Fillable Form DS 260 Online

The DS 260 Online form is used by individuals applying for an immigrant visa at a U.S. embassy or consulate abroad to convey certain important and personal information to the National Visa Center of the United States. The form may only be submitted online.

Form DS 260 Online Image
Answer a few simple questions to make your document in minutes
Start now and save your progress, finish on any device
Store securely, share online and make copies

What is Form DS-260?

 

Form DS-260, Immigrant Visa and Alien Registration Application, is a form used by foreign nationals applying for family-based green cards from abroad. It is called an “immigrant visa application” (where “immigrant” means a permanent resident, not a tourist or a person who is only traveling to the United States temporarily basis.

 

Anyone who is applying for a family-based or marriage-based green card from outside the United States needs to file the DS-260 online form, which is handled through the National Visa Center (NVC) and your local U.S. embassy or consulate.

 

To get started, you’ll need the case number, beneficiary ID number, and invoice number from the original welcome notice that the National Visa Center (NVC) sent you. Further, the entire Form DS 260 must be completed in English. You must transliterate any addresses or names that are not written in the Roman alphabet.

 

Also include details about all of your children, including stepchildren, adopted children, and biological children, regardless of their age or whether they will be joining you in the United States.

 

Make a list of all addresses you’ve lived at since the age of 16, not just the ones you’ve used as your official permanent address. If you continued to use your parents’ address as your permanent address while in college despite not living there, you’ll need to mention the addresses where you actually lived.

 

The green card may take several months to arrive at your address in the United States, so ensure that the mailing address you indicate will be valid throughout that time.

 

After you’ve submitted the DS-260 Form online, you won’t be able to make corrections. Ideally, you should double-check that all of your data is right the first time around. However, if you uncover a mistake after completing your DS-260, you may simply advise the consular officer at your interview about the mistake and seek to have it corrected at that time.

 

Once you’ve submitted the DS-260 online, you must print the confirmation page so you can bring it to your visa interview at the U.S. consulate.

 

After you submit your DS-260, the NVC will send out a notice (again via mail or email) confirming receipt of your DS-260, usually on the same day. You will then need to submit your supporting documents to the National Visa Center (NVC) as well.

 

Depending on which consulate is processing the application, you will either upload, email, or mail all of the supporting documents to the National Visa Center (NVC). The NVC is in charge of obtaining and forwarding all of the forms and documents required to process your green card application to the consulate. The consulate is in charge of setting up and conducting your immigrant visa interview, as well as making a final decision on your petition.

 

It’s important to submit these documents in the way the National Visa Center (NVC) instructs you to—some U.S. consulates require physical copies, while others allow for emailing or uploading digital copies.

 

Documents from the applicant's relatives:

 

  • Proof of your nationality (copy of birth certificate and passport photo page)
  •  
  • Copy of your marriage certificate (for marriage-based green cards)
  •  
  • Copy of marriage termination documents (divorce or death certificate), if you had any prior marriages
  •  
  • Copy of your military record, if you have served
  •  
  • Copy of police certificates showing any past infractions or lack thereof. These certificates, also called “police clearance letters,” must be obtained from:
  •  

  • Any place in your home country where you lived for at least six months after age 16
  •  
  • Any place outside of your home country where you lived for at least one year after age 16
  •  
  • Any jurisdiction where you’ve ever been arrested or charged with a crime, regardless of how long you lived there or what age you were at the time
  •  


    Documents from the sponsoring relative:

     

  • Proof of your ability to support your family member in the United States.
  •  
  • Copy of marriage termination documents (divorce or death certificate), if you had any prior marriages.
  •  
  • Proof of domicile, meaning you have significant ties to the United States. For a sponsoring spouse or family member living in the United States, proof of address or a state-issued ID is generally sufficient evidence.
  •  

    Depending on your case and the U.S. consulate processing your application, there might be additional documents required. That’s why it’s always a good idea to carefully check the notice you receive from the National Visa Center (NVC) for any special requirements.

     

    It’s important that you submit all of your supporting documents in one package. Also, you should only submit copies of your official documents, not originals. Be prepared to bring the originals to your green card interview at the U.S. consulate.

     

    How to fill out Form DS-260?

     

    Using PDFQuick, you can electronically fill out and download a PDF copy of the DS 260 Form in minutes. Fill it out by following the instructions below.

