SSI Claims System Intranet PRUCOL Screens

SCREEN SHOT 1: ALIEN STATUS - DEFAULT

FACSIMILE 1: ALIEN STATUS – DEFAULT
ALIEN STATUS
NAME
SSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSS SSSS
*INDICATES REQUIRED INFORMATION

SOCIAL SECURITY NUMBER(SSN)
SSS-SS-SSSS

ROLE
SSSSSSSSSSSSSSSSSSSSSSSSS

[1-M]
*U.S. ADMISSION DATE
THIS IS THE MOST RECENT DATE THE CLAIMANT ENTERED THE UNITED STATES FOR RESIDENCE PURPOSES.
99/99/9999
[2-O]
MM/DD/YYYY
[ ] UNKNOWN
[3-M]
*COUNTRY OF ORIGIN
THIS IS THE COUNTRY WHERE THE ALIEN RESIDED PRIOR TO ENTERING THE U.S., OR FROM WHERE THE ALIEN FILED FOR REFUGEE OR OTHER ALIEN STATUS
PRIOR TO ENTERING THE U.S. IT MAY OR MAY NOT BE THE PLACE OF BIRTH OF THE CLAIMANT.
-[4-M]
[6-O]
[5-O]
*ALIEN STATUS
LIST OF ALIEN STATUS CODES
REFERENCE: SI 00502.100
( ) AMERASIAN IMMIGRANT OR IRAQI/AFGHANI SPECIAL IMMIGRANT STATUS
CLASS OF ADMISSION AMERASIAN: AM1, AM2, AM3, AM6, AM7, AM8. CLASS OF ADMISSION IRAQI/AFGHANI SPECIAL IMMIGRANT: SI1, SI2, SI3, SI6, SI7,
SI8, SQ1, SQ2, SQ3, SQ6, SQ7, SQ8
( ) ASYLEE, SECTION 208 OF THE IMMIGRATION AND NATIONALITY ACT (INA)
CLASS OF ADMISSION: AS1, AS2, AS3, AS6, AS7, AS8
( ) BATTERY, CRUELTY OR VIOLENCE AGAINST WOMEN ACT PETITIONER
CLASS OF ADMISSION: IB1, IB2, IB3, IB6, IB7, OB8, IR6, IF1, Z14, DAS
( ) CONTINUOUS U.S. RESIDENCE SINCE PRIOR TO 1/1/1972 (PRUCOL); NOT ELIGIBLE UNLESS RECEIVING SSI ON 8/22/1996 AND CONTINUES TO MEET ALL
ELIGIBILITY FACTORS
( ) CUBAN OR HAITIAN ENTRANT
CLASS OF ADMISSION: C7P, CC, CNP, CH6, CU0, CU6, CU7, CU8, CU9, CUP, HA6-HA9, HB6-HB9, HC6-HC9, HD6-HD9, HE6-HE9, NC6-NC9
( ) DEPORTATION WITHHELD UNDER SECTION 241(B)(3) OR REMOVAL WITHHELD UNDER SECTION 243(H) OF THE IMMIGRATION AND NATIONALITY ACT (INA)
CLASS OF ADMISSION: DAS, ERF, ERP, IJ, DE, DEFER
( ) LAWFUL PERMANENT RESIDENT
CLASS OF ADMISSION: IR3, FX3, DV1, AR1, AY1, DT1, E11, GA6, LA6, LB6, IMM, LPR, XB3 AND INCLUDING ALL VALUES IN OTHER SELECTIONS
( ) LAWFUL PERMANENT RESIDENT, IMMIGRATION REFORM AND CONTROL ACT (IRCA) OF 1986
( ) LAWFUL TEMPORARY RESIDENT, IMMIGRATION REFORM AND CONTROL ACT (IRCA) OF 1986; NOT SPECIAL AGRICULTURAL WORKER (SAW) OR REPLENISHMENT
AGRICULTURAL WORKER (RAW)
CLASS OF ADMISSION: LTR, TW1, TW2, TS1, TS2
( ) LEGALIZED SPECIAL AGRICULTURAL WORKER (SAW) OR REPLENISHMENT AGRICULTURAL WORKER (RAW), IMMIGRATION REFORM AND CONTROL ACT (IRCA) OF
1986
CLASS OF ADMISSION: S16, S26, S1W, S2W, TR1, TR2, RAW
( ) PAROLEE, SECTION 212(D)(5) OF THE IMMIGRATION AND NATIONALITY ACT AND NOT CUBAN/HAITIAN ENTRANT; NOT ELIGIBLE UNLESS RECEIVING SSI ON
8/22/1996 AND CONTINUES TO MEET ALL ELIGIBILITY FACTORS
CLASS OF ADMISSION: DE, CC, CH, CP, DA, DT, R3, R4, PR
( ) REFUGEE, SECTION 207 OF THE IMMIGRATION AND NATIONALITY ACT (INA) OR SECTION 203(A)(7) OF THE INA PRIOR TO 1/1/1980
CLASS OF ADMISSION; SECTION 203(A)(7): R86, P7, P72, P75, P76, RRA, REF, SECTION 207: RE1-RE3, RE5-RE9, REF, RE, REUG
( ) STAY OF DEPORTATION, NON-QUALIFIED ALIEN
CLASS OF ADMISSION: Z13, Z14, Z15, Z56, Z57
( ) VOLUNTARY DEPARTURE
CLASS OF ADMISSION: FUG, VD
( ) ALLEGES VALID DHS STATUS; STATUS UNKNOWN OR NO OTHER APPLICABLE STATUS
( ) NO VALID DHS STATUS; ALLEGES PRESENCE IN THE U.S. ILLEGALLY OR DHS UNAWARE OF PRESENCE
( ) UNKNOWN
[7-M]
*ALIEN STATUS VERIFIED
( ) YES
( ) NO
[8-O]
[˅/˄] SHOW/HIDE PERSON REMARKS
[9-O]
PERSON REMARKS (PRINTED)
XX[MAXIMUM OF 1000 CHARACTERS]XX
[10-O]
[˅/˄] SHOW/HIDE FILE DOCUMENTATION NOTES
[11-O]
FILE DOCUMENTATION NOTES
XX[MAXIMUM OF 1000 CHARACTERS]XX
[12-O]
[CLEAR PAGE/UNDO CHANGES]

