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U.S.A. forms for Louisiana State University

BROWSE LOUISIANA STATE UNIVERSITY FORMS

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______|______|______
LOUISIANA STATE UNIVERSITY SYSTEM ATAX
See instructions on back. Alien Tax Information Request
for Payroll Office use
All non-U.S. citizens who receive compensation from LSU must complete this form. To ensure correct determination of your tax status, all applicable questions below
must be answered and a copy of the following documents must be attached:
™ Unexpired passport ™ I-94 Form “Arrival and Departure Record” (a small white card
inside your passport
™ U.S. Visa from your passport ™ I-20, IAP66, DS2019 or I-797 (H1-B).
Please print.
1. PERSONAL INFORMATION
a. Last Name First Name Middle b. U.S. Social Security Number
c. Street Address
d. City State Zip
2. STUDENT INFORMATION
a. Name of Academic
Department
b. Are you a student? (U one)
[ ] Yes [ ] No
c. If you have attended or are currently attending another U.S. educational institution, provide:
Name of educational institution: _____________________________________________________
Period of attendance: From _______/_______/_______ to _______/______/_______ Degree Granted (if any): ____________
d. Did you receive tax treaty
benefits at another U.S.
educational institution
during the current year
?
[ ] Yes [ ] No
3. IMMIGRATION & ALIEN TAX INFORMATION
(Permanent Residents with Green Cards may skip section 3.g but must provide copy of documentation)
a. Date of first
U.S. entry
b(1). Visa type upon
first U.S. entry
b(2). If you arrived on spouse/dependent visa, what was the visa type of
the primary visa holder (ex: visa type/student or nonstudent)?
c. Current Visa type (check appropriate box):
[ ] F-1 Student [ ] F-1 Student (on practical training) [ ] F-2 Spouse/Dependent of F-1 [ ] H-1 Distinguished Worker
[ ] J-1 Student [ ] J-1 Student (on "academic training") [ ] J-2 Spouse/Dep. of J-1 student [ ] TN - NAFTA Free Trade
[ ] Other J-1 Visitor (
U one) [ ] Other INS classification (list status):
[ ] Short-term scholar _________________________________________________
[ ] Professor
[ ] Research Scholar [ ] U.S. Permanent Resident (must provide documentation;
[ ] Other _____________________________________ e.g., copy of green card, etc.)
d. Country of Birth
e. Country of Citizenship
f. Country of Residence
(for tax purposes)
g. Furnish the requested information to detail the number of days you were physically present in the United States during
the calendar years listed below. Note: The term "calendar year" refers to the period January 1 to December 31.
Calendar
Year
(e.g. 20____)
Number of days
present in U.S.
during the year
Date of Entry Date of Exit Visa J-1 Sub type
(If applicable)
Did you receive tax treaty benefits?
Current calendar
[ ] Yes [ ] No
Last calendar year
[ ] Yes [ ] No
Two years ago
[ ] Yes [ ] No
Three years ago
[ ] Yes [ ] No
Four years ago
[ ] Yes [ ] No
Five years ago
[ ] Yes [ ] No
Six years ago
[ ] Yes [ ] No
RESIDENCE FOR TAX PURPOSES
h. Under Internal Revenue Service definitions, for tax purposes I am considered a
[ ] RESIDENT ALIEN [ ] NONRESIDENT ALIEN
4. CERTIFICATION OF INFORMATION
I certify to the best of my knowledge, all of the information I have provided above is true, correct and complete. Also, I understand it
is my responsibility to keep my employment authorization documents—including passport, IAP-66, I-20, I-688B, DS2019, or other INS
employment authorization—current (unexpired) at all times. To avoid being removed from the University payroll, I will inform Payroll
of any extensions, renewals, or changes in status by completing an I-9 form in the International Services Office by the expiration date
of the employment documentation.
Signature
Date Completed
_______/_______/200____
Month Day Year
C:\PAY\AlienReq.PAY r 10/06/03
HOW TO COMPLETE THE ALIEN TAX INFORMATION REQUEST FORM
You must complete the Alien Tax Information Request form because you are receiving income from the University. Since
the tax withholding requirements are different for resident aliens and nonresident aliens, it is essential to establish the
residency status of non U.S. Citizens. Therefore, it is necessary that you complete this form annually to assist us in
determining whether you should be classified for federal tax withholding purposes as a resident alien or a nonresident alien.
The instructions below will assist you in completing the Alien Tax Information Request form. Other questions can be
directed to the Payroll Office by calling 578-4844.
1a. Enter your full name: Last, First, Middle.
1b. Enter your U.S. social security number or Individual Taxpayer Identification Number ( ITIN). All employees must
have a U.S. social security number in order to work. You will not receive payment until you obtain and report your
social security number to the Payroll Office. Individuals ineligible for a social security number may apply for an ITIN
by filing form W-7, along with necessary documentation, in the Payroll Office.
1c-d. Enter your local address.
2a. Enter the name of the department where you are studying or working.
2b. Indicate whether or not you are a student by checking the appropriate box.
2c. Indicate if you are currently attending or have previously attended another U.S. educational institution and the dates
of attendance. Indicate any degree you may have already received.
2d. Indicate whether or not you have previously received treaty benefits during the current year at another institution by
checking the appropriate box.
3a. Enter the calendar date on which you entered the U.S. for the first time. Must include month, day and year.
Approximate if you are uncertain.
3b(1). Enter the visa type you held when you first entered the U.S.
3b(2). Enter the visa type of the primary visa holder if you entered the U.S. on a spouse or dependent visa.
3c. Indicate your current visa type by checking the appropriate box.
3d. Enter the name of the country where you were born.
3e. Enter the name of the country of your citizenship.
3f. Enter the name of the country of which you are a tax resident.
3g. Complete each row and column in this chart. For each year, enter the visa type(s) under which you were present. If
you were present under several visas during the same calendar year, enter all of the visas. Enter the total days of U.S.
Presence for each calendar year; this total should include all days of presence under all visa types. For the current
year, estimate, to the best of your ability, the exact number of days you will be present in the U.S. Also indicate if you
received tax treaty benefits during any of these periods.
3h. Indicate if you are a resident alien or nonresident alien for tax purposes by checking the appropriate box.
4. Sign and date
5. Return to the Office of Accounting Services, Payroll division, 204 Thomas Boyd Hall, as soon as possible.
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Completed 4 March 2020

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