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The Applicant Status Affidavit is an essential form utilized by individuals seeking public benefits, particularly in the state of Georgia. This document, governed by the Official Code of Georgia Annotated (O.C.G.A.) 50-36-1, serves as a declaration of identity and citizenship status, requiring the applicant to provide their full name, Social Security number, and a valid government-issued photo ID. The form requires the individual to affirm their age—confirming they are 18 or older—and to declare their citizenship status, selecting from options that include U.S. citizenship, legal permanent residency, or qualified alien status. For those who identify as non-citizens, there are additional requirements, such as the presentation of an Employment Authorization Document and various identification numbers issued by federal immigration authorities. Importantly, the applicant must consent to disclose their immigration status to relevant state departments, ensuring transparency and compliance with eligibility checks. Furthermore, the affidavit highlights the grave implications of providing false information, emphasizing legal accountability. By swearing to the truthfulness of the details provided, applicants uphold the integrity of the benefits system while facilitating their path to receiving essential services and supports.
Applicant Status Affidavit Example
STATE OF |
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APPLICANT STATUS AFFIDAVIT |
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[O.C.G.A. |
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Comes now the undersigned, who, upon oath duly taken, states: |
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1. My full name is |
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and my Social Security Number is |
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. I provide my unexpired |
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in support of this declaration of my name and identity. I am an applicant for a public benefit, and I am making the rep- resentations in this AFFIDAVIT to obtain that public benefit.
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I was born in [NAME OF COUNTRY] |
on |
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, and I am 18 years |
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of age or older. |
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I declare [INITIAL ONE]: [ |
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] that I am a U.S. Citizen; OR [ |
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] that I am a legal permanent resident; |
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OR [ ] that I am a qualified alien or
as amended, lawfully present in the United States.
4.Unexpired Employment Authorization Document: REQUIRED OF ALL
Alien Registration # |
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Card # |
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Citizenship Cert # |
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Passport # |
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(with) |
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Naturalization # |
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Stamp # |
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(or) |
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SEVIS ID # |
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Expiration Date: |
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5.Consent to Disclosure. I freely and voluntarily waive the confidentiality provisions of the Immigration
Reform and Control Act of 1986 (IRCA) to permit the Department of Homeland Security (DHS) to provide the Georgia Department of Labor information regarding my alien status for purposes of determining my eligibility for unemployment insurance benefits. I understand that IRCA precludes DHS from using, publishing, or making available information related to my application for adjustment to temporary residence except as provided by law (confidentiality provision).
6.I understand that knowingly and willingly making a false, fictitious, or fraudulent statement or representation in this affidavit is a violation of O.C.G.A. Code Section
Applicant Signature:
Claims Taker Signature
Employee ID# (4 digits):
For Central Office Only:
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Emp. Elig. Date |
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Secondary Verification |
q Yes q No |
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Remarks |
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Name: |
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SECURE AND VERIFIABLE DOCUMENTS UNDER O.C.G.A. &
Initials:
An unexpired United States passport or passport card
An unexpired United States military identification card
An unexpired driver’s license issued by one of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Islands, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer
An unexpired identification card issued by one of the United States, the District of Columbia, the commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Islands, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer
An unexpired tribal identification card of a federally recognized Native American tribe, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer
An unexpired United States Permanent Resident Card or Alien Registration Receipt Card
An unexpired Employment Authorization Document that contains a photograph of the bearer
An unexpired passport issued by a foreign government accompanied by a federal form specifying an individual’s lawful immigration status or other proof of lawful presence under federal immigration law
An unexpired Merchant Mariner Document or Merchant Mariner Credential issued by the United States Coast Guard
An unexpired Free and Secure Trade (FAST) card
An unexpired NEXUS card
An unexpired Secure Electronic Network for Travelers Rapid Inspection (SENTRI) card
An unexpired driver’s license issued by a Canadian government authority
A Certificate of Citizenship issued by the United States Department of Citizenship and Immigration Services (USCIS)
A Certificate of Naturalization issued by the United States Department of Citizenship and Immigration Services (USCIS) (Form
Certification of Birth issued by the United States Department of State (Form
Certification of Birth Abroad issued by the United States Department of State (Form
Consular Report of Birth issued by the United States Department of State (Form
An original or certified copy of a birth certificate issued by a state, county, municipal authority, or territory of the United States bearing an official seal with an unexpired
File Breakdown
| Fact Name | Details |
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| Governing Law | The Applicant Status Affidavit is governed by O.C.G.A. 50-36-1, which outlines the requirements for verifying eligibility for public benefits in Georgia. |
| Identification Requirement | Applicants must present an unexpired government-issued picture identification to confirm their identity when completing the affidavit. |
| Age Requirement | To fill out the affidavit, the applicant must be at least 18 years old, indicating a maturity level required for legal declarations. |
| Citizenship Status Declaration | The affidavit requires applicants to declare their citizenship status, choosing from U.S. citizen, legal permanent resident, or qualified alien/non-immigrant status. |
| Consequences of False Information | Providing false information in the affidavit can lead to criminal prosecution under O.C.G.A. Code Section 16-10-20, reflecting the seriousness of the document. |
Guide to Using Applicant Status Affidavit
Completing the Applicant Status Affidavit form is a critical step in your application process. This form gathers essential information pertaining to your identity and citizen status. After submitting the form, it will undergo verification to ensure compliance with eligibility requirements for the public benefits you are applying for.
