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Sample I-94 form USA – Arrival / Departure Record

When you arrive in US and go through US Port of Entry Process, you would be given either an electronic or paper based I-94 arrival/departure card. Below are few copies of I-94 Forms that are to be given/filled and Sample I-94 Cards that are stamped and given by CBP officer at Port of entry.

Electronic vs Paper based I-94 Form

Depending on how you enter the country, you may be either given a paper based I-94 form or electronic I-94. If you are given a physical I-94 form, then you need to fill it out manually and sign it. Since 2013, most of the arrivals and departure information is captured electronically, if you arrive by air(flight). If you arrive by land, then only you maybe asked to fill out physical I-94 form.

Let’s first look at samples of I-94 form, where the person entering US by filling out a physical I-94 form.

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.

CBP Officer will stamp the I-94 card 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 or D/S for Students. 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

I-94 Card Departure Arrival Card Sample - H1B Visa - Front Side

I-94 Card Departure Arrival Card Sample - H1B Visa - Back side

Sample I-94 Arrival Departure Card USA

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 visa stamping in Matamoros, Mexico and re-entering US. You can see the CBP Port of Entry Code that says ‘BRO’ on the stamp put by officer indicating Brownsville, TX. The main difference is the name, date of birth and other details are printed on it. No manual writing by CBP Officer.

I-94 Form - Arrival Departure Record by CBP Officer Sample at Port of Entry
Sample I-94 form for H1B

Sample Electronic I-94 Copy

If you were not given an I-94 physical card or copy to fill out by the immigration officials or airlines, then your I-94 would be available electronically. See below sample. You can read Guide to Print Electronic I-94 for complete info on the fields and how to print it online.

Sample Electronic I-94 Document Printed Online from 2013 - History Reference
Sample Electronic I-94 Arrival Departure Card

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.

Front Side of I-94 Form

Back Side of I-94 Form

Sample I-94 Form : Arrival and Departure Card to USA Port of Entry


Sample I-94 Form USA - Arrival Departure Record - Port of Entry - Back Side

Also, you can check your Arrival Departure I-94 Records online


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