SCREEN SHOT 2: ALIEN STATUS – ADDITIONAL FIELDS-(PRUCOL) ALIEN RECEIVING
BENEFITS ON 8/22/1996

FACSIMILE 2: ALIEN STATUS – ADDITIONAL FIELDS-(PRUCOL) ALIEN RECEIVING
BENEFITS ON 8/22/1996
ALIEN RECEIVING SSI BENEFITS
NAME
SSSSSSSSSSSSSSSSSSSS SSSSSSSSSSSSSSS SSSSSSSSSSSSSSSSSSSS SSSS
SSSSSSSSSSSSSSSSSSSSSSSSS

SOCIAL SECURITY NUMBER(SSN)
SSS-SS-SSSS

ROLE

[14-O]
*ALIEN RECEIVING SSI BENEFITS ON 8/22/1996, AND WHO HAS CONTINUED TO MEET ALL SSI ELIGIBILITY FACTORS
MORE INFO
( ) YES
( ) NO
( ) UNKNOWN

SPONSORED
[30-C]
*SPONSORED AT ANY TIME SINCE SS/SS/SSSS
(X) YES
( ) NO
( ) UNKNOWN
[31-C]
SPONSOR TYPE
IF SPONSOR TYPE IS EMPLOYER AND THE EMPLOYER IS A RELATIVE OF THE CLAIMANT, SELECT “PERSON.” IF THE
EMPLOYER IS NOT RELATED TO THE CLAIMANT, SELECT “ORGANIZATION.”
-[32-C]
[14-O]
*SPONSOR SIGNED A NEW VERSION AFFIDAVIT OF SUPPORT
MORE INFO
A NEW VERSION AFFIDAVIT OF SUPPORT IS A LEGALLY ENFORCEABLE AFFIDAVIT OF SUPPORT (DHS FORM I-864 OR
SIMILAR FORM) USED BY DHS FOR APPLICATIONS FOR IMMIGRANT VISAS OR FOR ADJUSTMENTS OF STATUS FILED ON OR
AFTER 12/19/1997. NEW SPONSOR DEEMING RULES APPLY.
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