Summary: CITIZENSHIP STATUS FORM UNIVERSITY OF MARYLAND Page 1
The following information is furnished for the purpose of determining my U.S. federal income tax withholding status for payments
made to me by the University of Maryland for calendar year_______________.
All applicable questions below must be answered.
Attach a copy of the document(s) listed on Page 4 of this form..
This form must be completed and returned with copies of required documents to Systems Payroll before any check can be issued.
Have you ever applied for a Social Security Number or Individual Taxpayers Identification Number?
Yes, my number is: ________________-______________-__________________________________
Yes, but I have not received the number yet. Attach a copy of the Social Security Administration receipt to this form
No, please apply immediately for a Social Security Number or Individual Taxpayer Identification Number. (Students should go to IES first).
Last name/Family name First Middle
Visa Type (from I-94) _______________________ I-94 expiration date ____________________________________________________
Country of residence __________________________________ Citizen of ______________________________________________________
Campus/Department/Distribution code ____________________/________________________/_____________________________________
I. Current INS classification and "GREEN CARD TEST": Please check one:
a. Permanent Resident: Are you a lawful U.S. immigrant or Permanent Resident who has an Alien Registration Card ("Green Card")?
b. Permanent Resident Applicant: Have you applied for Permanent Resident status and have received an "I-551" stamp in your Passport or an INS
letter stating approval of your application? YES NO