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    ds234-biodata

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    ds234-biodata

    Uploaded by

    oliviasilvertore
    6 views2 pages

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    6 views2 pages

    ds234-biodata

    Uploaded by

    oliviasilvertore

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    You are on page 1of 2

    U.S. Department of State OMB CONTROL NO.

    1405-0203
    EXPIRES: 10-31-2024
    Bureau of Population, Refugees and Migration ESTIMATED BURDEN: 20 MIN.

    SPECIAL IMMIGRANT VISA BIODATA FORM


    Special immigrant visa applicants who qualify for and request resettlement assistance from the Department of State must complete this form for each family member and
    submit it via email as a scanned attachment to the Resettlement Support Center for Middle East and North Africa (RSC MENA) at SIV_ope@iom.int.

    A. CASE INFORMATION (To be completed by NVC)

    NVC Case Number Assigned Post Post POC Information

    B. CASE MEMBER
    1. Case Size (Yourself plus family members 2. Are you the principal applicant (PA)? 3. If not, what is your relationship to the PA?
    traveling with you) (Husband, wife, son, daughter)
    Yes No

    4. Name as it Appears on your Passport (Last, First, Middle) 5. Gender

    6. Marital Status 7. Date of Birth (mm-dd-yyyy) 8. Place of Birth (City, Country)

    9. Nationality 10. Ethnicity 11. Religion

    12. Physical Address

    13. Phone Number(s)

    14. E-mail

    15. Occupation/Skill

    16. Education Level/Field of Study

    17. Native Language (Indicate Reading/Writing/Speaking ability)

    18. Other Language(s) (Indicate Reading/Writing/Speaking ability)

    19. English Speaking Ability (Good, Some, None)

    20. Pregnant Estimated Delivery Date (EDD) (mm/dd/yyyy)

    20. Health Issues (If yes, please explain)

    C. CROSS REFERENCE

    21. Do you have other immediate family members being processed on their own special immigrant visas? If yes, please provide your family member's
    name, relationship to you, and special immigrant visa case number.
    Yes No

    DS-234 Page 1 of 2
    07-2020 Submit one copy of the Special Immigrant Visa Biodata form for each family member.
    Send completed form(s) to the National Visa Center as an email attachment at NVCSIV@state.gov .
    Date of Birth
    Family Member Name (dd mmm yyyy) Special Immigrant Visa
    If unknown, Case Number
    check box
    Last First Middle Relationship to you

    7
    D. U.S. TIES

    22. Do you have family members or friends already residing in the United States? If yes, please provide family/friend information
    below. It may be possible to be resettled near them. If the number exceeds 7, please include them in the comments section. Yes No

    Name
    Relationship to you Gender Address Phone Number E-mail Address
    Last Middle
    First

    E. COMMENTS

    CONFIDENTIALITY STATEMENT AND PAPERWORK REDUCTION ACT STATEMENT


    The information asked for on this form is requested in accordance with Section 222(f) of the Immigration and Nationality Act, and is considered
    confidential. The information provided herein shall only be shared with State Department personnel, officers of other federal agencies including the
    Department of Health and Human Services and the Department of Homeland Security, and resettlement agency employees on a need to know basis.
    The U.S. Department of State uses the facts you provide on this form to facilitate the provision of Resettlement and Placement benefits and to assist
    in determining the location in the United States in which you will be resettled.

    Public reporting burden for this collection of information is estimated to average 20 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: DOS/PRM, Office of Admissions, 2025 E Street, NW
    Washington, DC 20522-0908.

    DS-234 Submit one copy of the Special Immigrant Visa Biodata form for each family member. Page 2 of 2
    Send completed form(s) to the National Visa Center as an email attachment at NVCSIV@state.gov .

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