Download I-160 Questions

DS-160 Questions for U visa (English version), ICWC
DS-160 Questions
https://ceac.state.gov/genniv/
Personal Information 1
1. Last Names:_________________________________________________________
2. Given names: _______________________________________________________
3. Have you ever used other names?________________________________________
4. Sex: M or F
5. Marital Status: Married, Single, Widowed, Divorced, Legally Separated
6. Date of Birth: __/__/______
7. City of Birth: ________________________________________________________
8. State/Province of Birth: ________________________________________________
9. Country of Birth: _____________________________________________________
Personal Information 2
10. Nationality: ________________________________________________________
11. Do you have or have you held a nationality other than the one indicated above?_______
12. National Identification Number: _____________________________________________
13. U.S. Social Security Number:_____________________________________________
14. U.S. Taxpayer I.D. Number: ________________________________________________
Address and Phone Information
15. Street Address (Line 1): ____________________________________________________
16. Street Address (Line 2) *Optional:___________________________________________
17. City: ________________________
18. State/Province:________________
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DS-160 Questions for U visa (English version), ICWC
19. Postal Zone/ZIP Code: _________
20. Country: _________________________________
21. Mailing Address: Is your Mailing Address the same as your Home Address? (This is the
address to which your passport will be sent if you qualify for a visa.)_________________
a. If not, mailing address: ____________________________________________
22. Phone
a.
b.
c.
d.
Home Phone Number:_______________________________________________
Work Number:_____________________________________________________
Work Fax Number: _________________________________________________
Mobile/Cell Phone Number: ____________________________________________
23. Email Address: ___________________________________________________________
Passport Information
24. Passport Number: _________________________________________________________
25. Passport Book Number: ____________________________________________________
26. Country/Authority that Issued the Passport: ____________________________________
27. Where was the Passport Issued?
a. City:________________________
b. State/Province: _______________
c. Country: ____________________
28. Issuance Date: ______________________
29. Expiration Date:_____________________
30. Have you ever lost a passport or had one stolen?_________________________________
31. Have you ever been issued a U.S. Visa? _____________________________________
32. Have you ever been refused a visa or admission to the U.S.? If so, please explain:
_______________________________________________________________________
Travel Information
33. Are you the principal applicant? ______________________________________________
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DS-160 Questions for U visa (English version), ICWC
34. If not the principal applicant,
a. Last names of Principal Applicant:_____________________________________
b. Given Names of Principal Applicant: ___________________________________
c. Principal Applicant’s Purpose of Trip to U.S: _______________________________
d. Principal Applicant’s Application Receipt/Petition Number:__________________
35. Intended Date of Arrival: __/__/_____
36. Intended Length of Stay in U.S.:________________
37. Address where you will stay in U.S.
a. Street Address (Line 1):______________________________________________
b. Street Address (Line 2) *Optional:_____________________________________
c. City:___________________________
d. State/Province:___________
e. Postal Zone/ZIP Code:____________
38. Person/Entity paying for your trip: Self, Other Person, Company/Organization
39. If Other Person,
a. Last names of Person Paying for Trip: __________________________________
b. Given names of Person Paying for Trip: _________________________________
c. Telephone Number: _________________________________________________
d. Email Address: _____________________________________________________
e. Relationship to you: _________________________________________________
f. Is the address of the party paying for your trip the same as your Home or Mailing
Address? _________
Travel Companions Information
40. Are there other persons traveling with you? ____________________________________
41. If yes,
a. Are you traveling as part of a group or organization? _______________________
b. If not with a group or org but with other individuals, Last names of person(s)
traveling with you: ____________________________________________________
c. Given names of person(s) traveling with you: ________________________________
d. Relationship with person: _______________________________________________
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DS-160 Questions for U visa (English version), ICWC
e. Has the person(s) ever been in the U.S.? Yes / No. If Yes, please write the arrival date
and length of stay for the last 5 visits to the U.S.:
1.
2.
3.
4.
5.
