Refugee Biographic Data Intake Script

Information Collection Intake Script.docx

Refugee Biographic Data

Refugee Biographic Data Intake Script

OMB: 1405-0102

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RSC Information Collections Questions which address the information you have in the document:

  • In which city/country were you born?

  • When is your birthday?

  • What is your ethnicity or tribe?

  • What religion do you practice?

    • Are you married and if so how long have you been married?

  • When did you flee your country of birth?

  • When did you arrive in your first country of asylum?

  • What is the highest level of school you completed?

    • What is the name of the school and its location?

    • When did you begin/stop attending this school?

    • Did you receive a degree or certificate from the school?

  • What was the last job you held?

    • Who was your employer?

    • What country was this job located in?

    • What is the address of the job?

    • When did you begin and end working at the job?

  • Do you have any artisan skills or trade of note?

  • What language are you most comfortable speaking?

    • Can you read/write in this language?

  • What is your ability to speak English?

    • Can read/write in English?

  • Do you know anyone in the US that you would like to be resettled near?

    • What is your relationship to this person?

    • Is the person a US resident and where do they live?

Additional Questions asked during the Prescreening Interview:

  • Bio 2 Tab

    • Have you ever been threatened by a group or individual?

      • If yes, by whom and how was the threat delivered?

  • Identification Tab

    • Have you ever used any other name (nickname) than the one you are presenting today ?

    • Do you have any documents with other names you might have used?

  • Medical Health Tab

    • Do you have any medical conditions you would like to report to me?

    • (Female applicants) Is anyone pregnant?

  • Citizenship Tab

    • What country are you a citizen of?

  • Address Tab

    • Please provide all addresses you have resided in for the last five years?

    • When did you start/stop residing at the address?

  • Military Service Tab

    • Have you ever served in the military?

      • Which branch of the military were you in?

      • What was your duty location?

      • What was the highest rank attained?

      • What was your specialty?

      • What was your serial number?

      • When did you start/end your military service?

  • Law Violations Tab

    • Have you ever been convicted of a crime?

      • What was the nature of your arrest?

      • In which country were you arrested?

      • What was the date of your arrest/release?

  • Organizations Tab

    • Have you ever been a member of a political, professional or social organization?

    • If yes, what was the organizations name and location?

    • When did you join the organization?

    • When did you stop being a member of the organization?

    • What was the purpose or nature of the organization?

    • What was your rank in the organization?

    • What were your duties in the organization?

    • How much were the organization dues?

  • US Visits Tab

    • Have you ever visited the US?

    • When did you enter/depart the US?

    • What was the purpose of your visit to the US?

    • Do you know what your alien number is after visiting the US?

  • Contact Info Tab

    • Please provide all phone number and email addresses you have used in the last five years.

      • When did you start/stop using this contact?

      • Is this contact the best way to reach you?

  • Family Tree

    • Please provide information about your parents, spouse, siblings and children.

      • Including all half, step, adopted and foster relationships.

    • What is the name of your family member?

    • What is your family member’s date of birth?

    • What is your relationship to this family member?

    • Where was your family member born?

    • Where does your family member live currently?

    • What is your family members contact information?

    • Is your family member married?

    • How many times has your family member been married?



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMarlon Hite
File Modified0000-00-00
File Created2021-01-27

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