--- metadata: title: Application to Replace Permanent Resident Card short title: I-90 revision_date: 2019-12-01 sessions are unique: True --- default screen parts: title: I-90 Application to Replace Permanent Resident Card --- imports: - datetime objects: - user: Individual - interpreter: Individual - preparer: Individual --- sections: - intro: Introductions - pt1: Part 1. Information About You - pt2: Part 2. Application Type - pt3: Part 3. Processing Information - pt4: Part 4. Accomodations for Individuals with Disabilities and/or Impairments - pt5: Part 5. Statement, Contact Info, Certification, Signature - final: Final Steps --- features: navigation: True progress bar: True --- mandatory: True code: | menu_items = [ action_menu_item('Roadmap', 'road_map') ] --- initial: True code: | if returning_user(minutes=0.5): welcome_back --- event: welcome_back question: | Welcome back! subquestion: | You are currently in the **${ nav.get_section(display=True) }** section. ${ nav } Press "Continue" to pick up where you left off. buttons: Continue: continue --- event: road_map question: | Roadmap subquestion: | You are currently in the **${ nav.get_section(display=True) }** section. ${ nav } Press "Continue" to resume the interview. buttons: Continue: continue --- question: | Welcome to the I-90 Application subquestion: | If you are not on a smartphone-sized device, you should see a navigation bar to the left. field: sees_nav_bar --- interview help: heading: How to use this website content: Please create an account and contact a DasQ staff member. --- default language: en --- question: What language would you prefer? ¿Cual idioma prefieres? field: user_language buttons: - English: en - Español: es --- code: | if user_language == "es": set_language(es) --- question: | I-90 Application to Replace Permanent Resident Card subquestion: | This interview will fill out a USCIS form I-90 with your provided information. Please be accurate with all information. pre: | Part 1. Information about you. help: | For more help, please contact us at 777-777-777, or email the site administrator, danny@keybored_co field: user_saw_intro section: pt1 --- question: | What is your Alien Registration Number? fields: - Alien Registration Number A-: user_aliennumber hint: A- --- question: If you have a USCIS Online Account number, please provide below. Otherwise, press continue. fields: - USCIS Account Number: user_uscisaccount required: False --- question: | What is your name? fields: - First Name: user_name_first - Last Name: user_name_last - Middle Name: user_name_middle required: False under: | NOTE: Your card will be issued in this name. --- question: Has your name changed since the issuance of your Permanent Resident Card? field: name_change buttons: - "Yes": True - "No": False - "N/A - I never received my previous card": False --- if: name_change == True question: Please provide your name exactly as it is printed on your current Permanent Resident Card. fields: - First Name: user_name_first1 - Last Name: user_name_last1 - Middle Name: user_name_middle1 required: False --- question: What is your mailing address? fields: - In Care of Name: user_addr_name - Street Number and Name: user_addr_street - Apt/Ste/Flr Number: user_addr_aptno required: False - Apt Type: user_addr_type datatype: radio hide if: variable: user_addr_aptno is: null choices: - Apartment: apt - Suite: suite - Floor: floor - City or Town: user_addr_city - State: user_addr_state - ZIP Code: user_addr_zip datatype: integer - Province: user_addr_province required: False - Postal