Read every question aloud in the client’s language and record the answer. Any Yes opens a notes box and flags the file for attorney review.
How to run this. Never let a client answer these alone. Use the plain wording here, not the form’s legal wording. “Ever” means ever — any country, any age, including sealed, expunged, dismissed, or juvenile matters; say that out loud before Section D. Never suggest an answer. If the client is unsure, mark Unsure — do not convert it to No.
Language0 / 42 answered0 flagged
A. Public charge & financial support
Q1
Have you EVER received public benefits in the U.S. — cash assistance, SSI, TANF, long-term care at government expense?
Q2
Do you currently have health insurance? Who pays for it?
Q3
Have you ever failed to support a family member you were legally required to support (including child support)?
B. Immigration history & violations
Q4
Have you EVER entered the U.S. without being inspected by an immigration officer?
Q5
Have you ever stayed in the U.S. longer than permitted on your I-94?
Q6
Have you ever worked in the U.S. without authorization?
Q7
Have you ever violated the terms of any visa or status you held?
Q8
Have you EVER been deported, removed, excluded, or granted voluntary departure?
Q9
Are you now, or have you ever been, in removal or deportation proceedings?
Q10
Has any immigration application you filed ever been denied, revoked, or withdrawn?
Q11
Have you ever been refused a visa or refused entry at the border or an airport?
Q12
Have you ever had a J-1 or J-2 visa subject to the two-year home residency requirement?
C. Fraud & misrepresentation
Q13
Have you EVER used a name other than your legal name with immigration or any government agency?
Q14
Have you ever used a false, altered, or another person's document for any purpose?
Q15
Have you EVER claimed to be a U.S. citizen — on a form, a job application (I-9), or verbally?
Q16
Have you ever registered to vote or voted in any U.S. election, at any level?
Q17
Have you ever lied to, or withheld information from, a U.S. immigration or consular officer?
Q18
Have you ever entered into a marriage for the purpose of obtaining an immigration benefit?
D. Criminal history — ask every question, even if they say no
Q19
Have you EVER been arrested, cited, charged, or detained by ANY law enforcement officer, in ANY country?
Q20
Include anything dismissed, expunged, sealed, pardoned, or from when you were a minor — has that ever happened?
Q21
Have you ever been convicted of any crime, or pled guilty or no contest?
Q22
Any traffic offenses involving alcohol, drugs, injury, or a suspended licence?
Q23
Have you ever violated any controlled-substance law, or been a drug user or addict?
Q24
Have you ever engaged in prostitution, or procured prostitution for others?
Q25
Have you ever been involved in money laundering, or trafficking in persons?
Q26
Have you ever helped, encouraged, or paid for anyone to enter the U.S. illegally — including relatives?
Q27
Are you currently on probation, parole, or under any court order?
E. Security, groups & armed service
Q28
Have you EVER served in any military, paramilitary, police, guerrilla, or self-defense unit, in any country?
Q29
Have you ever received weapons or combat training?
Q30
Have you EVER been a member of, or given money or help to, any political party, group, or organization anywhere?
Q31
Have you ever been involved with a group that used weapons or violence against people or property?
Q32
Have you ever been a member of the Communist or any totalitarian party?
Q33
Were you ever involved, in any way, with the Nazi government, genocide, torture, or killings?
Q34
Have you ever recruited or used child soldiers, or been involved in forced labour?
Q35
Have you ever been involved in severe violations of religious freedom while a government official?
F. Health & other grounds
Q36
Do you have a communicable disease of public health significance (e.g. TB, untreated syphilis)?
Q37
Do you have a physical or mental disorder with behaviour that has posed a threat to yourself or others?
Q38
Have you ever been treated for, or told you have, a substance use problem?
Q39
Are your vaccinations up to date, or do you object to vaccination on religious/moral grounds?
Q40
Do you intend to engage in any unlawful activity, or activity that could endanger U.S. safety?
Q41
Have you ever gambled illegally, or been a habitual drunkard?
Q42
Have you ever renounced U.S. citizenship to avoid taxes, or left the U.S. to avoid military service?
Flagged for attorney review:none yet
Escalate to the client’s attorney — do not proceed — for any arrest or criminal matter, removal or deportation history, fraud or false-document use, false claim to U.S. citizenship, unlawful voting, armed-group or military service, or a J-1 two-year requirement.
