Verification Request

• Legal Form Number: G-845
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form G-845 Edition 04/08/21 Page 1 of 3

Verification Request

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form G-845

OMB No. 1615-0101

Expires 04/30/2024

Part 1. Information From the Registered Agency

Immigration Document Number

Applicant Information

1.a.

START HERE - Type or print in black ink.►

NOTE: Only the Registered Agency should complete this

information.

To: U.S. Citizenship and Immigration Services (USCIS)

Attn: USCIS SAVE Program Status Verification Office

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.)

Alien Registration Number (A-Number)

1.b. Form I-94 Number (Arrival-Departure Record)

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1.c. Other Immigration Number

1.d. Name or Form Number of Document Containing the

Other Immigration Number

6. Student and Exchange Visitor Information System

(SEVIS) Number

3. Case Verification Number

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

4. Date of Birth (mm/dd/yyyy)

5. Social Security Number

From:

Applicant's Full Name as Shown on the Immigration

Document

2.a. Last Name

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)

7. Citizenship or Nationality

2.c. Middle Name

2.b. First Name

Please see next page for additional information.

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