Code: user_addr_postcode required: False - Country: user_addr_country --- question: Is your physical address different than your mailing address? field: phys_addr buttons: - "Yes": True - "No": False --- if: phys_addr == True question: What is your physical address? fields: - Street Number and Name: user_physaddr_street - Apt/Ste/Flr: user_physaddr_aptno required: False - AptType: user_physaddr_type datatype: radio hide if: variable: user_physaddr_aptno is: null choices: - Apartment: apt - Suite: suite - Floor: floor - City or Town: user_physaddr_city - State: user_physaddr_state - ZIP Code: user_physaddr_zip - Province: user_physaddr_province - Postal Code: user_physaddr_postcode - Country: user_physaddr_country --- question: Please Answer the Following Regarding your Background fields: - What is your gender?: user_gender input type: radio choices: - Male: user_gender_male - Female: user_gender_female - What is your date of birth?: user_birth_date datatype: date - What is your town or city of birth?: user_birth_city - What is your country of birth?: user_birth_country - What is your mother's first name?: user_mother_name - What is your father's first name?: user_father_name --- question: Please answer the following details regarding your admission to the United States. fields: - Class of Admission: user_admission_class - Date of Admission: user_admission_date datatype: date - U_S. Social Security Number: user_admission_ssn --- question: Part 2 Application Type subquestion: | NOTE: If your conditional permanent resident status (for example: CR1, CR2, CF1, CF2) is expiring within the next 90 days, then do not file this application. (See the What is the Purpose of This Application section of the Form I-90 Instructions for further information.) pre: | Part 2. Application Type field: user_readpt2 section: pt2 --- question: What is your current status? field: user_status buttons: - Lawful Permanent Resident: permanent - Permanent Resident - In Commuter Status: commuter - Conditional Permanent Resident: conditional --- if: user_status != 'conditional' question: What is the reason for your application? field: user_reason input type: radio choices: - My previous card has been lost, stolen, or destroyed: lost - My previous card was issued but never received: notreceived - My existing card has been mutilated: mutilated - My existing card has incorrect data because of Department of Homeland Security (DHS) error.: incorrect - My name or other biographic information has been legally changed since issuance of my existing card.: biochanged - My existing card has already expired or will expire within six months.: expire - I have reached my 14th birthday and am registering as required. My existing card will expire AFTER my 16th birthday.: fourteenbdayafter - I have reached my 14th birthday and am registeringas required. My existing card will expire BEFORE my 16th birthday.: fourteenbdaybefore - I am a permanent resident who is taking up commuter status: permtocommuter - I am a commuter who is taking up actual residence in the United States.: commutertoresident - I have been automatically converted to lawful permanent resident status.: autopermresident - I have a prior edition of the Alien Registration Card, or I am applying to replace my current Permanent Resident Card for a reason that is not specified above.: priorother --- if: user_reason == 'permtocommuter' question: What will your port of entry into the United States be? fields: - City, State: user_status_poe --- if: user_status == "conditional" question: What is the