     

    Personal, Address, and Phone Information

     

    Name Provided

     

    Enter your full name.

     

    Full Name in Native Language

     

    Enter your full name in your native language.

     

    Other Names Used

     

    Enter other names you used, if any.

     

    Sex

     

    Enter your sex.

     

    Current Marital Status

     

    Enter your current marital status.

     

    Date of Birth

     

    Enter your date of birth following the format: Month, Day, Year.

     

    City of Birth

     

    Enter your city of birth.

     

    State/Province of Birth

     

    Enter your state or province of birth.

     

    Country/Region of Birth

     

    Enter your country or region of birth.

     

    Country/Region of Origin (Nationality)

     

    Enter your nationality.

     

     

     

    Document Type

     

    Enter the type of document you will use to prove your identity.

     

    Document ID

     

    Enter your document ID.

     

    Country/Authority that Issued Document

     

    Enter the country or authority that issued that document.

     

    Document Type

     

    Enter the type of document you will use to prove your identity.

     

    Document ID

     

    Enter your document ID.

     

    Country/Authority that Issued Document

     

    Enter the country or authority that issued that document.

     

    Issuance Date

     

    Enter the document’s issuance date, following the format: Month, Day, Year.

     

    Expiration Date

     

    Enter the document’s expiration date, following the format: Month, Day, Year.

     

     

     

    Do you hold or have you held any nationality other than the one you have indicated above?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Other Country/Region of Origin (Nationality)

     

    If you answered yes, enter your other nationality. Otherwise, leave this space blank.

     

    Do you hold a passport from the country/region of origin (nationality) above?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Passport Number

     

    If you answered yes, enter that passport number. Otherwise, leave this space blank.

     

     

     

    Present Address

     

    Enter your present address, including street and apartment or suite number.

     

    City

     

    Enter the city of your present address.

     

    State/Province

     

    Enter the state or province of your present address.

     

    Postal Zone/ZIP Code

     

    Enter the postal zone or ZIP code of your present address.

     

    Country/Region

     

    Enter the country or region of your present address.

     

    From Date

     

    Enter the date from when you started living in your present address, following the format: Month, Day, Year.

     

     

     

    Have you lived anywhere other than this address since the age of sixteen?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the following information below. Otherwise, enter “N/A”.

     

    Previous Addresses (1, 2, 3, 4, and 5)

     

    Enter your previous addresses, including street and apartment or suite number.

     

    City

     

    Enter the city of your previous addresses.

     

    State/Province

     

    Enter the state or province of your previous addresses.

     

    Postal Zone/ZIP Code

     

    Enter the postal zone or ZIP code of your previous addresses.

     

    Country/Region

     

    Enter the country or region of your previous addresses

     

    From

     

    Enter the date from when you started living at your previous addresses.

     

    To

     

    Enter the date when you left your previous addresses.

     

     

     

    Primary Phone Number

     

    Enter your primary phone number.

     

    Secondary Phone Number

     

    Enter your secondary phone number.

     

    Work Phone Number

     

    Enter your work phone number.

     

    Email Address

     

    Enter your email address.

     

     

     

    Is your mailing address the same as your present address?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered no, complete the following information below. Otherwise, leave the spaces blank.

     

    Address

     

    Enter your mailing address, including street and apartment or suite number.

     

    City

     

    Enter the city of your mailing address.

     

    State/Province

     

    Enter the state or province of your mailing address.

     

    Postal Zone/ZIP Code

     

    Enter the postal zone or ZIP code of your mailing address.

     

    Country/Region

     

    Enter the country or region of your mailing address.

     

     

     

    Do you have an address in the United States where you intend to live?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the following information below. Otherwise, enter “N/A”.

     

    Name of person currently living at address

     

    Enter the name of the person currently living at the address.

     

    U.S. Address

     

    Enter the complete U.S. address.

     

    Phone Number

     

    Enter the phone number of the address.

     

     

     

    Is this address where you want your Permanent Residence Card (Green Card) mailed?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the following information below. Otherwise, enter the correct information where you want your Permanent Residence Card (Green Card) to be mailed.

     

    Contact Person

     

    Enter the name of your contact person.

     

    Address

     

    Enter the mailing address, including street and apartment or suite number.

     

    City

     

    Enter the city of the mailing address.

