Sample I-94 form USA - Arrival / Departure Record

Below are few copies of I-94 Forms that are to be filled and Sample I-94 Cards that are stamped and given by CBP officer at Port of entry.

Sample I-94 Card for H1B Visa at Port of Entry(Airport)

When you enter US at port of entry, CBP Officer asks you few questions and if convinced, they will tear the long part ( scroll down below to see full I-94 Sample) with your details on it and give you a copy of the small stub at the bottom. They will stamp it with the date of your entry, visa category that you are using to enter US ( H1B used in sample below ) and add the expiry date of your stay, which should be same as your H1B approval notice ending date. On the back side, they also enter the copy of your USCIS case number from your H1B approval notice. Below is a sample I94 form stamped by CBP Officer at Port of Entry in US at an airport.

Front Side of I-94 Card	Back Side of I-94 Card

Sample I-94 Card for H1B Visa Holders Stamped by CBP at Port of Entry ( Land Entry)

Below is a copy of I-94 Card that was given at Land Entry in Brownsville, TX after stamping in Matamoros, Mexico and re-entering US. The main difference is the name, date of birth and other details are printed on it. No manual writing by CBP Officer.

Sample I-94 Form – Arrival Departure Card – Filled at US Port of Entry

Below is the actual full blank I-94 form that you would fill at port of entry. Read How to fill I-94 Form at US Port of Entry for full guidance on filling it.