reason for your application? input type: radio field: user_condreason choices: - My previous card has been lost, stolen, or destroyed.: lost - My previous card was issued but never received.: notreceived - My existing card has been mutilated.: mutilated - My existing card has incorrect data because of DHS error.: incorrect - My name or other biographic information has legally changed since the issuance of my existing card.: biochange --- question: Please provide the following information pre: | Part 3. Processing Information fields: - "Where did you apply for an immigrant visa or adjustment of status?": user_processing_applocation - "Where was your immigrant visa issued, or which USCIS office were you granted adjustment of status?": user_processing_issuelocation - "Did you enter the United States with an immigrant Visa?": user_processing_visaentry datatype: yesnoradio - "What was your U.S. destination at the time of admission?" : user_processing_destination show if: variable: user_processing_visaentry is: true - "What was the port-of-entry where you were admitted to the United States? [City or Town and State]": user_processing_poecity show if: variable: user_processing_visaentry is: true - "Have you ever been in exclusion, deportation, or removal proceedings or ordered removed from the United States?": user_processing_deportation datatype: yesnoradio - "Since you were granted permanent residence, have you ever filed Form I-407, Abandonment by Alien of Status as Lawful Permanent Resident, or otherwise been determined to have abandoned your status?": user_processing_abandoned datatype: yesnoradio - "Please provide additional detailed information about your exclusion, deporation, or removal proceedings or removal order." : user_additional_deportorabandon datatype: area hide if: variable: user_processing_deportation is: false - "Please provide additional detailed information about your abandonment status" : user_additional_deportorabandon datatype: area hide if: variable: user_processing_abandoned is: false section: pt3 --- question: Please provide the following information. pre: | Biographic Information fields: - Ethnicity: user_ethnicity_hispanic input type: radio choices: - Hispanic or Latino: True - Not Hispanic or Latino: False - Race: user_race datatype: checkboxes choices: - Asian: asian - Black: black - Hawaiian / Pacific Islander: hawaiian - Indian: indian - White: white - Other: other - "Height (feet)": user_processing_heightft datatype: integer - "Height (inches)": user_processing_heightin datatype: integer - "Weight (pounds)": user_weight datatype: integer - Eye Color: user_eye input type: radio choices: - Black: black - Gray: gray - Maroon: maroon - Blue: blue - Green: green - Pink: pink - Brown: brown - Hazel: hazel - Unknown or Other: other - Hair Color: user_hair input type: radio choices: - Bald - "No" hair: bald - Brown: brown - Sandy: sandy - Black: black - Gray: gray - White: white - Blond: blond - Red: red - Unknown or Other: other --- question: Please provide the following information pre: | Part 4. Accommodations for Individuals with Disabilities and/or Impairments fields: - "Are you requesting an accomodation because of your disabilities and/or impairments?": user_disability datatype: yesnoradio - "I am deaf or hard of hearing": user_disability_deaf datatype: yesnoradio show if: variable: user_disability is: true - "I am requesting the following accommodation (If you are requesting a sign-language interpreter, indicate for which language (for example, American Sign Language))": user_deaf_request