Fillable Form G-845: Verification Request Part 1. Information From (Visa Pro)

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Form G-845: Verification Request Part 1. Information From (Visa Pro)

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Form G-845 05/29/18 Page 1 of 3
Verification Request
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form G-845
OMB No. 1615-0101
Expires 05/31/2021
Part 1. Information From the Registered Agency
Immigration Document Number
Applicant Information
1.a.
START HERE - Type or print in black ink.►
NOTE: Only the Registered Agency should complete this
information.
To: U.S. Citizenship and Immigration Services (USCIS)
Attn: USCIS SAVE Program Status Verification Office
Stamp, type, or print the name, address, and ZIP Code of the
Registered Agency. (Print clearly since USCIS may use
agency address below with a No. 10 window envelope.)
Alien Registration Number (A-Number)
1.b. Form I-94 Number (Arrival-Departure Record)
►
1.c. Other Immigration Number
1.d. Name or Form Number of Document Containing the
Other Immigration Number
6. Student and Exchange Visitor Information System
(SEVIS) Number
3. Case Verification Number
Documents Attached (Select all that apply)
8.a.
Photocopy of most recently issued immigration
document attached. Ensure copies are legible and
made from an original document. If the immigration
document is printed on both sides, attach a copy of
the front and back.
8.b.
Other Information Attached (Specify Documents)
Benefits Sought
9.a. Background Check
9.b. Driver's License/ID
9.c. Education Grant/Loan/Work Study
9.d. Employment Authorization
9.e. Food Stamps
9.f. Housing Assistance
4. Date of Birth (mm/dd/yyyy)
5. Social Security Number
From:
Applicant's Full Name as Shown on the Immigration
Document
2.a. Last Name
9.g. Medicaid/Medical Assistance
9.h. Social Security Number
9.i. SSI or RSDI
9.j. TANF
9.k. Unemployment Insurance
9.l. Other (Specify)
7. Citizenship or Nationality
2.c.
Middle Name
2.b. First Name
Please see next page for additional information.
A-
►
►
Form G-845 05/29/18 Page 2 of 3
Part 1. Information From the Registered Agency
(continued)
12. Title of Agency Official
13.a. Daytime Telephone Number (Include Area Code)
13.b. Extension Number (if applicable)
14. Fax Number (if any) (Include Area Code)
15. Date Request Completed
(mm/dd/yyyy)
16. Registered Agency Comments (if any)
7. Applicant was paroled into the United States under
section 212 of the Immigration and Nationality Act
(INA).
8. Conditional entrant of the United States
No Expiration Date (Indefinite)
Parole Granted Date
(mm/dd/yyyy)
Parole Expiration Date
(mm/dd/yyyy)
9. Nonimmigrant (Specify type or class and expiration
date)
10. U.S. Citizen
Type or Class
Expiration Date (mm/dd/yyyy)
5. Applicant has an application pending for the
following USCIS benefit:
6. Applicant was granted asylum or refugee status in
the United States
Applicant's Last Name Applicant's First Name
3. Applicant is employment authorized in the United
States as indicated:
No Expiration Date (Indefinite)
Expiration Date
(mm/dd/yyyy)
Previous Employment Authorization Dates
Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy)
4. Applicant is not employment authorized in the
United States
Registered Agency Information
11.a. Last Name
11.b. First Name
Full Name of Agency Official
Case Verification Number
10. Registered Agency Case Number
Please see next page for additional information.
Part 2. USCIS Responses
NOTE: Only USCIS should complete this information.
Upon review of these documents, information submitted, and
our records, we find the following for the applicant:
1. Lawful Permanent Resident of the United States
2.
Conditional Permanent Resident of the United
States
Form G-845 05/29/18 Page 3 of 3
6. Other
Applicant's Last Name Applicant's First Name
14. Deferred Action for Childhood Arrivals (DACA)
15. Temporary Protected Status (TPS)
16.
VAWA Self-Petitioner17.
Deferred Action Status
18. Withholding of Removal
Part 2. USCIS Responses (continued)
19. USCIS is searching indices for further information
20. This document is not valid because it appears to be:
(Select all that apply)
Expired
Altered
a.
b.
Counterfeitc.
13. Mexican Born Member of the Texas or Oklahoma
Band of Kickapoo Indians
I-872 Issuance Date: a.
(mm/dd/yyyy)
COA (KIC or KIP)
Other foreign born American Indian Date
of Entry:
b.
(mm/dd/yyyy)
COA
5. Unable to verify status based on the document
provided. If this is the applicant's most recently
issued immigration document, refer the applicant to
the document issuing authority.
USCIS Stamp
4. Copy provided of applicant's immigration document
is illegible. Submit a new request with legible
documents.
3. No determination can be made without seeing both
sides of the applicant's immigration document.
Attach copies (front and back) of the applicant's most
recently issued immigration document and submit a
new request.
American Indian born in Canada to whom the
provisions of INA 289 apply.
11. Cuban/Haitian entrant of the United States
12.
(mm/dd/yyyy)
Date Status Recognized
Case Verification Number
Pending prima facie VAWA self-petition
Approved VAWA self-petition
a.
b.
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.
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Form G-845: Verification Request Part 1. Information From (Visa Pro)

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Completed 29 July 2020

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