Affidavit of Support

OMB No. 1615-0014; Exp. 05/31/2011
Department of Homeland Security
U.S. Citizenship and Immigration Services

Instructions for Form I-134, Affidavit of Support
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 of
paper and indicate the part and number of the item to which the answer refers.

What Is the Purpose of This Form?
Section 212(a)(4) of the Immigration and Nationality Act (the
Act) bars the admission into the United States any alien who,
in the opinion of the U.S. Department of State officer
adjudicating a visa application, a Department of Homeland
Security officer, or an immigration judge adjudicating an
application for admission, is likely at any time to become a
public charge.

General Instructions
Fill Out Form I-134
1. Type or print legibly in black ink.
2. If extra space is needed to complete any item, attach a
continuation sheet, indicate the item number, and date and
sign each sheet.

Supporting Evidence
For aliens seeking admission or adjustment as permanent
residents as immediate relatives, family-based immigrants,
and certain employment based immigrants, as specified in
sections 212(a)(4)(C) and 213A of the Act and 8 CFR Part
213a, the petitioning relative must file Form I-864.
Form I-134 may be used in any case in which you are
inadmissible on public charge grounds, but in which you are
not required to have Form I-864 filed on his or her behalf.
Section 213 of the Act (not section 213A) permits the
admission of an alien who is inadmissible on public charge
grounds, in the discretion of the Secretary of Homeland
Security (or, for immigration judge cases, the discretion of the
Attorney General) upon the posting of a bond or other
undertaking (method). Form I-134, is the “undertaking”
prescribed in section 213 of the Act.
Do not use Form I-134 if the alien whom you are sponsoring
is required to have Form I-864 instead.

As the sponsor, you must show you have sufficient income
or financial resources to assure that the alien you are
sponsoring will not become a public charge while in the
United States.
Evidence should consist of copies of any of the
documents listed below that applies to your situation.
Failure to provide evidence of sufficient income or
financial resources may result in the denial of the alien's
application for a visa or his or her removal from the United
States.
Submit in duplicate evidence of income
and resources, as appropriate:
A. Statement from an officer of the bank or other financial
institutions with deposits, identifying the following details
regarding the account:
1. Date account opened;
2. Total amount deposited for the past year; and

Execution of Affidavit
If you are sponsoring more than one alien, you must submit a
separate Form I-134 for each alien. Form I-134 must be
signed in your full name. (Note: Signing Form I-134 is under
penalty of perjury under U.S. law). For this reason, it is not
necessary to sign Form I-134 before a notary, nor to have your
signature notarized after you sign it.

3. Present balance.
B. Statement(s) of your employer on business stationery
showing:
1. Date and nature of employment;
2. Salary paid; and
3. Whether the position is temporary or permanent.
C. If self-employed:
1. Copy of last income tax return filed; or
2. Report of commercial rating concern.
Form I-134 Instructions (05/21/10) Y

D. List containing serial numbers and denominations of bonds
and name of record owner(s).

Sponsor and Alien Liability
Under section 213 of the Act, if the person you are sponsoring
becomes a public charge, the agency that provides assistance
may be able to sue you to recover the cost of the assistance.
In addition to that provision, your income and assets may be
combined with the income and assets of the person you are
sponsoring in determining whether that person is eligible for
Food Stamps, 7 U.S.C. 2014(i)(1), Supplemental Security
Income (SSI), 42 U.S.C. 1382j, and Temporary Assistance for
Needy Families (TANF), 42 U.S.C. 608.

Translations
Any document containing a foreign language submitted to
USCIS shall be accompanied by a full English language
translation which the translator has certified as complete and
accurate, and by the translator's certification that he or she is
competent to translate from the foreign language into English.

Copies
Unless specifically required that an original document be filed
with an application or petition, an ordinary legible photocopy
(standard 8 1/2 x 11 letter size) may be submitted. Original
documents submitted when not required will remain a part of
the record.

