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Federal Free Printable Form 9210 (Rev. 7-2015) for 2019 Federal Alien Status Questionnaire

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Alien Status Questionnaire
Form 9210 (Rev. 7-2015)

Form Department of the Treasury - Internal Revenue Service 9210 Alien Status Questionnaire (July 2015) Taxpayer's name and address In reply refer to: Tax year Last four digits of Social Security Number Principal place of employment Furnish the following information concerning your alien status in the United States during the above tax year. 1. Name of country of which you are now a citizen or subject 2. Name of country in which you claimed residence during the above tax year 3. Visa Type (Letter and Number) under which you first entered the United States 4. List all other Visa Types which you held (Letter and Number), and dates obtained, if different than Visa shown in item 3, including Visa currently held Visa Type Date Obtained 5. For what reason did you come to the United States Education Work Vacation Teaching Foreign government employee Other If Other, explain 6. What was the date of your initial arrival in the United States 7. How long do you expect to remain in the United States Yes No 9. Did you ever apply for and/or have been granted lawful permanent residence in the United States (hold a Green Card) If Yes, explain Yes No 10. Did your family accompany you to the United States Yes No Yes No 8. Did you change your original intention about the length of your stay If Yes, explain Not married If Yes, what type of visa did your family enter the United States on (Number and Letter) Did your spouse, or any other member of your family, work in the United States If Yes, please furnish us a copy of their U.S. Federal income tax return Catalog Number 11842U www.irs.gov Form 9210 (Rev. 7-2015) Page 2 Yes No Yes No Yes No 13. Are you employed in the United States by the same employer for whom you worked in the foreign country prior to your move to the United States Yes No Not employed 14. Did you leave the United States after you first arrived Yes No Did not leave Yes No Yes No Yes No 11. Were you employed in the United States If Yes, please complete the following a. Were there any restrictions on the length of your employment b. If Yes to a. above, please state what the restrictions were c. Name and address of employer 12. Did you file a foreign income tax return with a foreign country while you were a resident in the United States If Yes, please provide us with a copy of the foreign tax return If Yes, please complete the following Did you intend to return When did you intend to return? Did you obtain a reentry permit What was the expiration date (including any extensions) of the permit Did you give up your United States residence when you departed the United States What was the date of your final departure from the United States How much income did you earn outside the United States in the year of your final departure 15. Please provide us in the space below all the dates of your arrival in, and departures from, the United States from the date you first arrived in the United States, and the purpose of each departure from the United States Arrival Date Departure Date Purpose Remarks Certification: Under penalty of perjury, I declare that I have examined this statement and, to the best of my knowledge and belief, it is true, correct, and complete Taxpayer's signature Date Catalog Number 11842U www.irs.gov Form 9210 (Rev. 7-2015)
Extracted from PDF file 2018-federal-form-9210.pdf, last modified September 2015

More about the Federal Form 9210 Other TY 2018

We last updated the Alien Status Questionnaire in February 2019, so this is the latest version of Form 9210, fully updated for tax year 2018. You can download or print current or past-year PDFs of Form 9210 directly from TaxFormFinder. You can print other Federal tax forms here.

Other Federal Other Forms:

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Form 8962 Premium Tax Credit
Form W-4V Voluntary Withholding Request
Form W-4 Employee's Withholding Allowance Certificate
Form 8840 Closer Connection Exception Statement for Aliens
Form 8965 Health Coverage Exemptions

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 9210 from the Internal Revenue Service in February 2019.

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Historical Past-Year Versions of Federal Form 9210

We have a total of four past-year versions of Form 9210 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2018 Form 9210

Form 9210 (Rev. 7-2015)

2017 Form 9210

Form 9210 (Rev. 7-2015)

2016 Form 9210

Form 9210 (Rev. 7-2015)

Alien Status Questionnaire 2015 Form 9210

Form 9210 (Rev. 7-2015)


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