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

OMB No. 1615-0076; Expires 11/30/2010

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

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

Instructions

Read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a separate sheet of
paper. Write your name and Alien Registration Number (A-Number), 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).

What Is the Purpose of Form I-865?
The purpose of Form I-865, Sponsor's Notice of Change of
Address is to report a sponsor's new address. You will need to
supply USCIS a completed and signed Form I-865.

When Should I Use Form I-865?
If at any time in the past you completed 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:
1. Becomes a U.S. citizen;
2. Can be credited with 40 quarters of work;
3. 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;
4. In a removal proceeding, loses the lawful permanent
resident status that the sponsored immigrant obtained based
on your Form I-864; or
5. 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:

2. Date of Birth - Use eight numbers to show your date of birth
(example: May 1, 1979, should be written 05/01/1979).
3. Place of Birth - Give the name of the country where you were
born. Include also the city and State or province.
4. A Number - This is your USCIS file number. If you do
not have an Alien Registration Number (A-Number) or
do not know it, leave this blank or write "None."
5. U.S. Social Security Number - This is your U.S. Social
Security Number. If you do not have a U.S. Social Security
Number, leave this blank.
6. 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.
7. Lawful Permanent Resident - Check the appropriate
box if you are a permanent resident.
8. New Home Address - Provide 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.
9. New Mailing Address - Provide your mailing address, if
different from your home address.
10.Telephone Number - Provide a telephone number with area
code where you can be reached during the day.

Part 2 - Information on Sponsored Immigrant(s)
1. 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.

Step 1 - Fill Out Form I-865.

Part 3 - Signature

Step 2 - Submit Your Form I-865.

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

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."
This form is divided into Parts 1 through 4. The following
information should help you fill out the form.

Part 1 - Information About You, the Sponsor
1. 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.

Part 4 - Signature of Person Preparing Form,
If Other Than the Sponsor
1. If you, the sponsor, did not fill out Form I-865, the preparer
must also sign, date, and give his or her address.

Step 2. Submit Your Form I-865
You must include the following items:
1. Your signed and completed Form I-865;

Instructions I-865 (Rev. 11/17/09) Y

2. Filing Fee. There is no filing fee for Form I-865;
3. 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 USCIS received the original Form
I-865.
USCIS will accept this documentation as proof that you
complied with the requirement to file Form I-865. For
example, if you send Form I-865 using the U.S. Postal Service,
you should keep with your file copy of Form I-865, the U.S.
Postal Service certified mail receipt or Express Mail shipping
label along with a return receipt, both bearing postmarks and
the address where you mailed Form I-865.
If you send Form I-865 by a commercial delivery service, you
should keep with your file copy of Form I-865, a photocopy
of the shipping label, and signature proof of delivery.

4. Submit your Form I-865. Where the notice should be sent
depends on where you now live. See below to determine
where to mail your notice.
If your new address is in Connecticut, Delaware, District
of Columbia, Maine, Maryland, Massachusetts, New
Jersey, New Hampshire, New York, Pennsylvania, Puerto
Rico, Rhode Island, Vermont, Virginia, West Virginia, or
the U.S. Virgin Islands, mail the notice to:
USCIS - Vermont Service Center
75 Lower Weldon Street
St. Albans, VT 05479-0001
If your new address is in Alabama, Arkansas, Florida,
Georgia, Kentucky, Louisiana, Mississippi, New Mexico,
North Carolina, Oklahoma, South Carolina, Tennessee, or
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
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

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
Form AR-11, Alien Change of Address Card, to comply with the
change of address requirement in 8 CFR 265.1, as well as filing
Form I-865.

USCIS Forms and Information
To order USCIS forms, call our toll-free number at
1-800-870-3676. You can also get USCIS forms and
information on immigration laws, regulations, and procedures
by telephoning our National Customer Service Center at
1-800-375-5283 or visiting our Internet website at
www.uscis.gov.
As an alternative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
our Internet-based system, InfoPass. To access the system,
visit our website. Use the InfoPass appointment scheduler and
follow the screen prompts to set up your appointment.
InfoPass generates an electronic appointment notice that
appears on the screen.

Privacy Act Notice
We ask for the information on this form, and associated
evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies.

Penalties
If you knowingly and willfully falsify or conceal a material
fact or submit a false document with your Form I-865, you
will face severe penalties provided by law and may be subject
to criminal prosecution.

Instructions I-865 (Rev. 11/17/09)Y Page 2

Paperwork Reduction Act
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a currently valid
OMB control number. The public reporting burden for this
collection of information is estimated at 15 minutes per
response, including the time for reviewing instructions and
completing and submitting the form. Send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
this burden, to: U.S. Citizenship and Immigration Services,
Regulatory Products Division, 111 Massachusetts Avenue,
N.W., 3rd Floor, Suite 3008, Washington, DC 20529-2210.
OMB No. 1615-0076. Do not mail your application to this
address.

Instructions I-865 (Rev. 11/17/09) Y Page 3

OMB No. 1615-0076; Expires 11/30/2010

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

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

START HERE-Type or print in black ink

For USCIS Use Only

Family Name

Given Name

Date of Birth (mm/dd/yyyy)

Date

Middle Name

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

A-Number (if any)

Receipt

Returned

Part 1. Information About You, the Sponsor

Resubmitted
Date

U.S. Social Security Number

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

Effective Date of Change of Address

Daytime Telephone (Area/Country Code)

State or Province

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-Number

Form I-865 (Rev. 11/17/09)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. 11/17/09)Y Page 2