NonBOA_ee_packet_2007 Payroll Forms
Payroll Forms 1 Payroll_Forms_1 Payroll_Forms_1 4 2013 pdf 258413772373414384
2013-04-16
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Gathering Employee Information
To help you set up payroll, have each employee complete Form W-4 (attached). Use the
completed form to record the employee’s filing status and allowances for federal income tax
withholding.
Also, have each employee complete an I-9 (attached). This federal form verifies the employee’s
eligibility to work in the U.S. Required: keep the completed form on file (you do not need to
enter any information from the form in your payroll account).
Your state might require each employee to complete additional forms. For more information, click
Taxes & Forms in the navigation bar at the top of the page, then click Employee Setup.
Form W-4 (2013)
Purpose. Complete Form W-4 so that your
employer can withhold the correct federal income
tax from your pay. Consider completing a new Form
W-4 each year and when your personal or financial
situation changes.
Exemption from withholding. If you are exempt,
complete only lines 1, 2, 3, 4, and 7 and sign the
form to validate it. Your exemption for 2013 expires
February 17, 2014. See Pub. 505, Tax Withholding
and Estimated Tax.
Note. If another person can claim you as a
dependent on his or her tax return, you cannot claim
exemption from withholding if your income exceeds
$1,000 and includes more than $350 of unearned
income (for example, interest and dividends).
Basic instructions. If you are not exempt, complete
the Personal Allowances Worksheet below. The
worksheets on page 2 further adjust your
withholding allowances based on itemized
deductions, certain credits, adjustments to income,
or two-earners/multiple jobs situations.
Complete all worksheets that apply. However, you
may claim fewer (or zero) allowances. For regular
wages, withholding must be based on allowances
you claimed and may not be a flat amount or
percentage of wages.
Head of household. Generally, you can claim head
of household filing status on your tax return only if
you are unmarried and pay more than 50% of the
costs of keeping up a home for yourself and your
dependent(s) or other qualifying individuals. See
Pub. 501, Exemptions, Standard Deduction, and
Filing Information, for information.
Tax credits. You can take projected tax credits into
account in figuring your allowable number of
withholding allowances. Credits for child or
dependent care expenses and the child tax credit
may be claimed using the Personal Allowances
Worksheet below. See Pub. 505 for information on
converting your other credits into withholding
allowances.
Nonwage income. If you have a large amount of
nonwage income, such as interest or dividends,
consider making estimated tax payments using Form
1040-ES, Estimated Tax for Individuals. Otherwise, you
may owe additional tax. If you have pension or annuity
income, see Pub. 505 to find out if you should adjust
your withholding on Form W-4 or W-4P.
Two earners or multiple jobs. If you have a
working spouse or more than one job, figure the
total number of allowances you are entitled to claim
on all jobs using worksheets from only one Form
W-4. Your withholding usually will be most accurate
when all allowances are claimed on the Form W-4
for the highest paying job and zero allowances are
claimed on the others. See Pub. 505 for details.
Nonresident alien. If you are a nonresident alien,
see Notice 1392, Supplemental Form W-4
Instructions for Nonresident Aliens, before
completing this form.
Check your withholding. After your Form W-4 takes
effect, use Pub. 505 to see how the amount you are
having withheld compares to your projected total tax
for 2013. See Pub. 505, especially if your earnings
exceed $130,000 (Single) or $180,000 (Married).
Future developments. Information about any future
developments affecting Form W-4 (such as
legislation enacted after we release it) will be posted
at www.irs.gov/w4.
Personal Allowances Worksheet (Keep for your records.)
A
Enter “1” for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . .
A
• You are single and have only one job; or
Enter “1” if:
B
• You are married, have only one job, and your spouse does not work; or
. . .
• Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less.
Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or more
than one job. (Entering “-0-” may help you avoid having too little tax withheld.) . . . . . . . . . . . . . .
C
Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . .
D
Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . .
E
Enter “1” if you have at least $1,900 of child or dependent care expenses for which you plan to claim a credit
. . .
F
(Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)
Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.
• If your total income will be less than $65,000 ($95,000 if married), enter “2” for each eligible child; then less “1” if you
have three to six eligible children or less “2” if you have seven or more eligible children.
{
B
C
D
E
F
G
}
• If your total income will be between $65,000 and $84,000 ($95,000 and $119,000 if married), enter “1” for each eligible child . . .
G
Add lines A through G and enter total here. (Note. This may be different from the number of exemptions you claim on your tax return.) a H
• If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions
For accuracy,
and Adjustments Worksheet on page 2.
complete all
• If you are single and have more than one job or are married and you and your spouse both work and the combined
earnings from all jobs exceed $40,000 ($10,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to
worksheets
avoid having too little tax withheld.
that apply.
• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.
{
H
Separate here and give Form W-4 to your employer. Keep the top part for your records.
Form
W-4
Department of the Treasury
Internal Revenue Service
1
Employee's Withholding Allowance Certificate
OMB No. 1545-0074
a Whether you are entitled to claim a certain number of allowances or exemption from withholding is
subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.
Your first name and middle initial
Last name
Home address (number and street or rural route)
2
3
Single
Married
2013
Your social security number
Married, but withhold at higher Single rate.
Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.
City or town, state, and ZIP code
4 If your last name differs from that shown on your social security card,
check here. You must call 1-800-772-1213 for a replacement card. a
5
6
7
Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2)
5
Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . .
6 $
I claim exemption from withholding for 2013, and I certify that I meet both of the following conditions for exemption.
• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and
• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.
If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . . a 7
Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.
Employee’s signature
(This form is not valid unless you sign it.)
8
Date a
a
Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)
For Privacy Act and Paperwork Reduction Act Notice, see page 2.
9 Office code (optional)
Cat. No. 10220Q
10
Employer identification number (EIN)
Form W-4 (2013)
Page 2
Form W-4 (2013)
Deductions and Adjustments Worksheet
Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.
1
2
3
4
5
6
7
8
9
10
Enter an estimate of your 2013 itemized deductions. These include qualifying home mortgage interest,
charitable contributions, state and local taxes, medical expenses in excess of 7.5% of your income, and
miscellaneous deductions . . . . . . . . . . . . . . . . . . . . . . . . .
$12,200 if married filing jointly or surviving spouse
Enter:
$8,950 if head of household
. . . . . . . . . . .
$6,100 if single or married filing separately
Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . .
Enter an estimate of your 2013 adjustments to income and any additional standard deduction (see Pub. 505)
Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to
Withholding Allowances for 2013 Form W-4 worksheet in Pub. 505.) . . . . . . . . . . . .
{
}
Enter an estimate of your 2013 nonwage income (such as dividends or interest) . . . . . . . .
Subtract line 6 from line 5. If zero or less, enter “-0-” . . . . . . . . . . . . . . . .
Divide the amount on line 7 by $3,900 and enter the result here. Drop any fraction . . . . . . .
Enter the number from the Personal Allowances Worksheet, line H, page 1 . . . . . . . . .
Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet,
also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1
1
$
2
$
3
4
$
$
5
6
7
8
9
$
$
$
10
Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)
Note. Use this worksheet only if the instructions under line H on page 1 direct you here.
Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)
1
2
Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if
you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more
than “3” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter
“-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . .
1
2
3
Note. If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to
figure the additional withholding amount necessary to avoid a year-end tax bill.
4
5
6
7
8
9
Enter the number from line 2 of this worksheet . . . . . . . . . .
4
Enter the number from line 1 of this worksheet . . . . . . . . . .
5
Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . .
Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . .
Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . .
Divide line 8 by the number of pay periods remaining in 2013. For example, divide by 25 if you are paid every two
weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2013. Enter
the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck
Table 1
Married Filing Jointly
If wages from LOWEST
paying job are—
Enter on
line 2 above
6
7
8
$
$
9
$
Table 2
All Others
If wages from LOWEST
paying job are—
Married Filing Jointly
Enter on
line 2 above
0
$0 - $8,000
0
$0 - $5,000
1
5,001 - 13,000
8,001 - 16,000
1
2
13,001 - 24,000
16,001 - 25,000
2
3
24,001 - 26,000
25,001 - 30,000
3
4
26,001 - 30,000
30,001 - 40,000
4
5
30,001 - 42,000
40,001 - 50,000
5
6
42,001 - 48,000
50,001 - 70,000
6
7
48,001 - 55,000
70,001 - 80,000
7
8
55,001 - 65,000
80,001 - 95,000
8
9
65,001 - 75,000
95,001 - 120,000
9
10
75,001 - 85,000
120,001 and over
10
85,001 - 97,000
11
12
97,001 - 110,000
13
110,001 - 120,000
14
120,001 - 135,000
15
135,001 and over
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this
form to carry out the Internal Revenue laws of the United States. Internal Revenue Code
sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your
employer uses it to determine your federal income tax withholding. Failure to provide a
properly completed form will result in your being treated as a single person who claims no
withholding allowances; providing fraudulent information may subject you to penalties. Routine
uses of this information include giving it to the Department of Justice for civil and criminal
litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions
for use in administering their tax laws; and to the Department of Health and Human Services
for use in the National Directory of New Hires. We may also disclose this information to other
countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal
laws, or to federal law enforcement and intelligence agencies to combat terrorism.
If wages from HIGHEST
paying job are—
$0
72,001
130,001
200,001
345,001
385,001
- $72,000
- 130,000
- 200,000
- 345,000
- 385,000
and over
Enter on
line 7 above
$590
980
1,090
1,290
1,370
1,540
All Others
If wages from HIGHEST
paying job are—
$0
37,001
80,001
175,001
385,001
- $37,000
- 80,000
- 175,000
- 385,000
and over
Enter on
line 7 above
$590
980
1,090
1,290
1,540
You are not required to provide the information requested on a form that is subject to the
Paperwork Reduction Act unless the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as long as their contents may
become material in the administration of any Internal Revenue law. Generally, tax returns and
return information are confidential, as required by Code section 6103.
The average time and expenses required to complete and file this form will vary depending
on individual circumstances. For estimated averages, see the instructions for your income tax
return.
If you have suggestions for making this form simpler, we would be happy to hear from you.
See the instructions for your income tax return.
OMB No. 1615-0047; Expires 08/31/12
Form I-9, Employment
Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
Instructions
Read all instructions carefully before completing this form.
Anti-Discrimination Notice. It is illegal to discriminate against
any individual (other than an alien not authorized to work in the
United States) in hiring, discharging, or recruiting or referring for a
fee because of that individual's national origin or citizenship status.
It is illegal to discriminate against work-authorized individuals.
Employers CANNOT specify which document(s) they will accept
from an employee. The refusal to hire an individual because the
documents presented have a future expiration date may also
constitute illegal discrimination. For more information, call the
Office of Special Counsel for Immigration Related Unfair
Employment Practices at 1-800-255-8155.
in Section 2 evidence of employment authorization that
contains an expiration date (e.g., Employment Authorization
Document (Form I-766)).
Preparer/Translator Certification
The Preparer/Translator Certification must be completed if
Section 1 is prepared by a person other than the employee. A
preparer/translator may be used only when the employee is
unable to complete Section 1 on his or her own. However, the
employee must still sign Section 1 personally.
Section 2, Employer
What Is the Purpose of This Form?
The purpose of this form is to document that each new
employee (both citizen and noncitizen) hired after November
6, 1986, is authorized to work in the United States.
When Should Form I-9 Be Used?
All employees (citizens and noncitizens) hired after November
6, 1986, and working in the United States must complete
Form I-9.
Filling Out Form I-9
Section 1, Employee
This part of the form must be completed no later than the time
of hire, which is the actual beginning of employment.
Providing the Social Security Number is voluntary, except for
employees hired by employers participating in the USCIS
Electronic Employment Eligibility Verification Program (EVerify). The employer is responsible for ensuring that
Section 1 is timely and properly completed.
Noncitizen nationals of the United States are persons born in
American Samoa, certain former citizens of the former Trust
Territory of the Pacific Islands, and certain children of
noncitizen nationals born abroad.
Employers should note the work authorization expiration
date (if any) shown in Section 1. For employees who indicate
an employment authorization expiration date in Section 1,
employers are required to reverify employment authorization
for employment on or before the date shown. Note that some
employees may leave the expiration date blank if they are
aliens whose work authorization does not expire (e.g., asylees,
refugees, certain citizens of the Federated States of Micronesia
or the Republic of the Marshall Islands). For such employees,
reverification does not apply unless they choose to present
For the purpose of completing this form, the term "employer"
means all employers including those recruiters and referrers
for a fee who are agricultural associations, agricultural
employers, or farm labor contractors. Employers must
complete Section 2 by examining evidence of identity and
employment authorization within three business days of the
date employment begins. However, if an employer hires an
individual for less than three business days, Section 2 must be
completed at the time employment begins. Employers cannot
specify which document(s) listed on the last page of Form I-9
employees present to establish identity and employment
authorization. Employees may present any List A document
OR a combination of a List B and a List C document.
If an employee is unable to present a required document (or
documents), the employee must present an acceptable receipt
in lieu of a document listed on the last page of this form.
Receipts showing that a person has applied for an initial grant
of employment authorization, or for renewal of employment
authorization, are not acceptable. Employees must present
receipts within three business days of the date employment
begins and must present valid replacement documents within
90 days or other specified time.
Employers must record in Section 2:
1.
2.
3.
4.
5.
Document title;
Issuing authority;
Document number;
Expiration date, if any; and
The date employment begins.
