Form G 845 Supplement PDF Details

The Form G-845 Supplement, issued by the U.S. Citizenship and Immigration Services (USCIS), plays a crucial role in verifying an individual's immigration status for agencies determining eligibility for various federal, state, and local public benefits. As per the directives of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, this form, along with the primary Form G-845, facilitates the request for verification from USCIS, ensuring that only eligible individuals receive the benefits they're entitled to. Designed specifically for use by registered agencies, the form requires detailed information about the applicant, including immigration document numbers, personal details, and the specific type of status verification being requested. It encompasses a wide range of statuses, from lawful permanent residents to refugees, asylees, Amerasian immigrants, and conditional entrants, among others. Furthermore, it addresses specific provisions for victims of abuse, affidavit of support requirements, and details relevant to special immigrant categories, including Cuban/Haitian entrants. The nuanced responses provided by USCIS based on the supplement request assists agencies in making informed decisions regarding benefit allocation, underscoring the importance of accurate and comprehensive completion of this document.

QuestionAnswer
Form NameForm G 845 Supplement
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesg 845sup g 845 supplement form

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OMB No. 1615-0101; Expires 01/31/2015

Department of Homeland Security

U.S. Citizenship and Immigration Services

Form G-845 Supplement, Document Verification Request Supplement

Section A. To Be Completed by Registered Agency Only

To: U.S. Citizenship and Immigration Services (USCIS)

5. Name of Agency Official

Attn.: USCIS SAVE Program Status Verification Office

6. Telephone Number (include area code)

From: Type or Stamp Name and Address of Registered Agency

Print clearly since USCIS may use above agency address with a No. 10 window envelope.

NOTE: A completed Form G-845 Supplement must be used with a completed Form G-845 to request verification - it may not be used alone. The information on this form concerns eligibility for Federal, State, and local public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, P.L. 104-193.

1.Immigration Document Number

Alien Registration Number (A-Number):

► A-

I-94 (Arrival-Departure Record) Number:

►

Other immigration number (if A-Number/I-94 Number is

not available):

Identify document containing the other immigration

number:

2.Applicant's name as shown on the immigration document (Last, First, Middle)

(

 

 

 

)

 

 

 

-

7. Date (mm/dd/yyyy): ►

8.Check the box(es) corresponding to the information your agency requests:

a. Immigration Status b. Citizenship Status

c. Special Benefit Provision for Certain Victims of Abuse

d. Affidavit of Support

For SSA Use Only:

USCIS to verify Cuban/Haitians Entrants by filling out Section C.

SSA-8510 attached (To be used only for applicants with proceedings pending with EOIR).

RSDI Claim: USCIS complete Items B. 4(a) and (b).

Status of this applicant as of 8/22/1996 is required USCIS to complete Item C. 1.

USCIS Stamp

3.Date of Birth (mm/dd/yyyy): ►

4. Social Security Number:

Form G-845 Supplement 01/08/12 N

Section A. To Be Completed by Registered Agency Only (continued)

Registered Agency Comments

Section B. To Be Completed by USCIS

USCIS Responses: After review of the documents and/or information submitted, and/or our records, we find that the document appears valid and relates to a/an:

1. Current Immigration Status (Check all that apply):

a. Lawful Permanent Resident (LPR) alien of the United States. Requesting agency must choose the date that they need to make their benefit determination (check only one):

Effective Date of LPR status/rollback date:

 

 

 

(mm/dd/yyyy)

Date Adjustment to LPR approved:

 

 

(mm/dd/yyyy)

Date Form I-485 Application Approved:

 

 

 

(mm/dd/yyyy)

(If alien adjusted to LPR status from status in the past 7 years, complete b, c, d, g, h, i, or j below.)

b. Refugee admitted to the United States under section 207 of the Immigration and Nationality Act (INA).

Date of admission as refugee:

 

(mm/dd/yyyy)

 

c. Asylee under section 208 of the INA. Date asylum granted:

 

(mm/dd/yyyy)

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:

 

(mm/dd/yyyy)

Form G-845 Supplement 01/08/12 N Page 2

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.

Date status granted:(mm/dd/yyyy)

b. Alien obtained lawful permanent (or conditional) resident status as the spouse, child, or unmarried son or daughter of a

lawful permanent resident alien.

 

Date status granted:

(mm/dd/yyyy)

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

4. Affidavit of Support:

a. Alien was sponsored on Form I-864, Affidavit of Support, under section 213A of the INA.

Service receipt date:

 

(mm/dd/yyyy)

Name of Sponsor:

Family Name

(Last Name)

Given Name

(First Name)

Middle Name

Sponsor's Social Security Number:

Sponsor's Street Address:

b.Alien was not sponsored on Form I-864.

Name of Joint Sponsor:

Family Name

(Last Name)

Given Name

(First Name)

Middle Name

Joint Sponsor's Social Security Number:

Joint Sponsor's Street Address:

See attached for information on additional joint sponsor(s).

