2/5/2016 NonimmigrantVisaReviewSecurityInformation

OnlineNonimmigrantVisaApplication(DS160) ApplicationIDAA005M2AVU

SecurityandBackgroundInformation

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Doyouhaveacommunicablediseaseofpublichealthsignificance?(Communicablediseasesof NO
publicsignificanceincludechancroid,gonorrhea,granulomainguinale,infectiousleprosy,
lymphogranulomavenereum,infectiousstagesyphilis,activetuberculosis,andotherdiseasesas
determinedbytheDepartmentofHealthandHumanServices.)

Doyouhaveamentalorphysicaldisorderthatposesorislikelytoposeathreattothesafetyor NO
welfareofyourselforothers?

Areyouorhaveyoueverbeenadrugabuseroraddict? NO

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Haveyoueverbeenarrestedorconvictedforanyoffenseorcrime,eventhoughsubjectofa NO
pardon,amnesty,orothersimilaraction?

Haveyoueverviolated,orengagedinaconspiracytoviolate,anylawrelatingtocontrolled NO
substances?

AreyoucomingtotheUnitedStatestoengageinprostitutionorunlawfulcommercializedviceor NO
haveyoubeenengagedinprostitutionorprocuringprostituteswithinthepast10years?

Haveyoueverbeeninvolvedin,ordoyouseektoengagein,moneylaundering? NO

HaveyouevercommittedorconspiredtocommitahumantraffickingoffenseintheUnitedStates NO
oroutsidetheUnitedStates?

Areyouthespouse,son,ordaughterofanindividualwhohascommittedorconspiredtocommit NO
ahumantraffickingoffenseintheUnitedStatesoroutsidetheUnitedStatesandhaveyouwithin
thelastfiveyears,knowinglybenefitedfromthetraffickingactivities?

Haveyouknowinglyaided,abetted,assistedorcolludedwithanindividualwhohascommittedor NO
conspiredtocommitaseverehumantraffickingoffenseintheUnitedStatesoroutsidetheUnited
States?

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Doyouseektoengageinespionage,sabotage,exportcontrolviolations,oranyotherillegal NO
activitywhileintheUnitedStates?

DoyouseektoengageinterroristactivitieswhileintheUnitedStatesorhaveyoueverengaged NO
interroristactivities?

Haveyoueverordoyouintendtoprovidefinancialassistanceorothersupporttoterroristsor NO
terroristorganizations?

Areyouamemberorrepresentativeofaterroristorganization? NO

Haveyoueverordered,incited,committed,assisted,orotherwiseparticipatedingenocide? NO

Haveyouevercommitted,ordered,incited,assisted,orotherwiseparticipatedintorture? NO

Haveyoucommitted,ordered,incited,assisted,orotherwiseparticipatedinextrajudicialkillings, NO
politicalkillings,orotheractsofviolence?

Haveyoueverengagedintherecruitmentortheuseofthechildsoldiers? NO

Haveyou,whileservingasagovernmentofficial,beenresponsibleforordirectlycarriedout,at NO
anytime,particularlysevereviolationsofreligiousfreedom?

Haveyoueverbeendirectlyinvolvedintheestablishmentorenforcementofthepopulation NO
controlsforcingawomantoundergoanabortionagainstherfreechoiceoramanorawomanto
undergosterilizationagainsthisorherfreewill?

https://ceac.state.gov/GenNIV/General/review/review_reviewsecurity.aspx?node=ReviewSecurity 1/2
2/5/2016 NonimmigrantVisaReviewSecurityInformation
Haveyoueverbeendirectlyinvolvedinthecoercivetransplantationofhumanorgansorbodily NO
tissue?

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Haveyoueversoughttoobtainorassistotherstoobtainavisa,entryintotheUnitedStates,or NO
anyotherUnitedStatesimmigrationbenefitbyfraudorwillfulmisrepresentationorother
unlawfulmeans?

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HaveyoueverwithheldcustodyofaU.S.citizenchildoutsidetheUnitedStatesfromaperson NO
grantedlegalcustodybyaU.S.court?

HaveyouvotedintheUnitedStatesinviolationofanylaworregulation? NO

HaveyoueverrenouncedUnitedStatescitizenshipforthepurposeofavoidingtaxation? NO

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https://ceac.state.gov/GenNIV/General/review/review_reviewsecurity.aspx?node=ReviewSecurity 2/2