USCIS Form G-845 "Verification Request"

What Is USCIS Form G-845?

This is a legal form that was released by the U.S. Department of Homeland Security - Citizenship and Immigration Services on May 29, 2018 and used country-wide. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on May 29, 2018;
  • The latest available edition released by the U.S. Department of Homeland Security - Citizenship and Immigration Services;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;

Download a fillable version of USCIS Form G-845 by clicking the link below or browse more documents and templates provided by the U.S. Department of Homeland Security - Citizenship and Immigration Services.

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Download USCIS Form G-845 "Verification Request"

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Form G-845 Supplement,
USCIS
Verification Request
Form G-845
Supplement
Department of Homeland Security
OMB No. 1615-0101
U.S. Citizenship and Immigration Services
Expires 05/31/2021
START HERE - Type or print in black ink.
3.
Case Verification Number
Part 1. Information From the Registered Agency
NOTE: Only the Registered Agency should complete this
information.
4.
Date of Birth
(mm/dd/yyyy)
To: U.S. Citizenship and Immigration Services (USCIS)
5.
Social Security Number
Attn: USCIS SAVE Program Status Verification Office
Information Requested by the Registered Agency (Select all
applicable boxes)
6.a.
Immigration Status
6.b.
Citizenship Status
Stamp, type, or print the name, address, and ZIP Code of the
Registered Agency. (Print clearly since USCIS may use
6.c.
Special Benefit Provision for Certain Victims of
agency address below with a No. 10 window envelope.)
Abuse
6.d.
Affidavit of Support
From:
6.e.
USCIS to verify Cuban/Haitian entrants by filling
out Part 3.
6.f.
Form SSA-8510, Authorization for the Social Security
Administration to Obtain Personal Information, or
other agency's equivalent release form, attached. (Use
NOTE: You may only submit a completed Form G-845
only for applicants with proceedings pending with
Supplement with a completed Form G-845 to request
EOIR.)
verification. You may not submit Form G-845 Supplement
alone. The information on this request concerns eligibility for
6.g.
For SSA only: Retirement, Survivors, and Disability
certain Federal, state, and local public benefits.
Insurance (RSDI) Claim. (USCIS completes Item
Numbers 4.a. - 4.d. in Part 2.)
Applicant Information
6.h.
Status of this applicant as of 8/22/1996 is required
(USCIS completes Item Numbers 1.a. - 1.b. in
Immigration Document Number
Part 3.)
1.a. Alien Registration Number (A-Number)
A-
Registered Agency Information
1.b. Form I-94 Number (Arrival-Departure Record)
Full Name of Agency Official
7.a. Last Name
1.c. Other Immigration Number
7.b. First Name
8.a. Daytime Telephone Number (Include Area Code)
1.d. Name or Form Number of Document Containing the
Other Immigration Number
8.b. Extension Number (if applicable)
Applicant's Full Name as Shown on the Immigration
Document
9.
Date Request Completed
2.a. Last Name
(mm/dd/yyyy)
2.b. First Name
2.c. Middle Name
Please see next page for additional information.
Form G-845 Supplement 05/29/18
Page 1 of 5
Form G-845 Supplement,
USCIS
Verification Request
Form G-845
Supplement
Department of Homeland Security
OMB No. 1615-0101
U.S. Citizenship and Immigration Services
Expires 05/31/2021
START HERE - Type or print in black ink.
3.
Case Verification Number
Part 1. Information From the Registered Agency
NOTE: Only the Registered Agency should complete this
information.
4.
Date of Birth
(mm/dd/yyyy)
To: U.S. Citizenship and Immigration Services (USCIS)
5.
Social Security Number
Attn: USCIS SAVE Program Status Verification Office
Information Requested by the Registered Agency (Select all
applicable boxes)
6.a.
Immigration Status
6.b.
Citizenship Status
Stamp, type, or print the name, address, and ZIP Code of the
Registered Agency. (Print clearly since USCIS may use
6.c.
Special Benefit Provision for Certain Victims of
agency address below with a No. 10 window envelope.)
Abuse
6.d.
Affidavit of Support
From:
6.e.
USCIS to verify Cuban/Haitian entrants by filling
out Part 3.
6.f.
Form SSA-8510, Authorization for the Social Security
Administration to Obtain Personal Information, or
