Systems and Procedures
A Division of The Corporate Controller's Office


Form Instructions

  1. Name – Enter the name using the format of Last or Surname, First or Given Name, Middle Name or Initial.
  2. Country of Citizenship – Enter the Country of Citizenship.
  3. PSU ID – Enter the nine digit PSU ID #.
  4. PSU Employment Position – Enter the employment position.
  5. Email Address – Enter the email address of the individual.
  6. College or department where employed – Enter the name of the college or department where employed.
  7. Social Security Number – Enter the Social Security number of the individual. As an employee you are required under law to provide PSU with a United States Social Security Number.
  8. Local Resident Street Address – Enter your local residence street address.
  9. Local Resident City – Enter your local residence city, state, and zip code portion of the address.
  10. Permanent Foreign Residence Street Address – Enter your permanent residence street address.
  11. Permanent Foreign Residence City – Enter your permanent residence city, country, and postal code portion of the address.
  12. Current Visa Type/Class – Check one of the following seven (7) visa options:
    1. Permanent Resident/Immigrant (go directly to Part III)
    2. F-1 Student
    3. J-1 Exchange Student (Provide DS2019)
    4. J-1 Exchange Visitor (not student visa) (Provide DS2019)
    5. J-2 or H-4 Spouse/Dependent of Exchange visitor/student (attach copy of employment authorization card – EAD Card)
    6. H- 1 Temporary employee of distinguished merit and/or ability
    7. DACA – Provide copy of documents and/or EAD card (copy)(go directly to Part III)
    8. Other – please specify in the next section of form

  1. Current I-94 – Enter the date your received your current I-94 document using the mm/dd/yyyy format (include 797 Notice of Change I-94’s).
  2. Data collection table – Data collected in Section C determines your USA tax residency status (NRA (Non-Resident Alien) or RA (Resident Alien) for Part III. List all USA entries and departures beginning with your very first entry into the USA on the first line of the table. Write the visa/travel type beside each date. If applicable, include all 797 Notice of Change I-94 dates and visa/class. The table consists of three columns and 5 rows.
    1. Column 1 – Date entered USA
    2. Column 2 – Date department USA
    3. Column 3 - Visa Class/Travel Document Type

  3. Residency Status – Select one of the three resident status options:
    1. I am a PERMANENT RESIDENT of the United Stated under U.S. Immigration Laws. Please ATTACH a copy of your I-94 document along with a completed, signed, and dated IRS Form W-9
    2. I am a RESIDENT of the United States FOR TAX PURPOSES. I have met the Substantial Presence Test for residency. ATTACH a copy of your I-94 document along with a completed, signed, and dated IRS Form W-9. For DACA – attach copy of EAD card along with a completed, signed, and dated IRS Form W-9.
    3. I am a NON-RESIDENT of the United States FOR TAX PURPOSES. I have NOT met the Substantial Presence Test for residency. Attach a copy of your I-94 document.

  4. To claim exemptions form U.S. federal income tax, please complete IRS form 8233 and the appropriate Revenue Procedure form (87-8 for students or 87-9 for teachers/researchers). Submit forms each tax year to the payroll office to receive exemption.
  5. Signature – Sign the printed form
  6. Date - Date the printed form
  7. For PAYROLL USE Only – Do not write in this section
  8. Send Original form to Payroll Office, 101 James M. Elliott Building, 120 S. Burrowes Street, State College, PA 16801
Image of Alien Information Request Form