Fiance Visa: How to fill out the DS-5540 Public Charge questionnaire, step by step

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Please note that the Department of State NO LONGER REQUIRES that K visa applicants fill out and submit this form, DS-5540 at their K visa interviews. The following Guidance is for your information and education only. 

However, the FAM allows consular officers to request this document (both hard copy or verbally) and / or ask questions from this document during the interview in order to determine the totality of circumstances for applicants.

Also note that the questions on form DS-5540 don’t necessarily make sense and may not be applicable to fiance visa applicants. That’s why you may see some odd-sounding or non-applicable questions.

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General information on the DS-5540 (discontinued form)

Make sure you’ve got the latest version of the form. The current accepted version is 1/2020. Although this is the first and only version, be sure to use the latest version if this changes in the future. There are currently 4 pages for this form. You may have to attach supporting evidence.

As per instructions, for immigrant visa applicants, you can upload this to the CEAC website (not available for K visa applicants). Or you can print out a hard copy and bring along to the K visa interview (if requested by the Consulate specifically). Do not bring this form unless they ask. Emailing the filled form may be acceptable if the consulate allows.

Remember, this form is supplemental to help them determine if you’re going to be a public charge or not. The primary method of showing financial strength is the I-134 Affidavit of Support. Officers may not even ask you to fill this form out, but rather, ask you these questions verbally including asking you to provide supporting evidence.

It’s best to print this on a computer on single-sided paper.

Sign your name in ink.

You don’t need to get this notarized because it’s under “penalty of perjury”.

The complete FAM rules provide minor clarifications to this form.

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PLEASE NOTE: This step-by-step guide is for your information only as a sample of a finished form. This is not legal advice or a suggestion on how to answer government forms. Please consult USCIS instructions for details.

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PART 1 – Information about you

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Question 1. Enter Beneficiary’s full legal name as it appears on your passport.

Question 2: Date of birth in mm-dd-yyyy format.

Question 3: Select either “yes” or “no” if the beneficiary has ever been to the US. As of yet, the instructions don’t mention whether you have to supply records of your past arrival/departure (I-94). However, it seems the questions are only meant as a prelude figure out if you’ve taken public benefits in the past (if you have been to the US).

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PART 2 – Your Health

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Question 4. Select either “yes” or “no” to indicate if you currently have health insurance in the US. If you do have active health insurance, select “yes” and attach proof that you’re covered.

As per the Presidential Proclamation, the following are acceptable forms of health coverage:

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• ❒ Employer-based coverage, including a retiree plan, association health plan, and coverage provided by the Consolidated Omnibus Budget Reconciliation Act of 1985;
• ❒ An unsubsidized health plan offered in the individual market within a State;
• ❒ A short-term limited duration health policy effective for a minimum of 364 days — or until the beginning of planned, extended travel outside the United States;
• ❒ A catastrophic plan;
• ❒ A family member’s plan;
• ❒ A medical plan under chapter 55 of title 10, United States Code, including coverage under the TRICARE program;
• ❒ A visitor health insurance plan that provides adequate coverage for medical care for a minimum of 364 days — or until the beginning of planned, extended travel outside the United States;
• ❒ A medical plan under the Medicare program
• ❒ Any other health plan that provides adequate coverage for medical care as determined by the Secretary of Health and Human Services or his designee.
• ❒ For persons over the age of 18, approved health insurance does not include coverage under the Medicaid program.

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If you select “no”, you must indicate in question 4A whether you will be covered within 30 days after entry with a K-1 visa. If you say “yes”, then you will have to list the specific approved health plan you’re going to be covered under and when the coverage starts.

If you select “no” that you won’t be covered with health insurance, this is a strong “negative weighted factor” against public charge.

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PART 3 – Your household size

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This part asks about the beneficiary’s household size after coming to the US. The members of a beneficiary’s household size are not necessarily the same as the household members of the sponsor (i.e. the person who fills out the I-134 Affidavit of Support).

Write the names of household members of the beneficiary as follows:

• ✔ Any child of the beneficiary who are coming as K-2 children
• ✔ Any child to whom the beneficiary pays child support for (>50%) and who won’t come to the US with a K-2 visa (regardless of which country the child lives in or who has custody).
• ✔ Any person whom the beneficiary financially supports (>50%) on tax returns (for example: ex-spousal support, regardless of which country this person lives in).
• ✔ Any person who provides the beneficiary with financial support (>50%) on their tax returns (for example: a parent of the beneficiary who carries the beneficiary as a dependent, regardless of which country this person lives in).
• ✔ For any of these people, you must provide their full name, their age, and their relationship to you. Include their current job (if any), whether they’re a US citizen or not, or whether they’re actively working in the US Armed forces.

The consulate will use this information to figure out if you’ve got dependents or liabilities that will remain even after you come to the US.

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PART 4 – Your assets, resources, and financial status

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Question 6: If this fiance visa applicant has worked in the US within the last 3 years, then write down the year, gross income, and whether or not you filed federal tax returns. For many, this question won’t apply if you’ve never been to the US or worked in the US. But if you have, then you will need to produce any tax returns you may have filed in the last 3 years.

Question 7: Select “yes” or “no” if you have worked in the US in the last 3 years but didn’t file tax returns. If you select “yes”, you will have to explain the reason why you didn’t pay US taxes.