datatype: area show if: user_disability_deaf - "I am blind or have low vision.": user_disability_blind datatype: yesnoradio show if: user_disability - "I am requesting the following accomodation.": user_blind_request datatype: area show if: user_disability_blind - "I have another type of disability and/or impairment": user_disability_other datatype: yesnoradio show if: user_disability - "Describe the nature of your disability and/or impairment and the accomodation you are requesting.": user_disability_request datatype: area show if: user_disability_other section: pt4 --- question: | Preparation Acknowledgement subquestion: | At my request, the preparer at Dominico American Society named Daniel Martinez prepared this application for me based only upon information I provided or authorized pre: | Part 5. Applicant Statement, Contact Information, Certification, Signature. field: user_statement_preparerread section: pt5 --- question: | I can read and understand English, and I have read and understand every question and instruction on this application and my answer to every question. pre: | Part 5. Applicant Statement, Contact Information, Certification, Signature. field: user_statement_readunderstand --- question: | Please provide your contact information if you would like to be notified of your application status. fields: - "Applicant's Daytime Telephone Number": user_phone_day required: False - "Applicant's Mobile Telephone Number": user_phone_mobile required: False - "Applicant's Email Address": user_email required: False --- question: Applicant Certification subquestion: | Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS may need to determine my eligibility for the immigration benefit I seek. I further authorize release of information contained in this application, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U_S. immigration laws. I understand that USCIS will require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an oath reaffirming that: 1) I reviewed and provided or authorized all of theinformation in my application; 2) I understood all of the information contained in, and submitted with, my application; and 3) All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in, and submitted with, my application, and that all of this information is complete, true, and correct. field: agree_certification --- question: | Please sign your name below. signature: user_signature under: | ${ user_name_first + " " + user_name_middle + " " + user_name_last } --- mandatory: True code: | sees_nav_bar user_language user_saw_intro user_aliennumber user_name_first user_name_last name_change user_addr_street user_addr_city user_addr_state user_addr_zip user_addr_province user_addr_postcode user_addr_country user_gender user_birth_date user_birth_country user_mother_name user_father_name user_admission_class user_admission_date user_admission_ssn user_readpt2 user_status user_processing_applocation user_weight user_disability user_statement_preparerread user_email agree_certification user_signature --- question: Here is your document. A copy has been emailed to Dominico-American Society Staff and an encrypted copy placed in our database. Have a great day. attachment: - name: I-90 Application to Replace Permanent Resident Card filename: i-90-${ user_name_last }-${ user_name_first } pdf template file: i-90.pdf template password: "" editable: False language: en variable name: complete_i_90 valid formats: pdf pdf/a: True fields: - "form1[0].#subform[0].#area[1].P1_Line1_AlienNumber[0]": ${ user_aliennumber } - "form1[0].