DS-160 Non-Immigrant Visa Questionnaire
Personal Information 1
1. Surnames
2. Given Names
3. Full Name in Native Alphabet
Not Applicable/Technology Not Available
4. Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)?
Yes
No
If yes, please list
5. Do you have a telecode that represents your name?
Yes
No
6. Sex
Male
Female
7. Marital Status
8. Date and 9. Place of Birth
/
/
City of Birth
State/Province of Birth
Country/Region of Birth
Personal Information 2
Country/Region of Origin (Nationality)
10. Do you hold or have you held any nationality other than the one indicated above on nationality?
Yes
No
If yes, what nationality (or nationalities)?
11. Are you a permanent resident of a country/region other than your country/region of origin (nationality) indicated above?
Yes
No
If yes, in what other countries do you hold permanent residency?
12. National Identification Number:
Does Not Apply
13. U.S. Social Security Number:
Does Not Apply
14. U.S. Taxpayer ID Number:
Does Not Apply
Travel Information
15. Purpose of Trip to the U.S. (type of visa)
16. Have you made specific travel plans?
Yes
No
If yes, provide following:
Date of Arrival in U.S.:
Arrival Flight (if known):
Arrival City:
Date of Departure from U.S.:
Departure Flight (if known):
Departure City:
Provide the locations you plan to visit in the U.S.:
Address where you will stay in the U.S.
Street Address:
City:
State:
ZIP Code (if known):
17. Person/Entity Paying for your Trip (type one):
(SELF, U.S. PETITIONER, OTHER PERSON, PRESENT EMPLOYER, EMPLOYER IN THE U.S., OTHER COMPANY/ORGANIZATION)
Travel Companions Information
18. Are there other persons traveling with you?
Yes
No
If yes, provide the following:
Surnames of Person Traveling with You:
Given names of Person Traveling with You:
Relationship with Person:
(PARENT, SPOUSE, CHILD, OTHER RELATIVE, FRIEND, BUSINESS ASSOCIATE, OTHER)
19. Are you traveling as a part of a group or organization?
Yes
No
If yes, provide the Name of Organization
Previous U.S. Travel Information
20. Have you ever been in the U.S.?
Yes
No
If yes, list arrival and departure for the last 5 visits:
Date Arrived:
Length of Stay (Years, Months, Weeks, Days, Less then 24 hours):
Do you or did you ever hold a U.S. Driver's License?
Yes
No
If yes, provide: Drivers License Number, State of Driver's License:
Date Arrived:
Length of Stay (Years, Months, Weeks, Days, Less then 24 hours):
Do you or did you ever hold a U.S. Driver's License?
Yes
No
If yes, provide: Drivers License Number, State of Driver's License:
Date Arrived:
Length of Stay (Years, Months, Weeks, Days, Less then 24 hours):
Do you or did you ever hold a U.S. Driver's License?
Yes
No
If yes, provide: Drivers License Number, State of Driver's License:
Date Arrived:
Length of Stay (Years, Months, Weeks, Days, Less then 24 hours):
Do you or did you ever hold a U.S. Driver's License?
Yes
No
If yes, provide: Drivers License Number, State of Driver's License:
Date Arrived:
Length of Stay (Years, Months, Weeks, Days, Less then 24 hours):
Do you or did you ever hold a U.S. Driver's License?
Yes
No
If yes, provide: Drivers License Number, State of Driver's License:
21. Have you ever been issued a U.S. Visa?
Yes
No
If yes, please provide:
Date Visa Was issued:
Visa Number:
Do Not Know
Are you applying for the same type of Visa?
Yes
No
Are you applying in the same country or location where the visa above was issued, and is this country or location your place of principal of residence?:
Yes
No
Have you been ten-printed (i.e. fingerprinted for all fingers)?
Yes
No
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
22. Have you ever been refused a U.S. Visa, or been refused admission to the United States, or withdrawn your application for admission at the port of entry?
Yes
No
If yes, please explain
23. Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and Immigration Services?
Yes
No
If yes, please explain
Address and Phone Information
24. Home Address
Street Address
City, State and Zip Code:
Country/Region:
25. Is Your Mailing Address the same as your Home Address?
Yes
No
If no, please list
Street Address
City, State and Zip Code:
Country/Region:
26. Country/Region:
27. Phone:
Primary Phone Number:
Secondary Phone Number:
Work Phone Number:
28. Email Address:
Please choose any of social media listed you have ever been active or had a registered account, also provide account indentificator for each, if you do not remember your account identificator put N/A or Do not remember.
ASK.FM:
Douban:
Facebook:
Flickr:
Google+:
Instagram:
Linkedin:
Myspace:
Pinterest:
Qzone(QQ):
Reddit:
Sina Weibo:
Tencent Weibo:
Tumblr:
Twitter:
Twoo:
Vine:
VKontakte:
Youku:
Youtube:
Passport Information
29. Passport/Travel Document Type (enter one):
(REGULAR, OFFICIAL, DIPLOMATIC, LAISSEZ-PASSER, OTHER)
30. Passport/Travel Document Number:
31. Passport Book Number:
Does Not Apply
32. Country/Authority that Issued Passport/Travel Document:
33. Where was the Passport/Travel Document issued?
City:
State/Province * If shown on passport:
Country/Region:
Issuance Date:
Expiration Date:
34. Have you ever lost a passport or had one stolen?
Yes
No
If yes, please explain
U.S. Point of Contact Information
35. Contact Person or Organization in the United States
Surnames:
Given Names:
Organization Name:
Relationship to you (enter one):
(RELATIVE, SPOUSE, FRIEND, BUSINESS ASSOCIATE, EMPLOYER, SCHOOL OFFICIAL, U.S. PETITIONER, OTHER)
36. Address and Phone Number of Point of Contact
U.S. Street Address:
City:
State:
ZIP Code (if known):
Phone Number:
Email Address:
Family Information: Relatives
37. Father's Information
Surname:
Given Name:
Date of Birth:
Is your father in the U.S?
