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Instructies voor formulier G-845 Supplement, Verificatieverzoek

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Instructions for Form G-845 Supplement,  
Verification Request  
USCIS  
Form G-845  
OMB No. 1615-0101  
Expires 04/30/2024  
Department of Homeland Security  
U.S. Citizenship and Immigration Services  
What Is the Purpose of This Form?  
An agency that is registered with the U.S. Citizenship and Immigration Services’ (USCIS) Systematic Alien Verification  
for Entitlements (SAVE) Program may file this form with Form G-845, Verification Request, to request more detailed  
information on immigration status, citizenship, and sponsorship.  
Who May File This Form?  
Any agency that has executed a Memorandum of Agreement with the USCIS SAVE Program may file this form if  
the agency needs additional information found on the Form G-845 Supplement that is not found on the Form G-845  
to administer certain benefits. If you are not sure whether you can use the Supplement, please check with the SAVE  
Program.  
General Instructions  
For each applicant, you must submit a completed Form G-845 Supplement with a completed Form G-845 to request  
verification. You may not submit the Form G-845 Supplement alone. The information on this request concerns  
eligibility for certain Federal, state, and local public benefits.  
If you do not follow the instructions, USCIS’ SAVE Program may return this form without a verification response, which  
may delay processing.  
For each applicant, you must complete a separate Form G-845 and Form G-845 Supplement and include copies of  
documents only for that individual. If a family unit applies for a benefit, submit a separate Form G-845 and Form G-845  
Supplement for each family member.  
USCIS provides forms free of charge through the USCIS Web site. In order to view, print, or fill out our forms, you  
should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/.  
Copies. Submit copies (front and back) of the applicant’s most recently issued immigration documentation. In addition  
to the most recently issued immigration documentation, you may also submit any relevant documents bearing on the  
applicant’s immigration status or admission. Ensure that copies are legible and made from original documents.  
How To Fill Out Form G-845 Supplement  
1. Type or print legibly in black ink.  
2. If you need extra space to complete any item within this request, attach a separate sheet of paper; type or print the  
applicant’s last name, first name, and Case Verification Number at the top of each sheet; and indicate the Page  
Number, Part Number, and Item Number to which the information refers.  
3. If you are filling the form out manually, type or print the applicant’s last name, first name and Case Verification  
Number at the top of each page. For example: Smith, John, 123456789123456.  
Form G-845 Supplement Instructions 04/08/21  
Page 1 of 4  
Specific Instructions  
Part 1. Information From the Registered Agency  
NOTE: Only the Registered Agency should complete the information in this part of the request.  
1. In the Tosection, stamp, type, or print the mailing address of the Registered Agency’s assigned Status Verification  
Office; you can find this address at www.uscis.gov/save.  
2. In the “From” section, stamp, type, or print the Registered Agency’s name, and mailing address with ZIP Code.  
NOTE: You MUST enter a complete return address into the “From” portion of the request. You also MUST  
complete ALL items in Part 1. (SAVE may use this portion of the form to display your address in a number 10  
window envelope.)  
3. Complete Item Numbers 1. - 10.  
Item Numbers 1a. - 1.d. Immigration Document Numbers. Enter the Alien Registration Number (A-Number) or  
Form I-94 Number in the space provided or both the A-Number and Form I-94 Number if both numbers are listed on the  
provided document. The A-Number is the letter “A” followed by a 7, 8, or 9-digit number. The Form I-94 Number is  
found on Form I-94, Arrival-Departure Record, and is 11 digits. If you received a paper Form I-94, check the front and  
back of the Form I-94. If the A-Number appears, record that number when requesting information because the A-Number  
refers to the most integral record available.  
Enter any other immigration numbers, such as the applicant’s foreign passport number or Certificate of Citizenship  
document number, in the data collection box entitled “Other Immigration Number.” Provide the name or form numbers  
of the documents that contain these immigration numbers in the next data collection box. These numbers can be included  
with the A-Number and Form I-94 Number. If it is a foreign passport, include the name of the country of issuance.  
Item Numbers 2.a. - 2.c. Full Name. Enter the applicant’s last name, first name, and middle name exactly as printed on  
the immigration document.  
Item Number 3. Case Verification Number. Enter the 15-digit case verification number if a query was initiated in the  
SAVE online system. If the SAVE online system was not used, leave this blank.  
Item Number 4. Date of Birth. Enter the applicant’s date of birth in the mm/dd/yyyy format.  