other agency's equivalent release form, attached. (Use
NOTE: You may only submit a completed Form G-845
only for applicants with proceedings pending with
Supplement with a completed Form G-845 to request
EOIR.)
verification. You may not submit Form G-845 Supplement
alone. The information on this request concerns eligibility for
6.g.
For SSA only: Retirement, Survivors, and Disability
certain Federal, state, and local public benefits.
Insurance (RSDI) Claim. (USCIS completes Item
Numbers 4.a. - 4.d. in Part 2.)
Applicant Information
6.h.
Status of this applicant as of 8/22/1996 is required
(USCIS completes Item Numbers 1.a. - 1.b. in
Immigration Document Number
Part 3.)
1.a. Alien Registration Number (A-Number)
A-
Registered Agency Information
1.b. Form I-94 Number (Arrival-Departure Record)
Full Name of Agency Official
7.a. Last Name
1.c. Other Immigration Number
7.b. First Name
8.a. Daytime Telephone Number (Include Area Code)
1.d. Name or Form Number of Document Containing the
Other Immigration Number
8.b. Extension Number (if applicable)
Applicant's Full Name as Shown on the Immigration
Document
9.
Date Request Completed
2.a. Last Name
(mm/dd/yyyy)
2.b. First Name
2.c. Middle Name
Please see next page for additional information.
Form G-845 Supplement 05/29/18
Page 1 of 5
Applicant's Last Name
Applicant's First Name
Case Verification Number
Part 1. Information From the Registered Agency
Part 2. USCIS Responses
(continued)
NOTE: Only USCIS should complete this information,
unless otherwise indicated.
Additional Information
Upon review of these documents, information submitted, and
10.
Registered Agency Comments (if any)
our records, we find the following for the applicant:
Current Immigration Status (Select all applicable boxes)
1.a.
Lawful Permanent Resident (LPR) of the United
States. (The Registered Agency must select only one
date necessary to make their benefit determination.)
Effective Date of LPR Status/Rollback
(mm/dd/yyyy)
Date Adjustment to LPR Approved
(mm/dd/yyyy)
PRIOR STATUS: If the applicant adjusted to LPR in the past
7 years from a status listed below in Item Numbers 1.b., 1.c.,
1.d., 1.g., 1.h., 1.i., or 1.j., select the appropriate prior status and
provide dates and class of admission where indicated.
1.b.
Refugee admitted to the United States under section
207 of the Immigration and Nationality Act (INA).
Date of Admission as a Refugee
(mm/dd/yyyy)
1.c.
Asylee under section 208 of the INA.
Date Asylum Granted
(mm/dd/yyyy)
1.d.
Applicant whose deportation has been withheld under
INA 243(h) (as in effect prior to April 1, 1997) or
whose removal has been withheld under
INA 241(b)(3).
Date Deportation or Removal Ordered Withheld
(mm/dd/yyyy)
1.e.
Applicant paroled into the United States under INA
212(d)(5) for a period of at least 1 year.
Date Parole Granted
(mm/dd/yyyy)
Date Parole Expires
(mm/dd/yyyy)
1.f.
Conditional entrant under INA 203(a)(7) prior to
April 1, 1980.
Date Status Granted
(mm/dd/yyyy)
Please see next page for additional information.
Form G-845 Supplement 05/29/18
Page 2 of 5
Applicant's Last Name
Applicant's First Name
Case Verification Number
Special Benefit Provision for Certain Victims of
Part 2. USCIS Responses (continued)
Abuse or Status as a Widow(er)
1.g.
American Indian born in Canada to whom the
provisions of INA 289 apply.
3.a.
Applicant obtained lawful (or conditional) permanent
resident status as the spouse, child, or widow(er) of a
Date Status Recognized
U.S. citizen.
(mm/dd/yyyy)
Date Status Granted
1.h.
Cuban/Haitian entrant as defined in section 501(e) of
(mm/dd/yyyy)
the Refugee Education Assistance Act of 1980.
3.b.
Applicant obtained lawful (or conditional) permanent
1.i.
Amerasian immigrant under section 584 of the
resident status as the spouse, child, or unmarried son
Foreign Operations, Export Financing, and Related
or daughter of a lawful permanent resident.
Programs Appropriations Act of 1988.
Date Status Granted
Date of Entry
(mm/dd/yyyy)
(mm/dd/yyyy)
3.c.
Applicant did not obtain status described in Item
1.j.
Applicant classified as an Iraqi/Afghan special
Number 3.a. or 3.b.
immigrant admitted under INA 101(a)(27).
Date of Entry
Affidavit of Support
(mm/dd/yyyy)
4.a.
Applicant was not sponsored on Form I-864.
Date Status Granted
Receipt Date
(mm/dd/yyyy)
(mm/dd/yyyy)
Class of Admission (COA)
4.b.
