Form I-865 Sponsor�s Notice of Change of Address

OMB No. 1615-0076; Expires 07/31/07

I-865, Sponsor's Notice
of Change of Address

Department of Homeland Security
U.S. Citizenship and Immigration Services

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a separate
sheet(s) of paper. Write your name and Alien Registration Number (A#), if any, at the top of each sheet and indicate the number of the
item that refers to your answer. Include the Part and letter or number of the item on the form relating to the additional information you
are providing (example: Part 2, Z). NOTE: U.S. Citizenship and Immigration Services (USCIS is comprised of offices of the former
Immigration and Naturalization Service (INS).
This form is divided into Parts 1 through 4. The following
Use Form I-865, Sponsor's Notice of Change of
information should help you fill out the form.
Address, to report a sponsor's new address.

Part 1 - Information about you, the sponsor.
You will need to give us a completed and signed
Form I-865.
To file this notice see Step 2 for specific instructions.

When Should I Use Form I-865?
If at any time in the past you completed a Form I-864,
Affidavit of Support, to sponsor an immigrant, you are
required to report your change of address within 30 days
of the change if the sponsorship agreement is still in force.
The sponsorship agreement remains in force until the
sponsored immigrant:
Becomes a U.S. citizen;
Can be credited with 40 quarters of work;
Departs the United States permanently and either formally
abandons lawful permanent resident status (by filing Form
I-407) or is formally held in a removal proceeding to have
abandoned that status;
In a removal proceeding, loses the lawful permanent
resident status that the sponsored immigrant obtained based
on your Form I-864; or
Dies.

How Do I File Form I-865?
A separate Form I-865 must be submitted for each person
who is filing a notice of address change. Follow the steps
below to complete the form:
Step 1 - Fill Out fhe Form I-865.
Step 2 - Submit Your Notice.
If you give us false documents, misrepresent facts or
otherwise engage in fraud, USCIS will take
appropriate action. This means you may lose current
and future immigration benefits. You may also face
penalties, including criminal and/or civil prosecution
leading to fines and/or imprisonment.

Step 1. Fill Out Form I-865.
Use black ink. Type or print clearly using capital letters. If an
item does not apply to you, write "N/A". If the answer is none,
write "NONE".

Family Name (Last name) - Give your legal name. If you
have two last names, include both and use a hyphen (-)
between the names, if appropriate.
Date of Birth - Use eight numbers to show your date of birth
(example: May 1, 1979, should be written 05/01/1979).
Place of Birth - Give the name of the country where you were
born. Include also the city and state or province.
A # - This is your USCIS (or former INS) file number. If
you do not have an Alien Registration Number (A#) or do
not know it, leave this blank or write "None".
U.S. Social Security # - This is your U.S. Social Security
number. If you do not have a U.S. Social Security number,
leave this blank.
U.S. Citizen - Check the appropriate box if you are a U.S.
citizen and provide proof of your citizenship if you became a
U.S. citizen following the filing of your Form I-864, Affidavit
of Support, or submission of a prior Form I-865 address change.
Lawful Permanent Resident - Check the appropriate
box if you are a permanent resident.
New Home Address - Give your new physical street address.
This must include a street number and name or a rural route
number. Do not put a post office box (P.O. Box) number here.
New Mailing Address - Give your mailing address, if
different from your home address.
Telephone Number - Give a telephone number with area
code where you can be reached during the day.

Part 2 - Information on sponsored immigrant(s).
Give the requested information about the sponsored
immigrant(s). If there is more than one immigrant, use a
separate sheet(s) of paper to provide complete information.

Part 3 - Signature.
You, the sponsor, must sign and date the notice. If you do not
sign the form, the notice will be returned as incomplete.

Part 4 - Signature of person preparing form,
if other than the sponsor.
If you, the sponsor, did not fill out the Form I-865, the
preparer must also sign, date and give his or her address.

Instructions I-865 (11/28/06) Y

Step 3. Submit Your Notice.
You must include the following items:
Your signed and completed Form I-865.
Filing Fee. There is no filing fee for Form I-865.
Retain a copy of your completed form. You should retain
in your records (1) a copy of the completed Form I-865, and
(2) evidence that you sent the original Form I-865 to the
correct USCIS office and the USCIS received the original
Form I-865.

Processing Information.
If the sponsor fails to give notice of a change in his or her
address, as required in 8 U.S.C. 1183a(d) and 8 CFR 213a.3, the
sponsor may be liable for the civil penalty established by 8
U.S.C. 1183a(d). The amount of the civil penalty will depend on
whether the sponsor failed to give this notice knowing that the
sponsored immigrant(s) has received means-tested public benefits.

