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Special Immigrant Visa Biodata Form DS-234 - Official Federal Forms

Special Immigrant Visa Biodata Form Form. This is a national form and can be used in Visa US Department Of State .
 Fillable pdf Last Modified 1/29/2013
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U.S. Department of State Bureau of Population, Refugees and Migration OMB APPROVAL NO. 1405-0203 EXPIRES: 01-31-2016 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 National Visa Center at NVCSIV@state.gov . 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 traveling with you) 2. Are you the principal applicant (PA)? Yes 4. Name as it Appears on your Passport (Last, First, Middle) No 5. Sex Male 6. Marital Status 7. Date of Birth (mm-dd-yyyy) 8. Place of Birth (City, Country) Female 3. If not, what is your relationship to the PA? (Husband, wife, son, daughter) 9. Nationality 10. Ethnicity 11. Religion 12. Physical Address 13. Phone Number(s) 14. E-mail 15. Last Occupation/Skill 16. Education Level/Field of Study 17. Native Language 18. Other Language(s) 19. English Speaking Ability (Good, Some, None) 20. Health Issues (Condition, Treatment, Pregnancy, Urgency, Comments) C. CROSS REFERENCE 21. Do you have other immediate family members being processed on their own special immigrant visas? Yes No DS-234 01-2013 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 . Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 22. If yes, do you wish to be resettled in the same city in the United States? If yes, please provide family member's/members' name(s), relationship to you and special immigrant visa case number(s). If the number of family members exceeds 7, please include them in the comments section. Family Member Name Last First Middle Relationship to you Date of Birth (dd mmm yyyy) If unknown, check box Yes No Special Immigrant Visa Case Number 1 2 3 4 5 6 7 D. U.S. TIES Select One Select One Select One Select One Select One Select One Select One 23. 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. Date of Birth (dd mmm yyyy) If unknown, check box Yes No Name Last First Middle Relationship to you Address Phone Number E-mail Address 1 2 3 4 5 6 7 E. COMMENTS Select One Select One Select One Select One Select One Select One Select One 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. Send completed form(s) to the National Visa Center as an email attachment at NVCSIV@state.gov . Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com
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