Form G-845 - Supplement, Document Verification Request Supplement - Department Of Homeland Security Page 3

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Section B. To Be Completed by USCIS (continued)
e. Alien paroled into the United States under section 212(d)(5) of the INA for a period of at least 1 year.
Date parole granted:
(mm/dd/yyyy)
Date parole expires:
(mm/dd/yyyy)
f. Conditional entrant under section 203(a)(7) of the INA prior to April 1, 1980.
Date status granted:
(mm/dd/yyyy)
g. American Indian born in Canada to whom the provisions of section 289 of the INA apply.
Date status recognized:
(mm/dd/yyyy)
h. Alien paroled into the United States as a Cuban/Haitian entrant, as defined in section 501(e) of the Refugee Education
Assistance Act of 1980. Date of parole/entry:
(mm/dd/yyyy)
i. Amerasian immigrant under section 584 of the Foreign Operations, Export Financing, and Related Programs
Appropriations Act of 1988. Date of entry:
(mm/dd/yyyy)
j. Alien classified as an Iraqi/Afghan special immigrant admitted under section 101(a)(27) of the INA.
Date of entry:
(mm/dd/yyyy)
Date status granted:
(mm/dd/yyyy)
Class of Admission (COA):
k. Other (indicate status):
Date status granted:
(mm/dd/yyyy)
COA (if applicable):
2. Citizenship Status:
U.S. Citizen.
Only for SSA RSDI Claims, SSA to fill in requested dates.
Status from:
(mm/dd/yyyy)
To:
(mm/dd/yyyy)
Response:
3. Special Benefit Provision for Certain Victims of Abuse:
a. Alien obtained lawful permanent (or conditional) resident status as the spouse, child, or widow(er) of a U.S. citizen.
(mm/dd/yyyy)
Date status granted:
b. Alien obtained lawful permanent (or conditional) resident status as the spouse, child, or unmarried son or daughter of a
lawful permanent resident alien.
(mm/dd/yyyy)
Date status granted:
c. Alien did not obtain status as described in 3(a) or 3(b) above.
Form G-845 Supplement 01/08/12 N Page 3

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