- Provide Your Full Name: Write your full legal name in the designated area on the form.
- Enter Your Social Security Number: Fill in your Social Security Number accurately.
- Attach Identification: Include a copy of your unexpired government-issued picture identification.
- State Your Birthplace: Indicate the country where you were born and provide your birth date.
- Confirm Your Age: Check the box certifying that you are 18 years of age or older.
- Select Citizenship Status: Choose one of the three options provided that accurately reflects your citizenship status.
- Fill Out Alien Registration Information: If applicable, provide your Alien Registration Number or other relevant identification numbers along with their expiration dates.
- Consent to Disclosure: Acknowledge your consent by filling in the appropriate section regarding confidentiality.
- Understand the Legal Implications: Read the statement carefully about making false representations.
- Applicant Signature: Sign and date the affidavit to validate your declaration.
- Claims Taker Signature: If required, have the claims taker sign the form and provide their employee ID.
Get Answers on Applicant Status Affidavit
What is the Applicant Status Affidavit form?
The Applicant Status Affidavit form is a document used to verify an individual’s citizenship or immigration status when applying for public benefits in Georgia. It requires applicants to provide personal information, including their identification and immigration status, in order to determine their eligibility for benefits such as unemployment insurance.
Who needs to fill out this form?
Anyone applying for public benefits in Georgia must complete the Applicant Status Affidavit if they are 18 years or older. This includes U.S. citizens, legal permanent residents, and qualified aliens or non-immigrants. Those who do not identify as U.S. citizens must provide additional information regarding their immigration status.
What information do I need to provide?
When completing the form, you will need to provide:
- Your full name and Social Security Number.
- Your government-issued photo identification.
- Your place of birth and date of birth.
- Your immigration status, with supporting details if you are not a U.S. citizen.
- Your Aliens Registration Number or other identifying numbers, if applicable.
What types of identification are accepted?
Accepted identifications include:
- Unexpired U.S. passport or passport card.
- Unexpired military identification card.
- Unexpired driver’s license from a U.S. state or territory.
- Tribal identification card from a federally recognized tribe.
- Permanent Resident Card or Employment Authorization Document.
- Other specified documents proving lawful presence.
What if I provide false information?
Providing false information on the affidavit can lead to severe consequences. It is considered a violation of state law and may result in criminal prosecution. Therefore, it’s crucial to ensure that all the information you provide is true and accurate to the best of your knowledge.
Why is consent to disclosure required?
The consent to disclosure allows the Department of Homeland Security to share your immigration status with the Georgia Department of Labor. This is necessary to assess your eligibility for benefits. By signing the affidavit, you waive certain confidentiality rights under the Immigration Reform and Control Act of 1986.
How do I submit the form?
After completing the Applicant Status Affidavit, you typically submit it alongside your application for public benefits. Check with the specific agency or department handling your application to find out their submission procedures, as they may vary.
Is there a deadline for submitting the form?
There is generally a deadline aligned with your public benefits application. It's vital to submit the affidavit promptly to avoid delays in processing your application. Check with the relevant agency for specific timelines related to your situation.
Common mistakes
Completing the Applicant Status Affidavit form can be challenging. Individuals often make several common mistakes that can result in delays or complications in processing their applications. Recognizing these errors can help applicants avoid unnecessary setbacks.
One frequent mistake involves omitting required information. Applicants should ensure that they provide their full name and Social Security Number clearly. Missing these essentials can lead to a rejection of the affidavit. Attention to detail is critical; every piece of information counts.
Many people also misidentify their citizenship status. Not accurately selecting between U.S. Citizen, legal permanent resident, or qualified alien can cause confusion. It's crucial that applicants review their immigration status carefully and check the appropriate box. Incorrectly indicating one's status may create significant issues later on.
Another error often made is failing to provide the necessary supporting documentation. If an applicant indicates they are not a U.S. citizen, they must supply an unexpired Employment Authorization Document or similar identification. Forgetting these documents can halt the process until the missing paperwork is submitted.
Signing the affidavit is a step that some may overlook. An unsigned application cannot be processed. Therefore, applicants should double-check that they have signed the form at the designated spot. Verification of a claims taker’s signature is equally important, as it signals that the application was received and processed correctly.
Misunderstanding the confidentiality provisions is also common. Some applicants may not realize that they are waiving certain confidentiality rights regarding their immigration status. Clarity about this aspect of the affidavit is essential. Understanding what information can be disclosed helps applicants make informed decisions.
Lastly, applicants might overlook the consequences of providing false information. The affidavit includes a statement about the legal ramifications of giving misleading or incorrect data. Knowing the significance of providing truthful information is imperative to avoid severe legal repercussions. Each individual’s responsibility in this process cannot be understated.
