New Client Immigration Intake Questionnaire (Wang Min)
Purpose and Instructions
- Purpose: This questionnaire is designed to collect complete and accurate information necessary to evaluate immigration options, admissibility, potential bars and waivers, and eligibility for benefits under the Immigration and Nationality Act (INA), corresponding regulations (8 C.F.R.), and applicable guidance.
- Confidentiality: Information provided is confidential and, if an attorney-client relationship is later formed, protected by the attorney-client privilege and attorney work-product doctrine to the extent permitted by law. At the intake stage, no legal services are provided and no attorney-client relationship is formed until a written engagement agreement is executed following a conflict check.
- Accuracy: Provide truthful, complete, and consistent information. Misrepresentations to counsel or to the U.S. Government may have serious consequences, including inadmissibility for fraud or willful misrepresentation (INA § 212(a)(6)(C)(i)).
- Documents: Provide legible copies of all relevant immigration, civil status, criminal, and travel documents referenced herein.
Language and Accessibility
- Preferred language: __________ Interpreter needed: [ ] Yes [ ] No
- If Yes, interpreter name/contact and certification (to be completed at signature page).
Section 1. Conflicts Check and Identifying Information
- Full legal name (as in passport): Wang Min
- Other names/aliases/maiden names/Chinese characters (if any): __________________________________
- Date of birth (YYYY-MM-DD): __________ Place of birth (City/Province/Country): __________
- Country(ies) of citizenship or nationality: __________
- A-Number (if any): A# __________
- U.S. Social Security Number (if any): __________
- USCIS Online Account Number (if any): __________
- Passport number(s) and issuing country(ies): __________ Expiration date(s): __________
- Current U.S. address: __________________________________ County: __________
- Phone(s): __________ Email: __________
- Emergency contact (name/relationship/phone/email): __________
- Prior counsel in any immigration matter (name/firm): __________ Dates: __________
- Adverse parties or related parties for conflicts check (e.g., petitioner, employer, spouse, prior spouse, sponsor): list full legal names and dates of birth:
- __________ DOB: __________ Relationship: __________
- __________ DOB: __________ Relationship: __________
Section 2. Immigration Status and History
- Current immigration status in the U.S. (e.g., B-2, F-1, H-1B, TPS, DACA, parole, no status): __________
- Last entry to the U.S.: Date: __________ Place: __________ Class of admission (per I-94): __________
- I-94 number: __________ Admit until date or D/S: __________
- Prior entries to the U.S. (list all, most recent first): date/place/class of admission: __________
- Have you ever overstayed or violated status (e.g., unauthorized employment, failure to maintain full-time study)? [ ] Yes [ ] No. If Yes, provide details and dates: __________
- Have you ever departed after accruing unlawful presence of 180+ days or 365+ days (INA § 212(a)(9)(B))? [ ] Yes [ ] No. Details/dates: __________
- Have you ever reentered or attempted to reenter without inspection after prior removal or after >1 year unlawful presence (INA § 212(a)(9)(C))? [ ] Yes [ ] No. Details: __________
- Have you ever been issued a Notice to Appear (NTA), placed in removal, exclusion, or deportation proceedings, or ordered removed/voluntarily departed (INA § 240, § 235(b), § 240B)? [ ] Yes [ ] No. If Yes, EOIR case number (if known): __________ Judge/Location: __________ Outcome/date: __________
- Have you ever been refused admission at a port of entry, withdrawn an application for admission, or been expeditedly removed (INA § 235(b)(1))? [ ] Yes [ ] No. Details: __________
- Have you ever been found inadmissible or deportable or granted any waiver (I-601, I-601A, I-212, § 212(d)(3))? [ ] Yes [ ] No. If Yes, specify ground(s) and decision(s): __________
- J-1/J-2 two-year home residence requirement (INA § 212(e)): [ ] Never J status [ ] Subject [ ] Not subject [ ] Unsure. If subject, any waiver (e.g., No Objection, Persecution, Hardship, IGA): __________
Section 3. Prior Applications and Immigration Documents
List all immigration filings, with approximate dates, locations, and outcomes. Provide copies of receipts, approvals, denials, RFEs, NOIDs, biometrics notices, and decisions.
- Family-based: I-130, I-129F, I-485, I-751, N-400, I-90, I-131 (AP), I-765 (EAD): __________
- Employment-based: PERM, I-140, I-485, I-129, H/L/O/P/E petitions: __________
- Humanitarian: I-589 (asylum), I-730, I-918 (U), I-914 (T), VAWA (I-360), TPS, DACA, SIJ (I-360), humanitarian parole: __________
- Waivers/consular: DS-160/260, § 221(g) refusals, § 212(d)(3) waivers, I-601, I-601A, I-212: __________
- FOIA/records requests (USCIS/CBP/ICE/EOIR/DOS): __________
Section 4. Family and Household
- Current marital status: [ ] Single [ ] Married [ ] Divorced [ ] Widowed [ ] Separated
- Current spouse: Full name: __________ DOB: __________ Country of birth: __________
- Date and place of marriage: __________ If spouse is a U.S. citizen or LPR: [ ] USC [ ] LPR [ ] Neither
- Prior marriages for you: number: ___; for spouse: number: ___. Provide details and termination documents for each prior marriage (divorce decree, death certificate, annulment).
