Acceptance. This form informs USCIS that you would like to receive a text or e-mail notification when this application is accepted for processing. You are not required to sign this form.
Place Form G-1145 on top of Form I-131 and staple both forms together.

STEP 2 - PREPARE PHOTOGRAPHS
For this step you will need two (2) color, passport-style photographs and a small envelope.
Your photograph must be taken within 30 days of the date you send this application to USCIS.
Write your name on the back of each photograph.
Write lightly (do not press down)
Write in pencil (do not use a pen or marker)
Write "Photographs for Form I-131 Application" on the front of a small envelope.
Put the photographs and envelope aside. You will be instructed to photocopy the photographs later in these instructions.
Remember that the photograph must meet the standard requirements for passport photographs described below.
STANDARD REQUIREMENTS FOR PASSPORT PHOTOGRAPHS
Color, Background, and Pose
- Photographs must be in color.
- Photographs must have a white or off-white background.
- Photographs must show a view of your whole face from the front.
- If you normally wear eyeglasses, you should wear them when you have your photograph taken.

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Guiding You Through Citizenship, Green Card and Visas Applications

You should not wear sunglasses or glasses with tinted lenses.
- In the photograph, your head should be bare. If you are required to wear a headdress (veil or other head covering) for religious reasons, it is okay to wear it when you have your photo taken, but your facial features (eyes, nose and mouth), must be visible in the photograph.
- Your expression in the photograph should be natural, with both eyes open and mouth closed.
- You should wear the clothing that you normally wear. You should not wear military uniforms or work uniforms.

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Guiding You Through Citizenship, Green Card and Visas Applications

Head Position and Placement

The drawing above shows correct photograph dimensions, head position and placement.
- Photographs should be 2 inches x 2 inches square (51 mm x 51 mm).
- Photographs must show the full head from hair to the bottom of the chin.
- The distance from the bottom of the photograph to eye level must be between 1-1/8 to 13/8 inches (25 mm to 35 mm).
- The head should take up approximately 1 to 1-3/8 inches (25 to 35 mm) of the photograph. www.us-immigration.com

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Guiding You Through Citizenship, Green Card and Visas Applications

EXAMPLES OF ACCEPTABLE PHOTOGRAPHS
These photographs each show acceptable pose, background, and quality. Remember that your photographs should be in color.

For more detailed photograph guidelines, including details on image quality, instructions for photographers and examples of unacceptable photographs, see "Guidelines for Immigration
Photographs" in the Application Center under "Resources."

STEP 3 - PREPARE SUPPORTING DOCUMENTS
In this step you will prepare your supporting documents.

REQUIRED SUPPORTING DOCUMENTS
Please include a copy of an official photo identity document showing your photo, name and date of birth.
Examples include a valid government-issued drivers license, passport identity page, www.us-immigration.com 7 of 11

DO NOT SEND THIS PAGE TO USCIS

Guiding You Through Citizenship, Green Card and Visas Applications

Form I-551, Permanent Resident Card ("Green Card") or any other official identity document that includes a photograph.
Note: Form I-94, Arrival-Departure Document, cant be used as a photo identity document.

A photocopy of both sides of your Form I-551, Permanent Resident Card ("Green Card").
(or)
If you have not yet received your "Green Card", a copy of the biographic page(s) of your passport and a copy of the visa page showing your initial admission as a
Permanent Resident, or I-551 stamp.
(or)
A copy of the Form I-797, Notice of Action, approval notice of an application for replacement of your "Green Card" or temporary evidence of Permanent Resident status. Note: If you do not include all of the documents listed, your application may be delayed or

rejected. Please be sure to include all of the documents listed. Please check off the documents as you prepare them so that you can be sure that you have included all of them.
If you do not have a required document and cannot get a certified copy of the original, please send certification from the person or authority that originally issued the document explaining why it cannot be provided. The USCIS will consider documents such as notarized affidavits in this case.
In addition, please be aware of the following important guidelines when submitting your supporting documents:
If you are filing using a name other than shown on the relevant documents, you must file your application with evidence of the legal change, such as a marriage certificate, adoption decree or court order.
You do not need to send original documents or certified copies unless instructed to do so.
Photocopies of these documents are acceptable for your initial application. USCIS will not return any original documents that you send.
If the documents requested are not in English, please send English-language translations of the documents. If you submit translated documents, you must also include a certification statement from the translator. This statement should state that the translator is competent to translate and that the translation is correct. The statement should also include the translators name, address, date of translation and signature.

