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ASSESSMENT FORM FOR 495 A/B/C Field Experience: CI495A CI495B CI495C Mid-point Final Pre-service Teacher: PS ID#: Date: Evaluator: Supervisor: School: Grade/subject: Mentor: Explanation of Ratings:
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c i 495 abc is a form used to report certain foreign assets and financial accounts.
U.S. persons who have a financial interest in or signature authority over foreign financial accounts or assets must file c i 495 abc.
c i 495 abc can be filled out electronically through the FinCEN website or by mailing a paper form to the FinCEN office.
The purpose of c i 495 abc is to help the U.S. government combat money laundering and other financial crimes.
c i 495 abc requires reporting of information such as the account number, account balance, and the name and address of the foreign financial institution.
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