US Visa Questionnaire for the DS-160 Form | Palm Bay



Aerial view of Miami Beach — US visa questionnaire for the DS-160 form

US Visa Questionnaire for the DS-160 Form

US visa

Please fill in every field of this questionnaire as fully and accurately as you can — we will use it to prepare your DS-160 form for your US visa application. The more complete and precise your answers, the fewer corrections will be needed later and the lower the risk of mistakes in the form itself.

On this page:

1. Personal details

1. Surname (as in your passport) *
2. Given name(s) (as in your passport) *
3. Full name in your native alphabet (as in your passport) *
4. Have you ever used other names or surnames? If yes, list them
5. Do you have a telecode that represents your name?
6. Sex *
7. Marital status *
8. Date of birth (day-month-year) *
9. City of birth *
10. State/province of birth
11. Country of birth *
12. Nationality *
13. Have you held any other nationality?
14. Are you a permanent resident of another country? If yes, which one

2. Identification numbers

15. National identification number / internal passport number
16. US Social Security Number (if any)
17. US Taxpayer ID number (if any)

3. Contact information

18. Home address: street, building, apartment, city, state/province, postal code, country *
19. Mailing address (if it is the same as your home address, write "same")
20. Phone number *
21. Secondary phone number (if any)
22. Work phone number (if any)
23. Other phone numbers used in the last 5 years (if any)
24. Other email addresses used in the last 5 years (if any)
25. Social media accounts used in the last 5 years — links (Facebook, Instagram, YouTube, X/Twitter, VK, etc.)
26. Other platforms where you have posted photos/videos (with links to the account)

4. Passport

27. Passport type *
28. Passport number *
28a. Passport book number (if any)
29. Issuing country *
30. City of issue *
31. State/province of issue
32. Country where issued (physical location, e.g. a consulate in the UAE)
33. Issue date and expiry date *
34. Have you ever lost a passport or had one stolen?

5. Trip information

35. Purpose of trip *
35a. Specify the visa subtype (e.g. B1 — business, B2 — tourism, B1/B2 — combined) *
36. Do you have a detailed travel plan? If yes, describe it
37. Intended arrival dates in the US *
38. How long do you plan to stay? *
39-40. Address where you will stay in the US: street, building, apartment, city, state, ZIP code *
41. Who is paying for the trip? *
42. Is anyone travelling with you?
43. Are you travelling as part of a group or organisation?
44. Who is travelling with you: full name and relationship

6. Previous US travel and visa history

45. Have you been to the US before? If yes, list your last 5 visits with arrival and departure dates
46. Have you ever held a US driver's licence? If yes, the number and issuing state
47. Have you ever been issued a US visa? If yes, the issue date and visa number
48. Are you applying for the same type of visa?
49. Are you applying in the same country where you applied before?
50. Have your fingerprints been taken before?
51. Has a US visa ever been lost or stolen?
52. Has a US visa ever been cancelled or revoked?
53. Have you ever been refused a US visa, refused admission to the US, or had a visa cancelled at the border? If yes, explain
54. Has anyone ever filed an immigrant petition on your behalf in the US?

7. US contact, family and relatives in the US

55. Contact in the US (if any): full name or organisation, relationship to you, address, phone, email, ZIP code
56. Father: full name and date of birth. Is he in the US?
57. Mother: full name and date of birth. Is she in the US?
58. Any other immediate or other relatives in the US?
59. Spouse: full name, nationality, date of birth, city and country of birth, home address (if the same as your mailing address — "same")

8. Work and education

60. Primary occupation: name of employer or school, address, phone *
61. Monthly income in local currency *
62. Describe your duties at work *
62a. Start date at your current job *
63. Previous employers/schools in the last 5 years: address, postal code, country, city, phone, job title, supervisor's full name, start and end dates, duties (for children — from secondary school onwards)
64. Education (secondary school and above): school name, address, city, postal code, country, course of study, start and end dates

9. Additional questions

65. Languages you speak *
66. Which countries have you travelled to in the last 5 years? *
67. Do you have any skills or training related to explosives, or nuclear, chemical or biological substances?
68. Have you served in the military? If yes: country, branch of service, rank/position, dates
Do you belong to a clan or tribe?
Have you belonged to, contributed to or worked for any professional, social or charitable organisation?
Have you ever served in, been a member of or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group or insurgent organisation (separate from a regular army)?
Did anyone help you fill in the DS-160 form? If yes, who
In which country and city will you submit your visa application? *

10. Security and background questions

This is a mandatory section of the official DS-160 form. For the vast majority of applicants, the answer to every question below is "No". Read through the list and answer the single overall question below. Answer honestly: false information can lead to a permanent ban on entering the US.

  • A communicable disease of public health significance
  • A mental or physical disorder that poses a threat to your safety or the safety of others
  • Drug abuse or drug addiction (current or past)
  • Arrest or conviction for any offence or crime (even if pardoned or covered by an amnesty)
  • Violating, or conspiring to violate, any law relating to controlled substances
  • Engaging in prostitution or procuring for commercialised vice within the last 10 years
  • Involvement in money laundering
  • Committing, or conspiring to commit, a human trafficking offence
  • Being the spouse, son or daughter of someone involved in human trafficking and having benefited from it in the last 5 years
  • Aiding, assisting or colluding with a human trafficker
  • Seeking to engage in espionage, sabotage, export control violations or any other illegal activity in the US
  • Engaging in terrorist activity, or intending to do so in the US
  • Providing financial or other support to terrorists or terrorist organisations
  • Being a member or representative of a terrorist organisation
  • Being the spouse, son or daughter of someone involved in terrorism within the last 5 years
  • Involvement in genocide (committing, ordering or assisting)
  • Involvement in torture (committing, ordering or assisting)
  • Involvement in extrajudicial or political killings or other acts of violence
  • Recruiting or using child soldiers
  • Being responsible, as a government official, for violations of religious freedom
  • Involvement in forcing a person to have an abortion or sterilisation against their will
  • Involvement in the coerced transplantation of human organs or tissue
  • Having been the subject of a removal or deportation hearing
  • Having sought a visa, entry into the US or any other immigration benefit by fraud
  • Failing to attend a removal or inadmissibility hearing within the last 5 years
  • Having been unlawfully present in the US, overstayed a visa or otherwise violated the terms of a US visa
  • Having been deported from any country
  • Withholding custody of a US citizen child outside the US from a person granted legal custody
  • Voting in the US in violation of the law
  • Renouncing US citizenship to avoid taxation
  • Attending a US public school in F status after 30.11.1996 without reimbursing the school
Does at least one of the items above apply to you? *
If you answered "Yes" — explain in detail which item it is and what happened

11. Photo requirements

Photo requirements: a square digital image (height equal to width), minimum 600×600 pixels, maximum 1200×1200 pixels. The photo must be in colour (24 bits per pixel) in the sRGB colour space, in JPEG format, no larger than 240 KB. Compression ratio no more than 20:1. You can check your photo against the requirements on the official website: tsg.phototool.state.gov/photo.

Upload your photo *
Comments (optional)
Your name *
Phone/WhatsApp *
Email *

* Fields marked with an asterisk are required.