#subform[0].P1_checkbox4[0]": ${ 'Yes' if name_change == True else 'No' } - "form1[0].#subform[0].P1_checkbox4[1]": ${ 'Yes' if name_change == False else 'No' } - "form1[0].#subform[0].P1_checkbox4[2]": ${ 'Yes' if name_change == False else 'No' } - "form1[0].#subform[0].P1_checkbox6c_Unit[0]": ${ 'Yes' if user_addr_type == "apt" else 'No' } - "form1[0].#subform[0].P1_checkbox6c_Unit[1]": ${ 'Yes' if user_addr_type == "suite" else 'No' } - "form1[0].#subform[0].P1_checkbox6c_Unit[2]": ${ 'Yes' if user_addr_type == "floor" else 'No' } - "form1[0].#subform[0].P1_Line2_AcctIdentifier[0]": ${ user_uscisaccount if user_uscisaccount != "" else '' } - "form1[0].#subform[0].P1_Line3a_FamilyName[0]": ${ user_name_last } - "form1[0].#subform[0].P1_Line3b_GivenName[0]": ${ user_name_first } - "form1[0].#subform[0].P1_Line3c_MiddleName[0]": ${ user_name_middle } - "form1[0].#subform[0].P1_Line5a_FamilyName[0]": ${ user_name_last1 if user_name_last1 != "" else '' } - "form1[0].#subform[0].P1_Line5b_GivenName[0]": ${ user_name_first1 if user_name_first1 != "" else '' } - "form1[0].#subform[0].P1_Line5c_MiddleName[0]": ${ user_name_middle1 if user_name_middle1 != "" else '' } - "form1[0].#subform[0].P1_Line6a_InCareofName[0]": ${ user_addr_name } - "form1[0].#subform[0].P1_Line6b_StreetNumberName[0]": ${ user_addr_street } - "form1[0].#subform[0].P1_Line6c_AptSteFlrNumber[0]": ${ user_addr_aptno } - "form1[0].#subform[0].P1_Line6d_CityOrTown[0]": ${ user_addr_city } - "form1[0].#subform[0].P1_Line6e_State[0]": ${ user_addr_state } - "form1[0].#subform[0].P1_Line6f_ZipCode[0]": ${ user_addr_zip } - "form1[0].#subform[0].P1_Line6g_Province[0]": ${ user_addr_province } - "form1[0].#subform[0].P1_Line6h_PostalCode[0]": ${ user_addr_postcode } - "form1[0].#subform[0].P1_Line6i_Country[0]": ${ user_addr_country } - "form1[0].#subform[0].P1_Line7a_StreetNumberName[0]": ${ user_physaddr_street if phys_addr else '' } - "form1[0].#subform[0].P1_Line7b_AptSteFlrNumber[0]": ${ user_physaddr_aptno if phys_addr else '' } - "form1[0].#subform[0].P1_Line7c_CityOrTown[0]": ${ user_physaddr_city if phys_addr else '' } - "form1[0].#subform[0].P1_Line7d_State[0]": ${ user_physaddr_state if phys_addr else '' } - "form1[0].#subform[0].P1_Line7e_ZipCode[0]": ${ user_physaddr_zip if phys_addr else '' } - "form1[0].#subform[0].P1_Line7f_Province[0]": ${ user_physaddr_province if user_physaddr_province else '' } - "form1[0].#subform[0].P1_Line7g_PostalCode[0]": ${ user_physaddr_postcode if user_physaddr_postcode else '' } - "form1[0].#subform[0].P1_Line7h_Country[0]": ${ user_physaddr_country if user_physaddr_country != "" else '' } - "form1[0].#subform[0].P1_checkbox7b_Unit[0]": ${ 'Yes' if user_physaddr_type == "apt" else 'No' } - "form1[0].#subform[0].P1_checkbox7b_Unit[1]": ${ 'Yes' if user_physaddr_type == "suite" else 'No' } - "form1[0].#subform[0].P1_checkbox7b_Unit[2]": ${ 'Yes' if user_physaddr_type == "floor" else 'No' } - "form1[0].#subform[1].P1_Line10_CityTownOfBirth[0]": ${ user_birth_city } - "form1[0].#subform[1].P1_Line11_CountryofBirth[0]": ${ user_birth_country } - "form1[0].#subform[1].P1_Line12_MotherGivenName[0]": ${ user_mother_name } - "form1[0].#subform[1].P1_Line13_FatherGivenName[0]": ${ user_father_name } - "form1[0].#subform[1].P1_Line14_ClassOfAdmission[0]": ${ user_admission_class } - "form1[0].#subform[1].P1_Line15_DateOfAdmission[0]": ${ user_admission_date } - "form1[0].#subform[1].P1_Line16_SSN[0]": ${ user_admission_ssn } - "form1[0].#subform[1].P1_Line8_female[0]": ${ 'Yes' if user_gender == "female" else 'No' } - "form1[0].