Form 9210 - Alien Status Questionnaire
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1
2Department of the Treasury - Internal Revenue Service
9210
Form
Alien Status Questionnaire
(July 2015)
Taxpayer's name and address
In reply refer to:
Tax year
Last four digits of Social Security Number
Principal place of employment
Furnish the following information concerning your alien status in the United States during the above tax year.
1. Name of country of which you are now a citizen or subject
2. Name of country in which you claimed residence during the above tax year
3. Visa Type
under which you first entered the United States
(Letter and Number)
4. List all other Visa Types which you held
, and dates obtained, if different than Visa shown in item 3, including Visa
(Letter and Number)
currently held
Visa Type
Date Obtained
5. For what reason did you come to the United States
Education
Work
Vacation
Teaching
Foreign government employee
Other
If Other, explain
6. What was the date of your initial arrival in the United States
7. How long do you expect to remain in the United States
8. Did you change your original intention about the length of your stay
Yes
No
If Yes, explain
9. Did you ever apply for and/or have been granted lawful permanent residence in the
Yes
No
United States
(hold a Green Card)
If Yes, explain
10. Did your family accompany you to the United States
Yes
No
Not married
If Yes, what type of visa did your family enter the United States on
(Number and Letter)
Did your spouse, or any other member of your family, work in the United States
Yes
No
If Yes, please furnish us a copy of their U.S. Federal income tax return
9210
Catalog Number 11842U
Form
(Rev. 7-2015)
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