This form contains 104 fields organized into 32 sections, giving it a Form Complexity Index of 72/100 (complex). Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Affiant Name
Affiant Full Name	Text	Enter the full legal name of the affiant (the person making the affidavit) exactly as it should appear on the form.
Birth Abroad (Date and Country)
Birth Abroad Date	Date	Enter the date you were born outside the United States.
Birth Abroad Country	Text	Enter the name of the country where you were born.
Birth in (City/Town, State) and Date
Place of Birth (City/Town, State)	Text	Enter the city or town and U.S. state where you were born (e.g., City/Town, State).
Date of Birth	Date	Enter the date on which you were born.
Fifth Child (Name, DOB, Place of Birth)
Fifth Child - Full Name	Text	Enter the full legal name of the fifth child (given name, middle name(s) and surname) as you want it recorded.
Fifth Child - Date of Birth	Date	Enter the birth date of the fifth child.
Fifth Child - Place of Birth	Text	Enter the city/town and country (and state if within the United States) where the fifth child was born.
Fifth Residence Abroad Row
Place (City, State)	Text	Enter the city and state of the residence abroad for this entry.
Date From	Date	Enter the start date of the period you were physically present or resided at this location.
Date To	Date	Enter the end date of the period you were physically present or resided at this location.
Purpose of Stay	Text	Describe the purpose(s) of the stay (for example: vacation, family visit, business trip, studies, employment, residence) and, if working, provide the employer name or note U.S. government/military service or dependent status if applicable.
First Child (Name, DOB, Place of Birth)
Child's Full Name	Text	Enter the full name of the first child for whom you are the biological parent.
Child's Date of Birth	Date	Enter the date of birth of the first child.
Child's Place of Birth	Text	Enter the city and country (or city and U.S. state if born in the United States) where the first child was born.
First Residence Abroad Row
Place of residence abroad (City, State)	Text	Enter the city and state (or province and country if outside the U.S.) of the place where you were physically present or had a residence for this entry.
From date	Date	Enter the starting date when this period of presence or residence abroad began.
To date	Date	Enter the ending date when this period of presence or residence abroad ended.
Purpose of stay	Text	Provide the purpose(s) of the stay (for example: vacation, family visit, business trip, studies, employment, residence); if you were working, include the employer name and note U.S. government or military service or dependent status if applicable.
Form Controls
Reset Form	Button	Button to reset the form to its default state.
Fourth Child (Name, DOB, Place of Birth)
Fourth Child - Name	Text	Enter the full name (first, middle if any, and last) of the fourth biological child of the affiant.
Fourth Child - Date of Birth	Date	Enter the fourth child's date of birth.
Fourth Child - Place of Birth	Text	Enter the city and country (and state if in the U.S.) where the fourth child was born.
Fourth Residence Abroad Row
Residence Place (City, State)	Text	Enter the city and state (or city and region) of the fourth residence abroad.
Residence From Date	Date	Enter the date when this period of residence abroad began.
Residence To Date	Date	Enter the date when this period of residence abroad ended.
Purpose of Stay / Employer	Text	Describe the purpose(s) of the stay (for example: vacation, family visit, business trip, studies, employment, or residence) and, if working abroad, provide the employer name and note U.S. government or military service or orders as a dependent when applicable.
Marital Status and Marriage Details
Married	Checkbox	Check this box if you are currently married.
Previously Married	Checkbox	Check this box if you were married in the past but are not currently married (for example divorced, widowed, or marriage annulled).
Single	Checkbox	Check this box if you have never been married and are not currently married.
Marriage Date	Date	Enter the date on which the marriage occurred. Fill only if 'Married' is 'Yes'. Depends on: Married
Spouse or Partner Name	Text	Enter the full name of the person you married or partnered with for this marriage entry. Fill only if 'Married' is 'Yes'. Depends on: Married
Country of Marriage	Text	Enter the name of the country where the marriage took place. Fill only if 'Married' is 'Yes'. Depends on: Married
Naturalization (Date and Office/State)
Naturalization Date	Date	Enter the date you were naturalized at a U.S. court or USCIS office.
Court or USCIS Office and State	Text	Enter the full name of the court or USCIS office where you were naturalized and the U.S. state in which it is located.
