Immigration Refusal Questionnaire

SECTION 01 · CLIENT INTAKE

Contact information

Only your first name, last name, and email address are required. All other questions are optional.

Your first name *

Your last name *

Your email address *

Your phone number

Alternative phone or WhatsApp

Country you currently live in

Preferred way to communicate, language, and scheduling notes

SECTION 02 · CLIENT INTAKE

What happened? Select all situations that apply

Choose Yes for every relevant situation. More than one event may apply; the appropriate sections will appear as you answer.

Your main immigration problem

A visa was refused or placed in administrative processing

An issued visa was revoked, cancelled, or annulled

CBP refused admission, withdrew my application for admission, or detained me at a port of entry

I received an expedited removal, deportation, exclusion, reinstatement, or immigration judge order

A USCIS petition or immigration application was denied, revoked, or reopened

A government officer found me inadmissible or identified a specific INA section

An arrest, charge, offense, conviction, or other criminal issue may be relevant

The government alleged false information, documents, concealment, or a false claim to citizenship

An overstay, unlawful presence, unauthorized work, unlawful entry, or a reentry bar may be relevant

Drug use, trafficking allegations, medical records, or substance issues may be relevant

Military, intelligence, security, or organizational associations may be relevant

I need a waiver, consent to reapply, or discretionary permission to enter

SECTION 03 · CLIENT INTAKE

Personal and citizenship information

Full legal name (if different from the contact name)

Middle name

All other names, aliases, and alternate spellings

Date of birth (YYYY-MM-DD)

City and country of birth

Current citizenship(s)

Former citizenship(s)

Country issuing your current passport

Current passport number

Passport expiration date

US Social Security Number (if any)

Alien Registration Number, A-Number (if any)

USCIS online account number

Current residential address

Mailing address, if different

Sex (as reflected in records, if relevant)

Current marital status

Additional nationalities / travel documents

Entry 1

Country

Document type and number

Valid from / through

SECTION 04 · CLIENT INTAKE

Priorities and intended immigration outcome

What would you like the firm to help you accomplish?

Visa or immigration classification you seek

Desired US travel or entry date

Known appeal, motion, departure, or filing deadline

Deadline notice or order that gives the date

Are you currently detained?

Do you have a deadline within 30 days?

Are you separated from a spouse, parent, or child because of this issue?

Describe what happened, in your own words

What outcome are you seeking and why is it important?

SECTION 05 · CLIENT INTAKE

Consular visa refusal or administrative processing

List every visa refusal or 221(g) processing notice

Entry 1

Visa category

Embassy or consulate / city

Interview date

Refusal or 221(g) worksheet date

Legal section(s) cited, exactly as written

Refused, administrative processing, or later approved

Documents requested

Officer questions and explanation

Relevant DS-160 or DS-260 confirmation number(s)

Consular case number / NVC number

Underlying USCIS petition receipt or approval number

Consular post and country

Did you receive a 221(g) refusal or administrative processing notice?

Did you receive a 214(b) refusal?

Did you receive a refusal under INA 212(a)?

Did the officer discuss a waiver?

What questions did the officer ask, and what answers did you give?

Copy the exact language from each refusal notice or worksheet

What facts or evidence have changed since the refusal?

SECTION 06 · CLIENT INTAKE

Visa cancellation, revocation, or prudential revocation

Record each visa cancellation or revocation

Entry 1

Date

Visa category

Post / agency

Section or reason cited

Notice received

Present status of visa

Was the revocation connected to an arrest or charge?

Was it described as a prudential revocation under INA 221(i)?

Did you receive written notification?

Was your visa physically cancelled or annotated?

Describe communications with DOS, the consulate, law enforcement, or airline

SECTION 07 · CLIENT INTAKE

CBP inspection, refusal of admission, or withdrawal

Each border or airport inspection / refusal

Entry 1

Date of encounter

Port of entry / preclearance / airport

Arrival route and carrier

Visa or status presented

Primary, secondary, detention and interviews

Documents given by CBP

Admission, withdrawal, expedited removal, parole, or other outcome

Most recent CBP outcome

Did you state a fear of returning to your country?

Did CBP search or copy your phone, computer, or messages?

Did you sign or initial a sworn statement?

Was an interpreter used?

Are parts of the sworn statement inaccurate?

What did CBP ask and what did you answer? Include any admissions or misunderstandings.

List any Forms I-860, I-867A/B, I-213, I-296, I-275, I-831, I-826, or other papers you received.

