E. COMMENTS
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.
Yes No
D. U.S. TIES
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 .
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.
Page 2 of 2DS-234
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.
Yes No
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.
CONFIDENTIALITY STATEMENT AND PAPERWORK REDUCTION ACT STATEMENT
Last First Middle
Relationship to you
Date of Birth
(dd mmm yyyy)
If unknown,
check box
Special Immigrant Visa Case Number
1
2
3
4
5
6
7
Family Member Name
Last First Middle
Relationship to you
Date of Birth
(dd mmm yyyy)
If unknown,
check box
3
2
Address
1
Name
Phone Number E-mail Address
6
5
4
7