Employers must sign and date the certification in Section 2.
Employees must present original documents. Employers may,
but are not required to, photocopy the document(s) presented.
If photocopies are made, they must be made for all new hires.
Photocopies may only be used for the verification process and
must be retained with Form I-9. Employers are still
responsible for completing and retaining Form I-9.
Form I-9 (Rev. 08/07/09) Y
For more detailed information, you may refer to the
USCIS Handbook for Employers (Form M-274). You may
obtain the handbook using the contact information found
under the header "USCIS Forms and Information."
Information about E-Verify, a free and voluntary program that
allows participating employers to electronically verify the
employment eligibility of their newly hired employees, can be
obtained from our website at www.uscis.gov/e-verify or by
calling 1-888-464-4218.
Section 3, Updating and Reverification
Employers must complete Section 3 when updating and/or
reverifying Form I-9. Employers must reverify employment
authorization of their employees on or before the work
authorization expiration date recorded in Section 1 (if any).
Employers CANNOT specify which document(s) they will
accept from an employee.
A. If an employee's name has changed at the time this form
is being updated/reverified, complete Block A.
B. If an employee is rehired within three years of the date
this form was originally completed and the employee is
still authorized to be employed on the same basis as
previously indicated on this form (updating), complete
Block B and the signature block.
C. If an employee is rehired within three years of the date
this form was originally completed and the employee's
work authorization has expired or if a current
employee's work authorization is about to expire
(reverification), complete Block B; and:
1. Examine any document that reflects the employee
is authorized to work in the United States (see List
A or C);
2. Record the document title, document number, and
expiration date (if any) in Block C; and
3. Complete the signature block.
Note that for reverification purposes, employers have the
option of completing a new Form I-9 instead of completing
Section 3.
What Is the Filing Fee?
There is no associated filing fee for completing Form I-9. This
form is not filed with USCIS or any government agency. Form
I-9 must be retained by the employer and made available for
inspection by U.S. Government officials as specified in the
Privacy Act Notice below.
USCIS Forms and Information
General information on immigration laws, regulations, and
procedures can be obtained by telephoning our National
Customer Service Center at 1-800-375-5283 or visiting our
Internet website at www.uscis.gov.
Photocopying and Retaining Form I-9
A blank Form I-9 may be reproduced, provided both sides are
copied. The Instructions must be available to all employees
completing this form. Employers must retain completed Form
I-9s for three years after the date of hire or one year after the
date employment ends, whichever is later.
Form I-9 may be signed and retained electronically, as
authorized in Department of Homeland Security regulations
at 8 CFR 274a.2.
Privacy Act Notice
The authority for collecting this information is the
Immigration Reform and Control Act of 1986, Pub. L. 99-603
(8 USC 1324a).
This information is for employers to verify the eligibility of
individuals for employment to preclude the unlawful hiring, or
recruiting or referring for a fee, of aliens who are not
authorized to work in the United States.
This information will be used by employers as a record of
their basis for determining eligibility of an employee to work
in the United States. The form will be kept by the employer
and made available for inspection by authorized officials of
the Department of Homeland Security, Department of Labor,
and Office of Special Counsel for Immigration-Related Unfair
Employment Practices.
Submission of the information required in this form is
voluntary. However, an individual may not begin employment
unless this form is completed, since employers are subject to
civil or criminal penalties if they do not comply with the
Immigration Reform and Control Act of 1986.
To order USCIS forms, you can download them from our
website at www.uscis.gov/forms or call our toll-free number at
1-800-870-3676. You can obtain information about Form I-9
from our website at www.uscis.gov or by calling
1-888-464-4218.
EMPLOYERS MUST RETAIN COMPLETED FORM I-9
DO NOT MAIL COMPLETED FORM I-9 TO ICE OR USCIS
Form I-9 (Rev. 08/07/09) Y Page 2
Paperwork Reduction Act
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a currently valid
OMB control number. The public reporting burden for this
collection of information is estimated at 12 minutes per
response, including the time for reviewing instructions and
completing and submitting the form. Send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
this burden, to: U.S. Citizenship and Immigration Services,
Regulatory Management Division, 111 Massachusetts
Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC
20529-2210. OMB No. 1615-0047. Do not mail your
completed Form I-9 to this address.
Form I-9 (Rev. 08/07/09) Y Page 3
OMB No. 1615-0047; Expires 08/31/12
Form I-9, Employment
Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
Read instructions carefully before completing this form. The instructions must be available during completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT
specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a
future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Verification (To be completed and signed by employee at the time employment begins.)