- Children (biological, adopted, step), list all: full name, DOB, place of birth, current location, immigration status: __________
- Parents: names, DOBs, country of residence, immigration status if in U.S.: __________
- Household size for affidavit of support/public charge analysis: __________
- Has anyone filed an I-130/I-140/I-360/I-730 on your behalf? [ ] Yes [ ] No. If Yes, petitioner’s name, relationship, receipt number, and priority date: __________
- Have you ever filed any petitions for relatives? [ ] Yes [ ] No. If Yes, list: __________
- Evidence of bona fide marital relationship (if applicable): joint lease/mortgage, joint bank accounts, insurance, taxes, utility bills, photos, correspondence, travel, affidavits.
Section 5. Education, Employment, and Financial Information
- Highest education level, degrees, institutions, dates: __________
- English proficiency: [ ] Fluent [ ] Intermediate [ ] Basic [ ] None. Other languages: __________
- Current and recent employment (last 10 years): employer name, address, job title, start/end dates, full-/part-time, salary, supervisor, EIN (if known): __________
- Prior unauthorized employment or work without proper authorization: [ ] Yes [ ] No. Details: __________
- Self-employment or ownership interests: __________
- Income (most recent tax year): wages, business income, other: __________
- Tax filings: Have you filed U.S. federal/state tax returns for all required years? [ ] Yes [ ] No. If No, explain: __________
- Public benefits received by you or household members (e.g., SSI, TANF, SNAP, Medicaid, housing assistance). Note: Certain benefits may not affect admissibility; provide full details with dates: __________
- Potential sponsor(s) for Form I-864/I-864A (if family-based AOS or IV): names, status, income, household size: __________
- Assets and liabilities (if relevant to public charge or I-864 sufficiency): __________
Section 6. Criminal, Security, and Conduct-Related Matters
Note: All arrests, citations, charges, and convictions must be disclosed, including expunged, sealed, or juvenile matters, as they may still be relevant to immigration (see INA § 212(a)(2) and related case law). Provide certified disposition records.
- Arrests/charges/convictions anywhere in the world: [ ] Yes [ ] No. If Yes, provide date, place, offense, statute, disposition/sentence, immigration consequences: __________
- Controlled substances use/possession, trafficking, or admission to essential elements: [ ] Yes [ ] No. Details: __________
- Prostitution, commercialized vice, money laundering, or human trafficking involvement: [ ] Yes [ ] No. Details: __________
- Immigration fraud/misrepresentation, false claim to U.S. citizenship, sham marriage, document fraud (INA § 212(a)(6)(C) and 18 U.S.C. § 1546): [ ] Yes [ ] No. Details: __________
- Alien smuggling/assisting unlawful entry (INA § 212(a)(6)(E)): [ ] Yes [ ] No. Details: __________
- Security-related grounds (terrorism-related inadmissibility grounds, memberships, training, material support, espionage) (INA § 212(a)(3)): [ ] Yes [ ] No. Details: __________
- Military service (any country), rank, dates, discharge, specialized training: __________
- Memberships/affiliations/organizations, including political parties, student groups, online forums, social media handles used in visa applications (past 5 years): __________
- Domestic violence or restraining orders (note VAWA/U relief may be implicated): [ ] Yes [ ] No. Details: __________
Section 7. Health and Vaccination
- Communicable diseases of public health significance, physical or mental disorders with associated harmful behavior, drug abuse/addiction, or lack of required vaccinations (INA § 212(a)(1)): [ ] Yes [ ] No. If Yes, describe diagnoses, treatment, medications, and documentation: __________
- Vaccination history (MMR, Varicella, Tdap, Influenza, COVID-19, Hepatitis B, etc.). Provide records: __________
- Health insurance coverage in the U.S.: [ ] Yes [ ] No. Carrier/Policy: __________
- Disabilities or accommodations needed for USCIS/EOIR appearances: __________
Section 8. Travel and Identity History
- All passports/national ID numbers, issuing authorities, and validity dates: __________
- Countries of residence for more than 6 months since age 16: __________
- International travel history for last 10 years (approximate dates, countries): __________
- Prior visa applications and outcomes (B/F/J/H/L/O/P/E/K/immigrant): dates, posts, refusals (INA § 214(b), § 221(g), § 212(a) grounds), administrative processing: __________
- Social media identifiers as required in DS-160/260 (last 5 years): __________
Section 9. Fear-Based and Humanitarian Considerations
- Do you fear harm, persecution, or torture if returned to your country? [ ] Yes [ ] No
- If Yes, describe protected grounds (race, religion, nationality, political opinion, particular social group), incidents, dates, perpetrators, and internal relocation considerations. Note: asylum (INA § 208), withholding (INA § 241(b)(3)), and CAT protection may be implicated: __________
- Victimization and protective relief:
- VAWA eligibility (spouse/parent/child of abusive USC/LPR): [ ] Yes [ ] No. Details: __________