#subform[1].P1_Line8_male[0]": ${ 'Yes' if user_gender == "male" else 'No' } - "form1[0].#subform[1].P1_Line9_DateOfBirth[0]": ${ user_birth_date } - "form1[0].#subform[1].P2_checkbox1[0]": ${ 'Yes' if user_status == "permanent" else 'No' } - "form1[0].#subform[1].P2_checkbox1[1]": ${ 'Yes' if user_status == "commuter" else 'No' } - "form1[0].#subform[1].P2_checkbox1[2]": ${ 'Yes' if user_status == "conditional" else 'No' } - "form1[0].#subform[1].P2_checkbox2[0]": ${ 'Yes' if user_reason == "lost" else 'No' } - "form1[0].#subform[1].P2_checkbox2[10]": ${ 'Yes' if user_reason == "autopermresident" else 'No' } - "form1[0].#subform[1].P2_checkbox2[11]": ${ 'Yes' if user_reason == "priorother" else 'No' } - "form1[0].#subform[1].P2_checkbox2[1]": ${ 'Yes' if user_reason == "notreceived" else 'No' } - "form1[0].#subform[1].P2_checkbox2[2]": ${ 'Yes' if user_reason == "mutilated" else 'No' } - "form1[0].#subform[1].P2_checkbox2[3]": ${ 'Yes' if user_reason == "incorrect" else 'No' } - "form1[0].#subform[1].P2_checkbox2[4]": ${ 'Yes' if user_reason == "biochanged" else 'No' } - "form1[0].#subform[1].P2_checkbox2[5]": ${ 'Yes' if user_reason == "expire" else 'No' } - "form1[0].#subform[1].P2_checkbox2[6]": ${ 'Yes' if user_reason == "fourteenbdayafter" else 'No' } - "form1[0].#subform[1].P2_checkbox2[7]": ${ 'Yes' if user_reason == "fourteenbdaybefore" else 'No' } - "form1[0].#subform[1].P2_checkbox2[8]": ${ 'Yes' if user_reason == "permtocommuter" else 'No' } - "form1[0].#subform[1].P2_checkbox2[9]": ${ 'Yes' if user_reason == "commutertoresident" else 'No' } - "form1[0].#subform[1].P2_Line2h1_CityandState[0]": ${ user_status_poe if user_reason == "commutertoresident" else '' } - "form1[0].#subform[2].P2_checkbox3[0]": ${ 'Yes' if user_condreason == "lost" else 'No' } - "form1[0].#subform[2].P2_checkbox3[1]": ${ 'Yes' if user_condreason == "notreceived" else 'No' } - "form1[0].#subform[2].P2_checkbox3[2]": ${ 'Yes' if user_condreason == "mutilated" else 'No' } - "form1[0].#subform[2].P2_checkbox3[3]": ${ 'Yes' if user_condreason == "incorrect" else 'No' } - "form1[0].#subform[2].P2_checkbox3[4]": ${ 'Yes' if user_condreason == "biochange" else 'No' } - "form1[0].#subform[2].P3_checkbox10[0]": ${ 'Yes' if user_eye == "black" else 'No' } - "form1[0].#subform[2].P3_checkbox10[1]": ${ 'Yes' if user_eye == "gray" else 'No' } - "form1[0].#subform[2].P3_checkbox10[2]": ${ 'Yes' if user_eye == "maroon" else 'No' } - "form1[0].#subform[2].P3_checkbox10[3]": ${ 'Yes' if user_eye == "blue" else 'No' } - "form1[0].#subform[2].P3_checkbox10[4]": ${ 'Yes' if user_eye == "green" else 'No' } - "form1[0].#subform[2].P3_checkbox10[5]": ${ 'Yes' if user_eye == "pink" else 'No' } - "form1[0].#subform[2].P3_checkbox10[6]": ${ 'Yes' if user_eye == "brown" else 'No' } - "form1[0].#subform[2].P3_checkbox10[7]": ${ 'Yes' if user_eye == "hazel" else 'No' } - "form1[0].#subform[2].P3_checkbox10[8]": ${ 'Yes' if user_eye == "other" else 'No' } - "form1[0].#subform[2].P3_checkbox11[0]": ${ 'Yes' if user_hair == "bald" else 'No' } - "form1[0].#subform[2].P3_checkbox11[1]": ${ 'Yes' if user_hair == "brown" else 'No' } - "form1[0].#subform[2].P3_checkbox11[2]": ${ 'Yes' if user_hair == "sandy" else 'No' } - "form1[0].#subform[2].P3_checkbox11[3]": ${ 'Yes' if user_hair == "black" else 'No' } - "form1[0].#subform[2].P3_checkbox11[4]": ${ 'Yes' if user_hair == "gray" else 'No' } - "form1[0].#subform[2].P3_checkbox11[5]": ${ 'Yes' if user_hair == "white" else 'No' } - "form1[0].#subform[2].P3_checkbox11[6]": ${ 'Yes' if user_hair == "blond" else 'No' } - "form1[0].