Printing L:\SUESFO~1\S8001.FRP - Social Security

15.17.(a) Have you, your child, or your parent, beensubjected to battery or extreme cruelty while in theUnited States?(b) Have you, your child, or your parent filed apetition with the Department of Homeland Securityfor a change in immigration status because of beingsubjected to battery or extreme cruelty?16. Are you, your spouse, or parent an active dutymember or a veteran of the armed forces of theUnited States?(a) When did you first make your home in the UnitedStates?(b) Have you lived outside of the United States sincethen?YouYESNOGo to (b) Go to #17YESNOGo to #16 Go to #17YES Explain inRemarks, thenGo to #17NO Go to #17(month, day, year)YESNOGo to (c) Go to #18Your Spouse, if filingYESNOGo to (b) Go to #17YESNOGo to #16 Go to #17YES Explain inRemarks, thenGo to #17NO Go to #17(month, day, year)YESNOGo to (c) Go to #18(c) Give the date(s) of residence outside the UnitedStates.DateLeft:DateReturned:(month, day, year)(month, day, year)DateLeft:DateReturned:(month, day, year)(month, day, year)18.19.(a) Have you been outside the United States (the 50States, District of Columbia and Northern MarianaIslands) 30 days prior to the filing date?(b) Give the date (month, day, year) you left theUnited States and the date you returned to the UnitedStates.(a) Do you have any unsatisfied felony warrants foryour arrest?(b) In which State or country was the warrantissued?YESNOGo to (b) Go to #19DateLeft:DateReturned:(month, day, year)(month, day, year)YouYESNOGo to (b) Go to #20Name of State/CountryGo to (c)(c) Was the warrant satisfied? YES NOGo to (d) Go to #20YESNOGo to (b) Go to #19DateLeft:DateReturned:(month, day, year)(month, day, year)Your Spouse, if filingYESNOGo to (b) Go to #20Name of State/CountryGo to (c)YESNOGo to (d) Go to #20(d) Date warrant satisfied:month, day, yearmonth, day, year20.(a) Do you have any unsatisfied Federal or Statewarrants for violating the conditions of probation orparole?(b) In which State or country was the warrantissued?YouYour Spouse, if filingYES NOYES NOGo to (b) Go to #21 Go to (b) Go to #21Name of State/Country Name of State/CountryGo to (c)Go to (c)(c) Was the warrant satisfied?(d) Date warrant satisfied:YES NOGo to (d) Go to #21month, day, yearYES NOGo to (d) Go to #21month, day, yearFORM SSA-8001-BK (01/2008)Page 4