- U nonimmigrant status (victim of qualifying crime, helpful to law enforcement): [ ] Yes [ ] No. Law enforcement certification possible? __________
- T nonimmigrant status (severe trafficking, compliance with requests): [ ] Yes [ ] No. Details: __________
- SIJ (Special Immigrant Juvenile): [ ] Yes [ ] No. Details: __________
- TPS or DED eligibility or history: [ ] Yes [ ] No. Details: __________
- Parole programs (e.g., humanitarian parole, family reunification, CHNV): [ ] Yes [ ] No. Details: __________
Section 10. Case Objectives and Strategy Inputs
- Primary immigration goal(s) (e.g., family-based AOS, consular processing, employment-based IV, naturalization, nonimmigrant change/extension, removal defense): __________
- Preferred processing (AOS in U.S. vs. consular processing abroad): __________
- Time constraints or status expiration dates (provide exact dates): __________
- Potential qualifying relatives for hardship waivers (USC/LPR spouse/parent/fiancé(e)): __________
- Priority date and category (if known) and country of chargeability: __________
- For employment-based options: job offer details, wage, prevailing wage, remote/hybrid/on-site, worksite locations, degree requirements, and whether PERM labor certification is contemplated: __________
Section 11. Document Checklist (provide copies, not originals, unless requested)
- Government IDs: passports (all), national IDs, birth certificate with certified translation, household register (if applicable).
- U.S. immigration: visas, I-94s, approval/denial notices, EADs, I-20/DS-2019, I-797s, entry stamps, travel history (CBP I-94 printout), NTAs, EOIR orders, ICE check-in records.
- Civil documents: marriage certificates, divorce decrees, death certificates, adoption decrees, name change orders.
- Criminal records: police reports, charging documents, certified court dispositions, probation/parole records.
- Financial/tax: last three years tax returns and W-2/1099, pay stubs, bank statements, employment letters, assets evidence.
- Relationship evidence: joint financials, leases/mortgages, insurance, photos, correspondence, affidavits.
- Medical: vaccination records, medical exam results (I-693 if applicable).
- Prior filings: complete copies of all forms submitted to USCIS/EOIR/DOS and all decision notices.
- Other: evidence supporting humanitarian claims, country condition reports, police clearances where required.
Section 12. Communications, Privacy, and Authorizations
- Preferred communication method: [ ] Email [ ] Phone [ ] Secure portal [ ] Messaging (encrypted)
- Consent to receive electronic communications and documents, including confidential information: [ ] Yes [ ] No
- Permission to contact prior counsel to obtain your file: [ ] Yes [ ] No. If Yes, provide authorization and contact details: __________
- Authorization to file FOIA/Privacy Act requests (USCIS/CBP/ICE/EOIR/DOS) to obtain your records: [ ] Yes [ ] No
- Consent to store your data in secure cloud-based systems compliant with applicable privacy and professional responsibility rules: [ ] Yes [ ] No
Section 13. Acknowledgments and Certifications
Please read carefully. Initial each statement.
- I understand that submission of this questionnaire does not create an attorney-client relationship, and no legal advice is provided until a written engagement agreement is executed and any conflicts are cleared. Initial: _____
- I certify that the information provided herein and in attached documents is true, correct, and complete to the best of my knowledge and belief. I understand that providing false information to U.S. immigration authorities can lead to denial, removal, inadmissibility under INA § 212(a)(6)(C), and criminal penalties. Initial: _____
- I authorize the firm to use the information provided solely for conflicts checking and preliminary evaluation of my case. Initial: _____
- I will promptly update the firm if any information changes or if I receive any notices from USCIS, DOS, CBP, ICE, or EOIR. Initial: _____
Signature Blocks
- Client signature: _______________________________ Date: __________
- Printed name: Wang Min
Interpreter Certification (if applicable)
- I, ________________________, certify that I am competent to interpret between English and __________; I have read and interpreted the contents of this questionnaire to the client in the client’s preferred language, and the client confirmed understanding.
- Interpreter signature: __________________________ Date: __________
- Contact information: ____________________________
For Office Use Only (to be completed by firm)
- Date received: __________ File number: __________ Conflict check complete: [ ] Clear [ ] Conflict
- Attorney assigned: __________ Next steps: __________ Critical dates: __________
Notice
- This form is intended for use in evaluating potential eligibility and risks under U.S. immigration law, including admissibility and removability grounds under INA §§ 212 and 237, eligibility for family- and employment-based immigrant and nonimmigrant classifications, humanitarian relief, and available waivers. The firm will apply current statutes, regulations, policy guidance, and controlling case law at the time of formal engagement. Policies are subject to change; final determinations are made by USCIS, DOS, CBP, ICE, and EOIR.
