G-845 Supplement
Download a blank fillable G-845 Supplement in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete G-845 Supplement with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2OMB No. 1615-0101; Expires 07/31/2011
G-845 Supplement, Document
Department of Homeland Security
Verification Request Supplement
U.S. Citizenship and Immigration Services
To Be Completed by the Submitting Agency
To:
U.S. Citizenship and Immigration Services
Date (mm/dd/yyyy)
Applicant's Name (Last, First, Middle)
Phone Number (Include Area Code)
Alien Registration Number or I-94 Number
Social Security
(
)
From: Typed or Stamped Name and Address of Submitting Agency
# 1
# 2
# 3
# 4
# 5
# 6
# 7
Complete the following items:
Show 08/22/96 status in #1 j.
Alleged 08/22/96 status:
For SSA Use Only:
To Be Completed by USCIS
1. Immigration Status (Check all that apply):
From the document or information submitted and/or a review of our records, we find that the person identified is a/an:
a.
Lawful Permanent Resident (LPR) alien of the United States.
(Complete b, c, d, g, h or i if alien adjusted to LPR status from one of those statuses in the past seven years.)
b.
Refugee admitted to the United States under Section 207 of the INA. (Complete Item 2 below.)
c.
Asylee under Section 208 of the INA. (Complete Item 3 below.)
d.
Alien whose deportation has been withheld under Section 243(h) of the INA (as in effect prior to April 1, 1997) or whose
removal has been withheld under Section 241(b)(3).
Date deportation or removal ordered withheld:
e.
Alien paroled into the United States under Section 212(d)(5) of the INA for a period of at least one year.
(Complete Items 3 and 4 below.)
f.
Conditional Entrant pursuant to Section 203(a)(7) of the INA prior to April 1, 1980.
g.
American Indian born in Canada to whom the provisions of Section 289 of the INA apply.
h.
Cuban/Haitian Entrant, as defined in Section 501(e) of the Refugee Education Assistance Act of 1980.
(Complete Item 3 below.)
Amerasian immigrant, pursuant to Section 584 of the Foreign Operations, Export Financing, and Related Programs
i.
Appropriations Act of 1988. (Complete Item 2 below.)
j.
Other (indicate status):
2. Date alien entered the United States:
3. Date status was granted:
4. Date status expires:
Form G-845 Supplement (07/25/08)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal