Fillable G-845 Supplement (Page 2 of 2) in pdf

G-845 Supplement Page 2

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To Be Completed by USCIS (Continued.)

5. Citizenship Status:

This document appears valid and relates to a U.S. citizen.

6. Special Benefit Provision for Certain Victims of Abuse:

a. This alien obtained Lawful Permanent (or Conditional) Resident Status as the spouse, child, or widow(er) of a U.S.

citizen.

b. This alien obtained Lawful Permanent (or Conditional) Resident Status as the spouse, child, or unmarried son or

daughter of a lawful permanent resident alien.

c. This alien did not obtain status as described in (a) or (b) above under Item 6.

7. Affidavit of Support:

a. This alien was sponsored on Form I-864, Affidavit of Support, under Section 213A of the INA.

Service receipt date:

(Complete Item 3 on Page 1.)

b. This alien was not sponsored on Form I-864.

Name of Sponsor

Name of Joint Sponsor(s) (if any)

Joint Sponsor's U.S. Social Security Number

Sponsor's U.S. Social Security Number

Joint Sponsor's Address

Sponsor's Address

NOTE: This supplement may be used in conjunction with Form G-845 to

See attached for information on additional joint

request verification: it cannot be used alone. It reflects information that

may be relevant to eligibility for Federal, State, and local public benefits

sponsor(s).

under the Personal Responsibility and Work Opportunity

Reconciliation Act of 1996, P.L. 104-193.

USCIS Stamp

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-845 Supplement (07/25/08) Page 2

G-845 Supplement Page 2

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