Form DS-3097 J-Nonimmigrant Exchange Visitor Program Annual Report

U.S. Department of State

ANNUAL REPORT

*OMB Approval No. 1405-0151
Expires : XX/XX/XXXX
Estimate Burden: 3 Hours

J-NONIMMIGRANT Exchange Visitor Program
Responsible Officer

Program Number
Reporting Period

Sponsoring Organization
Address

Include This Information on Any Attachments
STATISTICAL REPORT
1. Activity by Category

Category

2. Reconciliation of Forms DS-2019
Total Number of Records
Created in Each Category
to begin a New Program
J-1

1. Alien Physician

J-2

Use of Forms DS-2019 During the Reporting Period

Number of
Forms DS-2019

A. Allotment Carried Over from Previous Reporting Period
B. Allotment Received from DOS During Reporting Period
C. Number of Records Available During the Reporting Period (Add A + B)

2. Au Pair
D. Number of Records DS-2019 Created During the Reporting Period
3. Camp Counselor
E. Total Number of Invalid Records
4. Government Visitor
F. Remaining Records Available at End of Reporting Period (C - D + E =F)
5. Intern
6. International Visitor
7. Professor
8. Research Scholar
9. Short-Term Scholar
10. Specialist

3. Record Statuses

Number of
Records

A. Active Records
B. Inactive Records

11. Student - Post-Secondary
12. Student - Secondary School
13. Summer Work/Travel

C. No Show Records
D. Terminated Records
E. Invalid Records

14. Teacher
F. Transferred Records
15. Trainee
Total Number of Records

Special Instructions
Please submit Annual Reports by e-mail to the Office of Designation. E-mail addresses may be found at http://j1visa.state.gov/contact .
Paperwork Reduction Act (PRA) Statement
*Public reporting burden for this collection of information is estimated to average three hours per response, including time required for searching existing data sources, gathering the necessary
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 OMB
control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: U.S. Department of State, Office of Designation SA-44,
6th Floor, 301 4th Street, SW, Washington, DC 20547.
DS-3097
XX-XXXX

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PROGRAM EVALUATION
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. Your comments and assessments help us present the success of our shared mission of exchange to Congress, interested government agencies, and International
agencies and organizations. Please provide brief responses to the following questions.
1. Summary: Provide a brief summary of the activities in which exchange visitors were engaged, including:
1A. Program Effectiveness: Please provide an evaluation of program effectiveness including a description of one or two brief success stories that occurred during the reporting period.
1B. Trends/Changes: Describe any new directions, trends or significant changes that have occurred in your program during the reporting period.
1C. New Initiatives: Describe any new initiatives that you are planning in the upcoming year.
2. Difficulties: What difficulties are you having that are working against the quality and quantity of exchanges in your program and in the broader Exchange Visitor Program?
Examples: Credible employers, job availability, wages, housing, Consular Official/Visa issues, etc.
3. Reciprocity: Describe the nature and extent of reciprocity occurring in your exchange visitor program during the reporting year. If none, state: none.
4. Cross-Cultural Activities: Provide a summary of the cross-cultural activities you as a sponsor provided for your exchange visitors during the reporting year and your other efforts as a
sponsor to ensure cultural exchange for your exchange visitors.
5. Staff: Identify the number of staff (full and part time) used in the administration of your exchange visitor program.
Examples: Private sector entities should include total local and regional representatives, independent contractors, third parties, foreign agents , and volunteers.
6. Other comments:

CERTIFICATION
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 their accompanying spouses and dependents [22 CFR 62.14].

Name of Responsible Officer (Printed or Typed)

By checking this box, I certify that I am the individual submitting this document.

Date (mm-dd-yyyy)

Submission by e-mail is preferred, but hard copies in lieu of e-mail may be mailed to:
U.S. Department of State
Office of Designation
SA-44, 6th Floor
301 4th Street, SW
Washington, DC 20547

DS-3097

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