Identify incorrect statements, missing context, language problems, and supporting proof.

SECTION 08 · CLIENT INTAKE

Removal, deportation, exclusion, and immigration court history

Record every order or proceedings

Entry 1

Expedited, immigration judge, in absentia, reinstatement, deportation, exclusion, other

Order date

CBP, ICE, EOIR, BIA, circuit court

Court/location

A-Number / case number

INA charges

Departure or removal date

Appeal, motion, final, pending

Did you receive Form I-862 Notice to Appear?

Did you receive Form I-860 expedited removal order?

Did you receive Form I-871 reinstatement notice?

Was an order entered in your absence?

Were you granted voluntary departure?

Have you appealed or filed a motion to reopen or reconsider?

Were you interviewed for credible or reasonable fear?

Are you or were you detained by ICE?

Summarize hearing dates, court decisions, appeals, stays, motions, and compliance with departure deadlines.

Describe any three-year, five-year, ten-year, twenty-year, or permanent bar notice you received.

SECTION 09 · CLIENT INTAKE

INA grounds and inadmissibility findings

Each statutory ground or determination

Entry 1

INA section / 8 USC section exactly as stated

Date identified

DOS, CBP, USCIS, EOIR, other

Related application / case number

Facts used by government

Final finding / possible finding / pending / unknown

Most relevant category of inadmissibility

Did you receive a written inadmissibility finding?

Do you disagree with the factual or legal basis?

Have more than one ground or bar been mentioned?

Type the exact statutory language, refusal code or agency explanation.

Explain any disputed facts and supporting evidence.

SECTION 10 · CLIENT INTAKE

USCIS denial, revocation, or benefit-related decision

Record each petition, adjustment, waiver, or other USCIS decision

Entry 1

Form number and benefit

Receipt number

Date filed

Decision date

Denied, revoked, rejected, reopened, pending

Reasons and sections cited

Appeal or motion filed / deadline

Did you file or consider Form I-290B?

Was there an AAO appeal or BIA proceeding?

Was an approved petition returned from a consulate for review?

Summarize any RFE, NOID, NOIR, denial, revocation, appeal, or motion.

SECTION 11 · CLIENT INTAKE

US travel, admissions, stays, and departures

US travel and status periods (most recent first)

Entry 1

Arrival date

Departure date

Place of entry

Visa/status or admission class

I-94 number and admit-until

Work or study activities

Overstay, denial, change of status or other issue

Have you ever been inside the United States?

Have you ever stayed beyond permitted admission or status?

Have you ever worked without required authorization?

Have you ever entered the US without inspection or permission?

Are you now in the United States after a status expiration?

Date and place of first US entry

Visa or status at first US entry

Date and place of most recent US entry

Visa or status at most recent US entry

Date of most recent US departure

Most recent I-94 number

Most recent admit-until or D/S

Current immigration status, if in the US

Number of entries without inspection or permission, if any

SECTION 12 · CLIENT INTAKE

Unlawful presence, prior removals, and reentry bars

Each departure following an overstay or removal

Entry 1

Period of unauthorized stay / unlawfulness

Date of departure

Next US entry / attempted entry

Basis for alleged bar and documents

Were you told you have a three-year unlawful presence bar?

Were you told you have a ten-year unlawful presence bar?

Were you told that INA 212(a)(9)(A) applies because of removal?

Were you told INA 212(a)(9)(C) applies because of unlawful reentry or attempted reentry?

Have you remained outside the US continuously for a prolonged period?

Explain overstays, periods of authorized stay, departures, unlawful entries, and prior admission history.

Identify I-94 records, approvals, extensions, consular notices, or admission stamps.

SECTION 13 · CLIENT INTAKE

Arrests, charges, convictions, and dispositions

Every incident, including arrests without convictions, dismissed or expunged cases

Entry 1

Date of arrest or event

Location and jurisdiction

Statute and charge (original and amended)

Pending, dismissed, acquitted, conviction, diversion, warning, other

Exact outcome and sentence

Police reports, charging papers, certified dispositions

Actual underlying facts in your own words

Any arrest, citation or detention without charges?

Any pending charges or investigations?

Any deferred adjudication, plea in abeyance, diversion, or suspended sentence?

Any police warning or nonconviction matter outside the US?

Any DUI, reckless driving, or alcohol-related offense?

List sentencing, treatment, community service, probation completion, and rehabilitative evidence.

SECTION 14 · CLIENT INTAKE

Misrepresentation, false documents, and citizenship claims

Were any DS-160, DS-260, ESTA, or visa application answers inaccurate?

