DS-260 Questionnaire

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DS-260 Start

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1) Personal(1) 2) Personal(2) 3) Address & Contact 4) Family 5) Travel Information 6) Work/Education 7) Security (Med/Criminal) 8) Security (Immigration Law) 9) Security (Others) 10) Review

Personal (1)

1. Surnames

2. Given Names

Does Not Apply

3. Full Name in Native Alphabet

Does Not Apply / Technology Not Available

4. Have you ever used other names?

If yes, please list

5. Sex

6. Marital Status

7. Date and Place of Birth

Personal (2)

8. Country/Region of Origin (Nationality)

9. Provide travel document info (Passport or Other Document)

Document Type

Document/Passport Number

Issuing Country

Issuance Date

Expiration Date

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

If yes, Enter country name and passport number

Address & Contact

11. Present Address

Street

City

State/Province

Does Not Apply

ZIP/Postal

Does Not Apply

Country

Date Living Here From (YYYY-MM)

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

Please start with the most recent address and work backwards.

Street Address

City

State

Does Not Apply

Zip

Does Not Apply

Country/Region

Date Started Living Here

Date Ended Living Here

13. Primary Phone Number

Secondary Phone

Work Phone

14. Email Address

Used any other phones/emails in last 5 years?

Additional Phone Numbers (last 5 years)

Additional Emails (last 5 years)

15. Social Media (last 5 years)

If you used social media within the last five years, choose “Yes” and list your username/handle for each platform.

Yes No

List ALL usernames you have used:

ASK.FM Douban Facebook Flickr Google+ Instagram LinkedIn Myspace Pinterest Qzone(QQ) Reddit Sina Weibo Tencent Weibo Tumblr Twitter/X Twoo Vine VKontakte Youku Youtube

16. Is Your Mailing Address the same as your Present Address?

Yes No

If no, please list mailing address:

Street Address

City

State

Zip

Country/Region

17. Permanent address

Please provide the following information on where you intend to live after arrival in the United States. If you do not have a U.S. address at this time, just leave it blank. Further instructions will be provided later.

(Permanent address) Name of person currently living at address

Does Not Apply

(Permanent address) Street Address (Line 1)

(Permanent address) Street Address (Line 2) Optional

(Permanent address) City

(Permanent address) State

Does Not Apply

(Permanent address) Zip Code

Does Not Apply

(Permanent address) Phone Number

Does Not Apply

18. Is your present address where you want your Permanent Residence Card (Green Card) mailed?

Yes No

If no, please list mailing address for your Green Card:

Contact Person

Street Address

City

State

Zip

Country/Region

Family

19. Father

Surname

Given Name

Date and Place of Birth

Date of Birth

20. Is your father still living?

Yes No

Date of Death

21. Mother

Surname

Given Name

Date and Place of Birth

22. Is your mother still living?

Yes No

Date of Death

23. Current Spouse

Do you have a spouse currently?

Yes No

Surnames

Given names

Date of Birth

Place of Birth

Date and Place of Marriage

Occupation

If “Other”, describe (and any additional details)

Is your spouse immigrating to the U.S. with you?

Yes No

Is your spouse immigrating to the U.S. at a later date to join you?

Yes No

Do you have any previous spouses?

Yes No

Number of Previous Spouses:

Surnames

Given Names

Date of Birth

Date of Marriage

Date Marriage Ended

How was your marriage terminated?

Explain Other

Country/Region where marriage was terminated

24. Children

Do you have any children?

Yes No

If yes, provide Number of Children:

Child 1

Date and Place of Birth

DOB

City of Birth

State/Province of Birth

Country/Region of Birth

Does this child live with you?

Yes No

Is this child immigrating to the US with you?

Yes No

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

Yes No

Travel Information

25. Have you ever been in the U.S.?

Yes No

If yes, please provide your visits (most recent first).

Visit 1 (most recent)

Date Arrived (MM/DD/YYYY)

Length of Stay (Years / Months / Days / Weeks)

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

Yes No

If yes, please provide A#: Do Not Know

27. Have you ever been issued a U.S. Visa?

Yes No

Date Visa was issued (MM/DD/YYYY)

Visa Classification Do Not Know

Visa Number Do Not Know

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

Yes No

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

Yes No

28. Have you ever been refused a U.S. Visa, been refused admission to the United States, or withdrawn your application for admission at the port of entry?

Yes No

If yes, please explain below

Work / Education

29. CURRENT Primary Occupation

Primary Occupation (CURRENT OCCUPATION)

(AGRICULTURE, ARTIST/PERFORMER, BUSINESS, COMMUNICATIONS, COMPUTER SCIENCE, CULINARY/FOOD SERVICES, EDUCATION, ENGINEERING, GOVERNMENT, HOMEMAKER, LEGAL PROFESSION, MEDICAL/HEALTH, MILITARY, NATURAL SCIENCE, NOT EMPLOYED, PHYSICAL SCIENCES, RELIGIOUS VOCATION, RESEARCH, RETIRED, SOCIAL SCIENCE, STUDENT, OTHER)

*if other or not employed, please describe in short sentences

Primary Occupation

Present Employer or School Name

Present Employer or School Address

City

State/Province

Postal Zone/ZIP Code

Country/Region

From (MM/DD/YYYY)

Does this job require at least 2 years of training or experience?

