The USCIS I-864 form, also known as the Affidavit of Support, is a crucial document that demonstrates a sponsor's commitment to financially support an immigrant. This form ensures that the immigrant will not become a public charge and helps establish their eligibility for a green card. Understanding the requirements and implications of the I-864 can significantly impact the immigration process.
The USCIS I-864 form, also known as the Affidavit of Support, plays a crucial role in the immigration process for many individuals seeking to become lawful permanent residents in the United States. This form serves as a legally binding contract between a sponsor and the U.S. government, ensuring that the sponsored immigrant will not become a public charge. By submitting the I-864, sponsors demonstrate their financial ability to support the immigrant, typically requiring them to meet a specific income threshold based on the federal poverty guidelines. The form requires detailed information about the sponsor's income, assets, and household size, as well as documentation to verify the financial claims made. It is important to note that the obligations outlined in the I-864 continue until the sponsored immigrant either becomes a U.S. citizen, can be credited with 40 quarters of work, or leaves the United States. Understanding the nuances of the I-864 form is essential for both sponsors and immigrants, as it lays the foundation for a successful immigration journey and ensures compliance with U.S. immigration laws.
Affidavit of Support Under Section 213A of the INA
USCIS
Form I-864
Department of Homeland Security
OMB No. 1615-0075
U.S. Citizenship and Immigration Services
Expires 10/31/2021
For
Use
Only
Affidavit of Support Submitter
Petitioner
1st Joint Sponsor
2nd Joint Sponsor
Substitute Sponsor
5% Owner
Section 213A Review
MEETS
DOES NOT MEET
requirements
Reviewed By:
Office:
Date (mm/dd/yyyy):
Number of Support Affidavits in File
1
2
Remarks
To be completed by an
Select this box if
Attorney State Bar Number
Attorney or Accredited Representative
Form G-28 or
(if applicable)
USCIS Online Account Number (if any)
attorney or accredited
G-28I is attached.
representative (if any).
►START HERE - Type or print in black ink.
Part 1. Basis For Filing Affidavit of Support
I,
,
am the sponsor submitting this affidavit of support because (Select only one box):
1.a.
I am the petitioner. I filed or am filing for the
immigration of my relative.
1.b.
I filed an alien worker petition on behalf of the
intending immigrant, who is related to me as my
Mailing Address
(USPS ZIP Code Lookup)
2.a. In Care Of Name
2.b. Street Number
and Name
2.c. Apt. Ste. Flr.
2.d. City or Town
1.c.
I have an ownership interest of at least 5 percent in
which filed an alien worker petition on behalf of the
1.d.
I am the only joint sponsor.
2.e. State
2.g. Province
2.h. Postal Code 2.i. Country
2.f. ZIP Code
1.e.
I am the
first
second of two joint sponsors.
1.f.
The original petitioner is deceased. I am the
substitute sponsor. I am the intending immigrant's
NOTE: If you are filing this form as a sponsor, you must include proof of your U.S. citizenship, U.S. national status, or lawful permanent resident status.
Other Information
3.Country of Citizenship or Nationality
4.Date of Birth (mm/dd/yyyy)
5.Alien Registration Number (A-Number) (if any)
►A-
Part 2. Information About the Principal Immigrant
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
6.USCIS Online Account Number (if any)
►
7.Daytime Telephone Number
Form I-864 10/15/19
Page 1 of 10
Part 3. Information About the Immigrants You Are Sponsoring
1.I am sponsoring the principal immigrant named in Part 2.
Yes
No (Applicable only if you are sponsoring
family members in Part 3. as the second
joint sponsor or if you are sponsoring
family members who are immigrating
more than six months after the principal
immigrant)
2. I am sponsoring the following family members immigrating at the same time or within six months of the principal immigrant named in Part 2. (Do not include any relative listed on a separate visa petition.)
