Fillable Request for Alien Information for Employees and Fellows (State University of New York at Farmingdale)

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Request for Alien Information for Employees and Fellows (State University of New York at Farmingdale)

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U.S.A. forms for State University of New York at Farmingdale

BROWSE STATE UNIVERSITY OF NEW YORK AT FARMINGDALE FORMS

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Request for Alien Information for Employees and Fellows
IMPORTANT!
This is a two-part form. Completion of BOTH parts is REQUIRED to determine
residency and tax status.
Part 1 – Request for Alien Information
is used to obtain basic taxpayer
information for aliens.
Part 2 – Substantial Presence Test
is used for determining residency for tax
withholding purposes.
PART 1: Request for Alien Information:
Payee’s U.S. Social Security Number
or
Individual Tax Identification Number: ______________________
Full Name: ____________________________________________________________________________
Address in Home Country: _______________________________________________________________
Current Address: _______________________________________________________________________
Country of Citizenship: ___________________________ Date Entered U.S.A.: ____________________
Country of Tax Residency: _________________________
VISA Type Code: _____________________________VISA Number: ____________________________
Work Authorization Start Date: _______________ Work Authorization Expiration Date: ___________
Passport #: ______________
For Employees Only:
Date First Employed: ____________
Martial Status:
Single Married Other _________________
If Married, Is Spouse Here? Yes No If Yes, Number of Dependents: ________
CAMPUS USE ONLY
Payment Type: Employee Fellow Both
J Category Code: ________ Income Code: __________ Exemption Code: __________
Are the funds foreign sourced? Yes No Primary Activity: _________
Is there a tax treaty with country of tax residence and the USA? Yes No
Are they eligible for a treaty benefit? Yes No
***If yes, the following must be completed. ***
- For Employees – IRS Form 8233 and Supporting Statement for IRS Publication 519
- For Fellowships – IRS Form W-8BEN
If treaty exempt:
Maximum Benefit Amount $______________
Date Treaty Begins: ____________
Date Treaty Ends: _____________
Initials: ________ Date: ________
Page 1 of 2 Revised 6/3/2009
PART 2: Substantial Presence Test
(
Determination of Residence Status for Federal Tax Withholding Purposes
)
For More Information, Refer to IRS Tele-Tax Service at 1-800-829-4477 (Topic 851)
TEST 1
U.S. Residence
Status Test
CHECK ANY APPLICABLE BOX
I am a lawful permanent resident of the United States. Hold an Alien Registration Receipt
Card Form I-551 (commonly known as a "Green Card.")
If box was marked, you are a resident alien for tax purposes. Go to the "test results" section
and check the "resident alien" box.
If box is not marked, go to Test 2 and continue completing the tests.
TEST 2
Exemption
From
Substantial
Presence Test
CHECK ANY APPLICABLE BOX
I am a teacher, trainee, or non-student (i.e., professor, research scholar or specialist, short-
term scholar) on a J-1 or Q-1 VISA and have been in the USA for less than two of the
preceding six calendar years.
I am a student on an F-1, J-1, M-1 or Q-1 VISA and have been in the USA for a total of
five or fewer years.
I am a foreign government – related individual. (i.e., full time employee of an international
organization or have diplomatic or consular status.)
If box was marked, you are a nonresident alien for tax purposes. Go to the "test results" section
and check the "nonresident alien" box.
If box is not marked, go to Test 3 and continue completing the tests.
TEST 3
The Substantial
Presence Test
COMPLETE THE SPACES BELOW, INDICATING THE NUMBER OF DAYS PRESENT
IN THE U.S.A. DURING THE YEARS LISTED.
N
o. of Days
Enter Year Date Entered US Date Departed In USA
Current Year _________ __________ xxxxxxxx
_______ x 1 = ____
1st Preceding Year ________ __________ ________ _______ x 1/3 = ____
2
nd
Preceding Year _______ __________ ________ _______ x 1/6 = ____
Total _____
If total is greater than or equal to 183 and you are present in the U.S. at a minimum of 31 days
in the current year, then go to test results and check resident alien box. If total is less than 183
or if you have not been present in the U.S. for 31 days in the current year, you are a
nonresident alien for tax purposes. Go to the "Test Results" section and check the nonresident
alien box.
TEST
RESULTS
Your
Residence
Status
MARK APPROPRIATE FEDERAL TAX WITHHOLDING STATUS. (YOU MUST
CHECK ONE OF THESE BOXES.) FOR TAX PURPOSES, I CERTIFY THAT I AM:
Resident Alien The "USA" is your Country of Resident for tax purposes.
Nonresident Alien List your home country _________________ (the country of
residence where you have established a tax home base).
I hereby certify, under penalties of perjury, that the information and tests on this form that I have answered
are to the best of my knowledge and belief, true and correct.
____________________________________________________________ ____________________
Signature
D
ate
____________________________________________________________
Print Name Clearly
Page 2 of 2 Revised 6/3/2009
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Request for Alien Information for Employees and Fellows (State University of New York at Farmingdale)

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Completed 1 October 2020

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