Form DS-230 Application for Immigrant Visa and Alien Registration

U.S. Department of State

OMB APPROVAL NO. 1405-0015
EXPIRES: XX/XX/20XX
ESTIMATED BURDEN: XX HOUR*
(See Page 2)

APPLICATION FOR
IMMIGRANT VISA AND
ALIEN REGISTRATION

BIOGRAPHIC DATA
Instructions: Complete one copy of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please
print or type your answers to all questions. Mark questions that are Not Applicable with "N/A". If there is insufficient room on the form, answer on a
separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form.

1. Family Name

First Name

Middle Name

2. Other Names Used or Aliases (If married woman, give maiden name)
3. Full Name in Native Alphabet (If Roman letters not used)
4. Passport Number, Country of Issuance
5. Age

6. Sex

7. Date of Birth (mm-dd-yyyy)
Male

Female

8. Place of Birth
City/Town
9a. Country/Region of Origin (Nationality)

Country
Province
9b. Do you hold or have you held any nationality other than the one you have indicated in 9a?
Yes
No

9c. If "yes" in block 9b, list country/countries, and note if you carry a passport for each.
Yes
No
Passport

Country
10. Marital Status
Single (Never Married)

Married

Including my present marriage, I have been married

Widowed

Divorced

Separated

times.

11. Permanent address in the United States where you intend to live, if
known (street address including ZIP code). Include the name of a person
who currently lives there.

Telephone number

Yes
No
Passport

Country

12. Address in the United States where you want your Permanent
Resident Card (Green Card) mailed, if different from address in item #10
(include the name of a person who currently lives there).

Telephone number
14. Present Address (Street Address) (City or Town) (Province) (Country)

13. Present Occupation

Telephone Number (Home) Telephone Number (Office) E-mail Address
15a. Spouse's Maiden or Family Name

First Name

Middle Name

15b. Date (mm-dd-yyyy) and Place of Birth of Spouse
15c. Address of Spouse (If different from your own)

15d. Spouse's Occupation
15e. Date of Marriage (mm-dd-yyyy)

DS-230
06-2018

This Form May be Obtained Free at Consular Offices of the United States of America
Previous Editions Obsolete

Page 1 of 6

16a. Father's Family Name

First Name

16b. Father's Date of Birth
(mm-dd-yyyy)

16c. Place of Birth

Middle Name

16d. Current Address

17a. Mother's Family Name at Birth

First Name

17b. Mother's Date of Birth
(mm-dd-yyyy)

17c. Place of Birth

16e. If Deceased, Give
Year of Death

Middle Name

17d. Current Address

17e. If Deceased, Give
Year of Death

18. List Names, Dates and Places of Birth, and Addresses of ALL Children.
Name

Date (mm-dd-yyyy)

Place of Birth

Address (If different from your own)

19. List below all places you have lived for at least six months since reaching the age of 16, including places in your country of nationality.
Begin with your present residence.
City or Town

Province

Country

From/To (mm-dd-yyyy) or "Present"

20a. Person(s) named in 15 and 18 who will accompany you to the United States now.
20b. Person(s) named in 15 and 18 who will follow you to the United States at a later date.
21. List below all employment for the last ten years.
Employer

Location

Job Title

From/To (mm-dd-yyyy) or "Present"

22. In what occupation do you intend to work in the United States?
23. List below all educational institutions attended.
School and Location

From/To (mm-yyyy)

Course of Study

Degree or Diploma

24. Languages spoken or read?
25. Professional associations to which you belong?
26. Previous Military Service?

Yes

No

Branch

Dates of Service (mm-dd-yyyy)

Rank/Position

Military Speciality/Occupation

27. List dates of all previous visits to or residence in the United States. (If never, write "never") Give type of visa status, if known.
Give DHS "A" number if any.
From/To (mm-yyyy)

DS-230

Location

Type of Visa

This Form May be Obtained Free at Consular Offices of the United States of America
Previous Editions Obsolete

"A" Number (If known)

Page 2 of 6

SWORN STATEMENT
28. Name and Address of Petitioner

Telephone number
E-mail Address

Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. Attach an extra
sheet of paper if necessary. 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? A YES answer does not automatically signify ineligibility for a visa. Please
note that should you answer Yes to any of the following questions, you may be requested to provide documentation to support your explanation.