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Guiding You Through Citizenship, Green Card and Visas Applications

STEP 4 - PREPARE PAYMENT
In this step you will prepare payment for the application fee.
Note: If you do not send payment with your application, your application will be returned.

You must pay your application fee with a personal check, money order, or cashiers check. DO NOT send cash.
The check or money order must be drawn on a bank or other financial institution in the
United States and must be payable in U.S. currency.
Write your A-number on the back of your check or money order.
This application must be accompanied with a check or money order for $445.00 USD
(this includes a $85.00 USD biometric fee for fingerprinting) payable to: U.S.
Department of Homeland Security.

STEP 5 - PHOTOCOPY YOUR SIGNED APPLICATION, PHOTOGRAPHS
AND SUPPORTING DOCUMENTS
For this step you need your signed Form I-131, with attached G-1145, photographs and all supporting documents. Photocopy each page of your completed application and supporting documents, including photographs and fee (if any) and place them in a large envelope. These copies are for your records only. DO NOT send them to USCIS.

STEP 6 - SEND YOUR COMPLETED FORM I-131 APPLICATION FOR
TRAVEL DOCUMENT
You are almost finished! For this step ll need your original,youll need your original, completed and signed Form I-131 application and your supporting documents. You'll also need an envelope large enough to hold everything. www.us-immigration.com 9 of 11

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Guiding You Through Citizenship, Green Card and Visas Applications

Write your return address (the address where you live or where you receive your mail) in the upper left corner of the large envelope.
Using a paper-clip, attach your payment to the first page of your Form I-131 application. Place your supporting documents under your Form I-131 application.
Mail your application by certified mail or courier service and request a return receipt.
Send your application to:
USCIS Phoenix Lockbox ll need your original,For U.S. Postal Service (USPS) deliveries:
USCIS
PO Box 21281
Phoenix, AZ 85036
For Express mail and courier deliveries:
USCIS
Attn: AOS
1820 E. Skyharbor Circle S
Suite 100
Phoenix, AZ 85034

Please Note: It is important that you file your application as promptly as possible after

printing the completed form or forms from our site. USCIS reserves the right to publish updated forms at any time. The forms printed on our site are guaranteed to be current editions as-of the date that they are printed. However, American Immigration Center cannot be held responsible for the submission of expired forms due to unreasonable delay in filing on the part of the user. If you expect to delay submitting your application to USCIS, please be sure to confirm that the form you have printed is still being accepted by USCIS prior to filing. You can check the validity of your form at any time by logging into the Application
Support Center and reprinting your form.
Note: Applicants are required to notify USCIS of any change of address that occurs while an application is pending. You can notify USCIS of the change by submitting the change on-line at https://egov.uscis.gov/crisgwi/go?action=coa or by mail and contacting the agency via phone at 1-800-375-5283. www.us-immigration.com 10 of 11

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Guiding You Through Citizenship, Green Card and Visas Applications

Lastly, you should also notify the U.S. Postal Service of your address change and have all mail forwarded to your new address.
Note: USCIS allows applicants to Re-entry Permits and Refugee Travel Documents to

request expedited processing In order to request expedited processing, please include a statement with your application describing why you are requesting expedited service. When mailing in this request, please notate the outside of the envelope with the word EXPEDITE.
It is recommended that two pre-paid, self-addressed express mailers, e-mail addresses, and a fax number be provided with any expedite request for the Re-entry Permit or Refugee Travel
Document. If the expedite request is granted and you provide prepaid, self-addressed express mailers, USCIS will use the pre-paid mailers to send you the ASC appointment notice and travel document upon completion. If you do not provide pre-paid mailers, the appointment notice and travel document will be sent via regular mail.