#subform[2].P3_checkbox11[7]": ${ 'Yes' if user_hair == "red" else 'No' } - "form1[0].#subform[2].P3_checkbox11[8]": ${ 'Yes' if user_hair == "other" else 'No' } - "form1[0].#subform[2].P3_checkbox4[0]": ${ 'Yes' if user_processing_deportation else 'No' } - "form1[0].#subform[2].P3_checkbox4[1]": ${ 'Yes' if user_processing_deportation == False else 'No' } - "form1[0].#subform[2].P3_checkbox5[0]": ${ 'Yes' if user_processing_abandoned else 'No' } - "form1[0].#subform[2].P3_checkbox5[1]": ${ 'Yes' if user_processing_abandoned == False else 'No' } - "form1[0].#subform[2].P3_checkbox6[0]": ${ 'Yes' if user_ethnicity_hispanic else 'No' } - "form1[0].#subform[2].P3_checkbox6[1]": ${ 'Yes' if user_ethnicity_hispanic == False else 'No' } - "form1[0].#subform[2].P3_checkbox7_Asian[0]": ${ 'Yes' if user_race['asian'] else 'No' } - "form1[0].#subform[2].P3_checkbox7_Black[0]": ${ 'Yes' if user_race['black'] else 'No' } - "form1[0].#subform[2].P3_checkbox7_Hawaiian[0]": ${ 'Yes' if user_race['hawaiian'] else 'No' } - "form1[0].#subform[2].P3_checkbox7_Indian[0]": ${ 'Yes' if user_race['indian'] else 'No' } - "form1[0].#subform[2].P3_checkbox7_White[0]": ${ 'Yes' if user_race['white'] else 'No' } - "form1[0].#subform[2].P3_Line1_LocationAppliedVisa[0]": ${ user_processing_applocation } - "form1[0].#subform[2].P3_Line2_LocationIssuedVisa[0]": ${ user_processing_issuelocation } - "form1[0].#subform[2].P3_Line3a1_CityandState[0]": ${ user_processing_poecity } - "form1[0].#subform[2].P3_Line3a_Destination[0]": ${ user_processing_destination } - "form1[0].#subform[2].P3_Line8_HeightFeet[0]": ${ user_processing_heightft } - "form1[0].#subform[2].P3_Line8_HeightInches[0]": ${ user_processing_heightin } - "form1[0].#subform[2].P3_Line9_HeightInches1[0]": ${ weight1 } - "form1[0].#subform[2].P3_Line9_HeightInches2[0]": ${ weight2 } - "form1[0].#subform[2].P3_Line9_HeightInches3[0]": ${ weight3 } - "form1[0].#subform[2].P4_checkbox1[0]": ${ 'Yes' if user_disability else 'No' } - "form1[0].#subform[2].P4_checkbox1[1]": ${ 'Yes' if user_disability else 'No' } - "form1[0].#subform[2].P4_checkbox1a[0]": ${ 'Yes' if user_disability_deaf else 'No' } - "form1[0].#subform[2].P4_Line1a_AccomodationRequested[0]": ${ user_deaf_request } - "form1[0].#subform[3].P4_checkbox1b[0]": ${ 'Yes' if user_disability_blind else 'No' } - "form1[0].#subform[3].P4_checkbox1c[0]": ${ 'Yes' if user_disability_other else 'No' } - "form1[0].#subform[3].P4_Line1b_AccomodationRequested[0]": ${ user_blind_request } - "form1[0].#subform[3].P4_Line1c_AccomodationRequested[0]": ${ user_disability_request } - "form1[0].#subform[3].P5_Checkbox1a[0]": ${ 'Yes' if user_statement_readunderstand else 'No' } - "form1[0].#subform[3].P5_Checkbox1b[0]": ${ 'Yes' if user_language == "es" else 'No' } - "form1[0].#subform[3].P5_Checkbox2[0]": "Yes" - "form1[0].#subform[3].P5_Line1b_Language[0]": ${ 'Spanish' if user_language == "es" else '' } - "form1[0].#subform[3].P5_Line2_NameofRepresentative[0]": Daniel Martinez - "form1[0].#subform[3].P5_Line3_DaytimePhoneNumber[0]": ${ user_phone_day } - "form1[0].#subform[3].P5_Line4_MobilePhoneNumber[0]": ${ user_phone_mobile } - "form1[0].#subform[3].P5_Line5_EmailAddress[0]": ${ user_email } - "form1[0].#subform[3].P5_Line6a_SignatureofApplicant[0]": ${ user_signature } - "form1[0].#subform[3].P5_Line6b_DateofSignature[0]": ${ today() } - "form1[0].#subform[4].P6_checkbox3b_Unit[0]": "No" - "form1[0].#subform[4].P6_checkbox3b_Unit[1]": "No" - "form1[0].#subform[4].P6_checkbox3b_Unit[2]": "Yes" - "form1[0].