Free CBP Form I-408, Application to Pay Off or Discharge Alien Crewman - Federal

OMB No. 1651-0106 Exp. 08-31-2011 DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

APPLICATION TO PAY OFF or DISCHARGE ALIEN CREWMAN
DATE OF ARRIVAL:

To be filed in triplicate. See instructions on reverse. ARRIVAL MANIFEST FILED AT (PORT): I. CARRIER: I hereby request authorization to pay off/discharge the alien crewmen listed below. II.
NAME IN FULL FAMILY NAME GIVEN NAME AND MIDDLE INITIAL NATIONALITY AND PASSPORT NUMBER

ACTION BY CBP

NOTE: IF ADDITIONAL SPACE IS REQUIRED, ATTACH LIST IN TRIPLICATE.

III. REASON FOR REQUEST:

IV. ARRANGEMENTS FOR DEPARTURE FROM THE U.S. OF THE LISTED CREWMEN AND DATE AND PORT OF DEPARTURE, AIR CARRIER
AND FLIGHT NUMBER OR VESSEL.

MAILING ADDRESS OF CARRIER:

SIGNATURE

TITLE

FOR GOVERNMENT USE ONLY
APPLICATION: OFFICE: SIGNATURE: TITLE: GRANTED DENIED DATE: COPY: MAILED SIGNATURE: TITLE: DELIVERED

DATE:

CBP Form I-408 (06/09)

OMB No. 1651-0106 Exp. 08-31-2011 DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

APPLICATION TO PAY OFF or DISCHARGE ALIEN CREWMAN
DATE OF ARRIVAL:

To be filed in triplicate. See instructions on reverse. ARRIVAL MANIFEST FILED AT (PORT): I. CARRIER: I hereby request authorization to pay off/discharge the alien crewmen listed below. II.
NAME IN FULL FAMILY NAME GIVEN NAME AND MIDDLE INITIAL NATIONALITY AND PASSPORT NUMBER

ACTION BY CBP

NOTE: IF ADDITIONAL SPACE IS REQUIRED, ATTACH LIST IN TRIPLICATE.

III.

REASON FOR REQUEST:

IV.

ARRANGEMENTS FOR DEPARTURE FROM THE U.S. OF THE LISTED CREWMEN AND DATE AND PORT OF DEPARTURE, AIR CARRIER AND FLIGHT NUMBER OR VESSEL.

MAILING ADDRESS OF CARRIER:

SIGNATURE

TITLE

FOR GOVERNMENT USE ONLY
APPLICATION: OFFICE: SIGNATURE: TITLE: GRANTED DENIED DATE: COPY: MAILED SIGNATURE: TITLE: DELIVERED

DATE:

CBP Form I-408 (06/09)

OMB No. 1651-0106 Exp. 08-31-2011 DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

APPLICATION TO PAY OFF or DISCHARGE ALIEN CREWMAN
DATE OF ARRIVAL:

To be filed in triplicate. See instructions on reverse. ARRIVAL MANIFEST FILED AT (PORT): I. CARRIER: I hereby request authorization to pay off/discharge the alien crewmen listed below. II.
NAME IN FULL FAMILY NAME GIVEN NAME AND MIDDLE INITIAL NATIONALITY AND PASSPORT NUMBER

ACTION BY CBP

NOTE: IF ADDITIONAL SPACE IS REQUIRED, ATTACH LIST IN TRIPLICATE.

III.

REASON FOR REQUEST:

IV.

ARRANGEMENTS FOR DEPARTURE FROM THE U.S. OF THE LISTED CREWMEN AND DATE AND PORT OF DEPARTURE, AIR CARRIER AND FLIGHT NUMBER OR VESSEL.

MAILING ADDRESS OF CARRIER:

SIGNATURE

TITLE

FOR GOVERNMENT USE ONLY
APPLICATION: OFFICE: SIGNATURE: TITLE: GRANTED DENIED DATE: COPY: MAILED SIGNATURE: TITLE: DELIVERED

DATE:

CBP Form I-408 (06/09)

NOTICE SECTION 256 OF THE IMMIGRATION AND NATIONALITY ACT (8 USC 1286)
Note: The authorities and responsibilities of the Attorney General now be long to the Secretary of Homeland Security It shall be unlawful for any person, including the owner, agent consignee, charterer, master or commanding officer vessel or aircraft, to pay off or discharge an alien crewman, except an alien lawfully admitted for permanent residence, employed on board a vessel or aircraft arriving in the United States without first having obtained the consent of the Attorney General. If it shall appear to the satisfaction of the Attorney General that any alien crewman has been paid off or discharged in the United States in violation of the provisions of this section, such owner, agent, consignee, charterer, master, commanding officer or other person, shall pay to the Commissioner the sum of $3,000 for each such violation. No vessel or aircraft shall be granted clearance pending the determination of the question of the liability to the payment of such sums or while such sums remain unpaid, except that clearance may be granted prior to the determination of such question of the liability to the payment of such sums or while such sums remain unpaid, except that clearance may be granted prior to the determination of such question upon the deposit of an amount sufficient to cover such sums, or of a bond approved by the commissioner with sufficient surety to secure the payment thereof. Such fine may, in the discretion of the Attorney General be mitigated to not less than $1,500 for each violation, upon such terms as he shall think proper.

INSTRUCTIONS
1. Filing - The application must be completed in triplicate and delivered or mailed to the nearest office of U.S. Customs
and Border Protection (CBP).

2. Execution - The signature and title of either the owner, agent, consignee, charterer, master or commanding officer of
the vessel or aircraft seeking authorization to pay off or discharge crewmen must be included on the application.

3. General - Inadequate or incomplete data required in items III, Reason for request, and IV, Arrangements for departure,
may result in denial of the application.

4. Disposition - The original and one copy of the granted application will be returned to the applicant. The copy must be
submitted with the departure manifest. One copy of the application will be retained by CBP with the arrival manifest.

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0106. The estimated average time to complete this application is 25 minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.

CBP Form I-408 (Back)(06/09)