Section C. To Be Completed by USCIS for SSA

USCIS Responses: After review of the documents and/or information submitted, and/or our records, we find that the document appears valid and relates to:

1.Immigration Status of alien as of 8/22/1996:

(enter status as of this date or "not applicable" as appropriate) Status at Entry:

2.Immigration Status of Cuban/Haitian nationals:

a. Is the Alien a Cuban or Haitian national? (Select only one)

COA:

Yes

No If not C/H, STOP

b.Alien paroled into the United States as a Cuban/Haitian entrant (status pending) as defined in section 501 (e) of the Refugee Education Assistance Act of 1980, on or after 04/21/1980 (Category 1A), or a Cuban Haitian entrant paroled on or after October 10, 1980 (Category 1B).

SSA to fill in requested dates Status from:

 

(mm/dd/yyyy) to:

 

(mm/dd/yyyy)

Response:

Form G-845 Supplement 01/08/12 N Page 4

 

Section C. To Be Completed by USCIS for SSA

(Continued)

 

 

 

 

 

c. Alien paroled into the United States who has not acquired any other status under the INA. (Category 2A)

SSA to fill in requested dates Status from:

 

(mm/dd/yyyy)

to:

(mm/dd/yyyy)

Response:

 

 

 

 

 

 

 

 

 

 

 

 

d. Alien paroled into the United States in the custody of Federal, State, or local enforcement authorities for law enforcement

purposes.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of entry:

 

 

 

 

 

(mm/dd/yyyy)

 

 

 

 

e.1. Alien whose asylum application filed under section 208 of the INA is pending with DHS. (Category 2C)

Date asylum application filed:

 

 

 

 

 

 

(mm/dd/yyyy)

 

 

 

 

 

 

 

 

e.2. Alien whose asylum application filed under section 208 of the INA is pending with EOIR. (Category 2B)

(SSA attach Form SSA-8510) Date asylum application referred to EOIR:

 

(mm/dd/yyyy)

f. Alien paroled into the United States who is the subject of removal proceedings under the INA but has no final order.

(Category 2B)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date alien placed into proceedings:

 

 

 

 

 

 

(mm/dd/yyyy)

 

g. Person does not meet any of the categories described above.

 

 

 

 

3. Removal Proceedings:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. Alien is subject to an order of removal which is final, non-appealable, and legally enforceable.

 

Date order became final:

 

 

 

 

 

 

(mm/dd/yyyy)

 

 

 

 

b. Alien is subject to an order of supervision after an order of removal.

 

Date of order:

 

 

 

 

 

(mm/dd/yyyy)

 

 

 

 

c. Alien is NOT subject to an order of removal which is final, non-appealable, and legally enforceable.

4. Adjusted to Lawful Permanent Resident

 

 

 

 

 

 

 

 

 

 

 

a. Cuban or Haitian entrant who adjusted to LPR status under:

 

 

 

 

NACARA

HRIFA

 

 

IRCA of 1986

CAA of 1966

 

Date Form I-485 was approved:

 

 

 

 

 

(mm/dd/yyyy) COA:

 

 

b. Alien is NOT an LPR or adjusted under a different section of law.

 

Form G-845 Supplement 01/08/12 N Page 5

Section D. USCIS Comments

Comments:

Form G-845 Supplement 01/08/12 N Page 6

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Be mindful when filling out this document. Ensure each and every field is filled out properly.

1. The Form G 845 Supplement necessitates specific information to be entered. Make sure the next blanks are complete:

The best way to fill out Form G 845 Supplement portion 1

2. The third stage is to complete these blanks: Immigration Document Number, Alien Registration Number ANumber, I ArrivalDeparture Record Number, USCIS to verify CubanHaitians, SSA attached To be used only for, RSDI Claim USCIS complete Items B, Status of this applicant as of is, Other immigration number if, not available, Identify document containing the, USCIS Stamp, number, Applicants name as shown on the, Last First Middle, and Date of Birth mmddyyyy.

Form G 845 Supplement completion process clarified (stage 2)

3. In this specific stage, review Form G Supplement N. Each of these have to be filled in with utmost attention to detail.

Form G 845 Supplement conclusion process shown (portion 3)

It is easy to make errors when filling in your Form G Supplement N, so be sure to reread it before you submit it.

4. Filling out Registered Agency Comments, and Section B To Be Completed by USCIS is vital in this part - always don't rush and fill out each and every empty field!

Filling out part 4 of Form G 845 Supplement

5. This pdf should be concluded by filling out this area. Below you will notice an extensive listing of fields that require accurate information for your form submission to be faultless: Current Immigration Status Check, a Lawful Permanent Resident LPR, make their benefit determination, Effective Date of LPR, mmddyyyy, Date Adjustment to LPR approved, mmddyyyy, Date Form I Application Approved, mmddyyyy, If alien adjusted to LPR status, b Refugee admitted to the United, Date of admission as refugee, mmddyyyy, c Asylee under section of the INA, and mmddyyyy.

Form G 845 Supplement completion process detailed (part 5)

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