     

    State

     

    Enter the state of the mailing address.

     

    ZIP Code

     

    Enter the ZIP code of the mailing address.

     

    Phone Number

     

    Enter your or your contact person’s phone number.

     

     

     

    Family Information

     

    Father’s Surnames

     

    Enter your father’s surnames.

     

    Father’s Given Names

     

    Enter your father’s given names.

     

    Date of Birth

     

    Enter your father’s date of birth, following the format: Month, Day, Year.

     

    City of Birth

     

    Enter your father’s city of birth.

     

    State/Province of Birth

     

    Enter your father’s state or province of birth.

     

    Country/Region of Birth

     

    Enter your father’s country or region of birth.

     

    Is your father still living?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered no, complete the next line. Otherwise, enter “N/A”.

     

    Year of death

     

    Enter your father’s year of death.

     

     

     

    Mother’s Surnames

     

    Enter all your mother’s surnames.

     

    Mother’s Given Names

     

    Enter all your mother’s given names.

     

    Date of Birth

     

    Enter your mother’s date of birth, following the format: Month, Day, Year.

     

    City of Birth

     

    Enter your mother’s city of birth.

     

    State/Province of Birth

     

    Enter your mother’s state or province of birth.

     

    Country/Region of Birth

     

    Enter your mother’s country or region of birth.

     

    Is your mother still living?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered no, complete the next line. Otherwise, enter “N/A”.

     

    Year of death

     

    Enter your mother’s year of death.

     

     

     

    Do you have any previous spouses?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the following information below. Otherwise, enter “N/A”.

     

    Previous Spouses’ Name (1 and 2)

     

    Enter the names of your previous spouses.

     

    Date of Birth

     

    Enter your previous spouse’s date of birth, following the format: Month, Day, Year.

     

    Date of Marriage

     

    Enter the date of your marriage, following the format: Month, Day, Year.

     

    Date Marriage Ended

     

    Enter the date your marriage ended, following the format: Month, Day, Year.

     

    How was your marriage terminated?

     

    Enter how your marriage was terminated (for example: through annulment, divorce, or widower).

     

    Country/Region where marriage was terminated

     

    Enter the country or region where your marriage was terminated.

     

     

     

    Do you have any children?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the following information below. Otherwise, enter “N/A”.

     

    Number of Children

     

    Enter the number of children you have.

     

    Child Name (1, 2, 3, 4, and 5)

     

    Enter your children’s names.

     

    Date of Birth

     

    Enter your children’s date of birth, following the format: Month, Day, Year.

     

    City of Birth

     

    Enter your children’s city of birth.

     

    State of Birth

     

    Enter your children’s state of birth.

     

    Country/Region of Birth

     

    Enter your children’s country or region of birth.

     

    Does this child live with you?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Address

     

    Enter your children’s addresses, including their street and apartment or suite number.

     

    City

     

    Enter the city of your children’s addresses.

     

    State/Province

     

    Enter the state or province of your children’s addresses.

     

    Postal Zone/ZIP Code

     

    Enter the postal code or ZIP code of your children’s addresses.

     

    Country/Region

     

    Enter the country or region of your children’s addresses.

     

    Is this child immigrating to the U.S. with you?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Is this child immigrating to the U.S. at a later date to join you?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

     

     

    Previous U.S. Travel Information

     

    Have you ever been in the U.S.? 

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Were you issued an Alien Registration Number by the Department of Homeland Security?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the next line. Otherwise, enter “N/A”.

     

    Alien Registration Number

     

    Enter your alien registration number.

     

     

     

    Provide information on your last five U.S. visits

     

    Date Arrived (1, 2, 3, 4, and 5)

     

    Enter the dates of your arrivals, following the format: Month, Day, Year.

     

    Length of Stay

     

    Enter the length of your stay (for example: one week, one month, or one year).

     

     

     

    Have you ever been issued a U.S. visa?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the following information below. Otherwise, enter “N/A”.

     

    Date Visa Was Issued

     

    Enter the date the visa was issued, following the format: Month, Day, Year.

     

    Visa Classification

     

    Enter the visa classification.

     

    Visa Number

     

    Enter the visa number.

