Form 9210 — Alien Status Questionnaire

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f9210.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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(July 2015)

Department of the Treasury - Internal Revenue Service

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

7. Did you change your original intention about the length of your stay Yes No

If Yes, explain

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 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 Yes No

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)

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11. Were you employed in the United States Yes No

If Yes, please complete the following

a. Were there any restrictions on the length of your employment Yes No

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

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

Yes No Not employed

14. Did you leave the United States after you first arrived Yes No Did not leave

If Yes, please complete the following

Did you intend to return Yes No

When did you intend to return?

Did you obtain a reentry permit

What was the expiration date (including any extensions) of the permit

Yes No

Did you give up your United States residence when you departed the United States Yes No

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)