Official Federal Forms > US Citizenship And Immigration Services
Document Verification Request G-845 - Official Federal Forms
| Document Verification Request Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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Department of Homeland Security U.S. Citizenship and Immigration Services OMB No. 1615-0101; Expires 01/31/2015 Form G-845, Document Verification Request Section A. To Be Completed by Registered Agency Only To: U.S. Citizenship and Immigration Services (USCIS) Attn: USCIS SAVE Program Status Verification Office 9. Check all that apply: a. Photocopy of primary immigration document attached. Ensure copies are legible. If there is print on both sides of the immigration document, attach a copy of front and back. b. Other Information Attached (specify documents): From: Type or Stamp Name and Address of Registered Agency Print clearly since USCIS may use above agency address with a No. 10 window envelope. 1. Immigration Document Number: Alien Registration Number (A-Number) 10. Benefit TANF I-94 (Arrival-Departure Record) Number Education Grant/ Loan/ Work Study Other immigration number (if A-Number/I-94 Number not available): Housing Assistance Identify document containing the other immigration number: 2. Applicant's name as shown on the immigration document (Last, First, Middle) Medicaid/Medical Assistance Background Check Other (specify below) 3. Nationality 11. Name of Agency Official 4. Date of Birth (mm/dd/yyyy): 5. Social Security Number: 6. Student and Exchange Visitor Information System (SEVIS) Number: 7. Case Verification Number 14. Fax Number (include area code): 8. Registered Agency Case Number 15. Date (mm/dd/yyyy): 13. Telephone Number (include area code) 12. Title of Agency Official Food Stamps Unemployment Insurance Employment Authorization Social Security Number SSI or RSDI Driver's License/ID A- ( ) - Form G-845 01/08/12 N American LegalNet, Inc. www.FormsWorkFlow.com Section A. To Be Completed by Registered Agency Only (continued) Registered Agency Comments Section B. To Be Completed by USCIS USCIS RESPONSES: After review of the documents and/or information submitted, and/or of our records, we find that the document appears valid and relates to a/an: 1. Lawful Permanent Resident alien of the United States. 2. Conditional Resident alien of the United States. 3. Alien employment authorized in the United States as indicated: a. No expiration (indefinite) b. Expires on (mm/dd/yyyy): c. Prior employment authorization date(s): 8. 9. Cuban/Haitian entrant of the United States. Conditional entrant of the United States. 7. Alien paroled into the United States under section 212 of the Immigration and Nationality Act (INA). a. No expiration (Indefinite) b. Parole granted on (mm/dd/yyyy): c. Parole expires on (mm/dd/yyyy): 10. Nonimmigrant alien. (Specify type or class below): 11. American Indian born in Canada to whom the provisions of section 289 of the INA apply. Date status recognized (mm/dd/yyyy): 4. Alien not employment authorized in the United States. 5. Alien has an application pending for (specify USCIS benefit): 12. U.S. Citizen. OTHER USCIS RESPONSES: 13. USCIS is searching indices for further information. 14. This document is not valid because it appears to be: (Check all that apply) 6. Alien granted asylum or refugee status in the United States. a. Expired b. Altered c. Counterfeit Form G-845 01/08/12 N Page 2 American LegalNet, Inc. www.FormsWorkFlow.com Section C. USCIS Comments 1. Unable to process request without an original consent of disclosure statement signed by the applicant. Resubmit request. 2. No determination can be made from the information submitted. Obtain copy of the original alien registration document. Resubmit request. 3. No determination can be made without seeing both sides of the documents submitted. Resubmit request. 4. Cannot read document copy. Resubmit request. 5. Other: USCIS Stamp Form G-845 01/08/12 N Page 3 American LegalNet, Inc. www.FormsWorkFlow.com
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