3. I am sponsoring the following family members who are immigrating more than six months after the principal immigrant.
Family Member 1
4.a. Family Name
4.b. Given Name
4.c. Middle Name
5.Relationship to Principal Immigrant
6. Date of Birth (mm/dd/yyyy)
7.Alien Registration Number (A-Number) (if any)
► A-
8.USCIS Online Account Number (if any)
Family Member 2
9.a. Family Name
9.b. Given Name
9.c. Middle Name
10.Relationship to Principal Immigrant
11. Date of Birth (mm/dd/yyyy)
12.Alien Registration Number (A-Number) (if any)
13.USCIS Online Account Number (if any)
Family Member 3
14.a. Family Name
14.b. Given Name
14.c. Middle Name
15.Relationship to Principal Immigrant
16.Date of Birth (mm/dd/yyyy)
17.Alien Registration Number (A-Number) (if any)
18.USCIS Online Account Number (if any)
Family Member 4
19.a. Family Name
19.b. Given Name
19.c. Middle Name
20.Relationship to Principal Immigrant
21.Date of Birth (mm/dd/yyyy)
22.Alien Registration Number (A-Number) (if any)
23.USCIS Online Account Number (if any)
Family Member 5
24.a. Family Name
24.b. Given Name
24.c. Middle Name
25.Relationship to Principal Immigrant
26.Date of Birth (mm/dd/yyyy)
27.Alien Registration Number (A-Number) (if any)
28.USCIS Online Account Number (if any)
Page 2 of 10
Part 3. Information About the Immigrants You Are Sponsoring (continued)
29. Enter the total number of immigrants you are sponsoring on
this affidavit which includes the principal immigrant listed
in Part 2., any immigrants listed in Part 3., Item
Numbers 1. - 28. and (if applicable), any immigrants listed
for these questions in Part 11. Additional Information.
Do not count the principal immigrant if you are only
Sponsor's Physical Address
4.a. Street Number
4.b. Apt. Ste. Flr.
4.c. City or Town
sponsoring family members entering more than 6 months
after the principal immigrant.
Part 4. Information About You (Sponsor)
Sponsor's Full Name
4.d. State
4.f. Province
4.g. Postal Code
4.h. Country
4.e. ZIP Code
Sponsor's Mailing Address
2.h. Postal Code
2.i. Country
3.Is your current mailing address the same as your physical
address?
No
If you answered "No" to Item Number 3., provide your physical address in Item Numbers 4.a. - 4.h.
5.Country of Domicile
7.City or Town of Birth
8.State or Province of Birth
9.Country of Birth
10.U.S. Social Security Number (Required)
Citizenship or Residency
11.a.
I am a U.S. citizen.
11.b.
I am a U.S. national.
11.c.
I am a lawful permanent resident.
12.Sponsor's A-Number (if any)
13.Sponsor's USCIS Online Account Number (if any)
Military Service (To be completed by petitioner sponsors only.)
14.I am currently on active duty in the U.S. Armed Forces
or U.S. Coast Guard.
Page 3 of 10
Part 5. Sponsor's Household Size
NOTE: Do not count any member of your household more than once.
Persons you are sponsoring in this affidavit:
5.
6.
Retired Since (mm/dd/yyyy)
Unemployed Since (mm/dd/yyyy)
1.Provide the number you entered in Part 3., Item Number
29.
Persons NOT sponsored in this affidavit:
2. Yourself.
3.If you are currently married, enter "1" for your spouse.
4.If you have dependent children, enter the number here.
5.If you have any other dependents, enter the number here.
6.If you have sponsored any other persons on Form I-864 or Form I-864EZ who are now lawful permanent residents,
enter the number here.
7.OPTIONAL: If you have siblings, parents, or adult children with the same principal residence who are combining their income with yours by submitting Form
I-864A, enter the number here.
8.Add together Part 5., Item Numbers 1. - 7. and enter the number here.
Household Size:
Part 6. Sponsor's Employment and Income
I am currently:
1. Employed as a/an
2.Name of Employer 1
7.My current individual annual income is:
$
Income you are using from any other person who was counted in your household size, including, in certain conditions, the intending immigrant. (See Form I-864 Instructions.) Please indicate name, relationship, and income.
Person 1
8.Name
9.Relationship
10.
Current Income
Person 2
11.
Name
12.
Relationship
13.
Person 3
14.Name
15.Relationship
16. Current Income
Person 4
3. Name of Employer 2 (if applicable)
17. Name
4.
Self-Employed as a/an (Occupation)
18.
19. Current Income
Page 4 of 10
Household Size
1 2 3
4 5 6
7 8 9
Other
Poverty Guideline
Year: 2 0
Poverty Line:
(continued)
20.My Current Annual Household Income (Total all lines from Part 6. Item Numbers 7., 10., 13., 16., and 19.; the total will be compared to Federal Poverty Guidelines on
Form I-864P.)
21.
The people listed in Item Numbers 8., 11., 14., and
17.have completed Form I-864A. I am filing along with this affidavit all necessary Form I-864As completed by these people.
22. One or more of the people listed in Item Numbers 8., 11., 14., and 17. do not need to complete Form I-864A because he or she is the intending immigrant and has no accompanying dependents.
Federal Income Tax Return Information
23.a. Have you filed a Federal income tax return for each of the
three most recent tax years?
NOTE: You MUST attach a photocopy or transcript of your Federal income tax return for only the most recent tax year.
23.b. (Optional) I have attached photocopies or transcripts of my Federal income tax returns for my second and third most recent tax years.
My total income (adjusted gross income on Internal Revenue Service (IRS) Form 1040EZ) as reported on my Federal income tax returns for the most recent three years was:
Tax Year
Total Income
24.a. Most Recent
24.b. 2nd Most Recent
24.c. 3rd Most Recent
25. I was not required to file a Federal income tax return as my income was below the IRS required level and I have attached evidence to support this.
Part 7. Use of Assets to Supplement Income
(Optional)
If your income, or the total income for you and your household, from Part 6., Item Numbers 20. or 24.a. - 24.c., exceeds the Federal Poverty Guidelines for your household size, YOU ARE NOT REQUIRED to complete this Part 7. Skip to Part 8.
Your Assets (Optional)
1.Enter the balance of all savings and checking accounts.
2.Enter the net cash value of real-estate holdings. (Net value means current assessed value minus mortgage debt.)
3.Enter the net cash value of all stocks, bonds, certificates of deposit, and any other assets not already included in Item Number 1. or Item Number 2.
4.Add together Item Numbers 1. - 3. and enter the number
here.
TOTAL: $
Assets from Form I-864A, Part 4., Item Number 3.d., for:
5.a. Name of Relative
5.b. Your household member's assets from Form I-864A
(optional).$
Assets of the principal sponsored immigrant (optional).
The principal sponsored immigrant is the person listed in Part 2., Item Numbers 1.a. - 1.c. Only include the assets if the principal immigrant is being sponsored by this affidavit of support.
6.Enter the balance of the principal immigrant's savings and
checking accounts.
7.Enter the net cash value of all the principal immigrant's real estate holdings. (Net value means investment value
minus mortgage debt.)
8.Enter the current cash value of the principal immigrant's stocks, bonds, certificates of deposit, and other assets not included in Item Number 6. or Item Number 7.
Page 5 of 10
Sponsor's Household Income
3
(Page 5, Line 10)
4
5
6
7
8
9
The total value of all assets, line 10, must equal 5 times (3 times for spouses and children of
USC's, or 1 time for orphans to be formally adopted in the U.S.) the difference between the
poverty guidelines and the sponsor's household income, line 10.
What If I Choose Not to Sign Form I-864?
(Optional) (continued)
The U.S. Government cannot make you sign Form 1-864 if you
9.
Add together Item Numbers 6. - 8. and enter the number
do not want to do so. But if you do not sign Form I-864, the
intending immigrant may not become a lawful permanent
resident in the United States.
Total Value of Assets
What Does Signing Form I-864 Require Me To Do?
Add together Item Numbers 4., 5.b., and 9. and enter the
If an intending immigrant becomes a lawful permanent resident
number here.
in the United States based on a Form I-864 that you have
signed, then, until your obligations under Form I-864 terminate,
you must:
Part 8. Sponsor's Contract, Statement, Contact
Information, Declaration, Certification, and
Signature
NOTE: Read the Penalties section of the Form I-864 Instructions before completing this part.
Sponsor's Contract
Please note that, by signing this Form I-864, you agree to assume certain specific obligations under the Immigration and Nationality Act (INA) and other Federal laws. The following paragraphs describe those obligations. Please read the following information carefully before you sign Form I-864. If you do not understand the obligations, you may wish to consult an attorney or accredited representative.
What is the Legal Effect of My Signing Form I-864?
If you sign Form I-864 on behalf of any person (called the intending immigrant) who is applying for an immigrant visa or for adjustment of status to a lawful permanent resident, and that intending immigrant submits Form I-864 to the U.S. Government with his or her application for an immigrant visa or adjustment of status, under INA section 213A, these actions create a contract between you and the U.S. Government. The intending immigrant becoming a lawful permanent resident is the consideration for the contract.