#subform[4].P6_Line1a_InterpretersFamilyName[0]": "Martinez" - "form1[0].#subform[4].P6_Line1b_InterpretersGivenName[0]": "Daniel" - "form1[0].#subform[4].P6_Line2_NameofBusinessor[0]": "Dominico-American Society of Queens" - "form1[0].#subform[4].P6_Line3a_StreetNumberName[0]": "40-27 97th St" - "form1[0].#subform[4].P6_Line3b_AptSteFlrNumber[0]": 1 - "form1[0].#subform[4].P6_Line3c_CityTown[0]": "Corona" - "form1[0].#subform[4].P6_Line3d_State[0]": "NY" - "form1[0].#subform[4].P6_Line3e_ZipCode[0]": "11368" - "form1[0].#subform[4].P6_Line3h_Country[0]": "USA" - "form1[0].#subform[4].P6_Line4_InterpretersDaytimePhoneNumber[0]": "718-457-5395" - "form1[0].#subform[4].P6_Line5_InterpretersEmailAddress[0]": "danny@keybored.co" - "form1[0].#subform[4].P6_Line6b_DateofSignature[0]": ${ today() } - "form1[0].#subform[4].P7_checkbox3b_Unit[0]": "No" - "form1[0].#subform[4].P7_checkbox3b_Unit[1]": "No" - "form1[0].#subform[4].P7_checkbox3b_Unit[2]": "Yes" - "form1[0].#subform[4].P7_Line1a_FamilyName[0]": "Martinez" - "form1[0].#subform[4].P7_Line1b_PreparersGivenName[0]": "Daniel" - "form1[0].#subform[4].P7_Line2_NameofBusinessor[0]": "Dominico-American Society of Queens" - "form1[0].#subform[4].P7_Line3a_StreetNumberName[0]": "40-27 97th St" - "form1[0].#subform[4].P7_Line3b_AptSteFlrNumber[0]": 1 - "form1[0].#subform[4].P7_Line3c_CityTown[0]": "Corona" - "form1[0].#subform[4].P7_Line3d_State[0]": "NY" - "form1[0].#subform[4].P7_Line3e_ZipCode[0]": "11368" - "form1[0].#subform[4].P7_Line3h_Country[0]": "USA" - "form1[0].#subform[4].P7_Line4_PreparersDaytimePhoneNumber[0]": "718-457-5395" - "form1[0].#subform[4].P7_Line6_PreparersEmailAddress[0]": "danny@keybored.co" - "form1[0].#subform[5].P7_checkbox7[0]": "Yes" - "form1[0].#subform[5].P7_checkbox7[1]": "No" - "form1[0].#subform[5].P7_checkbox7Extend[0]": "No" - "form1[0].#subform[5].P7_checkbox7Extend[1]": "No" - "form1[0].#subform[5].P7_Line8b_DateofSignature[0]": ${ today() } - name: g-1145 filename: g-1145-${ user_name_last }-${ user_name_first } pdf template file: g-1145.pdf template password: "" valid formats: pdf pdf/a: True editable: False language: en fields: - "form1[0].#subform[0].LastName[0]": ${ user_name_last } - "form1[0].#subform[0].FirstName[0]": ${ user_name_first } - "form1[0].#subform[0].MiddleName[0]": ${ user_name_middle } - "form1[0].#subform[0].Email[0]": ${ user_email } - "form1[0].#subform[0].MobilePhoneNumber[0]": ${ user_phone_mobile } field: last_screen mandatory: True --- code: | phys_data = [ "user_physaddr_street", "user_physaddr_aptno", "user_physaddr_city", "user_physaddr_state", "user_physaddr_zip", "user_physaddr_province", "user_physaddr_postcode", "user_physaddr_country", "user_physaddr_type" ] if phys_addr == False: for datum in phys_data: datum = "" mandatory: True --- code: | if user_reason != "permtocommuter": user_status_poe = "" mandatory: True --- code: | if user_status != "conditional": user_condreason = "" mandatory: True --- code: | if user_processing_visaentry == False: user_processing_poecity = "" user_processing_destination = "" mandatory: True --- code: | user_weight1 = str(user_weight) weight = list(user_weight1) if len(weight) == 3: weight1 = weight[0] weight2 = weight[1] weight3 = weight[2] if len(weight) == 2: weight1 = 0 weight2 = weight[0] weight3 = weight[1] mandatory: True --- code: | if user_disability == False: user_disability_deaf = False user_deaf_request = "" user_disability_blind = False user_blind_request = "" user_disability_other = False user_disability_request = "" mandatory: True