Section 1. Employee Information And Attestation




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For aliens authorized to work, provide your Alien Registration/USCIS Number OR Form I-94 Admission Number.

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OR
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OR
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Preparer and/or Translator Certification

Check one:

I did not use a preparer or translator.
A preparer(s) and/or translator(s) assisted the employee in completing Section 1.
(To be completed and signed if Section 1 is prepared by a person other than the employee)

Preparer or Translator