Print Name:
Last
First
Middle Initial Maiden Name
Address (Street Name and Number)
City
State
Apt. #
Date of Birth (month/day/year)
Zip Code
Social Security #
I attest, under penalty of perjury, that I am (check one of the following):
I am aware that federal law provides for
imprisonment and/or fines for false statements or
use of false documents in connection with the
completion of this form.
A citizen of the United States
A noncitizen national of the United States (see instructions)
A lawful permanent resident (Alien #)
An alien authorized to work (Alien # or Admission #)
until (expiration date, if applicable - month/day/year)
Employee's Signature
Date (month/day/year)
Preparer and/or Translator Certification (To be completed and signed if Section 1 is prepared by a person other than the employee.) I attest, under
penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.
Preparer's/Translator's Signature
Print Name
Date (month/day/year)
Address (Street Name and Number, City, State, Zip Code)
Section 2. Employer Review and Verification (To be completed and signed by employer. Examine one document from List A OR
examine one document from List B and one from List C, as listed on the reverse of this form, and record the title, number, and
expiration date, if any, of the document(s).)
List A
OR
List B
AND
List C
Document title:
Issuing authority:
Document #:
Expiration Date (if any):
Document #:
Expiration Date (if any):
CERTIFICATION: I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, that
the above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on
and that to the best of my knowledge the employee is authorized to work in the United States. (State
(month/day/year)
employment agencies may omit the date the employee began employment.)
Signature of Employer or Authorized Representative
Print Name
Business or Organization Name and Address (Street Name and Number, City, State, Zip Code)
Title
Date (month/day/year)
Section 3. Updating and Reverification (To be completed and signed by employer.)
A. New Name (if applicable)
B. Date of Rehire (month/day/year) (if applicable)
C. If employee's previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
Document Title:
Document #:
Expiration Date (if any):
l attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented
document(s), the document(s) l have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized Representative
Date (month/day/year)
Form I-9 (Rev. 08/07/09) Y Page 4
LISTS OF ACCEPTABLE DOCUMENTS
All documents must be unexpired
LIST A
LIST B
Documents that Establish Both
Identity and Employment
Authorization
OR
1. U.S. Passport or U.S. Passport Card
2. Permanent Resident Card or Alien
Registration Receipt Card (Form
I-551)
3. Foreign passport that contains a
temporary I-551 stamp or temporary
I-551 printed notation on a machinereadable immigrant visa
4. Employment Authorization Document
that contains a photograph (Form
I-766)
5. In the case of a nonimmigrant alien
authorized to work for a specific
employer incident to status, a foreign
passport with Form I-94 or Form
I-94A bearing the same name as the
passport and containing an
endorsement of the alien's
nonimmigrant status, as long as the
period of endorsement has not yet
expired and the proposed
employment is not in conflict with
any restrictions or limitations
identified on the form
6. Passport from the Federated States of
Micronesia (FSM) or the Republic of
the Marshall Islands (RMI) with
Form I-94 or Form I-94A indicating
nonimmigrant admission under the
Compact of Free Association
Between the United States and the
FSM or RMI
LIST C
Documents that Establish
Employment Authorization
Documents that Establish
Identity
AND
1. Driver's license or ID card issued by
a State or outlying possession of the
United States provided it contains a
photograph or information such as
name, date of birth, gender, height,
eye color, and address
2. ID card issued by federal, state or
local government agencies or
entities, provided it contains a
photograph or information such as
name, date of birth, gender, height,
eye color, and address
3. School ID card with a photograph
4. Voter's registration card
5. U.S. Military card or draft record
6. Military dependent's ID card
7. U.S. Coast Guard Merchant Mariner
Card
1. Social Security Account Number
card other than one that specifies
on the face that the issuance of the
card does not authorize
employment in the United States
2. Certification of Birth Abroad
issued by the Department of State
(Form FS-545)
3. Certification of Report of Birth
issued by the Department of State
(Form DS-1350)
4. Original or certified copy of birth
certificate issued by a State,
county, municipal authority, or
territory of the United States
bearing an official seal
5. Native American tribal document
8. Native American tribal document
9. Driver's license issued by a Canadian
government authority
For persons under age 18 who
are unable to present a
document listed above:
10. School record or report card
11. Clinic, doctor, or hospital record
6. U.S. Citizen ID Card (Form I-197)
7. Identification Card for Use of
Resident Citizen in the United
States (Form I-179)
8. Employment authorization
document issued by the
Department of Homeland Security
12. Day-care or nursery school record
Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274)
Form I-9 (Rev. 08/07/09) Y Page 5
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