     

     

     

    If you answer yes to any of the following questions, please explain below:

     

    Have any of your U.S. visas ever been lost or stolen?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have any of your U.S. visas ever been cancelled or revoked?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever been refused a U.S. visa, been refused admission to the U.S., withdrawn your application for admission at the port of entry?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes to any of these questions, please explain:

     

    Enter a detailed explanation in the space provided.

     

     

     

    Work, Education, and Training Information

     

    Primary Occupation

     

    Enter your primary occupation.

     

    Do you have any other occupations?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the next line. Otherwise, enter “N/A”.

     

    Other Occupations

     

    Enter your other occupations.

     

    In which occupation do you intend to work in the U.S.

     

    From the mentioned occupations, enter in which one you intend to work in the United States.

     

     

     

    Were you previously employed?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the following information below. Otherwise, enter “N/A”.

     

    Employer Name (1, 2, 3, 4, and 5)

     

    Enter your employers’ names.

     

    Employer Street Address

     

    Enter your employers’ street addresses.

     

    City

     

    Enter your employer’s city.

     

    State/Province

     

    Enter your employers’ state or province.

     

    Postal Zone/ZIP Code

     

    Enter your employers’ postal zone or ZIP code.

     

    Country/Region

     

    Enter your employers’ country or region.

     

    Telephone Number

     

    Enter your employers’ telephone numbers.

     

    Job Title

     

    Enter your job titles.

     

    Supervisor’s Surnames

     

    Enter your supervisors’ surnames.

     

    Supervisor’s Given Names

     

    Enter your supervisors’ given names.

     

    Employment Date From

     

    Enter the dates of your employment, following the format: Month, Day, Year.

     

    Employment Date To

     

    Enter the dates you left your job, following the format: Month, Day, Year.

     

     

     

    Have you attended any educational institutions at a secondary level or above?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the following information below. Otherwise, enter “N/A”.

     

    Number of Educational Institutions Attended

     

    Enter the number of education institutions you attended.

     

    Name of Institution (1 and 2)

     

    Enter the names of the institutions.

     

    Address of Institution

     

    Enter the addresses of the institutions.

     

    City

     

    Enter the city of the institutions.

     

    State/Province

     

    Enter the state or province of the institutions.

     

    Postal Zone/ZIP Code

     

    Enter the postal zone or ZIP code of the institutions.

     

    Country/Region

     

    Enter the country or region of the institutions.

     

    Course of Study

     

    Enter the courses of your study.

     

    Degree or Diploma

     

    Enter your degrees or diplomas.

     

    Date of Attendance From

     

    Enter the dates you started attending the institutions, following the format: Month, Day, Year.

     

    Date of Attendance To

     

    Enter the dates you ended attending the institutions, following the format: Month, Day, Year.

     

     

     

    Have you ever served in the military?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answered yes, complete the following information below. Otherwise, enter “N/A”.

     

    Name of Country/Region

     

    Enter the name of the country or region of the military you served.

     

    Branch of Service

     

    Enter the branch of service.

     

    Rank/Position

     

    Enter your rank or position.

     

    Military Specialty

     

    Enter your military specialty.

     

    Date of Service From

     

    Enter the date you started the service, following the format: Month, Day, Year.

     

    Date of Service To

     

    Enter the date you left the service, following the format: Month, Day, Year.

     

     

     

    Petitioner Information

     

    Petitioner is my

     

    Enter your relationship with the petitioner.

     

    Petitioner Name

     

    Enter the petitioner’s name.

     

    Petitioner Address

     

    Enter the petitioner’s address, including street and apartment or suite number.

     

    City

     

    Enter the city of the petitioner’s address.

     

    State/Province

     

    Enter the state or province of the petitioner’s address.

     

    Postal Zone/ZIP Code

     

    Enter the postal zone or ZIP code of the petitioner’s address.

     

    Country/Region

     

    Enter the country or region of the petitioner’s address.

     

    Telephone

     

    Enter the petitioner’s telephone number.

     

    Mobile/Cell Telephone

     

    Enter the petitioner’s mobile or cell phone number.

     

    Email Address

     

    Enter the petitioner’s email address.

