U.S. Department of Justice Executive Office for Immigration Review Immigration Court OMB# 1125-0004 Alien's Change of Address Form/ Immigration Court If you move or change your phone number, the law requires you to file this Change of Address Form with the Immigration Court. You must file this form within five (5) working days of a change in your address or phone number. You will only receive notification as to the time, date, and place of hearing or other official correspondence at the address which you provide. Changes in address or telephone numbers communicated through any means except this form, e.g., pleadings, motion papers, correspondence, telephone calls, applications for relief, etc. will not be recognized and the address information and record will remain unchanged. Failure to appear at any hearing before an Immigration Judge, when notice of that hearing or other official correspondence was served on you or sent to the address you provided, may result in one or more of the following actions: l If you are not already detained, you may be taken into custody by the Department of Homeland Security (DHS) and held for further action; and If you are in removal proceedings: Your hearing may be held in your absence under Section 240 of the Immigration and Nationality Act (INA), and an order of removal may be entered against you. Furthermore, you may become ineligible for the following forms of relief from removal for a period of 10 years after the date of the entry of the final order: 1. Voluntary Departure as provided for in Section 240B of the INA; 2. Cancellation of Removal as provided for in Section 240A of the INA; 3. Adjustment of Status or Change of Status as provided for in Section(s) 245, 248, or 249 of the INA. If you are in deportation proceedings: Your hearing may be held in your absence under Section 242B of the Immigration and Nationality Act (INA) (1995), and an order of deportation may be entered against you. Furthermore, you may become ineligible for the following forms of relief from deportation for a period of 5 years after the date of the entry of the final order: 1. Voluntary Departure as provided for in Section 242(b) of the INA (1995); 2. Suspension of Deportation or Voluntary Departure as provided for in Section 244 of the INA (1995); 3. Adjustment of Status or Change of Status as provided for in Section(s) 245, 248, or 249 of the INA (1995). If you are in exclusion proceedings: Your application for admission to the United States may be considered withdrawn, and your hearing may be held in your absence and an order of exclusion and deportation entered against you. Name: My OLD address was: ("In care of" other person, if any) Alien Number: A My NEW address is: ("In care of" other person, if any) (Number, Street, Apartment) (City, State and ZIP Code) (City, State and ZIP Code) (Country, if other than U.S.) (New Telephone Number) (Number, Street, Apartment) (Country, if other than U.S.) I SIGN HERE X Signature Date PROOF OF SERVICE (You Must Complete This) (Name) (Date) mailed or delivered a copy of this Change of Address Form on to the Office of the Chief Counsel for the DHS (U.S. Immigration and Customs Enforcement-ICE) at (Number and Street, City, State, Zip Code) - SIGN HERE X Signature Form EOIR - 33/IC Revised July 2015 American LegalNet, Inc. www.FormsWorkFlow.com MAILING INSTRUCTIONS 1) Copy the completed form and mail or deliver it to the Office of the Chief Counsel DHS-ICE at the address you inserted in the PROOF OF SERVICE. The PROOF OF SERVICE certifies that you provided a copy of the form to DHS. 2) Fold the page at the dotted lines marked "Fold Here" so that the address is visible. (IMPORTANT: Make sure the address section is visible after folds are made.) 3) Secure the folded form by stapling along the open end marked "Fasten Here." 4) Place appropriate postage stamp in the area marked "Place Stamp Here." 5) Write in your return address in the area marked "PUT YOUR ADDRESS HERE." 6) Mail the original form to the Immigration Court whose address is printed below. Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control number. We try to create forms and instructions that are accurate, can be easily understood, and which impose the least possible burden on you to provide us with information. The estimated average time to complete this form is five (5) minutes. If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the Executive Office for Immigration Review, Office of the General Counsel, 5107 Leesburg Pike, Suite 2600, Falls Church, Virginia 22041. Fold Here PUT YOUR ADDRESS HERE Place Stamp Here U.S. Department of Justice Immigration Court 606 S. Olive St., 15th Floor Los Angeles, CA 90014 Fold Here Privacy Act Notice The information on this form is required by 8 U.S.C. � 1229(a)(1)(F)(ii) and 8 C.F.R � l003.15(d)(2) in order to notify the Immigration Court of any change of address and any change of telephone number. The information you provide is mandatory. Failure to provide the requested information limits the notification you will receive and may result in the adverse consequences noted above. EOIR may share this information with others in accordance with approved routine uses described in EOIR's system of records notice EOIR�001, Records and Management Information System and EOIR-003. Form EOIR - 33/IC Revised July 2015 Fasten Here American LegalNet, Inc. www.FormsWorkFlow.com