Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Document Verification Request Form. This is a Official Federal Forms form and can be use in US Citizenship And Immigration Services.
Loading PDF...
Tags: Document Verification Request, G-845S, Official Federal Forms US Citizenship And Immigration Services,
OMB No. 1615-0101; Expires 07/31/2011
Department of Homeland Security
U.S. Citizenship and Immigration Services
G-845S, Document
Verification Request
SAVE
Section A. To Be Completed by the Submitting Agency
To:
U.S. Citizenship and Immigration Services (USCIS)
6.
Verification Number
7.
Photocopy of Document Attached
(If printed on both sides, attach a copy of the front and back.)
Other Information Attached (Specify documents.)
From: Typed or Stamped Name and Address of Submitting Agency
8. (Benefit)
(Your Case Number)
TANF
Education Grant/Loans/Workstudy
Food Stamps
Attn:
Immigration Status Verification Unit
Housing Assistance
(USCIS may use above address with a No. 10 window envelope)
1.
2.
Medicaid/Medical Assistance
Alien Registration Number or Form I-94 Number
Applicant's Name (Last, First, Middle)
Unemployment Insurance
Employment Authorization
Other (specify)
3.
Nationality
9.
4.
Date of Birth (mm/dd/yyyy)
10. Title of Submitting Official
5. U.S. Social Security Number
Name of Submitting Official
11. Date (mm/dd/yyyy)
12. Telephone Number
(
)
Section B. To Be Completed by USCIS
USCIS RESPONSES: From the documents or information submitted and/or a review of our records, we find that:
1.
This document appears valid and relates to a Lawful
Permanent Resident alien of the United States.
8.
This document appears valid and relates to an alien who is a
conditional entrant.
2.
This document appears valid and relates to a Conditional
Resident alien of the United States.
9.
This document appears valid and relates to an alien who is a
nonimmigrant.
3.
This document appears valid and relates to an alien authorized
employment as indicated below:
a.
Full-Time
b.
Part-Time
c.
No Expiration (Indefinite)
d. Expires on (Specify mm/dd/yyyy below):
4.
(Specify type or class below)
10.
11.
12.
This document appears valid and relates to an alien not
authorized employment in the United States.
Continue to process as legal alien. USCIS is searching indices
for further information.
This document is not valid because it appears to be:
(Check all that apply)
a. Expired
This document appears valid and relates to an alien who has an
application pending for:
(Specify USCIS benefit below)
b. Altered
c. Counterfeit
USCIS Stamp
5.
This document relates to an alien having been granted asylum/
refugee status in the United States.
6.
This document appears valid and relates to an alien paroled
into the United States pursuant to Section 212 of the I&N Act.
7.
This document appears valid and relates to an alien who is a
Cuban/Haitian entrant.
Form G-845S (Rev.07/25/08) Y
American LegalNet, Inc.
www.FormsWorkflow.com
Comments
13.
No determination can be made from the information submitted. Please obtain a copy of the original alien registration
documentation and resubmit.
14.
No determination can be made without seeing both sides of the document submitted. (Please resubmit request.)
15.
Copy of document is not readable. (Please resubmit request.)
Permanently Residing Under Color of Law "PRUCOL"
PRUCOL requests can only be submitted by the Social Security Administration for Supplemental Security Income cases that pre-date
August 22, 1996.
16.
USCIS is actively pursuing the removal of an alien in this class/category.
17.
USCIS is not actively pursuing the removal of an alien in this class/category at this time.
18.
Other.
Instructions
1. Submit copies (front and back) of alien's original documentation.
2. Make certain a complete return address has been entered in the "From" portion of the form.
3. The Alien Registration Number (A-number) is the letter "A" followed by a series of seven, eight, or nine digits. The number found
on Form I-94 may also be recorded in the block. (Check the front and back of the Form I-94 document. If the A-number appears,
record that number when requesting information, instead of the longer admission number, because the A-number refers to the
most integral record available.)
4.
If Form G-845 is submitted without copies of the applicant's original documentation, it will be returned to the submitting agency
without any action taken.
5. Address this verification request to the U.S. Citizenship and Immigration Services verification office assigned to you by the SAVE
Program Office. For further information, please visit www.uscis.gov.
Paperwork Reduction Act
An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of information
unless it displays a currently valid OMB control number. The public reporting burden for this collection of information is estimated at
5 minutes per response, including the time for reviewing instructions and completing and submitting the form. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:
U.S. Citizenship and Immigration Services, Regulatory Management Division, 111 Massachusetts Avenue, N.W., 3rd Floor, Suite
3008, Washington, DC 20529. OMB No. 1615-0101. Do not mail your application to this address.
Form G-845S (Rev. 07/25/08) Y Page 2
American LegalNet, Inc.
www.FormsWorkflow.com
