A bill to amend the Immigration and Nationality Act to provide penalties for certain persons who employ, or who refer for employment, aliens who are in the United States illegally, to provide that certain aliens illegally in the United States may have their status adjusted to that of permanent residents, and for other purposes.

Makes unlawful, under the Immigration and Nationality Act, the employment or referral for employment in the United States of an alien who has not been lawfully admitted to the United States for permanent residence.

States that a person who employs or refers for employment such an individual shall not be deemed to have violated this Act if he: (1) obtains a form signed by the individual stating that he is a citizen or lawfully-admitted alien; and (2) signs a form stating that he has read the individual's birth certificate or any other document which validates the individual's statement. Directs the Attorney General to make such forms available.

States that any person who employs or refers for employment any alien in violation of this Act shall be fined not more than $500 for each day of each such alien's employment or for such referral.

Directs the Attorney General to adjust the status of such an alien to that of an alien lawfully admitted for permanent residence if the alien: (1) makes application therefor within one year after the date of enactment of this Act; (2) is found to have been continuously physically present within the United States from February 22, 1973, up to the time of his application for adjustment of status under this Act; and (3) is found, upon inspection and examination by the Attorney General, to be admissible as an immigrant under the Immigration and Nationality Act.

Requires any officer or employee of the Department of Health, Education, and Welfare to disclose to the Immigration and Naturalization Service the name and most recent address of any alien who such officer or employee knows is not lawfully in the United States and who is receiving specified assistance under the Social Security Act.

Provides up to five years imprisonment, a $2,000 fine, or both, for any person who knowingly forges, counterfeits, alters, or falsely makes any immigrant or nonimmigrant visa, permit, border crossing card, alien registration receipt card, or other document prescribed for entry into or as evidence of authorized stay in the United States.

States that this Act shall become effective on the first day of the first month after expiration of 90 days following the date of its enactment.