Documents used along the form
The Applicant Status Affidavit form plays a crucial role in verifying an individual's eligibility for public benefits based on their citizenship or immigration status. In addition to this form, several other documents are often utilized to complement the affidavit process. These documents assist in confirming identity and lawful status, which is essential for the claims process.
- Government-Issued Identification: This includes any valid photo ID issued by the government, such as a passport or military ID. It serves as proof of identity and supports the claims made in the affidavit.
- Employment Authorization Document (EAD): Required for non-citizens, the EAD validates that the individual is authorized to work in the United States. It contains important identifiers that link the individual to their immigration status.
- Permanent Resident Card: Also known as a Green Card, this document proves that an individual has lawful permanent residency in the United States. It is often necessary for confirming eligibility for benefits.
- Certificate of Citizenship/Naturalization: Issued by U.S. Citizenship and Immigration Services, these certificates affirm an individual's status as a U.S. citizen, which may be relevant for certain benefits applications.
- Birth Certificate: An original or certified copy of a birth certificate, particularly when paired with a government-issued ID, can be used to establish identity and citizenship status for various legal purposes.
Overall, the combined use of these documents enhances the verification process, ensuring that individuals receive the benefits to which they are entitled while complying with legal requirements. It is essential to understand the importance of each document in fostering a smoother and more efficient application process.
Similar forms
- Employment Authorization Document (EAD): Like the Applicant Status Affidavit, the EAD serves as proof of legal status. It confirms that an individual can work in the U.S. and must be presented by non-citizens to secure certain benefits.
- Certificate of Citizenship: This document establishes that a person is a U.S. citizen and provides similar information regarding identity and eligibility for public benefits, much like the Applicant Status Affidavit.
- Certificate of Naturalization: This certificate indicates that an individual has become a U.S. citizen through naturalization. It addresses identity verification and is essential for various legal and public benefits.
- Alien Registration Receipt Card: Often referred to as a green card, this document outlines a person's immigration status. It is necessary for non-citizens applying for public benefits, paralleling the evidence needed in the affidavit.
- U.S. Passport: A passport proves citizenship and identity. Similar to the Applicant Status Affidavit, it entails personal information and can be used to verify eligibility for various benefits.
- Tribal Identification Card: Issued by federally recognized tribes, this identification establishes a person's tribal affiliation and identity, much like the information provided in the affidavit about citizenship or immigration status.
Dos and Don'ts
When filling out the Applicant Status Affidavit form, it is essential to adhere to certain best practices and avoid common mistakes. The following list outlines what to do and what to avoid:
- Ensure accuracy. Fill in your full name and Social Security Number without errors.
- Provide valid identification. Attach unexpired government-issued photo ID to support your identity.
- Declare your status truthfully. Clearly state whether you are a U.S. citizen, legal permanent resident, or qualified alien.
- Sign the affidavit. Your signature confirms that the information provided is correct.
- Read carefully. Review the entire form to ensure you understand each section before submitting.
- Keep a copy. Maintain a copy of the completed form for your records.
- Avoid incomplete information. Do not leave any required fields blank.
- Do not submit expired documents. Ensure all identification provided is current.
- Avoid false statements. Do not make assertions that you know to be untrue.
- Refrain from signing under duress. Ensure that you feel comfortable with all the information before signing.
- Do not overlook deadlines. Submit your affidavit within the required time frame for benefits eligibility.
Misconceptions
Understanding the Applicant Status Affidavit can prevent misunderstandings. Here are some common misconceptions:
- It's only for U.S. citizens. The form is necessary for both citizens and certain non-citizens applying for public benefits.
- Any form of identification is acceptable. Only unexpired government-issued photo IDs are considered valid.
- Submitting false information has no consequences. Providing false information can lead to criminal prosecution.
- It doesn't matter if I don’t have an Employment Authorization Document. Non-citizens must provide this document if they are not U.S. citizens.
- All information remains confidential. You consent to share your alien status information with the Department of Homeland Security for eligibility purposes.
- Once submitted, my affidavit cannot be changed. You can update your information if it changes after submission, but it’s important to notify the appropriate authority.
- This affidavit is optional. It is a required form to access certain public benefits.
Key takeaways
When filling out the Applicant Status Affidavit form, keep these important points in mind:
- Verify Your Identity: Always provide an unexpired government-issued photo ID. This ensures that your identity is confirmed as part of the application process.
- Choose Your Status Correctly: Clearly indicate your citizenship status by selecting one of the options provided. It is crucial for determining eligibility.
- Provide Necessary Numbers: If you are not a U.S. citizen, you must provide your Alien Registration Number or other relevant identifiers as required.
- Understand Consent Implications: Be aware that you are consenting to the disclosure of your immigration status to the Department of Homeland Security. This is necessary for eligibility checks regarding public benefits.
- Affirm Accuracy: You must swear that all information provided is accurate. Knowingly providing false information can lead to serious legal consequences.