STEP 7 - NEXT STEPS
Please read the detailed filing instructions above carefully. Any mistakes or omissions will result in a delay and may cause your application to be rejected. If you have any questions about these instructions, please contact cs@us-immigration.com.
Within 24 hours of accepting your application for processing, USCIS will send you a text and/or e-mail notification that your application has been accepted. The message will provide a receipt number and a brief statement on how to get additional information about the status of your case.
You can expect to receive an official Receipt Notice from USCIS via mail within 30 days of filing your completed Form I-131, Application for Travel Document. USCIS will notify you when processing is completed on your case by sending you a Duplicate Approval Notice on
Form I-797.
You can check the status of your case by logging in to www.uscis.gov and entering the receipt number that appears on your USCIS Receipt Notice.
After you receive the Receipt Notice, you will receive an Appointment Notice requesting your appearance at your local Application Support Center to have your fingerprints taken. Failure to appear to be fingerprinted or for other biometric services may result in a denial of your application. Unless USCIS requires additional information from you to complete processing of your application, you will not receive any further communication from USCIS until you receive the final decision on your case.

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Application for Travel Document

USCIS
Form I-131

Department of Homeland Security
U.S. Citizenship and Immigration Services

Action Block

Receipt

For
USCIS
Use
Only

OMB No. 1615-0013
Expires 03/31/2016

To Be Completed by an Attorney/
Representative,
if any.
Fill in box if G-28 is attached to represent the applicant.

Document Hand Delivered
By:

Date:

/

/

/

Document Issued
Re-entry Permit (Update
"Mail To" Section)

Refugee Travel Document
(Update "Mail To" Section)

Single Advance Parole

Multiple Advance Parole
Valid Until:
/
/

Mail To
(Re-entry &
Refugee
Only)
/

Attorney State
License Number:

Address in Part 1
US Consulate at:
Intl DHS Ofc at:

► Start Here. Type or Print in Black Ink

Part 1. Information About You
1.a. Family Name
(Last Name) SALAMBERE
1.b. Given Name
(First Name) RAGNAGNEWENDE
1.c. Middle Name JEAN DE DIEU

Physical Address

2.c. Apt.

7070 CAPITOL COURT
Flr.

2.e. State NE

2.f.

6.

Country of Birth
Country of Citizenship

Zip Code 68132

Class of Admission
UU - UNKNOWN

860

OMAHA

2.i.

4.

BURKINA FASO

2.d. City or Town

2.h. Province

Alien Registration Number (A-Number)
► A- 0 6 3 0 2 4 4 6 3

5.

Ste.

2.g. Postal Code

3.

SENEGAL

2.a. In Care of Name
2.b. Street Number and Name

Other Information

7.

Gender

8.

Date of Birth

9.

U.S. Social Security Number (if any)

Male

Female
(mm/dd/yyyy) ► 06/06/1984

► 1 7 2 9 7 1 4 7 5

Country USA

Form I-131 03/22/13 N

Page 1 of 5

Part 2. Application Type
1.a.

I am a permanent resident or conditional resident of the United States, and I am applying for a reentry permit. 1.b.

I now hold U.S. refugee or asylee status, and I am applying for a Refugee Travel Document.

1.c.

I am a permanent resident as a direct result of refugee or asylee status, and I am applying for a Refugee
Travel Document.

1.d.

I am applying for an Advance Parole Document to allow me to return to the United States after temporary foreign travel.

2.h. In Care of Name

1.e.

I am outside the United States, and I am applying for an Advance Parole Document.

2.i.

1.f.

I am applying for an Advance Parole Document for a person who is outside the United States.

Street Number and Name

2.j.

Apt.

If you checked box "1.f." provide the following information about that person in 2.a. through 2.p.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

2.f.

Country of Citizenship

2.g. Daytime Phone Number

(

)

-

Physical Address (If you checked box 1.f.)

Ste.

Flr.

2.k. City or Town
2.l.

State

2.m. Zip Code

2.n. Postal Code
2.o. Province

2.c. Middle Name
2.d. Date of Birth

2.e. Country of Birth

2.p. Country

(mm/dd/yyyy) ►

Part 3. Processing Information
1.

