Form G-845 Table of Changes

TABLE OF CHANGES – FORM

Form G-845, Verification Request

OMB Number: 1615-0101

Date 12/01/2014

Reason for Revision: Form, instructions, and supplement were revised to incorporate form design and standard language updates, and operational and customer needs.

Current Location	Current Text	Proposed Text
New		[Page 1] START HERE – Type or print in black ink. [Page 2-4, in the header] Applicant’s Last Name Applicant’s First Name Case Verification Number
Page 1-2, Section A. To Be Completed by Registered Agency Only	[Page 1] To: U.S. Citizenship and Immigration Services (USCIS) Attn: USCIS SAVE Program Status Verification Office [Fillable field] From: Type or Stamp Name and Address of Registered Agency [Fillable field] Print clearly since USCIS may use above agency address with a No. 10 window envelope. 1. Immigration Document Number… Alien Registration Number (A-Number) I-94 (Arrival-Departure Record) Number Other immigration number (if A-Number/I-94 Number not available): Identify document containing the other immigration number: 2. Applicant's name as shown on the immigration document (Last, First, Middle) 3. Nationality… 9. Check all that apply: a. Photocopy of primary immigration document attached. Ensure copies are legible. If there is print on both sides of the immigration document, attach a copy of front and back. b. Other Information Attached (specify documents): 10. Benefit TANF Unemployment Insurance Education Grant/Loan/ Work Study Employment Authorization Food Stamps Social Security Number Housing Assistance SSI or RSDI Medicaid/Medical Assistance Driver's License/ID Background Check Other (specify below) 11. Name of Agency Official 12. Title of Agency Official 13. Telephone Number (include area code) 14. Fax Number (include area code): 15. Date (mm/dd/yyyy) [Page 2] Registered Agency Comments	[Page 1] Part 1. Information from the Registered Agency NOTE: Only the Registered Agency should complete this information. To: U.S. Citizenship and Immigration Services (USCIS) Attn: USCIS SAVE Program Status Verification Office [Drop-down box] 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.) From: [Fillable fields] Applicant Information Immigration Document Number 1.a. 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 Applicant’s Full Name as Shown on the Immigration Document 2.a. Last Name 2.b. First Name 2.c. Middle Name 3. Case Verification Number 4. Date of Birth (mm/dd/yyyy) 5. Social Security Number 6. Student and Exchange Visitor Information System (SEVIS) Number 7.Citizenship or Nationality 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 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) [Page 2] Registered Agency Information 10. Registered Agency Case Number Full Name of Agency Official 11.a. Last Name 11.b. First Name 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)
Page 2, Section B. To Be Completed by USCIS	USCIS RESPONSES: After review of the documents, and/or information submitted, and/or of our records, we find that the document appears valid and relates to a/an: Lawful Permanent Resident alien of the United States. Conditional Resident alien of the United States. Alien employment authorized in the United States as indicated No expiration date (indefinite) Expires on (mm/dd/yyyy) Prior employment authorization date(s): [6 data collections] Alien not employment authorized in the United States Alien has an application pending for (specify USCIS benefit): Alien granted asylum or refugee status in the United States Alien paroled into the United States under section 212 of the Immigration and Nationality Act (INA). No expiration (Indefinite) Parole granted on (mm/dd/yyyy) Parole expires on (mm/dd/yyyy) 9. Conditional entrant of the United States. 10. Nonimmigrant alien (Specify type or class below): [1 field] 12. U.S. Citizen 13. USCIS is searching indices for further information 14. This document is not valid because it appears to be: Expired Altered Counterfeit 8. Cuban/Haitian entrant of the United States 11. American Indian born in Canada to whom the provisions of section 289 of the INA apply. Date status recognized (mm/dd/yyyy)	[Page 2] 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 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) Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy) Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy) 4. Applicant is not employment authorized in the United States 5. Applicant has an application pending for the following USCIS benefit: 6. Applicant was granted asylum or refugee status in the United States 7. Applicant was paroled into the United States under section 212 of the Immigration and Nationality Act (INA). No Expiration Date (Indefinite) Parole Granted Date (mm/dd/yyyy) Parole Expiration Date (mm/dd/yyyy) 8. Conditional entrant of the United States 9. Nonimmigrant (Specify type or class and expiration date) [2 fields] Type or Class Expiration Date (mm/dd/yyyy) 10. U.S. Citizen [below] [below] ADDITIONAL USCIS RESPONSES 11. Cuban/Haitian entrant of the United States 12. American Indian born in Canada to whom the provisions of INA 289 apply. Date Status Recognized (mm/dd/yyyy) 13. Mexican Born Member of the Texas or Oklahoma Band of Kickapoo Indians I-872 Issuance Date (mm/dd/yyyy) COA (KIC or KIP)________ Other foreign born American Indian Date of Entry (mm/dd/yyyy) COA________________ [new] 14. Deferred Action for Childhood Arrivals (DACA) 15. Temporary Protected Status (TPS) 16. Deferred Action Status 17. VAWA Self-Petitioner _a. Pending prima facie VAWA self-petition _b. Approved VAWA self-petition 18. Withholding of Removal 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 Counterfeit
Page 3, Section C. USCIS Comments	Unable to process without an original consent of disclosure statement signed by the applicant. Resubmit request. No determination can be made from the information submitted. Obtain copy of the original alien registration document. Resubmit request. No determination can be made without seeing both sides of the documents submitted. Resubmit request. Cannot read document copy. Resubmit request. Other: [Box for] USCIS Stamp	[Page 3] 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. 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. 4. Copy provided of applicant’s immigration document is illegible. Submit a new request with legible documents. 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. 6. Other [Box for] USCIS Stamp

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