Documentation of Income and Resources
An alien applying for SSI must make available to the Social
Security Administration documentation concerning his or her
income and resources and those of the sponsor, including
information that was provided in the corresponding
application.
An alien applying for TANF or Food Stamps must make
similar information available to the State public assistance
agency.
The U.S. Secretary of Health and Human Services and the
U.S. Secretary of Agriculture are authorized to obtain copies
of any such documentation submitted to U.S. Citizenship and
Immigration Services, (USCIS) or the U.S. Department of
State and to release such documentation to a State public
assistance agency.

Joint and Several Liability Issues

Where To File?
Where you submit the form depends on whether the alien you
are sponsoring is in or outside the United States and what type
of application is being submitted. See the instructions
provided with the corresponding application for detailed
information on where to submit this affidavit of support.

What Is the Filing Fee?
There is no filing fee for Form I-134.

Address Changes

Sections 1621(e) of the Social Security Act and
subsection 5(i) of the Food Stamp Act also provide that an
alien and his or her sponsor shall be "jointly and severally
liable" to repay any SSI, TANF, or Food Stamp benefits that
are incorrectly paid because of misinformation provided by a
sponsor or because of a sponsor's failure to provide
information, except where the sponsor was without fault or
where good cause existed. "Jointly and severally liable" means
the alien and sponsors are each liable up to the full amount of
any repayment due.

If you change your address and you have an application or
petition pending with USCIS, you may change your address
online at www.uscis.gov, click on "Online Change of
Address" with USCIS," and follow the prompts, or you may
complete and mail Form AR-11, Alien's Change of Address
Card, to:
U.S. Citizenship and Immigration Services
Change of Address
P.O. Box 7134
London, KY 40742-7134

Incorrect payments that are not repaid will be withheld from
any subsequent payments you or your sponsor are otherwise
eligible under the Social Security Act or Food Stamp Act.

For commercial overnight or fast freight services only, mail to:

These provisions do not apply to SSI, TANF, or Food
Stamp eligibility of aliens admitted as refugees, granted
asylum or Cuban/Haitian entrants as defined in section
501(e) of P.L. 96-422, and to dependent children of the
sponsor or sponsor's spouse.

U.S. Citizenship and Immigration Services
Change of Address
1084-I South Laurel Road
London, KY 40744

Form I-134 Instructions (05/21/10)Y Page 2

Processing Information
Any Form I-134 that is not signed will be rejected with a
notice that your Form I-134 is deficient. You may correct
the deficiency and resubmit Form I-134. Form I-134 is not
considered properly filed until accepted by USCIS.

Initial processing
Upon your Form I-134 has been accepted, it will be checked
for completeness, including submission of the required initial
evidence. Failure to completely fill out Form I-134 or file it
without required initial evidence, may result in the denial of
your application.

Requests for more information or interview
We may request more information or evidence, or we may
request that you appear at a USCIS office for an interview.
We may also request that you submit the originals of any
copy. We will return these originals when they are no longer
required.

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 Web site at www.
uscis.gov.
As an altenative 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 Web site. 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.

Penalties
If you knowingly and willfully make any false statement on
Form I-134, or conceal any material fact, or submit a false
document with Form I-134, we will deny the application for
immigration benefits that the alien for whom you are
submitting Form I-134 has filed, and may deny any other
immigration benefits.

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 seeking. 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. Failure
to provide this information, and any requested evidence, may
delay a final decision or result in denial of your request.
Authority for the collection of the information requested on
this form is contained in 8 U.S.C. 1182(a)(4), 1183, 1184(a),
and 1258.
The information will be used principally by USCIS, or by any
consular officer to whom it may be furnished, to support an
alien's application for benefits under the Act and specifically
the assertion that you have adequate means of financial
support and will not become a public charge. Submission of
the information is voluntary.
The information may also be disclosed to other Federal, State,
local, and foreign law enforcement and regulatory agencies,
including the U.S. Departments of Health and Human
Services, Agriculture, State, Defense and any component (if
the applicant has served or is serving in the U.S. Armed
Forces), Central Intelligence Agency, and individuals and
organizations during the course of any investigation to obtain
further information required to carry out USCIS functions.

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 90 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. OMB
No. 1615-0014. Do not mail your application to this
address.

In addition, you will face severe penalties provided by law and
may be subject to criminal prosecution.
Form I-134 Instructions (05/21/10) Y Page 3