Electronic Diversity Visa Entry Form
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ELECTRONIC DIVERSITY VISA ENTRY FORM
OMB Control Numbe Fo Expires Estimated Burden
Submission Confirmation: Application Received Success!
A Diversity Visa 2009 Lottery Entry Form was received on Thursday, November 15, 2007 at 6:29:0 EST and has been entered into the system. Please print this page for your personal records. You w need to use your browser's print button for this. Your application is now complete, after printing you close this window using your browser's close button. Applicant Name: MIA, MD SAJAL Birth Date: Tuesday, January 05, 1988 Eligibility Country: Bangladesh
Do not submit additional Entry Forms with th
person as the Primary Applicant! Multiple entries will disqualify the applicant from participation in the Lottery. PAPERWORK REDUCTION ACT *Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, D.C. 20520. Copyright Information
OMB Control Numbe Fo Expires Estimated Burden
Submission Confirmation: Application Received Success!
A Diversity Visa 2009 Lottery Entry Form was received on Thursday, November 15, 2007 at 6:29:0 EST and has been entered into the system. Please print this page for your personal records. You w need to use your browser's print button for this. Your application is now complete, after printing you close this window using your browser's close button. Applicant Name: MIA, MD SAJAL Birth Date: Tuesday, January 05, 1988 Eligibility Country: Bangladesh
Do not submit additional Entry Forms with th
person as the Primary Applicant! Multiple entries will disqualify the applicant from participation in the Lottery. PAPERWORK REDUCTION ACT *Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, D.C. 20520. Copyright Information
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