Arrival date:
Arrival date:
Arrival date:
Arrival date:
Arrival date:
Length of Stay:
Length of Stay:
Length of Stay:
Length of Stay:
Length of Stay:
Previous U.S. Travel Information
42. Have you ever been in the U.S.?____________________________________ If yes, when?
Arrival date:
Arrival date:
Arrival date:
Arrival date:
Arrival date:
Length of Stay:
Length of Stay:
Length of Stay:
Length of Stay:
Length of Stay:
43. Did you ever get a U.S. Driver License? _________________________________________
44. If so, State in which license was granted: ________________________________________
45. License Number: ___________________________________________________________
46. Have you ever been issued a U.S. visa? ________________________________________
47. If yes,
a.
b.
c.
d.
Date last visa was issued: __/__/_____
Visa number: ______________________________________________________
Are you applying for the same type of visa? ______________________________
Are you applying in the same country where the visa above was issued and is the
country your principal country of residence?
___________________________________
e. Have you been ten-printed? ___________________________________________
Ten-printed means that you have provided fingerprints for all your fingers, as
opposed to having provided only two fingerprints.
f. Has your U.S. visa ever been lost or stolen? ______________________________
g. Has your U.S. visa ever been cancelled or revoked? _______________________
48. Have you ever been refused a U.S. visa, been refused admission to the U.S., or withdrawn
your application for admission at the point of entry?____________________
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DS-160 Questions for U visa (English version), ICWC
49. Has anyone ever filed an immigrant petition on your behalf with the United States
Citizenship and Immigration Services?
a. If yes, who and for what type of petition? And if it was denied, why? ____________
_____________________________________________________________________
_____________________________________________________________________
U.S. Point of Contact Information
50. Last names of Contact Person: ______________________________________________
51. Given names of Contact Person: _____________________________________________
52. Organization Name: _______________________________________________________
53. Relationship to You: ______________________________________________________
54. U.S. Street Address: ______________________________________________________
55. City: ___________________
56. State: __________
57. Zip Code: ____________________
58. Phone Number: __________________________________
59. Email: __________________________________________________________________
Family Information: Relatives
60. Father’s Full Name and Date of Birth: ________________________________________
a. Is your father in the U.S.? ___________________
b. If yes, Father’s Status: _____________________
61. Mother’s Full Name and Date of Birth:
a. Is your mother in the U.S.? _________________
b. If yes, Mother’s Status:____________________
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DS-160 Questions for U visa (English version), ICWC
62. Do you have any immediate relatives other than your parents in the U.S.?_____________
Immediate Relatives: Means fiancé/fiancée, spouse (husband/wife), child
(son/daughter), or sibling (brother/sister).
a. If yes, for each,
i. Last names: _________________________________________________
ii. Given Names: _______________________________________________
iii. Relationship to you: ___________________________________________
iv. Relative’s status: _____________________________________________
63. Do you have any other relatives in the U.S.? ____________________________________
Present Work/Education/Training Information
64. Primary Occupation: ______________________________________________________
65. Present Employer or School Name: __________________________________________
66. Street Address: __________________________________________________________
67. City: ______________________________
68. State/Province: _____________________
69. Postal Code/Zip Code: _______________
70. Country: __________________________
71. Phone Number: __________________________________
72. Monthly Salary in Local Currency (if employed): _______________________________
73. Briefly describe your duties: _______________________________________________
Previous Work/Education/Training Information
74. Were you previously employed? ___________
Employer/Employment Information: NOTE: Provide your employment information for
the last five years, if applicable.
a.
b.
c.
d.
e.
f.
Job Title? _____________________________________________
Supervisor’s Name: _____________________________________
Dates worked from and to: ________________________________
Job Title? _____________________________________________
Supervisor’s Name: _____________________________________
Dates worked from and to: ________________________________
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DS-160 Questions for U visa (English version), ICWC
75. Have you attended any educational institutions at a secondary level or above? ____________
You must answer Yes to this question if you have ever attended, for any length of time, a
high school/secondary school (or its equivalent in your country) or college, university,
graduate school, a doctoral program, or a vocational program.
a. Level of Education? ______________________________________________
76. Provide the following information on the educational institution(s) you have attended.
a. Name of Institution
b. Address:
Street Address (Line 1)
Street Address (Line 2) *Optional
City
State/Province
Does Not Apply
Postal Zone/ZIP Code
Country: ____________________
Does Not Apply
c. Course of Study
Course of Study : For middle school/junior high or high school course of study
please indicate “Academic” or “Vocational.” For all other educational levels please
indicate your major or concentration.
