Sample Immigration Psychological Evaluation Report
A section-by-section look at what an immigration psychological evaluation, also called a psychosocial evaluation, actually contains. Mock data, real structure, co-signed by two licensed clinicians and delivered nationwide.
An immigration psychological evaluation report runs 12 to 25 pages, follows the DSM-5-TR framework, and is addressed to USCIS. The sample below uses mock data and placeholder names, so you can see every section an adjudicator reads, from the referral question to the clinical impressions, exactly as our co-signed reports are structured. The service is offered nationwide by secure video, with New Mexico as the home base.
What does an immigration psychological evaluation report look like?
It is a structured forensic report, 12 to 25 pages, addressed to USCIS and co-signed by two licensed clinicians. The mock sample below walks the report top to bottom. Placeholder names stand in for a real evaluee, and the findings are shown as neutral placeholders, so nothing here is a real case or a predetermined clinical conclusion.
Mock sample, not a real case. Zero client information.
Immigration Psychological Evaluation, prepared for USCIS. Placeholder names and mock findings throughout.
1. Referral and Identifying Information
Evaluee: [CLIENT NAME]. Date of birth: [DOB]. A-number: [A-NUMBER]. Referred by [Attorney name], Esq., of [referring office] in connection with a [case type] filing. The referral question and the qualifying relationship at issue are stated here.
2. Methodology and Disclosures
The evaluation was conducted across two interview sessions held by secure video, [date] and [date]. The section discloses evaluator and co-signing clinician credentials and licensure, the language of interview, the instruments administered, the collateral reviewed, a statement of impartiality and the absence of a therapeutic relationship, and the limits of confidentiality. It states that the report is offered for legal-proceeding use and is not a treatment record.
3. Instruments Administered
The PHQ-9 and GAD-7 are administered on every case. Case-indicated instruments (for example the PCL-5 with the LEC-5, the PSS-14, or the WHODAS 2.0) are added when the history calls for them. Scores are reported with their standard interpretive ranges: [instrument scores and interpretation rendered here].
4. Clinical Interview and Relevant History
The account given during the interview is documented here in the words of the interviewee, with direct quotes attributed and the source of each statement named. Relevant psychosocial, medical, occupational, and family history is recorded as reported and, where available, as corroborated by reviewed collateral: [interview narrative and history rendered here].
5. Mental Status Observations
Observed presentation is described in specific, behavioral terms: appearance, orientation, mood and affect, thought process, and any observed distress, with the concrete behavior named rather than summarized: [mental status observations rendered here].
6. Clinical Impressions (DSM-5-TR)
Any diagnostic impression is stated only where the data meet named DSM-5-TR criteria, which are cited. Where partial criteria are met, the report uses subclinical framing rather than a label: [clinical impressions rendered here under DSM-5-TR criteria]. No predetermined finding is stated.
7. Hardship Analysis and Malingering Assessment
The findings are tied to the legal standard the case must meet, using Istanbul Protocol opinion language (consistent with, highly consistent with, typical of). An explicit malingering assessment documents the internal consistency of self-report across the two sessions and against the instrument scores: [hardship nexus and malingering assessment rendered here].
8. Signatures
The report is signed by the evaluating clinician and co-signed by the independently licensed Clinical Social Worker who reviewed it, with the license of each clinician named. Annexes for the instruments and any diagnostic criteria follow.
What should a psychological evaluation report for USCIS include?
A USCIS-facing evaluation includes the referral question, identifying information, a methodology and disclosures section, the instruments administered, the clinical interview and relevant history, mental status observations, clinical impressions against DSM-5-TR criteria, a hardship analysis tied to the legal standard, an explicit malingering assessment, and dual-clinician signatures. Every evaluation administers the PHQ-9 and GAD-7, with case-indicated instruments added when the history calls for them.
For a deeper look at the instruments and how the interview works, see the psychosocial evaluation guide, and for who is qualified to sign it, see who can perform the evaluation.
How many pages should an immigration hardship evaluation be?
Between 12 and 25 pages, depending on the case. The length follows the complexity of the clinical picture and the number of instruments the case calls for, not a pricing tier. Thoroughness matters because an adjudicator reads the whole report: the sourced findings, the DSM-5-TR analysis, and the hardship nexus each need room to be documented properly. A report that is complete and specific is harder to discount than a short letter of assertion.
Who writes and signs the report?
Every report is co-signed by two clinicians. A Licensed Master Social Worker conducts the evaluation and drafts the report, and an independently licensed Clinical Social Worker, the firm's Clinical Lead, reviews and co-signs it before release. The dual-clinician model means the clinical evidence in a USCIS filing carries two licensed signatures, with independent clinical review built into the process.
Read the clinician bios for each evaluator and the Clinical Lead.
Request the full sample
Attorneys can request the complete sample report as a PDF. It carries the same mock data and placeholder names as the viewer above, in the full report layout. Send the request through the contact form and note that you would like the sample.
Pricing is flat and published: $750 standard, with expedited and same-day options. See the transparent pricing for every report, review the how the evaluation is scheduled and delivered, or read how referrals work for attorneys.
For the flagship hardship case, see the I-601A extreme hardship evaluation, or the VAWA psychological evaluation for survivor cases. More questions? See the frequently asked questions.
Frequently asked questions
Is this a real case?
No. The sample uses mock data and placeholder names, and contains zero client information. It exists to show the structure of the report, the sections an adjudicator reads, and the method behind them. No real evaluee, diagnosis, or case fact appears anywhere in it.
How many pages is the report?
An immigration psychological evaluation report runs 12 to 25 pages, depending on the case. Length follows the complexity of the clinical picture and the number of instruments the case calls for, not a pricing tier. The report is delivered in English addressed to USCIS.
Will the report state a diagnosis before the evaluation?
No. The evaluator reaches no predetermined finding. Any diagnostic impression is supported by named DSM-5-TR criteria and by the clinical interview and standardized instruments, and when the picture does not meet full criteria for a disorder, the report says so rather than forcing a label. The sample shows placeholder findings only, never an invented conclusion.
Is the sample available in Spanish?
Yes. Kipu Terra is a fully bilingual firm, and this page and its sample are available in English and Spanish. The interview can be conducted in either language. The finished report itself is delivered in English addressed to USCIS, with a brief Spanish-language summary available on request.
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