NOTES FOR FILLING IN THE APPLICATION FORM – ENG
If there is more than one such applicant this information must be provided for each additional applicant
Authorization for Release of Health Information Pursuant to HIPAA
When filing out Item 11 which requests the date or event when the authorization will expire
Form W-9 (Rev. October 2018)
Purpose of Form. An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer.
Permission to share information form
Authority of person filling out this form to act on behalf of the applicant or member:* * If this form is being flled out by someone who has been.
Form 3949-A - IRS.gov
Section A – Information About the Person or Business You Are Reporting Fill in Tax Years and dollar amounts if known (e.g.
Form 8809 (Rev. August 2020)
3 Check your method of filing information returns. (check only one box). Use a separate Form 8809 for each method. Electronic. Paper. 4 If you are requesting an
IRS.gov
number (SSN) or individual taxpayer identification number. (ITIN). Reminders For more information about filing Form SS-4 and related issues see: • Pub.
Instructions for Form W-8BEN (Rev. October 2021)
30 nov. 2020 For the latest information about developments related to. Form W-8BEN and ... to incorporate the use of this form by an individual who is.
This form is used to advise Medicare of the person or persons you
Form CMS-10106 (Rev 09/17). Instructions. Information to Help You Fill Out the. “1-800-MEDICARE Authorization to Disclose Personal Health Information” Form.
PRIVACY ACT STATEMENT PAPERWORK REDUCTION ACT
AUTHORITIES: Collection of this information is authorized by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; AFFIANT (The person filling out this form).
Form W-9 (Rev October 2018) - Internal Revenue Service
• Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U S person (including a resident alien) to provide your correct TIN If you do not return Form W-9 to the requester with a TIN you might be subject to backup withholding See What is backup withholding later Cat No 10231X Form W-9 (Rev
Petition for Amerasian Widow(er) or Special - USCIS
Use Form W-9 to request the taxpayer identification number (TIN) of a U S person (including a resident alien) and to request certain certifications and claims for exemption (See Purpose of Form on Form W-9 ) Withholding agents may require signed Forms W-9 from U S exempt recipients to overcome a presumption of foreign status
Form 3949-A Information Referral - Internal Revenue Service
Provide as much information as you know about the person or business you are reporting Complete if you are reporting an individual Include their name street address city state ZIP code social security number or taxpayer identification number occupation date of birth marital status name of spouse (if married) and email address
Part 2 Information about the Beneficiary S A M P L E - USCIS
Form I-134A START HERE - Type or print in black ink Part 1 Basis for Filing 1 I am filing this form on behalf of: Myself as the beneficiary 3 Date of Birth (mm/dd/yyyy) M FSingle Never Married Married Divorced Widowed Legally Separated Marriage Annulled Other (Explain): Another individual who is the beneficiary Part 2 Information
Form I-360 Petition for Amerasian Widow(er) or Special
Information About Person or Organization Filing This Petition Family Name (Last Name) Your Full Name NOTE: You must complete Part 1 as the petitioner if you are filing this petition on behalf of another person If you are a Violence Against Women Act (VAWA) self-petitioner or special immigrant juvenile skip to Part 1 Item Number 7
National POLST Patient Guide to the POLST Form
The POLST form was not created for patients to fill out and complete: your provider should be the person filling it out after talking with you This Guide was created to help patients and caregivers learn more about the POLST form The POLST Form: 3 Decisions In talking with your provider about POLST you will be talking about:
important : read the instructions before filling out this form
NYC Department of Finance l The Office of the Taxpayer Advocate FORM DOF-911 INSTRUCTIONS by mail: The Office of the Taxpayer Advocate 375 Pearl Street 26th Floor New York NY 10038 by e-fax: 646-500-6907 if you already have a deadline to take action filing this form does not extend the deadline
PSC-PEPP-1 Commonwealth of Pennsylvania Pennsylvania
Name of person filling out form Enter the person’s name to contact with any questions relating to the form Title Enter the title of the person completing the form Telephone Number/ Email address Enter the telephone number including area code & extension and email address of the person completing the form
Function Report- Adult - The United States Social Security
number provided on the letter sent with the form or contact the person who asked you to complete the form If you need the address or phone number for the office that provided the form you can get it by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) HOW TO COMPLETE THIS FORM
Searches related to information about the person filling the form filetype:pdf
AUTHORIZATION TO FILL IN APPLICATION OR INFORMATION NOTICE: The applicant or permittee account holder is legally responsible for the actions of any person given access to the permittee account holder’s AIMS online account or authorization to fill in and submit any application or other information
Who can file a self petition?
- Depending on the classification you seek, you can either file this petition for another person or for yourself. On this petition, the "beneficiary" or "self-petitioner" means the person for whom this petition is being filed, whether that person is yourself or another person. 1.
How do I provide a beneficiary's information?
- Provide the beneficiary's information in Item Number 3. below. For dependent family members, use the space provided in Part 15. Additional Information. NOTE: Submit photocopies of Form I-94 Arrival-Departure Record, Form I-797 (Notice of Action), and/or other USCIS documents identifying these periods of stay in the R classification.
What if I don't complete my petition?
- Petitioner's or Authorized Signatory's Signature Date of Signature (mm/dd/yyyy) NOTE TO ALL PETITIONERS AND AUTHORIZED SIGNATORIES: If you do not completely fill out this petition or fail to submit required documents listed in the Instructions, USCIS may delay a decision on or deny your petition.
What is the purpose of a tax return form?
- The primary purpose of this form is to report potential violations of the Internal Revenue laws. The information may be disclosed to the Department of Justice to enforce the tax laws. Providing the information is voluntary. Not providing all or part of the information will not affect you.