29. MEDICAL AND HEALTH INFORMATION

YES NO

a. Do you have a communicable disease of public health significance such as tuberculosis (TB)?
b. Do you have documentation to establish that you have received vaccinations in accordance with U.S. law?
c. 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?
d. Are you or have you ever been a drug abuser or addict?
e. Explain all "Yes" answers in this section.

30. CRIMINAL INFORMATION

YES NO

a. Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon amnesty, or other similar action?
b. Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?
c.

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?

d.

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

e. Have you ever been involved in, or do you seek to engage in, money laundering?
f. Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States?
g.

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?

h.

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?

i. Have you ever committed a serious criminal offense in the United States and asserted immunity from prosecution?
j. Explain all "Yes" answers in this section.

31. BACKGROUND AND SECURITY INFORMATION PART 1

YES NO

a. Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States?
b. Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities?
c. Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations?
d.

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 last five years?

e. Are you a member or representative of a terrorist organization?
f. Have you ever ordered, incited, assisted, or otherwise participated in genocide?
g. Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?
h.

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

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

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

k. Explain all "Yes" answers in this section.

DS-230

This Form May be Obtained Free at Consular Offices of the United States of America
Previous Editions Obsolete

Page 3 of 6

32. BACKGROUND AND SECURITY INFORMATION PART 2

YES NO

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

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)?

c.

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?

d.

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?

e.

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?

f.

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

g.

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?

h. Explain all "Yes" answers in this section.

33. IMMIGRATION VIOLATIONS
a.

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?

b. Have you ever been the subject of a removal or deportation hearing?
c. Have you failed to attend a hearing on removability or inadmissibility within the last five years?

d.

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?

e. Are you subject to a civil penalty under INA 274C?
f. Have you been ordered removed from the U.S. during the last five years?
g. Have you been ordered removed from the U.S. for a second time within the last 20 years?
h. Have you ever been unlawfully present and ordered removed from the U.S. during the last ten years?
i. Have you ever been convicted of an aggravated felony and been ordered removed from the U.S.?
j.

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?

k.

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?

l.

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?

m. Have you ever been removed or deported from any country?
n. Explain all "Yes" answers in this section.

DS-230

This Form May be Obtained Free at Consular Offices of
The United States of America

Page 4 of 6

34. MISCELLANEOUS

YES NO

a.

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?

b.

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?

c.

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?

e. 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?
f.

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

g. Are you coming to the U.S. to practice polygamy?
h. Are you permanently ineligible for U.S. citizenship?
i.

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?

j. Have you voted in the United States in violation of any law or regulation?
k. Have you ever renounced United States citizenship for the purpose of avoiding taxation?
l. Have you ever departed the United States in order to evade military service during a time of war?
m. Have you ever renounced United States citizenship for the purpose of avoiding taxation?
n. Have you ever departed the United States in order to evade military service during a time of war?
o. Are you a former exchange visitor (J) who has not yet fulfilled the two-year foreign residence requirement?
p.

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

q. Explain all "Yes" answers in this section.

35a. Have you ever applied for a Social Security Number (SSN)?
No
Yes
Give the number
Would you like to receive a replacement
card? (You must answer YES to question
35b. to receive a card.)
Yes

No

Do you want the Social
Security Administration to
assign you a SSN and issue a
card? (You must answer YES
to question 35b. to receive a
number and a card.)
Yes

No

35b. Consent to Disclosure: I authorize disclosure of information
from this form to the Department of Homeland Security (DHS), the
Social Security Administration (SSA), such other U.S. Government
agencies as may be required for the purpose of assigning me an SSN
and issuing me a Social Security card, and I authorize the SSA to share
my SSN with DHS.
Yes
No
The applicant's response does not limit or restrict the Government's
ability to obtain his or her SSN, or other information on this form, for
enforcement or other purposes as authorized by law.

