601-1 Family Reunification Travel Questionnaire

DEPARTMENT OF HOMELAND SECURITY

FAMILY REUNIFICATION TRAVEL QUESTIONNAIRE
Traveler First Name
Date of Birth

Traveler Middle Name
Gender

Passport Number

Traveler Last (Family) Name

A Number
Country Passport Issued

Traveler Phone Number

Phone works in U.S.

Language(s) Spoken

Issued Date (MM/DD/YYYY)

Expiration Date (MM/DD/YYYY)

Traveler Email Address (if available)
Attorney / NGO Name and Contact Information (Phone and/or email)

TRAVEL DOCUMENTS
All travel documents are required (pending home country requirements) prior to booking and traveling to the United States.
The below listed items must be met or completed before travel arrangements will be completed.
I-131 Form Submitted and Parole Request Granted
Home Country Exit Travel Documents (e.g. Passport) Completed
Single Parent Travel Documents (if applicable)
US Embassy/Consulate Appointment: (Fingerprint Collection, Identity Interview, Travel Foil applied in Passport)
Appointment Drop off Date of the Passport:
Anticipated Pickup Date:
Completed COVID-19 Pre-travel Testing (only negative test results will be accepted for travel purposes)

TRAVEL INFORMATION
Departure Airport Location (City, Country)

Final Airport Destination Location (or Airport Region)

Intended U.S. Address
Travelers Requested Time Frame for Travel Itinerary

Email to receive Electronic Itinerary

Number of Planned Checked Bags

Full Names, Date of Birth, and Country of Citizenship of others in your traveling party for coordination of Travel Itinerary

SPECIAL ASSISTANCE REQUEST (Check all that apply)
Transportation and Lodging Assistance
Hotel in home country (prior to flight)
Number of hotel nights required:
Transportation to airport in home country
Mode of transportation to be used:
Special Needs Assistance (e.g., Wheelchair)

Coordination of In-Transit Support (Further coordination and
confirmation is required). Please explain assistance requested:
Reunification Assistance at Airport (Private Room, Escort)
Notification of Expected Media Engagement (upon arrival)
Additional Notes:

Traveling with an Infant/Infant Care
(Car Seat, Nursing Room, Stoller)
Pre-arranged non-government Escort
(attorney, non-government organization, etc.)
DHS Form XXX (6/21)

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