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Get CBP I-95 2012

Wt. Date of Birth Place of Birth Passport Number/Nationality Arrived by Air Sea CBP Form I-95 02/12 Department of Homeland Security U.S. Customs and Border Protection 5 U.S.C. OMB N0. 1651-0114 DEPARTMENT OF HOMELAND SECURITY U*S* Customs and Border Protection CREWMAN S LANDING PERMIT Family Name Home Address Expires 02/28/2015 FIN or A No* Given Name Initial Address in United States Hair Eyes Ht. 552a e 3 Privacy Act Notice Information collected on this form is required by Title 8 of the U*S* Code specifically the Immigration and Nationality Act 8 U*S*C. 1282 and 8 CFR 251. 1 c 252. 1 e and 264. 1. The purpose of this collection is to provide for the application and approval of alien crew members for permission to temporarily land in the United States. The information solicited on this form will be used to assist DHS in determining your eligibility for such privileges and may be made available to other government agencies for law enforcement purposes as necessary. All alien crew members seeking to land in the U*S* unless otherwise excepted must provide this information* Failure to provide this information may result in a denial to land in the United States and result in your removal* Paperwork Reduction Act Statement An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 16510114. The estimated average time to complete this application is 5 minutes. If you have any comments regarding the burden estimate you can write to U*S* Customs and Border Protection th Office of Regulations and Rulings 799 9 Street NW* Washington DC 20229. Arrival Date Place of CBP Officer Signature SAMPLE FOR REFERENCE ONLY By accepting this conditional permit to land the holder agrees to all the conditions incident to the issuance thereof and to deportation from the United States in accordance with the provisions of section 252 b of the Immigration and Nationality Act. 552a e 3 Privacy Act Notice Information collected on this form is required by Title 8 of the U*S* Code specifically the Immigration and Nationality Act 8 U*S*C. 1282 and 8 CFR 251. 1 c 252. 1 e and 264. 1. The purpose of this collection is to provide for the application and approval of alien crew members for permission to temporarily land in the United States. 1282 and 8 CFR 251. 1 c 252. 1 e and 264. 1. The purpose of this collection is to provide for the application and approval of alien crew members for permission to temporarily land in the United States. The information solicited on this form will be used to assist DHS in determining your eligibility for such privileges and may be made available to other government agencies for law enforcement purposes as necessary. The information solicited on this form will be used to assist DHS in determining your eligibility for such privileges and may be made available to other government agencies for law enforcement purposes as necessary. All alien crew members seeking to land in the U*S* unless otherwise excepted must provide this information* Failure to provide this information may result in a denial to land in the United States and result in your removal* Paperwork Reduction Act Statement An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. .

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