Applicant was sponsored on Form I-864, Affidavit of
Support, under INA 213A.
1.k.
Other (Indicate Status)
Receipt Date
(mm/dd/yyyy)
Date Status Granted
4.c. Sponsor's Information
(USPS ZIP Code Lookup)
(mm/dd/yyyy)
Last Name
Class of Admission (COA) (if applicable)
First Name
Middle Name
Citizenship Status
Social Security Number
2.a.
U.S. Citizen
Street Number
2.b.
Not a U.S. Citizen
and Name
2.c.
For SSA only: Status Dates for RSDI Claims
Apt.
Ste.
Flr.
(Registered Agency representative provides dates)
City or Town
From
(mm/dd/yyyy)
State
ZIP Code
To
(mm/dd/yyyy)
Province
Response
Postal Code
Country
Please see next page for additional information.
Form G-845 Supplement 05/29/18
Page 3 of 5
Applicant's Last Name
Applicant's First Name
Case Verification Number
2.b.
Applicant paroled into the United States as a Cuban/
Part 2. USCIS Responses (continued)
Haitian entrant (status pending) as defined in section
4.d. Joint Sponsor's Information
501(e) of the Refugee Education Assistance Act of
1980, on or after April 21, 1980 (Category 1A), or a
Last Name
Cuban/Haitian entrant paroled on or after October 10,
1980. (Category 1B).
First Name
Status Dates (Registered Agency representative
provides dates)
Middle Name
From
(mm/dd/yyyy)
Social Security Number
To
(mm/dd/yyyy)
Street Number
and Name
Response
Apt.
Ste.
Flr.
City or Town
2.c.
Applicant paroled into the United States who has not
acquired any other status under the INA.
State
ZIP Code
(Category 2A)
Status Dates (Registered Agency representative
Province
provides dates)
Postal Code
From
(mm/dd/yyyy)
Country
To
(mm/dd/yyyy)
Response
4.e.
Information on additional joint sponsors attached.
2.d.
Applicant paroled into the United States in the
Part 3. USCIS Additional Responses
custody of Federal, state, or local enforcement
NOTE: Only USCIS should complete this information,
authorities for law enforcement purposes.
unless otherwise indicated. Please do not preselect
Date of Entry
Department of Homeland Security (DHS) responses.
(mm/dd/yyyy)
Upon review of these documents, information submitted, and
our records, we find the following for the applicant:
2.e.
Applicant's asylum application was filed under INA
208 and is pending with DHS. (Category 2C)
Immigration status as of 8/22/1996
Date Asylum Application Filed
1.a.
Type or print "N/A," as appropriate
(mm/dd/yyyy)
2.f.
Applicant's asylum application was filed under INA
1.b. Immigration status at initial entry
208 and is pending with EOIR. (Category 2B)
NOTE: Registered Agency must attach Form SSA-8510, or
Immigration Status of Cuban/Haitian Nationals
other agency's equivalent release form.
2.a. Is the applicant a Cuban or Haitian national as indicated
Date Asylum Application Referred to EOIR
by the document provided by the applicant?
(mm/dd/yyyy)
Yes
No
If you answered "NO," do not process form any further.
Please see next page for additional information.
Form G-845 Supplement 05/29/18
Page 4 of 5
Applicant's Last Name
Applicant's First Name
Case Verification Number
Part 3. USCIS Additional Responses (continued)
Part 4. USCIS Comments
2.g.
NOTE: Only USCIS should complete this information.
Applicant who is in removal proceedings for whom a
final, non-appealable, legally enforceable order of
removal has NOT been entered. (Category 2B.)
Date Placed Into Proceedings
(mm/dd/yyyy)
2.h.
Applicant does not meet any of the categories
described above.
Removal Proceedings
3.a.
Applicant is subject to an order of removal that is
final, non-appealable, and legally enforceable.
Date Order Became Final
(mm/dd/yyyy)
3.b.
Applicant is subject to an order of supervision after
an order of removal.
Date of Order
(mm/dd/yyyy)
3.c.
Applicant is NOT subject to an order of removal that
is final, non-appealable, and legally enforceable.
Adjusted to Lawful Permanent Resident Status
4.a.
Cuban or Haitian national (or citizen) as indicated on
the document provided by the applicant who adjusted
status under:
Nicaraguan Adjustment and Central American
Relief Act (NACARA)
Haitian Refugee Immigration Fairness Act
(HRIFA)
Immigration Reform and Control Act of 1986
(IRCA)
Cuban Adjustment Act of 1966 (CAA)
Date Form I-485 Approved
USCIS Stamp
(mm/dd/yyyy)
Class of Admission (COA)
4.b.
Applicant is NOT an LPR or adjusted under a
different section of law.
Form G-845 Supplement 05/29/18
Page 5 of 5