Yes No

Job Title

Duties (Describe the type of work you are doing. Be as specific as possible.)

Employment Date From

Employment Date To

30. Do you have other occupations?

Yes No

Occupation name

Other Employer or School Name

Other Employer or School Address

City

State/Province

Postal/ZIP Code

Country/Region

Does this job require at least 2 years of training or experience?

Yes No

Job title

Duties (Describe the type of work you are doing. Be as specific as possible.)

Employment Date From

Employment Date To

31. Were you previously employed?

If Yes, provide all your employers from the last ten (10) years, starting with your most recent employer. Proceed to the Previous Work section below and complete the information.

Yes No

Number of Employers (last 10 years):

Employer Name

Telephone Number

Street Address (Line 1)

Street Address (Line 2) Optional

City

State / Province

Postal / ZIP Code

Country / Region

Job title

Employment Date From

Employment Date To

Supervisor’s Surname

Supervisor’s Given names

Does this job require at least 2 years of training or experience?

Yes No

*Explain >>

Duties

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

If Yes, provide all educational institutions at a secondary level or above you have attended. Proceed to the Education section below and complete the information.

Yes No

Number of Institutions:

Name of Institution

Course of Study

Street Address (Line 1)

Street Address (Line 2) Optional

City

State / Province

Postal / ZIP Code

Country / Region

Degree or Diploma

Date of Attendance From

Date of Attendance To

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

Unknown

34. Have you traveled to any countries/regions within the last five years?

Yes No

Country/Region

Notes (optional)

35. Have you served in the military?

Yes No

Name of Country/Region

Branch of Service

Rank/Position

Military Specialty

Date of Service From

Date of Service To

36. Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?

Yes No

37. Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience?

Yes No

Explain Skills or Training

38. 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?

Yes No

Explain

39. Can you speak and/or read languages other than your native language?

Yes No

List the languages that you speak and/or read

40. Petitioner Information

Please provide the following information concerning the individual/entity that filed a petition on your behalf.

Petitioner is my

Petitioner Organization Name

Street Address

City

State/Province Does Not Apply

Postal Zone/ZIP Code Does Not Apply

Country/Region

Telephone

Mobile/Cell Phone Does Not Apply

Email Address Does Not Apply

Security — Medical & Criminal

Security and Background: Medical and Health Information

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

Yes No

If yes, please explain

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

Yes No

If no, please explain

43. 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?

Yes No

If yes, please explain

44. Are you now or have you ever been a drug abuser or addict?

Yes No

If yes, please explain

Security and Background: Criminal Information

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

47. 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?

Yes No

If yes, please explain

48. 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?

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

51. 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?

Yes No

If yes, please explain

52. 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?

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

56. Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including providing financial assistance or other support to terrorists or terrorist organizations, in the past five years?

Yes No

If yes, please explain

57. Are you a member or representative of a terrorist organization?

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

Security — Immigration Law

Security and Background: Security Information 2

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

65. 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?

Yes No

If yes, please explain

66. 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?

Yes No

If yes, please explain

67. Have you ever been directly involved in 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?

Yes No

If yes, please explain

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

Yes No

If yes, please explain

69. 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?

Yes No

If yes, please explain

Security and Background: Immigration Law Violations Information 1

70. 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?

Yes No

If yes, please explain

71. Have you ever been removed or deported from any country?

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

74. 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?

Yes No

If yes, please explain

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

Yes No

If yes, please explain

76. Have you been ordered removed from the U.S. in the last five years?

Yes No

If yes, please explain

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

Yes No

If yes, please explain

Security and Background: Immigration Law Violations Information 2

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

80. 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?

Yes No

If yes, please explain

81. 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?

Yes No

If yes, please explain

Security and Background: Miscellaneous Information 1

82. 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?

Yes No

If yes, please explain

83. 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?

Yes No

If yes, please explain

84. Have you voted in the United States in violation of any law/regulation?

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

87. 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?

Yes No

If yes, please explain

88. 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?

Yes No

If yes, please explain

Security and Background: Miscellaneous Information 2

89. Are you a health care 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?

Yes No

If yes, please explain

90. Are you permanently ineligible for U.S. citizenship?

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

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

Yes No

If yes, please explain

Security and Background: Miscellaneous Information 3

96. Have you ever applied for a Social Security number?

Yes No

97. Were you issued a number?

Yes No

If yes, please list

Do Not Know

98. Do you need a new card issued?

Yes No

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

Yes No

100. 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 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?

Yes No

Review & Submit

Review your answers. You can also download a copy as JSON or Excel.