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If someone needs a letter of recommendation for an O-1 visa and the letter is a bit over-the-top, do you just sign it anyway?

Support letters should be a true representation of your accomplishments. Inaccurate information could come back to hurt you, for example, when applying for a green card through the EB1 visa category (which is most common for O-1 visa holders). The EB-1 visa requires much more documentation and evidence, and you don’t want any of the additional pieces of documentation or evidence to contradict the O-1 support letter you submitted.