TRIP Redress

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TRIP Redress – Data Entry

PLEASE NOTE THIS FORM MAY BE SAVED AND CONTINUED!

Please do not use ALL CAPS.
1. Capitalize the first word of a sentence.
2. Capitalize Proper Nouns and Names (e.g. John Smith)

The following form is to be completed if you have had difficulties during travel screenings at transportation hubs such as airports or U.S. borders. These difficulties include:

watch list issues

screening problems at ports of entry

situations where travelers believe they have been unfairly or incorrectly delayed, denied boarding or identified for additional screening at our nation’s transportation hubs

Items with a * ARE REQUIRED/MANDATORY INPUT/ENTRY.

I. BASIC INFORMATION

First Name

Please type your First Name (as it appears in your Passport or other identification document presented at the Border)

Middle Name

Last Name

Please select if you are

US Citizen or
Lawful Permanent Resident
Neither apply to me

Gender

Female
Male

Date of Birth

MM/DD/YYYY

Country of Birth

City of Birth

State or Province of Birth

II. CONTACT INFORMATION

Mobile Phone Number

Email Address

III. MAILING ADDRESS

Street or PO Box

City of Town

State or Province

Zip or Postal Code

Country

Physical Address (if different)

Yes – different
No – same as above

IV. DEMOGRAPHIC INFORMATION (Optional)

Hair Color

Eye Color

V. IF APPLICABLE – Provide all other Names you have ever used including aliases, maiden name, and nicknames

Other Names Used (optional)

Other Names Used 2 (optional)

VI. Height & Weight (optional)

Unit of Measure

Imperial (U.S.)
Metric

Weight

Height (ft)

Height (in)

VII. AT LEAST ONE TRAVEL EXPERIENCE IS REQUIRED TO COMPLETE THE APPLICATION

Select the Number of TRAVEL EXPERIENCES you wish to address

One
Two
Three

Choose the best answer regarding Your Travel Experience

My experience is an aviation-related screening or incident.
My experience involves port of entry, immigration, customs, or Border Patrol.
My experience is related to a privacy violation or exposure of personal information.

RE: Incident 1

Which scenarios best describe Your Travel Experience?

I was denied entry into the United States.
I am a foreign student or exchange visitor who is unable to travel.
I was given an information sheet by a CBP Officer.
I was referred for secondary screening when clearing U.S. Customs and Border Protection.
My Electronic System for Travel Authorization (ESTA) application was denied.
I got an “X” at the kiosk (APC or Global Entry).
My Electronic Visa Update System (EVUS) enrollment was unsuccessful.
My Global Entry application was denied.
Other (Please explain in the MESSAGE SECTION at the end of this form)

RE: Incident 1

Date of Entry into the U.S.

RE: Incident 1

Port of Entry into the U.S.

RE: Incident 1

Date of Departure from the U.S.

RE: Incident 1

Port of Departure from the U.S.

RE: Incident 1

Airline Name – if any

RE: Incident 1

Flight Number – if any

RE: Incident 1

Sea Vessel Name – if any

RE: Incident 1

Cruise Ticket Number – if any (copy)

RE: Incident 1

Name Used at Entry into U.S. – if not your Name as it appears in your Travel Document

RE: Incident 1

Incident Details

RE: Incident 1 – Please describe in comprehensive details all you may remember from this incident.

Travel Experience 2

Travel Experience 3

VIII. IDENTIFICATION DOCUMENTS / DATA

Passport

Yes – to be uploaded

Selecting this form of identification requires that you upload the biographic page – unless our firm has possession of an electronic version, and it is current

Passport Card

Yes – to be uploaded

Please upload the your Passport Card – front and back – unless our firm has possession of an electronic version, and it is current

Driver's License

Yes – to be uploaded

Please upload the your Driver’s License – front and back – unless our firm has possession of an electronic version, and it is current

Immigration – Non-immigrant Visa

Yes – to be uploaded

Please upload a copy of your current visa – unless our firm has possession of an electronic version

I-94 Admission

Yes – to be uploaded

Please upload a copy of your current I-94 Card – unless our firm has possession of an electronic version.
Additionally electronic version may be accessed by accessing their DHS website at: www.cbp.gov/i94

Nexus

Yes – to be uploaded

Please upload a copy of your current Nexus Card (front and back) – unless our firm has possession of an electronic version.

Message, Comment, Discussion or Additional Information

Please provide any additional or other information that is necessary for this application.

IX. EVIDENCE REQUIRED (DOCUMENTS NECESSARY):

Please label your files as follows:
Label – Description

PP (Lastname) – for your Passport

PPC (Lastname) – for your Passport Card

Nexus (Lastname) – for your Nexus Card

DL (Lastname) – for your Driver’s License

File Upload

Click or drag files to this area to upload. You can upload up to 15 files.

Signature

Clear Signature

Your signature above authorizes CARUSO LAW PLLC to continue processing your application consistent with the information/evidence submitted with this form.

Save and Resume Later

1-877-5CARUSO

TRIP Redress – Data Entry

I. BASIC INFORMATION

II. CONTACT INFORMATION

III. MAILING ADDRESS

IV. DEMOGRAPHIC INFORMATION (Optional)

V. IF APPLICABLE – Provide all other Names you have ever used including aliases, maiden name, and nicknames

VI. Height & Weight (optional)

VII. AT LEAST ONE TRAVEL EXPERIENCE IS REQUIRED TO COMPLETE THE APPLICATION

Travel Experience 2

Travel Experience 3

VIII. IDENTIFICATION DOCUMENTS / DATA

IX. EVIDENCE REQUIRED (DOCUMENTS NECESSARY):

United States

Canada

USMCA/CU