Form G-845 - Verification Request Page 3
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1
2
3Applicant's Last Name
Applicant's First Name
Case Verification Number
3.
No determination can be made without seeing both
Part 2. USCIS Responses (continued)
sides of the applicant's immigration document.
11.
Cuban/Haitian entrant of the United States
Attach copies (front and back) of the applicant's most
recently issued immigration document and submit a
12.
American Indian born in Canada to whom the
new request.
provisions of INA 289 apply.
4.
Copy provided of applicant's immigration document
Date Status Recognized
is illegible. Submit a new request with legible
(mm/dd/yyyy)
documents.
13.
Mexican Born Member of the Texas or Oklahoma
5.
Unable to verify status based on the document
Band of Kickapoo Indians
provided. If this is the applicant's most recently
issued immigration document, refer the applicant to
a.
I-872 Issuance Date:
the document issuing authority.
(mm/dd/yyyy)
6.
Other
COA (KIC or KIP)
b.
Other foreign born American Indian Date
of Entry:
(mm/dd/yyyy)
COA
14.
Deferred Action for Childhood Arrivals (DACA)
15.
Temporary Protected Status (TPS)
16.
Deferred Action Status
17.
VAWA Self-Petitioner
a.
Pending prima facie VAWA self-petition
b.
Approved VAWA self-petition
18.
Withholding of Removal
19.
USCIS is searching indices for further information
20.
This document is not valid because it appears to be:
(Select all that apply)
a.
Expired
USCIS Stamp
b.
Altered
c.
Counterfeit
Part 3. USCIS Comments
NOTE: Only USCIS should complete this information.
1.
Unable to process request without an original consent
of disclosure statement signed by the applicant.
Resubmit request.
2.
No determination can be made because insufficient
information was submitted. Obtain a copy of the
applicant's most recently issued immigration
document. Submit a new request.
Form G-845 05/20/15 N
Page 3 of 3
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