Was any diploma, work record, employment letter, identity record, or other document inaccurate?

Did you ever claim to be a US citizen or register/vote as one?

Did a consultant, school agent, employer, or another person prepare the disputed information?

Were you given INA 212(a)(6)(C)(i), (ii), or any other related notice?

Quote the statement or answer the government says was false; what was the truth?

Who provided the information, what did you know at the time, and when did you discover it?

Why was the information given, and what did the officer ask or investigate?

Have you corrected the record? Explain timing and documentation.

SECTION 15 · CLIENT INTAKE

Drug-use, medical, and trafficking allegations

Did you admit using controlled substances to an officer or medical examiner?

Were you accused of possessing, distributing, helping, or trafficking drugs?

Was there a foreign drug investigation, warning, diversion, or noncriminal disposition?

Did a panel physician, USCIS doctor, or consular officer discuss a medical ground?

Have you completed treatment, evaluation, or testing?

Drug, medical, or agency incidents

Entry 1

Date

Country and agency

Substance or allegation

Use, possession, trafficking allegation, medical issue, other

Conviction, warning, no charge, pending, other

Supporting records and statements

Explain the actual facts and what was stated to officials, including whether statements are disputed.

SECTION 16 · CLIENT INTAKE

Security, military, and organizational associations

Military, government, security, political, or other organizational history

Entry 1

Organization or unit

Country

Role and duties

Dates

Any allegations, questioning or disciplinary records

Was INA 212(a)(3) or a terrorism-related ground raised?

Was a reason-to-believe trafficking ground, such as INA 212(a)(2)(C), raised?

Have you served in the military, police, intelligence, or security forces?

Describe the alleged association, actual duties, evidence, official reviews, and any exoneration.

SECTION 17 · CLIENT INTAKE

Waiver, permission to reapply, or discretionary relief

Which remedy has been discussed?

Prior waiver or permission-to-reapply filings

Entry 1

Form or relief type

Receipt/case number

Filed

Decision and date

Approval/denial grounds

Do you have a US citizen or lawful permanent resident spouse or parent?

Do you have US citizen or lawful permanent resident children?

Are urgent humanitarian or public interest factors involved?

Was a waiver or I-212 previously denied?

Identify qualifying family relationships and US immigration status.

Describe separation, health, finances, care needs, education, psychological impacts, and hardship evidence.

Describe rehabilitation, good character, compliance, employment, and other favorable considerations.

Explain previous waiver decisions and what changed.

SECTION 18 · CLIENT INTAKE

Family ties and immigration sponsorship

Spouse, parents, children, and other relevant family members

Entry 1

Name

Relationship

US citizen, green card, visa status, outside US

Where living

Birth date

Caregiving or other special circumstances

Do you have a pending or approved US family or employment petition?

Do you have a US employer or organization sponsoring you?

Petition form and category

Petition receipt number, approval date, and priority date

SECTION 19 · CLIENT INTAKE

Documents, FOIA records, and official correspondence

List relevant government notices and evidence

Entry 1

Form, notice, letter or record

USCIS, DOS, CBP, ICE, EOIR, or other

Date

Related reference

Do you have a copy?

Important content

Have you requested records through FOIA?

Are critical refusal or removal documents missing?

Do records require translation?

List documents you have, need to obtain, or plan to share securely.

Any important dates, facts, or legal issues not covered above.

SECTION 20 · CLIENT INTAKE

Additional explanations and final submission

This is a confidential law firm intake, not a government filing or waiver application. Do not email passports or other original documents.

Questions you want our office to address

Other explanations, dates, important facts, or corrections

Contact information

What happened? Select all situations that apply

Personal and citizenship information

Priorities and intended immigration outcome

Consular visa refusal or administrative processing

Visa cancellation, revocation, or prudential revocation

CBP inspection, refusal of admission, or withdrawal

Removal, deportation, exclusion, and immigration court history

INA grounds and inadmissibility findings

USCIS denial, revocation, or benefit-related decision

US travel, admissions, stays, and departures

Unlawful presence, prior removals, and reentry bars

Arrests, charges, convictions, and dispositions

Misrepresentation, false documents, and citizenship claims

Drug-use, medical, and trafficking allegations

Security, military, and organizational associations

Waiver, permission to reapply, or discretionary relief

Family ties and immigration sponsorship

Documents, FOIA records, and official correspondence

Additional explanations and final submission

Secure submission