[PDF] DS-260 IV Application SAMPLE SENSITIVE BUT UNCLASSIFIED. Bureau of

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SENSITIVE BUT UNCLASSIFIED Bureau of Consular Affair s Consular Systems and Technology October 2019 er DS - 260

IV Application

Sign In Page

2

Sign In Page

3

Sign In Page

4

5 Summary Information Page

Example of a piVot case Summary page.

6 Getting Started Page Immigration Visa and Alien

Registration Application

7 Personal Information 1 Page

religious,

8 Personal Information 1 Page

9

Personal Information 2 Page

10

Personal Information 2 Page

11 e you held any nationality other than the one indicated in question above

Personal Information 2 Page

12

Personal Information 2 Page

13

14 Present and Previous Address Information Page

Please note sections added for Additional

Telephone and Email Address. Additional field for Social Media and Other Social Media.

15 Present and Previous Address Information Page

Please note sections added for Additional

Telephone and Email Address. Additional field for Social Media and Other Social Media.

Page Continued

16 Page Continued

17

18 Mailing and Permanent Address Page

19 Mailing and Permanent Address Page

Displayed for all

20 Mailing and Permanent Address

ss Country/Region. . 21

22 Mailing and Permanent Address Page

R 23

Family Information: Parents Page

24 Displayed for all applicants.

Family Information: Parents Page

25

Family Information: Parents Page

26 Displayed for all applicants. Answers to all que

Family Information: Parents Page

27 Displayed for all

applicants. Answered to your address the same as your

Family Information: Parents Page

28

Family Information: Spouse Page

29

Family Information: Spouse Page

30 Displayed for applicants who indic

Family Information: Spouse Page

31

Family Information: Spouse Page

32

33 Family Information: Previous Spouse Page

Family Information: Previous Spouse Page

34
35
36

37 Displayed for al

38 Previous U.S. Travel Information Page

Displayed for all applicants. All questions are answered

39 Previous U.S. Travel Information Page

Present Work/Education/Training Information Page

40 Displayed for all applicants over the age of 14

Present Work/Education/Training Information Page

41 you intend to work in

ical in

Present Work/Education/Training Information Page

42

Present Work/Education/Training Information Page

43

Present Work/Education/Training Information Page

44 n which occupation do you intend to work in

Present Work/Education/Training Information Page

45
Displayed for all applicants over the age of 14. P

Present Work/Education/Training Information Page

46
the U.S.?

Present Work/Education/Training Information Page

47

Present Work/Education/Training Information Page

48 Displayed only for Diversity Visa (DV)

principal applicants when Primary

Occupation is not

Present Work/Education/Training Information Page

49 Displayed only for Diversity Visa (DV) principal

applicants when Primary Occupation is not

Present Work/Education/Training Information Page

50 Displayed only for Diversity Visa (DV) principal

applicants when Primary Occupation is not

Answer to other

is

Previous Work/Education/Training Information Page

51 Displayed for all applicants who meet one of the following criteria:

m Burma, China, Cuba, India, Iran, North Korea, Pakistan, Saudi

Arabia,

Sudan, Syria, or Stateless

es: E11, E12, E13, E21, E31, E32, EW3, SD1, SR1, SE1, C51, T51, SI1, SQ1, SF1, SG1, SH1, SJ1, SK1, SN1, R51, and I51, DV-1. Displayed for all applicants who meet one of the following criteria:

Previous Work/Education/Training Information Page

52 is male and age is between 14 and 60

Burma, China, Cuba, India, Iran, North Korea,

Pakistan, Saudi Arabia, Sudan, Syria, or Stateless homemaker applicant is a principal applicant and is applying for any of the following visa classes: E11, E12, E13,

E21, E31, E32, EW3, SD1, SR1, SE1, C51, T51, SI1,

SQ1, SF1, SG1, SH1, SJ1, SK1, SN1, R51, and I51,

DV-1.

Previous Work/Education/Training Information Page

53

Previous Work/Education/Training Information Page

54 to both

Previous Work/Education/Training Information Page

55

Previous Work/Education/Training Information Page

56
page.

