G-845s Document Verification Request - Immihelp
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1
2U.S. Department of Justice
OMB #1115>0122
SAVE
Document Verification Request
Immigration and Naturalization Service
Section A > to be completed by the submitting agency.
6. Verification Number
To: Immigration and Naturalization Service
"
7.
Photocopy of Document Attached.
(If printed on both sides, attach a copy of the front and of the
back.)
"
Other Information Attached (Specify documents).
8. (Benefit)
(Your Case Number)
From: Typed or Stamped Name and Address of Submitting Agency
"
AFDC
"
Education Grant/Loans/Workstudy
"
Food Stamp
"
Housing Assistance
"
Medicaid/Medical Assistance
Attn: Status Verifier
"
Unemployment Insurance
"
(INS may use above address with a #20 window envelope.)
Employment Authorization
"
Other (specify)
1.
Alien Registration or I>94 Number
2.
Applicantπs Name (Last, First, Middle)
9. Name of Submitting Official
3.
Nationality
10. Title of Submitting Official
4.
Date of Birth (Month/Day/Year)
11. Date
5.
Social Security Number
12. Telephone Number
Section B > to be completed by INS
INS RESPONSE: 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
8. " This document appears valid and relates to an
Lawful Permanent Resident alien of the
alien who is a conditional entrant.
9. " This document appears valid and relates to an
United States.
2. " This document appears valid and relates to a
alien who is a nonimmigrant
(specify type or class below)
Conditional Resident alien of the United
States.
3. " This document appears valid and relates to an
10. " This document appears valid and relates to an
alien authorized employment as indicated
alien not authorized employment in the United
below:
States.
a. " Full>Time
11. " Continue to process as legal alien.
INS
is
b. " Part>Time
searching indices for further information.
" No Expiration (Indefinite)
12. " This document is not valid because it appears to
c.
d. " Expires on
be
(check all that apply)
a. " Expired
(specify Month/Day/Year, below)
b. " Altered
4. " This document appears valid and relates to an
" Counterfeit
c.
alien who has an application pending for
INS Stamp
(specify INS benefit below)
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.
" Please see reverse for additional comments.
Form G>845S (Rev. 06/06/89) Y
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