U.S. Department of State
OMB APPROVAL NO. 1405-0203
Bureau of Population, Refugees and Migration
ESTIMATED BURDEN: 20 MIN.
SPECIAL IMMIGRANT VISA BIODATA FORM
Special immigrant visa applicants who qualify for and request resettlement assistance from the Department of State must complete this form for each
family member and submit it via email as a scanned attachment to the National Visa Center at NVCSIV@state.gov .
A. CASE INFORMATION (To be completed by NVC)
NVC Case Number
Post POC Information
B. CASE MEMBER
1. Case Size (Yourself plus family members
3. If not, what is your relationship to the PA?
2. Are you the principal applicant (PA)?
traveling with you)
(Husband, wife, son, daughter)
4. Name as it Appears on your Passport (Last, First, Middle)
6. Marital Status
7. Date of Birth (mm-dd-yyyy)
8. Place of Birth (City, Country)
12. Physical Address
13. Phone Number(s)
15. Last Occupation/Skill
16. Education Level/Field of Study
17. Native Language
18. Other Language(s)
19. English Speaking Ability (Good, Some, None)
20. Health Issues (Condition, Treatment, Pregnancy, Urgency, Comments)
C. CROSS REFERENCE
21. Do you have other immediate family members being processed on their own special immigrant visas?
Page 1 of 2
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 .