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Sample I-94 form USA – Arrival / Departure Record

When you arrive in the US and go through the US Port of Entry Process, you would be given either an electronic or paper-based I-94 arrival/departure card. Below are a few copies of the I-94 Forms that are to be given/filled and Sample I-94 Cards that are stamped and given by the CBP officer at the US 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 an 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 arrival and departure information is captured electronically, if you arrive by air(flight). If you arrive by land, then only you may be asked to fill out a physical I-94 form.

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

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

When you enter the US at a port of entry, CBP Officer asks you a few questions and if convinced, they will tear the long part ( scroll down below to see the 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, the visa category that you are using to enter the US ( H1B used in the sample below ), and add the expiry date of your stay, which should be the 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 a CBP Officer at the Port of Entry in the 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 the I-94 Card that was given at Land Entry in Brownsville, TX after visa stamping in Matamoros, Mexico, and re-entering the US. You can see the CBP Port of Entry Code that says ‘BRO’ on the stamp put by the CBP 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 the below sample screenshot. 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 a port of entry.  Read  How to fill I-94 Form at a 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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