Previous Work/Education/Training Information Page

57

Previous Work/Education/Training Information Page

58 e.
Additional Work/Education/Training Information Page

59 Displayed for all applicants who are 14 years or older. The answer to the question is unanswered. No

Additional Work/Education/Training Information Page 60
Additional Work/Education/Training Information Page 61
Displayed for all applicants who meet one of the following two criteria: e applicant is Male and age is between 14 and 60 and Nationality (or Other Nationality) is NOT AFGHANISTAN, BURMA, CHINA, CUBA, INDIA, IRAQ, IRAN, NORTH KOREA, PAKISTAN, SAUDI

ARABIA, SUDAN, SYRIA, OR STATELESS

Nationality (or Other Nationality) is AFGHANISTAN, BURMA, CHINA, CUBA, INDIA, IRAN, NORTH KOREA, PAKISTAN, SAUDI ARABIA, SUDAN, SYRIA, OR STATELESS. Additional Work/Education/Training Information Page 62
between 14 and 60 and Nationality (or Other Nationality) is NOT

AFGHANISTAN, BURMA, CHINA,

CUBA, INDIA, IRAQ, IRAN, NORTH

KOREA, PAKISTAN, SAUDI ARABIA, SUDAN, SYRIA, OR STATELESS

Nationality (or Other Nationality) is

AFGHANISTAN, BURMA, CHINA,

CUBA, INDIA, IRAQ, IRAN, NORTH KOREA, PAKISTAN, SAUDI ARABIA, SUDAN, SYRIA, OR

STATELESS.

Part 1

Additional Work/Education/Training Information Page

63 Part 2

Additional Work/Education/Training Information Page 64
Additional Work/Education/Training Information Page 65
between 14 and 60 and Nationality (or Other Nationality) is

NOT AFGHANISTAN,

BURMA, CHINA, CUBA,

INDIA, IRAQ, IRAN,

NORTH KOREA,

PAKISTAN, SAUDI

ARABIA, SUDAN,

SYRIA, OR STATELESS

Nationality) is

AFGHANISTAN,

BURMA, CHINA, CUBA,

INDIA, IRAQ, IRAN,

NORTH KOREA,

PAKISTAN, SAUDI ARABIA, SUDAN, SYRIA, OR STATELESS. Additional Work/Education/Training Information Page 66

Petitioner Information Page

67 Displayed for all applicants.

Petitioner Information Page

68

Petitioner Information Page

69 Displayed for all

Petitioner Information Page

70

71 Security and Background: Medical and Health

Information Page

72

73 Security and Background: Medical and Health

Information Page

74 Security and Background: Criminal Information Page

75 Security and Background: Criminal Information Page

Displayed

76 Security and Background: Security Information 1 Page

77

78 Security and Background: Security Information 1 Page

Displayed for all applic

79 Security and Background: Security Information 2 Page

80 Security and Background: Security Information 2 Page

Displayed for all applicants. Answers to

Security and Background: Immigration Law Violation

Information 1 Page

81 Displayed for all applicants who answered "No" to "Have you ever been to the U.S.?" on the Previous U.S.

Travel page.

Security and Background: Immigration Law Violation

Information 1 Page

82 Displayed for all applicants who answered "No" to "Have you ever been to the U.S.?" on the Previous U.S. Travel

page Security and Background: Immigration Law Violation

Information 1 Page

83
Security and Background: Immigration Law Violation

Information 1 Page

84 Displayed for all applicants who answ

Part 1:

Security and Background: Immigration Law Violation

Information 1 Page

85

86 Security and Background: Immigration Law Violation

Information 2 Page

Security and Background: Immigration Law Violation ous U.S. 87

88 Security and Background: Miscellaneous Information 1

Page

Displayed for all applicants. A

89 Security and Background: Miscellaneous Information 1

Page

Displayed

90 Security and Background: Miscellaneous Information 2

Page 91

92 Security and Background: Miscellaneous Information 2

Page

Displayed

93

Social Security Number Information Page

94

Social Security Number Information Page

95

Social Security Number Information Page

96 Displayed for all applicants. Answers to the first three ques

97 Sign and Submit Page

98 Sign and Submit Page

Displayed for all applican

99

100 Sign and Submit Page

If you are from B

Republic of the Congo, Djibouti, Egypt, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Iraq, Kenya,

Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda,

Yemen then you will have an extra box on your Sign and Submit page. Applicants must certify they reviewed the

FGM/C government fact sheet, given they are from a FGM/C prevalent country/region. 101

102 Sign and Submit Page

Republic of the Congo, Djibouti, Egypt, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Iraq, Kenya,

Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda,

Yemen then you will have an extra box on your Sign and Submit page. Applicants must certify they reviewed the

FGM/C government fact sheet, given they are from a FGM/C prevalent country/region. 103

104 Confirmation Page

Displayed for applicants when the case is at NVC.

105

Confirmation Page

106 Displayed for applicants when the case is at Post Displayed for DV applicants when

the case is at KCC

Confirmation Page

107

Confirmation Page

108 Displayed for DV applicants when the case is at Post

109 Copyright Page Immigrant Visa and Alien

Registration Application

110 Disclaimer Page Immigrant Visa and Alien

Registration Application

111 Paperwork Reduction Act Page Immigrant Visa

and Alien Registration Applicationquotesdbs_dbs50.pdfusesText_50

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