---
type: tax-form
category: employment
person: Xuewei Jiang
date: 2020-05-29
provider: University of Southern California
source: jiang_usc_final_signed_tax_2020.pdf
---

# GLACIER Tax Documents -- Final Signed Package -- Jiang Xuewei

This is the final signed submission package containing the GLACIER Tax Summary Report (signed), instructions, signed W-4, and tax information page.

## Page 1: Tax Summary Report (Signed)

**GLACIER -- Nonresident Alien Tax Compliance System**

Header: HOLD 4

### Summary of Information Entered Into GLACIER

| Field | Value |
|-------|-------|
| Name | Xuewei Jiang |
| SSN / ITIN | 092-99-3215 |
| Email Address | xueweijiang0313@gmail.com |
| Country of Tax Residence | China, People's Republic of |
| Country of Citizenship | China, People's Republic of |
| Current Immigration Status | F1 Student |
| Original Immigration Status | (blank) |
| Immigration Status Expiration | May 31, 2021 |
| Department Name | Marshall School of Business |
| USC ID Number | 8872791406 |

| Field | Value |
|-------|-------|
| Changed Immigration Status? | No |
| Immigration Status Change Date | (blank) |
| Date of Entry to U.S. | August 11, 2011 |
| Estimated Date of Departure | May 31, 2021 |

#### U.S. Presence Days

| Year | Days |
|------|------|
| 2015 | 297 Days |
| 2014 | 303 Days |
| 2013 | 332 Days |
| 2012 | 284 Days |
| 2011 | 143 Days |

### Tax Determinations and Results

Based on the data entered, GLACIER has made the following determinations:

| Field | Value |
|-------|-------|
| Tax Residency Status | Resident Alien for U.S. Tax Purposes |
| Residency Status Change Date | Not Applicable |
| Residency Status Start Date | Not Applicable |

### Compensation/Wages/Salary

| Field | Value |
|-------|-------|
| Applicable Tax Withholding Rate | As Requested on Form W-4 |
| Tax Treaty Exemption Status | Taxable |
| Tax Treaty Time Limit | Not Applicable |
| Tax Treaty Exemption Period | Not Applicable |
| Tax Treaty Dollar Limit | Not Applicable |

**TAX** (watermark/stamp)

| Field | Value |
|-------|-------|
| FICA Tax Status | Taxable (*Exempt if Student) |
| FICA Tax Start Date | (blank) |

### Required Forms and Document Copies

**Required Forms:**
- Form W-4

**Required Document Copies:**
- Form I-20
- Form I-94/I-94W Card
- Visa Sticker/Stamp (in Passport)

### Certification

| Field | Value |
|-------|-------|
| Signature | (signed) |
| Date | 05/29/2020 |

052920

---

## Page 2: Tax Summary Report Instructions

(Same GLACIER instructions page. See jiang_glacier_tax_docs_2020.md for full text.)

Submit to:
Your HR Payroll Analyst / Or Your Supervisor
The University of Southern California
Los Angeles, CA 90089
Telephone: 213-740-8855
payroll@usc.edu

### Additional Information

Based on the information entered, you are a Resident Alien for Tax Purposes. As such, you may have tax withheld from your payments in the same manner as a U.S. citizen.

---

## Page 3: Form W-4 (2020) -- Signed

**Employee's Withholding Certificate**
Department of the Treasury, Internal Revenue Service
OMB No. 1545-0074

### Step 1: Enter Personal Information

| Field | Value |
|-------|-------|
| (a) First name and middle initial | Xuewei |
| Last name | Jiang |
| (b) Social security number | 092-99-3215 |
| Address | 1000 Escalon Ave. Apt. K2087 |
| City or town, state, and ZIP code | Sunnyvale, CA 94085 |

(c) Filing Status:
- [ ] Single or Married filing separately
- [x] Married filing jointly (or Qualifying widow(er))
- [ ] Head of household

### Step 2: Multiple Jobs or Spouse Works

(Not filled in)

### Step 3: Claim Dependents

| Field | Value |
|-------|-------|
| Total (line 3) | $ 3 |

### Step 4 (optional): Other Adjustments

| Field | Value |
|-------|-------|
| 4(a) Other income | $ (blank) |
| 4(b) Deductions | $ (blank) |
| 4(c) Extra withholding | $ (blank) |

### Step 5: Sign Here

| Field | Value |
|-------|-------|
| Employee's signature | (signed -- cursive signature) |
| Date | 05/29/2020 |

### Employers Only

(blank)

Cat. No. 10220Q, Form W-4 (2020)

---

## Page 4: U.S. Tax Information for Non-United States Citizens

(Same Arctic International LLC informational page. See jiang_glacier_tax_docs_2020.md for full text.)

(c) 2015 Arctic International LLC All Rights Reserved. For use in connection with the GLACIER Online Tax Compliance System.