Item Number 5. U.S. Social Security Number. Enter the applicant’s U.S. Social Security Number, if applicable.  
Item Numbers 6.a. - 6.h. Information Requested by the Registered Agency. Select all applicable boxes to indicate the  
verification requested.  
Item Numbers 7.a. - 8.b. Registered Agency Information. Enter the submitting official’s first and last name, title,  
daytime telephone number, and extension number in the spaces provided.  
Item Number 9. Date Request Completed. Enter the date that the submitting official completed the Form G-845  
Supplement.  
Item Number 10. Registered Agency Comments (if any). The Registered Agency may enter additional information  
about the immigration verification request. Use this box for providing additional information or comments such as:  
1. Aliases;  
2. Date of entry into the United States;  
3. Previous receipt numbers; and  
4. Special requests from the Registered Agency.  
Form G-845 Supplement Instructions 04/08/21  
Page 2 of 4  
Part 2. USCIS Responses  
Only USCIS should complete the information in this part of the request, except as indicated below.  
Item Number 2.c. Status Dates for RSDI Claims. If the Social Security Administration (SSA) is requesting additional  
verification for an SSA Retirement, Survivors, and Disability Insurance (RSDI) claim, the SSA representative must  
provide the period of time for the applicant’s status related to the RSDI claim.  
Part 3. USCIS Additional Responses  
Only USCIS should complete the information in this part of the request, except as indicated below. Please do not  
preselect Department of Homeland Security (DHS) responses.  
Item Numbers 2.b. - 2.c. Status Dates for Cuban/Haitian Nationals. If the Registered Agency is requesting  
verification for an applicant paroled into the United States as a Cuban/Haitian entrant with status pending (Categories 1A  
and 1B) or who did not acquire any other status under the INA (Category 2A), the Registered Agency’s representative  
must provide the period of time for the applicant’s status related to the verification request.  
NOTE: If the Registered Agency is requesting verification for an applicant paroled into the United States as a Cuban/  
Haitian entrant with an EOIR-pending asylum application (Item Number 2.f.), the Registered Agency’s representative  
must attach Form SSA-8510, Authorization for the Social Security Administration to Obtain Personal Information, or  
other agency’s equivalent release form, with this request.  
Part 4. USCIS Comments  
Only USCIS should complete the information in this part of the request.  
Processing Information  
Upon receipt, the SAVE Program Status Verification Office will review the form for completeness, including submission  
of any attached documents. If the Form G-845 Supplement is not completely filled out, USCIS will return the form  
to you with no verification response.  
Also, if the Form G-845 Supplement is submitted without a completed Form G-845 and a copy of the applicant’s most  
recently issued immigration documentation, USCIS will return it to you with no verification response.  
USCIS Forms and Information  
To ensure you are using the latest version of this form, visit the USCIS Web site at www.uscis.gov where you can obtain  
the latest USCIS forms and immigration-related information. If you do not have Internet access, you may order USCIS  
forms by calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by calling the  
USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.  
USCIS Privacy Act Statement  
USCIS AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the  
Immigration and Nationality Act, sections 101, et seq.  
PURPOSE: The primary purpose for providing the information on this form is to verify the status of the applicant.  
DISCLOSURE: Failure to provide the requested information, and any requested evidence, may delay a response to your  
request.  
Form G-845 Supplement Instructions 04/08/21  
Page 3 of 4  
ROUTINE USES: DHS may share the information you provide on this form with other Federal, state, local, and foreign  
government agencies and authorized organizations under approved routine uses described in the associated published  
system of records notices [DHS/USCIS-004 - Systematic Alien Verification for Entitlements Program System of Records,  
September 21, 2011, 76 FR 58525], which you can find at www.dhs.gov/privacy. DHS may also make the information  
available, as appropriate, for law enforcement purposes or in the interest of national security.  
Paperwork Reduction Act  
An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection  
of information, unless it displays a currently valid OMB control number. The public reporting burden for this collection  
of information is estimated at 5 minutes per response, including the time for reviewing instructions and completing  
and submitting the request. Send comments regarding this burden estimate or any other aspect of this collection of  
information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Office of  
Policy and Strategy, Regulatory Coordination Division, 5900 Capital Gateway Drive, Mail Stop #2140, Camp Springs,  
MD 20588-0009; OMB No. 1615-0101. Do not mail your completed Form G-845 Supplement to this address.  
Form G-845 Supplement Instructions 04/08/21  
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