Other Biological Parent - Name and Citizenship Status
Other Biological Parent Full Name	Text	Enter the full legal name of the other biological parent of the child(ren) for whom this application is being filed, as it should appear on official documents.
Is a citizen or national of the U.S.	Checkbox	Check this box if the other biological parent is a U.S. citizen or U.S. national.
Is not a citizen of the U.S.	Checkbox	Check this box if the other biological parent is not a U.S. citizen.
Other Parent Citizenship - Birth Abroad to U.S. Citizen(s)
Date of birth abroad	Date	Enter the date on which the other parent was born abroad. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Country of birth abroad	Text	Enter the name of the country where the other parent was born abroad. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Other Parent Citizenship - Birth in U.S.
City/Town and State of Birth (other parent)	Text	Enter the city or town and the U.S. state where the other parent was born. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Date of Birth (other parent)	Date	Enter the date the other parent was born in the United States. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Other Parent Citizenship - Naturalization
Naturalization Date	Date	Enter the date when the other parent was naturalized (the date of naturalization). Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Court or USCIS Office and State	Text	Enter the full name of the court or USCIS office and the U.S. state where the naturalization proceeding occurred. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Other Parent US Residence - Row 1
Place (City, State)	Text	Enter the U.S. city and state where the other biological parent was physically present or maintained a residence. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
From Date	Date	Enter the start date of the period during which the other biological parent was present or resided in the United States. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
To Date	Date	Enter the end date of the period during which the other biological parent was present or resided in the United States. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Purpose of Stay	Text	Briefly state the reason(s) for the stay in the United States (for example: vacation, family visit, employment, studies, residence), including employer name or U.S. government/military status if applicable. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Other Parent US Residence - Row 2
Place (City, State)	Text	Enter the city and U.S. state where the other biological parent was physically present or had a residence for this entry. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Date From	Date	Enter the start date for the period the other biological parent was physically present or resident in the United States for this entry. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Date To	Date	Enter the end date for the period the other biological parent was physically present or resident in the United States for this entry. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Purpose of Stay	Text	Provide the purpose(s) of the stay during that period (for example: vacation, family visit, employment, study, residence; if working, you may provide employer name or note U.S. government/military service). Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Other Parent US Residence - Row 3
Place (City, State)	Text	Enter the city and U.S. state where the other biological parent was physically present or had a residence for this entry. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Date From	Date	Enter the starting date for this period of U.S. physical presence or residence for the other biological parent. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Date To	Date	Enter the ending date for this period of U.S. physical presence or residence for the other biological parent. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Purpose of Stay	Text	Provide the purpose of the stay for this period (for example: vacation, family visit, employment, studies, residence, business trip, etc.). Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Other Parent US Residence - Row 4
Place (City, State)	Text	Enter the U.S. city and state where the other parent was physically present or had a residence for this row. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
From Date	Date	Enter the starting date for this period of physical presence or residence. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
To Date	Date	Enter the ending date for this period of physical presence or residence. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Purpose of Stay	Text	Indicate the purpose(s) of the stay in the United States for this period (for example: vacation, family visit, business trip, studies, employment, residence); include employer name or note U.S. government/military service if applicable. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Other Parent US Residence - Row 5
Place (City, State)	Text	Enter the city and state in the United States where the other biological parent was physically present or had a residence (e.g., City, State). Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Residence From Date	Date	Enter the date when the other biological parent began the period of presence or residence at the place listed. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Residence To Date	Date	Enter the date when the other biological parent ended the period of presence or residence at the place listed. Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Purpose of Stay	Text	Describe the purpose(s) of the stay at that U.S. location (for example: vacation, family visit, business, studies, employment, residence; include employer name or note U.S. government/military service if applicable). Fill only if 'Is a citizen or national of the U.S.' Fill only if 22 is 'Yes'. Depends on: Is a citizen or national of the U.S.
Second Child (Name, DOB, Place of Birth)
Child’s Name	Text	Enter the full name of the child (first, middle, and last) for this listed child.
Child’s Date of Birth	Date	Enter the child’s date of birth for this listed child.
Child’s Place of Birth	Text	Enter the city/town and country (and state if in the U.S.) where this child was born.
Second Residence Abroad Row
Place (City, State)	Text	Enter the city and state (or city and country if outside the U.S.) where you were physically present or had a residence.
Residence From Date	Date	Enter the date when this period of residence abroad began.