     

     

     

    Security and Background Information

     

    Do you have a communicable disease of public health significance such as tuberculosis (TB)?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Do you have documentation to establish that you have received vaccinations in accordance with U.S. law?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you or have you ever been a drug abuser or addict?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever been arrested or convicted for any offense or crime, even though subject or a pardon, amnesty, or other similar action?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you the spouse, son, or daughter of an individual who has violated any controlled substance trafficking law, and have knowingly benefited from the trafficking activities in the past five years?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring prostitutes within the past 10 years?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever been involved in, or do you seek to engage in, money laundering?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever committed or conspired to commit to human trafficking offense in the United States or outside the United States?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever knowingly aided, abetted, assisted, or colluded with an individual who has been identified by the President of the United States as a person who plays a significant role in a severe form of trafficking in persons?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the United States or outside the United States and have you within the last five years, knowingly benefited from the trafficking activities?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you a member or representative of a terrorist organization?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever engaged in the recruitment of or the use of child soldiers?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious freedom?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you a member of or affiliated with the Communist or other totalitarian party?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever directly or indirectly assisted or supported any of the groups in Columbia known as the Revolutionary Armed Forces of Columbia (FARC), National Liberation Army (ELN), or United Self-Defense Forces of Columbia (AUC)?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever, through abuse of governmental or political position converted for personal gain, confiscated or expropriated property in a foreign nation to which a United States national had claim of ownership?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you the spouse, minor child, or agent of an individual who has through abuse of governmental or political position converted for personal gain, confiscated or expropriated property in a foreign nation to which a United States national had claim of ownership?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever been directly involved in the establishment or enforcement of population controls forcing a woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or her free choice?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever disclosed or trafficked in confidential U.S. business information obtained in connection with U.S. participation in the Chemical Weapons Convention?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you the spouse, minor child, or agent of an individual who has disclosed or trafficked in confidential U.S. business information obtained in connection with U.S. participation in the Chemical Weapons Convention?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other United States immigration benefit by fraud or willful misrepresentation or other unlawful means?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever been a subject of a removal or deportation hearing?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you failed to attend a hearing on removability or inadmissibility within the last five years?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official or otherwise violated the terms of a U.S. visa?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you subject to a civil penalty under INA 274C?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you been ordered removed from the U.S. during the last five year?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you been ordered removed from the U.S. for a second time within the last 20 years?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever been unlawfully present and ordered removed from the U.S. during the last ten years?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever been convicted of an aggravated felony and been ordered removed from the U.S.?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever been unlawfully present in the U.S. for more than 180 days (but no more than one year) and have voluntarily departed the U.S. within the last three years?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever been unlawfully present in the U.S. for more than one year or more than one year in the aggregate at any time during the last 10 years?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever intentionally assisted another person in withholding custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you voted in the United States in violation of any law or regulation?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever renounced United States citizenship for the purpose of avoiding taxation?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you attended a public elementary school or a public secondary school on student (F) status after November 30, 1996 without reimbursing the school?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Do you seek to enter the United States for the purpose of performing skilled or unskilled labor but have not yet been certified by the Secretary of Labor?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you a graduate of a foreign medical school seeking to perform medical services in the United States but have not yet passed the National Board of Medical Examiners examination or its equivalent?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you a healthcare worker seeking to perform such work in the United States but have not yet received certification from the Commission on Graduates of Foreign Nursing Schools or from an equivalent approved independent credentialing organization?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you permanently ineligible for U.S. citizenship?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Have you ever departed the United States in order to evade military service during a time of war?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you coming to the U.S. to practice polygamy?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you a former exchange visitor (J) who has not yet fulfilled the two-year foreign residence requirement?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Has the Secretary of Homeland Security of the United States ever determined that you knowingly made a frivolous application for asylum?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Are you likely to become a public charge after you are admitted to the United States?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    If you answer yes to any of the following questions, please explain below:

     

    Enter a detailed explanation in the space provided.

     

     

     

    Social Security Number Information

     

    Have you ever applied for a Social Security number?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Do you want the Social Security Administration to issue a Social Security number and a card?

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

    Do you authorize disclosure of information from this form to the Department of Homeland Security, the Social Security Administration, and such other U.S. Government agencies as may be required for the purposes of assigning you a Social Security Number (SSN) and issuing you a Social Security card and do you authorize the Social Security Administration to share your SSN with the Department of Homeland Security? 

     

    Mark the appropriate box for your answer. You may select:

     

  • Yes
  •  
  • No
  •  

     

     
     

    Table of Contents