d. Date of Attendance From
(Format: DD-MMM-YYYY)
Date of Attendance To
e. Phone Number of the School: _______________________________________
77. Do you belong to a clan or tribe? ____________________
78. Have you traveled to any countries within the last five years? ___________________
a. If yes, which countries? ______________________________
79. Have you belonged to, contributed to, or worked for any professional, social, or charitable
organization? __________________________________
80. Do you have any specialized skills or training, such as firearms, explosives, nuclear,
biological, or chemical experience? _______________________________________
81. Have you ever served in the military? _______________________________________
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DS-160 Questions for U visa (English version), ICWC
82. Have you ever served in, been a member of, or been involved with a paramilitary unit,
vigilante unit, rebel group, guerrilla group, or insurgent organization? __________________
83. Provide a List of Languages You Speak: ________________________________________
Security and Background: Medical and Health Information
84. Do you have a communicable disease of public health significance? ____________________
Communicable diseases of public significance include chancroid, gonorrhea,
granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage
syphilis, active tuberculosis, and others diseases as determined by the Department of
Health and Human Services.
85. 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?_________
86. Are you or have you ever been a drug abuser or addict (have problems with drugs)? ____
Security and Background: Criminal Information
87. Have you ever been arrested or convicted for any offense or crime, even though subject of a
pardon, amnesty, or other similar action?_________________________________
88. Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled
substances (drugs)? __________
89. 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? _________
90. Have you ever been involved in, or do you seek to engage in, money laundering? ______
91. Have you ever committed or conspired to commit a human trafficking offense in the United
States or outside the United States? __________________
92. Have you ever knowingly aided, abetted, assisted or colluded with an individual who has
committed, or conspired to commit a severe human trafficking offense in the United States or
outside the United States? ______________________________
93. Are you 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?
_________________________________
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DS-160 Questions for U visa (English version), ICWC
Security and Background: Security Information
94. Do you seek to engage in espionage, sabotage, export control violations, or any other illegal
activity while in the United States? ___________
95. Do you seek to engage in terrorist activities while in the United States or have you ever
engaged in terrorist activities? ____________
96. Have you ever or do you intend to provide financial assistance or other support to terrorists
or terrorist organizations? ____________
97. Are you a member or representative of a terrorist organization? ___________
98. Do you seek to engage in espionage, sabotage, export control violations, or any other illegal
activity while in the United States? _______________________
99. Do you seek to engage in terrorist activities while in the United States or have you ever
engaged in terrorist activities? ______________________________
100. Have you ever or do you intend to provide financial assistance or other support to
terrorists or terrorist organizations? ___________________________
101.
Are you a member or representative of a terrorist organization? _________________
102. Have you ever ordered, incited, committed, assisted, or otherwise participated in
genocide? ___________________________________
103.
Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?
_______________________________
104. Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial
killings, political killings, or other acts of violence? _____________________________
105.
Have you ever engaged in the recruitment or the use of child soldiers? _______________
106. Have you, while serving as a government official, been responsible for or directly carried
out, at any time, particularly severe violations of religious freedom? ____________________
107. 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 will? ___________________________
108. Have you ever been directly involved in the coercive transplantation of human organs or
bodily tissue? __________________________________________
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DS-160 Questions for U visa (English version), ICWC
Security and Background: Immigration Law Violation Information
109.
Have you ever been the subject of a removal or deportation hearing? _______________
110. 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? _____________________________________________________
111. Have you failed to attend a hearing on removability or inadmissibility within the last five
years? _____________________________________________________________________
112. 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? _________________
a. If so, explain circumstances: _______________________________________
______________________________________________________________
______________________________________________________________
Security and Background: Miscellaneous Information
113. 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? __________
114.
Have you voted in the United States in violation of any law or regulation? __________
115.
Have you ever renounced United States citizenship for the purpose of avoiding taxation?
___________________________________________
116. Have you attended a public elementary school on student (F) status or a public secondary
school after November 30, 1996 without reimbursing the school? _____________________
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