Completing the Document Verification Request Supplement

The Document Verification Request Supplement (G-845 Supplement) (See Appendix F) may only be used in conjunction with the Document Verification Request (Form G-845S or Form G-845), not separately. It should also be completed as fully as possible by the benefit issuing agency or institution. The following information should be provided on Form G-845 Supplement by the benefit issuing agency or institution

• Non-citizen applicant’s last, first, and middle name;

• Social Security Number (if available);

• Alien Registration Number (A-Number) and/or I-94 Number;

• Typed or stamped name and address of submitting agency;

• Current date;

• Submitting agency’s telephone number.

Refer to the “Completing the Document Verification Request” topic in this Section for more detailed instructions on providing this information.

The benefit issuing agency or institution should indicate what status information is required from INS by checking off the appropriate numbered block9s) in the “Complete

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Appendix 2

the following items:” section on the top portion of the Form G-845 Supplement. It is very important that the benefit issuing agency or institution complete this section, so that INS can provide all appropriate INS status information required to make a determination regarding the applicant’s eligibility for benefits under Title IV of PRWORA, as amended. The following INS information can be obtained by submitting Form G-845 Supplement:

1. Immigration status;

2. Date alien entered the United States; Date status was granted;

3. Date status expires;

4. Citizen status;

5. Special benefit provisions for certain victims of abuse; and

6. Affidavit of Support.