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Question 8A: if the K visa applicant is currently employed, then write your yearly compensation (in US dollars). You may have to produce local government tax returns if asked by the consulate. If you’re currently earning income and above the 125% Federal Poverty Guideline (FPG), then it’s a heavily positive factor. The same applies if the US sponsor is above 125% when sponsoring the fiance visa applicant.

Question 8B: If the visa applicant is currently accepting, offered, etc. a job in the US, then you may include this information. This will help the consulate determine that you’ve got financial support soon after arriving in the US. However, for fiance visa applicants, this isn’t a big factor because fiance visa applicants aren’t allowed to work before they get their EAD/AP card while adjusting status. Therefore, this is not going to help even if you think you’re going to get employed as soon as you get your EAD/AP card.

Question 8C: if the visa applicant currently has income or source of funds that will continue even after emigrating to the US, you can write the supplemental income here. For example, if the K visa applicant has stocks dividends, rental income, pension income, child support, investment income, royalties, etc. that produce cash flow and will continue even after coming to the US, you can include the income here. If you choose to include this income information, the Embassy officers may ask you to produce evidence to support this claim. For example, you may be required to show your stock broker accounts, or 1099-D type tax forms to show dividend income, rental receipts, or so on.

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Question 9: list the assets you have. Cash assets include checkings or savings accounts. Non-cash assets are properties, real estate, annuities, securities, bonds, insurance policies, certificates of deposit (CDs), educational accounts (college funds), retirement accounts, etc. Any usable assets must be “sellable” within 12 months in order for it to count as an asset. Choose from the dropdown menu to select which asset you want to claim. Then list their “location” and dollar figure. If you need more space, attach a separate sheet of paper as “Part 8 additional information”.

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Question 10: In this question, list the type of liabilities or debts that you have. From the dropdown menu, you’ll see mortgages, car loans, credit card debt, educational loans, personal loans, and more. This information may be used by the Embassy in figuring out what kind of liabilities may follow you into the US. If you need additional space to input entries, you can attach a separate sheet of paper for “Part 8 additional information”.

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Question 11: If the visa applicant has ever been to the US before and applied for, gotten, used or received public benefit after February 24, 2020, fill out this section. As per FAM, the public benefits are described as follows:

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• ❒ “Any Federal, state, local, or tribal cash assistance for income maintenance, including supplemental security income (SSI) and Temporary Assistance for Needy Families (TANF);
• ❒ Supplemental Nutrition Assistance Program (SNAP);
• ❒ Housing Choice Voucher Program;
• ❒ Project-Based Rental Assistance (including Moderate Rehabilitation);
• ❒ Subsidized Housing; or
• ❒ Medicaid, except for benefits received for an emergency medical condition, services or benefits funded by Medicaid but provided under the Individuals with Disabilities Education Act (IDEA), school-based services or benefits provided to individuals of secondary school age, benefits received by an alien under 21 years of age, or benefits received by a woman during pregnancy or during the 60-day period beginning on the last day of the pregnancy.”

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If the visa applicant has been to the US and used these public benefits, list the type of benefit, agency that granted it, dates of grant / expiration and the reason for using this benefit.

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Question 12: Select “yes” or “no” if you or your family members were exempt from the “public charge” inadmissibility when you received these public benefits. Examples of exempt immigrant categories include: refugees, asylees, some special immigrants, aliens under TPS, etc. as listed in CFR 212.23(a).

Question 13: asks you to predict if you’re going to use any public benefits in the future. If you answer “yes”, you should provide a detailed explanation.

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Question 14: Select “yes” or “no” to indicate if you’ve ever received a fee waiver for any USCIS benefit. Examples include fee waivers for certain forms. This doesn’t apply if you’re exempt from the public charge inadmissibility as listed in CRF 212.23(a) such as refugees or asylees.

If you have received a fee waiver (whether or not you’re public charge exempt) you will list the date of the fee waiver, type of benefit and the receipt number.

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PART 5 – Your education and skills

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Question 15: Select “yes” or “no” to indicate if you’ve got an equivalent high school diploma or higher. If you have a college education or higher, indicate that, too. List the educational degrees you’ve earned. If you need more space, write it in the Part 8 additional information on a separate sheet of paper.

Question 16: List your occupational skills, if any. Skills include: professional licenses, specialized training or education, certifications, language proficiency, etc. Indicate the company or school which issued this license, the license # if any, and expiration date.

These skills help the Embassy officers to understand the likelihood you’ll be healthily employed in the US and have the necessary skills to be above poverty limits.

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PART 6 – Translator

PART 7 – Preparer

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In these two questions 17 and 18, write down the information (if any) of any translator of this form and anyone who is preparing the form aside from the visa applicant. If you’ve completed this entire form by yourself, you won’t need to complete this section Part 6 or Part 7.

PART 8 – Additional Information. If you have any additional entries to make or answers to clarify (from above questions) you may attach a separate sheet of paper to fully answer any remaining questions. Be sure to indicate the form number, question number, the full answer, your signature and date.

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PART 9 – Declarant’s signature

Sign and date the form by the visa applicant or guardian. No need to notarize or certify this form. You may print a scanned copy with a signature.

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Supporting documents

You may need to attach supporting documents in connection with any question in the DS-5540 that requires further support (e.g. health insurance coverage).

Once again, this form has been discontinued and is NO longer required for K visa applicants at any stage.