Date of Intended Departure
(mm/dd/yyyy) ► 04/19/2015

2.

Expected Length of Trip (in days)

4.a. Have you ever before been issued a reentry permit or
Refugee Travel Document? (If "Yes" give the following information for the last document issued to you):
Yes

640

3.a. Are you, or any person included in this application, now in exclusion, deportation, removal, or rescission proceedings? Yes
No

4.b. Date Issued

No

(mm/dd/yyyy) ►

4.c. Disposition (attached, lost, etc.):

3.b. If "Yes", Name of DHS office:
If you are applying for a non-DACA related Advance Parole Document, skip to Part 7; DACA recipients must complete Part 4 before skipping to Part 7.

Form I-131 03/22/13 N

Page 2 of 5

Part 3. Processing Information (continued)
Where do you want this travel document sent? (Check one)
5.
6.

To the U.S. address shown in Part 1 (2.a through
2.i.) of this form.
To a U.S. Embassy or consulate at:

10.b. Street Number and Name
10.c. Apt.

6.a. City or Town

Ste.

Flr.

10.d. City or Town

6.b. Country
7.

10.a. In Care of Name

10.e. State

To a DHS office overseas at:

10.f. Zip Code

7.a. City or Town

10.g. Postal Code

7.b. Country

10.h. Province

If you checked "6" or "7", where should the notice to pick up the travel document be sent?

10.i. Country

8.

To the address shown in Part 2 (2.h. through 2.p.) of this form.

10.j. Daytime Phone Number

9.

To the address shown in Part 3 (10.a. through 10.i.) of this form.:

(

)

-

Part 4. Information About Your Proposed Travel
1.a. Purpose of trip. (If you need more space, continue on a separate sheet of paper.)

1.b. List the countries you intend to visit. (If you need more space, continue on a separate sheet of paper.)

BURKINA FASO

I AM GOING BACK IN MY COUNTRY TO TAKE CARE
OF MY BROTHER AND SISTERS AND HELP THEM BE
MORE STABLE. WE LOST OUR PARENTS AND I AM
RESPONSIBLE OF THEM.

Part 5. Complete Only If Applying for a Re-entry Permit
Since becoming a permanent resident of the United States (or during the past 5 years, whichever is less) how much total time have you spent outside the United States?
1.a.
1.b.
1.c.

less than 6 months
6 months to 1 year
1 to 2 years

Form I-131 03/22/13 N

1.d.
1.e.
1.f.

2 to 3 years
3 to 4 years more than 4 years

2.

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

Page 3 of 5

Part 6. Complete Only If Applying for a Refugee Travel Document
1.

3.c. Applied for and/or received any benefit from such country
(for example, health insurance benefits)?

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. Include your
Name and A-Number on the top of each sheet.
2.

Do you plan to travel to the country named above?

Yes

No

Yes

No

Since you were accorded refugee/asylee status, have you, by any legal procedure or voluntary act:
4.a. Reacquired the nationality of the country named above?

Yes

No

Since you were accorded refugee/asylee status, have you ever:

4.b. Acquired a new nationality?

Yes

No

3.a. Returned to the country named above? 4.c. Been granted refugee or asylee status in any other country?

Yes

No

Yes

No

3.b. Applied for and/or obtained a national passport, passport renewal, or entry permit of that country?
Yes

No

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

If the person intended to receive an Advance Parole Document is outside the United States, provide the location (City or Town and Country) of the U.S. Embassy or consulate or the DHS overseas office that you want us to notify.
2.a. City or Town

4.a. In Care of Name
4.b. Street Number and Name
4.c. Apt.

Ste.

Flr.

4.d. City or Town
4.e. State

4.f.

Zip Code

4.g. Postal Code
4.h. Province

2.b. Country
If the travel document will be delivered to an overseas office, where should the notice to pick up the document be sent?:
3.

Country

4.j.

Daytime Phone Number

(

)

-

To the address shown in Part 2 (2.h. through 2.p.) of this form.

4.

4.i.

To the address shown in Part 7 (4.a. through 4.i.) of this form.