Yes
No
36. Were you assisted in completing this application?
(If answer is Yes, give name and address of person assisting you, indicating whether relative, friend, travel agent, attorney, or other)

DS-230

This Form May be Obtained Free at Consular Offices of
The United States of America

Page 5 of 6

DO NOT WRITE BELOW THE FOLLOWING LINE
The consular officer will assist you in answering item 45.
DO NOT SIGN this form until instructed to do so by the consular officer
37. I claim to be:
A Family-Sponsored Immigrant
An Employment-Based Immigrant

I derive foreign state chargeability
under Sec. 202(b) through my

Preference
Numerical limitation
(foreign state)

A Diversity Immigrant
A Special Category (Specify)
(Returning resident, Hong Kong, Tibetan, Private Legislation, etc.)

I understand that I am required to surrender my visa to the United States Immigration Officer at the place where I apply to enter the United States, and that the
possession of a visa does not entitle me to enter the United States if at that time I am found to be inadmissible under the immigration laws.
I understand all the information I have provided in, or in support of, this application may be provided to other U.S. government agencies authorized to use
such information for purposes including enforcement of the laws of the United States. I understand all of the information contained in this form and I certify
under penalty of perjury under the laws of the United States of America that the foregoing is complete, true, and correct. I understand that any willfully false or
misleading statement or willful concealment of a material fact made by me herein may result in refusal of the visa, denial of admission to the United States, and,
may subject me to criminal prosecution and/or removal from the United States.
I, the undersigned applicant for a United States immigrant visa, do solemnly swear (or affirm) that all statements which appear in this application have been
made by me and that they are true and complete to the best of my knowledge and belief. I do further swear (or affirm) that, if admitted into the United States, I
will not engage in activities which would be prejudicial to the public interest, or endanger the welfare, safety, or security of the United States; in activities which
would be prohibited by the laws of the United States relating to espionage, sabotage, public disorder, or in other activities subversive to the national security;
in any activity a purpose of which is the opposition to or the control, or overthrow of, the Government of the United States, by force, violence, or other
unconstitutional means.
I understand that if I am issued an immigrant visa and I am a male between the ages of 18 and 25, I am required by law to register with the Selective Service
System in accordance with the Military Service Act.
I understand all the foregoing statements, having asked for and obtained an explanation on every point which was not clear to me.

Signature of Applicant
Subscribed and sworn to before me this

day of

at:
Consular Officer

PAPERWORK REDUCTION ACT STATEMENT
Public reporting burden for this collection of information is estimated to average 125 minutes per response, including
time required for searching existing data sources, gathering the necessary documentation, providing the information
and/or documents required, and reviewing the final collection. You do not have to supply this information unless this
collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate
and/or recommendations for reducing it, please send them to: PRA_BurdenComments@state.gov.
CONFIDENTIALITY STATEMENT
AUTHORITIES: The information on this form is requested pursuant to Section 212(a) and 221 and as required by
Section 222 of the Immigration and Nationality Act. Section 222(f) provides that the records of the Department of State
and of diplomatic and consular offices of the United States pertaining to the issuance and refusal of visas or permits to
enter the United States shall be considered confidential and shall be used only for the formulation, amendment,
administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of
such records may, in the discretion of the Secretary of State, be made available to a court provided the court certifies
that the information contained in such records is needed in a case pending before the court.
PURPOSE: The U.S. Department of State uses the information provided on this form to determine an individual's
eligibility for a U.S. visa. Individuals who fail to submit this form or who do not provide all the requested information may
be denied a U.S. visa. Although furnishing this information is voluntary, failure to provide this information may delay or
prevent the processing of an individual visa application.
DS-230

This Form May be Obtained Free at Consular Offices of
The United States of America

Page 6 of 6