Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently have any of the following diseases (communicable diseases are specified pursuant to section 361(b) of the Public Health Service Act):
- Cholera
- Difteria
- Infectious tuberculosis
- Plague
- Smallpox2
- Yellow fever
- Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg virus disease, Crimean-Congo
- Severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality
Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority?*
Have you ever violated any law related to possessing, using, or distributing illegal drugs?*
Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?*
Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States?*
Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government?*
Have you ever been denied a U.S. visa you applied for with your current or previous passport, or have you ever been refused admission to the United States or withdrawn your application for admission at a U.S. port of entry?*
Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?*
Have you traveled to, or been present in Iraq, Syria, Iran, Sudan, Libya, Somalia or Yemen on or after March 1, 2011?*