NOTE: If the sponsor is a permanent resident, he or she must file
a Form AR-11, Alien Change of Address Card, to comply with
USCIS will accept this documentation as proof that you
the change of address requirement in 8 CFR 265.1, as well as
compiled with the requirement to file Form I-865. For
example, if you send Form I-865 using the U.S. Postal Service, filing this Form I-865.
you should keep with your file copy of Form I-865, the U.S.
USCIS Forms and Information. To request USCIS forms, call
Postal Service certified mail receipt or Express Mail shipping
our toll-free forms line at 1-800-870-3676. You may also get
label along with a return receipt, both bearing postmarks and
USCIS forms and information about immigration laws and
the address where you mailed Form I-865.
regulations by calling our National Customer Service Center at
If you send Form I-865 by a commercial delivery service, you 1-800-375-5283 or visiting our internet website at
should keep with your file copy of Form I-865 a photocopy of www.uscis.gov.
the shipping label and signature proof of delivery.
Use InfoPass for Appointments. As an alternative to waiting in
Submit your Form I-865. Where the notice should be sent
line for assistance at your local USCIS office, you can now
depends on where you now live. See below to determine
schedule an appointment through our internet-based system,
where to mail your notice.
InfoPass. To access the system, visit our website at
If your new address is in Connecticut, Delaware, District
www.uscis.gov. Use the InfoPass appointment scheduler and
of Columbia, Maine, Maryland, Massachusetts, New
follow the screen prompts to set up your appointment. InfoPass
Jersey, New Hampshire, New York, Pennsylvania, Puerto
generates an electronic appointment notice that appears on the
Rico, Rhode Island, Vermont, Virginia, West Virginia or
screen. Print the notice and take it with you to your appointment.
the U.S. Virgin Islands, mail the notice to:
The notice gives the time and date of your appointment, along
with the address of the USCIS office.
USCIS - Vermont Service Center
75 Lower Weldon Street
Privacy Act Notice. As a sponsor, you are required by statute to
St. Albans, VT 05479-0001
provide us with your change of address. The information
requested on the form will be used principally by the USCIS to
If your new address is in Alabama, Arkansas, Florida,
verify your compliance with the change of address requirement,
Georgia, Kentucky, Louisiana, Mississippi, New Mexico,
and to notify agencies that furnish means-tested public benefits of
North Carolina, Oklahoma, South Carolina, Tennessee or
your address change, if requested.
Texas, mail the notice to:
USCIS - Texas Service Center
P.O. Box 851804
Mesquite, TX. 75185-1804
If your new address is in Arizona, California, Guam,
Hawaii or Nevada, mail the notice to:
USCIS - California Service Center
P.O. Box 10485
Laguna Niguel, CA 92607-0485

The information may also, as a matter of routine use, be disclosed
to other Federal, State and local agencies providing means-tested
public benefits for use in civil action against you for breach of
contract. It may also be disclosed as a matter of routine use to
other Federal, State, local or foreign law enforcement and
regulatory agencies to enable these entities to carry out their law
enforcement responsibilities. Failure to provide the information
may result in the imposition of the penalty established in 8
U.S.C. 1183a(d).

If you live anywhere else in the United States, mail the
notice to:

USCIS - Nebraska Service Center
P.O. Box 87485
Lincoln, NE 68501-7485
Instructions I-865 (Rev. 11/28/06)Y Page 2

Paperwork Reduction Act Notice. You are not required to
respond to this form unless it displays a currently valid OMB
control number.
We try to create forms and instructions that are accurate, can be
easily understood and impose the least possible burden on you
to provide us with information. Often this is difficult because
some immigration laws are very complex.
The estimated average time to complete and file this notice is
15 minutes.
If you have comments regarding the accuracy of this estimate,
or suggestions for making this form simpler, you may write to:
U.S. Citizenship and Immigration Services, Regulatory
Management Division, 111 Massachusetts Avenue, N.W.,3rd
floor, Suite 3008, Washington, DC 20529. Do not mail your
completed notice to this address.

Instructions I-865 (Rev. 11/28/06) Y Page 3

OMB No. 1615-0076; Expires 07/31/07

I-865, Sponsor's Notice
of Change of Address

Department of Homeland Security
U.S. Citizenship and Immigration Services

For USCIS Use Only

START HERE- Please type or print in black ink.

Family Name

Given Name

Date of Birth (mm/dd/yyyy)

Date

Middle Name

Place of Birth (City, State/Province /Country)

Resubmitted
Date

U.S. Social Security Number

A Number (if any)

Receipt

Returned

Part 1. Information about you, the sponsor.

Date

Your current status- (check one)
I am a

U.S. Citizen

Action Block

Lawful Permanent Resident

NOTE: If you became a U.S. citizen following the filing of your Form I-864, Affidavit
of Support, or submission of a prior Form I-865 address change, include a copy of proof
of your U.S. citizenship (example: naturalization certificate, certificate of citizenship,
U.S. passport) with this notice.
Your New Home Address - Street Number and Name; include apt. # if applicable.

City

State or Province

Zip/Postal Code

Country

Effective Date of Change of Address

Daytime Telephone (Area/Country Code)

E-Mail Address (if any)
Remarks

Your New Mailing Address - NOTE: You do not need to complete this section if your
new mailing address is the same as your new home address above.
Street Number and Name; include apt.#, if applicable.

C/O (in care of):

City

State or Province

Effective Date of Change of Address

Daytime Telephone (Area/Country Code)

Zip/Postal Code

E-Mail Address (if any)

Part 2. Information on sponsored immigrant(s). (If more than one person, continue this part on a separate sheet(s) of paper.)
Provide the requested information on the person(s) your are sponsoring:.
Family Name

Given Name

Middle Name

A#

Form I-865 (Rev. 11/28/06)Y

Part 3. Sponsor's Signature. (Read the information on penalties in the instructions before completing this part.)
I certify, under penalty of perjury under the laws of the United States of America, that all the information provided on this notice is
true and correct.
Signature

Date (mm/dd/yyyy)

Part 4. Signature of person preparing form, if other than above. (Sign below.)
I declare that I prepared this request at the request of the above person and it is based on all information of which I have knowledge.
Preparer's Signature

Preparer's Printed Name

Preparer's Firm Name (if applicable)

Preparer's Address

Daytime Phone Number (with area code)

Fax Number (if any)

Date (mm/dd/yyyy)

E-Mail Address (if any)

Form I-865 (Rev.11/28/06)Y Page 2