Under this contract, you agree that, in deciding whether the intending immigrant can establish that he or she is not inadmissible to the United States as a person likely to become a public charge, the U.S. Government can consider your income and assets as available for the support of the intending immigrant.
A.Provide the intending immigrant any support necessary to maintain him or her at an income that is at least 125 percent of the Federal Poverty Guidelines for his or her household size (100 percent if you are the petitioning sponsor and are on active duty in the U.S. Armed Forces or U.S. Coast Guard, and the person is your husband, wife, or unmarried child under 21 years of age); and
B.Notify U.S. Citizenship and Immigration Services (USCIS) of any change in your address, within 30 days of the change, by filing Form I-865.
What Other Consequences Are There?
If an intending immigrant becomes a lawful permanent resident in the United States based on a Form I-864 that you have signed, then, until your obligations under Form I-864 terminate, the U.S. Government may consider (deem) your income and assets as available to that person, in determining whether he or she is eligible for certain Federal means-tested public benefits and also for state or local means-tested public benefits, if the state or local government's rules provide for consideration (deeming) of your income and assets as available to the person.
This provision does not apply to public benefits specified in section 403(c) of the Welfare Reform Act such as emergency Medicaid, short-term, non-cash emergency relief; services provided under the National School Lunch and Child Nutrition Acts; immunizations and testing and treatment for communicable diseases; and means-tested programs under the Elementary and Secondary Education Act.
What If I Do Not Fulfill My Obligations?
If you do not provide sufficient support to the person who becomes a lawful permanent resident based on a Form I-864 that you signed, that person may sue you for this support.
Page 6 of 10
Signature (continued)
If a Federal, state, local, or private agency provided any covered means-tested public benefit to the person who becomes a lawful permanent resident based on a Form I-864 that you signed, the agency may ask you to reimburse them for the amount of the benefits they provided. If you do not make the reimbursement, the agency may sue you for the amount that the agency believes you owe.
If you are sued, and the court enters a judgment against you, the person or agency that sued you may use any legally permitted procedures for enforcing or collecting the judgment. You may also be required to pay the costs of collection, including attorney fees.
If you do not file a properly completed Form I-865 within 30 days of any change of address, USCIS may impose a civil fine for your failing to do so.
When Will These Obligations End?
Your obligations under a Form I-864 that you signed will end if the person who becomes a lawful permanent resident based on that affidavit:
A.Becomes a U.S. citizen;
B.Has worked, or can receive credit for, 40 quarters of coverage under the Social Security Act;
C.No longer has lawful permanent resident status and has departed the United States;
D.Is subject to removal, but applies for and obtains, in removal proceedings, a new grant of adjustment of status, based on a new affidavit of support, if one is required; or
E.Dies.
NOTE: Divorce does not terminate your obligations under Form I-864.
Your obligations under a Form I-864 that you signed also end if you die. Therefore, if you die, your estate is not required to take responsibility for the person's support after your death. However, your estate may owe any support that you accumulated before you died.
Sponsor's Statement
NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.
I can read and understand English, and I have read
and understand every question and instruction on this
affidavit and my answer to every question.
The interpreter named in Part 9. read to me every
question and instruction on this affidavit and my
answer to every question in
a language in which I am fluent, and I understood
everything.
2.
At my request, the preparer named in Part 10.,
prepared this affidavit for me based only upon
information I provided or authorized.
Sponsor's Contact Information
3.Sponsor's Daytime Telephone Number
4.Sponsor's Mobile Telephone Number (if any)
5.Sponsor's Email Address (if any)
Sponsor's Declaration and Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS or the U.S. Department of State (DOS) may require that I submit original documents to USCIS or DOS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS or DOS may need to determine my eligibility for the benefit that I seek.
I furthermore authorize release of information contained in this affidavit, in supporting documents, and in my USCIS or DOS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law.
I certify, under penalty of perjury, that all of the information in my affidavit and any document submitted with it were provided or authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my affidavit and that all of this information is complete, true, and correct.
A.I know the contents of this affidavit of support that I signed;
B.I have read and I understand each of the obligations described in Part 8., and I agree, freely and without any mental reservation or purpose of evasion, to accept each of those obligations in order to make it possible for the immigrants indicated in Part 3. to become lawful permanent residents of the United States;
C.I agree to submit to the personal jurisdiction of any Federal or state court that has subject matter jurisdiction of a lawsuit against me to enforce my obligations under this Form I-864;
Page 7 of 10
Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and
D.
