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G-845 Supplement, Document Verification Request Supplement

Purpose of Form

This form reflects information that may be relevant to eligibility for Federal, State, and local public benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. 104-193.

Number of Pages

Form 6; Instructions 2.

Edition Date

01/08/12. A new edition of this form is coming soon. In the meantime, customers may file using the 01/08/12 edition.  No other previous editions accepted.

Where to File

Submit this form in conjunction with Form G-845: it cannot be used alone.  To obtain the mailing address for your Form G-845 or G-845 Supplement click on the "Direct Filing Addresses for Form G-845, and G-845 Supplement" page.

Filing Fee


Special Instructions

This form should not be used alone, but only in conjunction with Form G-845 to request verification.

This page can be found at:

Last Reviewed/Updated: 06/26/2013