Yes
No
If yes, what is his status? (enter one): (U.S. CITIZEN, U.S. LEGAL PERMANENT RESIDENT (LPR), NONIMMIGRANT, OTHER/I DON'T KNOW)
38. Mothers's Information
Surname:
Given Name:
Date of Birth:
Is your mother in the U.S?
Yes
No
If yes, what is her status? (enter one): (U.S. CITIZEN, U.S. LEGAL PERMANENT RESIDENT (LPR), NONIMMIGRANT, OTHER/I DON'T KNOW)
39. Do you have any immediate relatives, not including parents, in the United States?
Yes
No
If yes, please provide the following for each member:
Surnames:
Given Names:
Relationship to you (enter one):
(SPOUSE, FIANCE/FIANCEE, CHILD, SIBLING)
Surnames:
Given Names:
Relationship to you (enter one):
(SPOUSE, FIANCE/FIANCEE, CHILD, SIBLING)
Surnames:
Given Names:
Relationship to you (enter one):
(SPOUSE, FIANCE/FIANCEE, CHILD, SIBLING)
Present Work/Education/Training Information (NOTE: Provide the following information concerning your current employment or education)
40. Primary Occupation (Job Title):
41. Please enter one category below that best fits your job: (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:
Previous Work/Education/Training Information (NOTE: Provide your employment information for the last five years that you were employed, if applicable)
42. Were you previously employed within the last five years?
Yes
No
If yes, list the information below for each prior employer, beginning with most recent:
Employer/Company Name:
Full Company Address:
City:
State/Province:
Postal Zone/ZIP Code:
Country/Region:
Phone Number:
Job Title:
Supervisor's Surname:
Supervisor's Given Name:
Start Date:
End Date:
Monthly Income In Local Currency (if employed):
Brief description of duties:
Employer/Company Name:
Full Company Address:
City:
State/Province:
Postal Zone/ZIP Code:
Country/Region:
Phone Number:
Job Title:
Supervisor's Surname:
Supervisor's Given Name:
Start Date:
End Date:
Monthly Income In Local Currency (if employed):
Brief description of duties:
Employer/Company Name:
Full Company Address:
City:
State/Province:
Postal Zone/ZIP Code:
Country/Region:
Phone Number:
Job Title:
Supervisor's Surname:
Supervisor's Given Name:
Start Date:
End Date:
Monthly Income In Local Currency (if employed):
Brief description of duties:
43. Have you attended any educational institutions at a secondary level or above?
Yes
No
If yes, list the information below for each prior institute, beginning with most recent:
Name Of Institution:
Street Address:
City:
State/Province:
Postal Zone/ZIP Code:
Country/Region:
Course of Study:
Date of Attendance From:
Date of Attendance To:
Name Of Institution:
Street Address:
City:
State/Province:
Postal Zone/ZIP Code:
Country/Region:
Course of Study:
Date of Attendance From:
Date of Attendance To:
Name Of Institution:
Street Address:
City:
State/Province:
Postal Zone/ZIP Code:
Country/Region:
Course of Study:
Date of Attendance From:
Date of Attendance To:
Additional Work/Education/Training Information (NOTE: Provide the following work, education, or training related information. Provide complete and accurate information to all questions that require an explanation.)
44. Do you belong to a clan or tribe?:
Yes
No
If yes, provide the following information:
Clan or Tribe Name:
45. Provide a List of Languages You Speak (Delimited By Commas)
46.Have you traveled to any countries/regions within the last five years?
Yes
No
If yes, please provide a list of Countries/Regions visited (Delimited by Commas)
47. Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?:
Yes
No
If yes, provide a List of Organizations:
48. Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience?
Yes
No
If yes, please explain
49. Have you ever served in the military?
Yes
No
If yes, provide the following information:
Name of Country/Region:
Branch of Service:
Rank/Position:
Military Speciality:
Date of Service From:
Date of Service To:
50. 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
If yes, please explain
Security and Background: Part 1
(NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.)
51. 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 other diseases as determined by the Department of Health and Human Services.)
Yes
No
If yes, please explain
52. 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
53. Are you or have you been a drug abuser or addict?
Yes
No
If yes, please explain
Security and Background: Part 2
(NOTE: Provide the following security and background information. Provide complete and accurate answers to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.)
54. Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?
Yes
No
If yes, please explain
55. 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
56. Have you ever been involved in, or do you seek to engage in, money laundering?
Yes
No
If yes, please explain
57. 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
58. 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?
Yes
No
If yes, please explain
59. 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
Security and Background: Part 3
(NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.)
60. 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
61. 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
62. 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
63. Are you a member or representative of a terrorist organization?
Yes
No
If yes, please explain
64. Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?
Yes
No
If yes, please explain
65. Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?
Yes
No
If yes, please explain
66. 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
67. Have you ever engaged in the recruitment or the use of child soldiers?
Yes
No
If yes, please explain
68. 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
69. 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?
Yes
No
If yes, please explain
70. Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue?
Yes
No
If yes, please explain
Security and Background: Part 4
(NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.)
71. 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
Security and Background: Part 5
(NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer.)
72. 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
73. Have you voted in the United States in violation of any law or regulation?
Yes
No
If yes, please explain
74. Have you ever renounced United States citizenship for the purposes of avoiding taxation?
Yes
No
If yes, please explain
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