Form DS-3097 Annual Report, J-1 Exchange Visitor Program

Mail/FAX Report to:
ECA/EC/ECD - Exchange Visitor
Program
301 4th Street, SW - Room 734, SA-44
Washington, DC 20547
FAX: (202) 401-9809

U.S. Department of State

OMB Approval No. 1405-0151
Expires : XXXXXXXXXXXXX
Estimate Burden: I Hour

ANNUAL REPORT

J -1 Exchange Visitor Program
Program Number
Reporting Period

Responsible Officer

Include This Information on Any Attachments

Sponsoring Organization
Address
STATISTICAL REPORT
1. Activity by Category
Category
1. (a) Student - Secondary School
(b) Student - Post-Secondary
2. Trainee
3. Teacher
4. Professor
5. International Visitor
6. Alien Physician
7. Government Visitor
8. Research Scholar
9. Short-Term Scholar
10. Specialist
11. Camp Counselor
12. Summer Work/Travel
13. Au Pair
14. Intern
Total Number of Participants

2. Reconciliation of Forms DS-2019
Total Number of
Participants in Each
Category of Your Program
During the Reporting

Use of Forms DS-2019
During the Reporting Period

Number of Document Numbers of Forms
DS-2019
Forms
(Indicate Singly or as Range(s). Use
DS-2019 separate sheet of paper, as needed)

A. BLANK Forms DS-2019 "On Hand"
(BEGINNING of Reporting Period)
B. BLANK Forms DS-2019 received from DOS during
Reporting Period
(Don't include Forms DS-2019 "On Hand")
C. Number of Forms DS-2019 available during the
Reporting Period. (Add A+B)
D. Number of Forms DS-2019 issued or used during the
Reporting Period
E. Remaining (BLANK) of Forms DS-2019 at END of the
Reporting Period (Subtract C - D)
F. Number of Forms DS-2019 issued to participants
beginning a new Program during Reporting Period
G. Number of Forms DS-2019 issued during the
Reporting Period for extension, transfer, change of
category, reinstatement replacement amendments
and J-2 dependents
H. Number of Forms DS-2019 voided, destroyed, lost,
stolen or issued but not used

PAPERWORK REDUCTION ACT
Public reporting burden for this collection of information is estimated to average one hour per response, including time required for searching existing data sources, gathering the necessary data and/or
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 Office of
Management and Budget (OMB) number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: Information Collection Officer,
U.S. Department of State, A/RPS/DIR, 1800 G Street (Suite 2400), NW, Washington, DC 20522.
DS-3097
02-2006

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PROGRAM EVALUATION

CERTIFICATION

A core mission of the Exchange Visitor Program is to promote mutual understanding between
people of the United States and other countries through educational and cultural exchanges.
Comments and assessments from you help us present the success of our shared mission of
exchange to Congress, interested government agencies, and International agencies and
organizations. On a separate sheet, please provide brief responses to the following questions.
Please include both those factors that may be under our jurisdiction and outside factors that we
may wish to address in our relationships with other private and public organizations and/or U.S.
government and international agencies.

I certify that the information in this report is complete and correct to the best of my knowledge and
belief; and, that the above named program sponsor has complied with all health and accident
insurance requirements for exchange visitors and any accompanying spouse and their dependents
[22 CFR §62.14].
Name of Responsible Officer (Printed or Typed)
Signature of Responsible Officer (Signed)

(1) What new directions, trends, or significant changes have occurred in your program and what
changes do you plan or expect for the future? Examples: new cooperative of bilateral
exchange Initiatives, new countries, shifts in undergraduate or graduate participation, shifts in
countries of origin, variations in sources of funding, etc.).

Date (mm-dd-yyyy)

(2) What general problems do you see working against the quality and quantity of exchanges in
your program and in the broader Exchange Visitor Program?
(3) What new developments seem to be working especially well to improve or facilitate
exchanges?
(4) If your program conducts exit interviews or assesses the exchange visitors' experiences
in other ways, what are some of their comments regarding the Exchange Visitor

REPORTING PERIODS AND DUE DATES FOR ANNUAL REPORTS
The reporting period and due dates are set forth in the designation letters for exchange visitor
program sponsors and are reflected below.

Program? Example: major positive or negative experiences; how the exchange visitor
experience will affect their professional and/or personal lives when they return home;
other comments that might help us evaluate our administration of the Exchange Visitor

Program Types

Reporting Period

Due Date

Program.
(5) Do you have, or are you planning to organize an exchange visitor alumni association?

July 1 - June 30

July 31

Business Organization (P-4)
and Various Non-Profit
Organizations (P-3)

January 1 - December 31

January 31

PROGRAM EXPANSION: INCREASE IN THE ANNUAL ALLOTMENT
OF FORMS DS-2019 FOR THE NEXT REPORTING PERIOD

Camp Counselor Programs (P-3/P-4)

October 1 - September 30

October 31

Do you anticipate program growth exceeding 10 percent for the NEXT Reporting Period? If yes,
provide a basis upon which the expansion will occur.

Summer Work/Travel Programs

January 1 - December 31

January 31

January 1 - December 31

January 31

October 1 - September 30

October 31

January 1 - December 31

June 15

January 1 - December 31

January 31

(6) Provide the number of Americans who went abroad and a brief description of their activity.

YES

NO

With respect to the proposed increase in the Exchange Visitor Program, the sponsor for whom this
report has been submitted, anticipates that there will be adequate staffing and sufficient support
services to administer this Exchange Visitor Program.
Will you need additional forms for program growth or for other reasons? Provide detailed
information if the program is not growing significantly but the need for Forms DS-2019 is
increasing.

Academic & Research Organizations

Academic Institutions

(P-3/P-4)

(Training Programs/P-3)

Government Programs (G-1through G-6)

Au Pair Programs

(P-3)

High School Programs (P-3)
YES

(P-1, P-2 & P-3)

NO

Indicate the number of Forms DS-2019 needed beyond the annual supply

DS-3097

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