Residence To Date	Date	Enter the date when this period of residence abroad ended.
Purpose of Stay	Text	Describe the purpose(s) of the stay (for example: vacation, family visit, business trip, studies, employment, residence) and, if applicable, include the employer name and note U.S. government or military service or dependent orders.
Seventh Child (Name, DOB, Place of Birth)
Seventh Child - Name	Text	Enter the full name of the seventh child (given name, middle name(s), and family name) for whom you are the biological parent.
Seventh Child - Date of Birth	Date	Enter the birth date of the seventh child.
Seventh Child - Place of Birth	Text	Enter the city and country (and state if applicable) where the seventh child was born.
Sixth Child (Name, DOB, Place of Birth)
Child's Full Name	Text	Enter the sixth child's full legal name (given name, middle name(s) and surname) as you want it recorded.
Child's Date of Birth	Date	Enter the sixth child's date of birth.
Child's Place of Birth	Text	Enter the city and state or city and country where the sixth child was born (include country if born outside the United States).
Third Child (Name, DOB, Place of Birth)
Child's Full Name	Text	Enter the full legal name of the third child as it should appear on official records.
Child's Date of Birth	Date	Enter the third child’s date of birth.
Child's Place of Birth	Text	Enter the city, state/province and country where the third child was born.
Third Residence Abroad Row
Place (City, State)	Text	Enter the city and state/province (and country if different) of the residence abroad where you were physically present.
Date From	Date	Enter the starting date of the period you were physically present or resided at this location abroad.
Date To	Date	Enter the ending date of the period you were physically present or resided at this location abroad.
Purpose of Stay	Text	Indicate the purpose(s) of the stay (for example: vacation, family visit, business trip, studies, employment, residence); if working abroad, provide the employer name or note if it was U.S. government/military service or on orders as a dependent.
U.S. Residence Row 1 (Place, From, To, Purpose)
Place (City, State)	Text	Enter the city and U.S. state where you were physically present or maintained a residence during this period (for example, "Seattle, WA").
From Date	Date	Enter the starting date when you began residence or physical presence at the place listed.
To Date	Date	Enter the ending date when your residence or physical presence at the place ended, or indicate if it is still ongoing per the form instructions.
Purpose of Stay	Text	Provide the reason(s) for your presence or residence at this location (for example: vacation, family visit, business trip, studies, employment, or residence).
U.S. Residence Row 2 (Place, From, To, Purpose)
Place (City, State)	Text	Enter the city and state in the United States where you were physically present or had a residence for this entry (e.g., "Boston, MA").
From Date	Date	Enter the starting date when this period of physical presence or residence began.
To Date	Date	Enter the ending date when this period of physical presence or residence ended.
Purpose of Stay	Text	Briefly describe the purpose(s) of your stay at the place and dates listed (for example: vacation, family visit, studies, employment, residence, business trip).
U.S. Residence Row 3 (Place, From, To, Purpose)
Place (City, State)	Text	Enter the city and state (or other U.S. place) where you were physically present or had a residence for this entry.
From (start date)	Date	Enter the date when this period of physical presence or residence at the listed place began.
To (end date)	Date	Enter the date when this period of physical presence or residence at the listed place ended.
Purpose of stay	Text	Provide the primary purpose(s) of the stay at this place (for example: vacation, family visit, business trip, studies, employment, residence, etc.).
U.S. Residence Row 4 (Place, From, To, Purpose)
Place (City, State)	Text	Enter the U.S. city and state where you were physically present or had a residence for this entry.
From Date	Date	Enter the starting date when this period of presence or residence in the listed place began.
To Date	Date	Enter the ending date when this period of presence or residence in the listed place ended.
Purpose of Stay	Text	Provide the primary purpose(s) of the stay in that place (for example: vacation, family visit, business trip, studies, employment, residence, etc.).
U.S. Residence Row 5 (Place, From, To, Purpose)
Place (City, State)	Text	Enter the city and state in the United States where you were physically present or had a residence for this entry.
From Date	Date	Enter the starting date of the period you were present or resident at the place listed.
To Date	Date	Enter the ending date of the period you were present or resident at the place listed.
Purpose of Stay	Text	Briefly describe the purpose(s) of your stay at this location (for example: vacation, family visit, business trip, studies, employment, residence).

Form DS-5507, Affidavit of Physical Presence Instructions