Each of the Federal income tax returns submitted in
support of this affidavit are true copies, or are
unaltered tax transcripts, of the tax returns I filed
with the IRS;
Interpreter's Mailing Address
3.a. Street Number
3.b. Apt. Ste. Flr.
3.c. City or Town
E.
I understand that, if I am related to the sponsored
immigrant by marriage, the termination of the
marriage (by divorce, dissolution, annulment, or
other legal process) will not relieve me of my
obligations under this Form I-864; and
F.
I authorize the Social Security Administration to
release information about me in its records to
USCIS and DOS.
3.d. State
3.f. Province
3.g. Postal Code
3.h. Country
3.e. ZIP Code
Sponsor's Signature
6.a. Sponsor's Signature
6.b. Date of Signature (mm/dd/yyyy)
NOTE TO ALL SPONSORS: If you do not completely fill out this affidavit or fail to submit required documents listed in the Instructions, USCIS or DOS may deny your affidavit.
Part 9. Interpreter's Contact Information, Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)
1.b. Interpreter's Given Name (First Name)
2.Interpreter's Business or Organization Name (if any)
Interpreter's Contact Information
4.Interpreter's Daytime Telephone Number
5.Interpreter's Mobile Telephone Number (if any)
6.Interpreter's Email Address (if any)
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
which is the same language specified in Part 8., Item Number 1.b., and I have read to this sponsor in the identified language every question and instruction on this affidavit and his or her answer to every question. The sponsor informed me that he or she understands every instruction, question, and answer on the affidavit, including the Sponsor's Declaration and Certification, and has verified the accuracy of every answer.
Interpreter's Signature
7.a. Interpreter's Signature
7.b. Date of Signature (mm/dd/yyyy)
Page 8 of 10
Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor
Provide the following information about the preparer.
Preparer's Full Name
1.a. Preparer's Family Name (Last Name)
1.b. Preparer's Given Name (First Name)
2.Preparer's Business or Organization Name (if any)
Preparer's Mailing Address
Preparer's Statement
7.a.
I am not an attorney or accredited representative but
have prepared this affidavit on behalf of the sponsor
and with the sponsor's consent.
7.b.
I am an attorney or accredited representative and my
representation of the sponsor in this case
extends
does not extend beyond the
preparation of this affidavit.
NOTE: If you are an attorney or accredited representative, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, or G-28I, Notice of Entry of Appearance as Attorney In Matters Outside the Geographical Confines of the United States, with this affidavit.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this affidavit at the request of the sponsor. The sponsor then reviewed this completed affidavit and informed me that he or she understands all of the information contained in, and submitted with, his or her affidavit, including the
Sponsor's Declaration and Certification, and that all of this information is complete, true, and correct. I completed this affidavit based only on information that the sponsor provided to me or authorized me to obtain or use.
Preparer's Signature
8.a. Preparer's Signature
Preparer's Contact Information
4.Preparer's Daytime Telephone Number
5.Preparer's Mobile Telephone Number (if any)
6.Preparer's Email Address (if any)
8.b. Date of Signature (mm/dd/yyyy)
Page 9 of 10
Part 11. Additional Information
If you need extra space to provide any additional information within this affidavit, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this affidavit or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
2.A-Number (if any)
3.a. Page Number 3.b. Part Number 3.c. Item Number
3.d.
4.a. Page Number 4.b. Part Number 4.c. Item Number
4.d.
5.a. Page Number 5.b. Part Number 5.c. Item Number
5.d.
6.a. Page Number 6.b. Part Number 6.c. Item Number
6.d.
7.a. Page Number 7.b. Part Number 7.c. Item Number
7.d.
Page 10 of 10
Fedex Frieght - It is advisable to reference the FXF 100 Series Rules Tariff for comprehensive shipping terms.
Complemento Carta Porte - Can include a delivery address separate from the billing address.
Free Doctor Release to Return to Work - The Work Release form must be reviewed and approved by designated authorities.
Filling out the USCIS I-864 form, also known as the Affidavit of Support, is a crucial step in the immigration process for many individuals seeking to bring family members to the United States. Here are some key takeaways to consider when completing this important document:
By understanding these key aspects of the I-864 form, sponsors can navigate the process more effectively and support their loved ones in achieving their immigration goals.