Form I-131 03/22/13 N

Page 4 of 5

Part 8. Signature of Applicant (Read the information on penalties in the Form instructions before completing

this Part.) If you are filing for a Re-entry Permit or Refugee Travel Document, you must be in the United States to file this application.

1.a. I certify, under 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 of Applicant

1.b. Date of Signature (mm/dd/yyyy) ►
2.

Daytime Phone Number

(

2 1 3

)

2 5 8 - 8 8 3 1

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 9. Information About Person Who Prepared This Application, If Other Than the Applicant
NOTE: If you are an attorney or representative, you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with this application. Preparer's Contact Information
4.

(

Preparer's Full Name
Provide the following information concerning the preparer:

Preparer's Daytime Phone Number

5.

)

Extension

-

Preparer's E-mail Address (if any)

1.a. Preparer's Family Name (Last Name)

Declaration
1.b. Preparer's Given Name (First Name)
2.

Preparer's Business or Organization Name

Preparer's Mailing Address
3.a. Street Number and Name
3.b. Apt.

Ste.

3.f.

6.a. Signature of Preparer
6.b. Date of Signature (mm/dd/yyyy) ►

Flr.

3.c. City or Town
3.d. State

To be completed by all preparers, including attorneys and authorized representatives: I declare that I prepared this benefit request at the request of the applicant, that it is based on all the information of which I have knowledge, and that the information is true to the best of my knowledge.

3.e. Zip Code

NOTE: If you require more space to provide any additional information, use a separate sheet of paper. You must include your Name and A-Number on the top of each sheet.

Postal Code

3.g. Province
3.h. Country

Form I-131 03/22/13 N

Page 5 of 5

e-Notification of Application/Petition Acceptance
USCIS
Form G-1145

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0109
Expires 09/30/2016

What Is the Purpose of This Form?
Use this form to request an electronic notification (e-Notification) when U.S. Citizenship and Immigration Services accepts your immigration application. This service is available for applications filed at a USCIS Lockbox facility.

General Information
Complete the information below and clip this form to the first page of your application package. You will receive one e-mail and/or text message for each form you are filing.
We will send the e-Notification within 24 hours after we accept your application. Domestic customers will receive an e-mail and/or text message; overseas customers will only receive an e-mail. Undeliverable e-Notifications cannot be resent.
The e-mail or text message will display your receipt number and tell you how to get updated case status information. It will not include any personal information. The e-Notification does not grant any type of status or benefit; rather it is provided as a convenience to customers.
USCIS will also mail you a receipt notice (I-797C), which you will receive within 10 days after your application has been accepted; use this notice as proof of your pending application or petition.

USCIS Privacy Act Statement
AUTHORITIES: The information requested on this form is collected pursuant to section 103(a) of the Immigration and Nationality
Act, as amended INA section 101, et seq.
PURPOSE: The primary purpose for providing the information on this form is to request an electronic notification when USCIS accepts immigration form. The information you provide will be used to send you a text and/or email message.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information may prevent
USCIS from providing you a text and/or email message receipting your immigration form.
ROUTINE USES: The information provide on this form will be used by and disclosed to DHS personnel and contractors in accordance with approved routine uses, as described in the associated published system of records notices [DHS-USCIS-007 Benefits Information System and DHS-USCIS-001 - Alien File (A-File) and Central Index System (CIS), which can be found at www.dhs.gov/privacy]. The information may also be made available, as appropriate for law enforcement purposes or in the interest of national security.

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
3 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 Coordination Division, Office of Policy and Strategy, 20 Massachusetts
Avenue, NW, Washington, DC 20529-2140. OMB No. 1615-0109. Do not mail your completed Form G-1145 to this address.
Complete this form and clip it on top of the first page of your immigration form(s).
Applicant/Petitioner Full Last Name
SALAMBERE

Applicant/Petitioner Full First Name
RAGNAGNEWENDE

Applicant/Petitioner Full Middle Name
JEAN DE DIEU

E-mail Address

Mobile Phone Number (Text Message)

PAXJEANS34@YAHOO.FR

1-213-2588831

Form G-1145 09/15/14 Y

Page 1 of 1

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