Affidavit of Support Under Section 213A of the Act

Instructions for Request for Exemption for
Intending Immigrant’s Affidavit of Support
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-864W

OMB No. 1615-0075
Expires 03/31/2015

What Is the Purpose of Form I-864W?
Form I-864, Affidavit of Support Under Section 213A of the INA, (or in certain cases, Form I-864 EZ, Affidavit of
Support Under Section 213A of the INA) is legally required for most family-based immigrants and some employmentbased immigrants to show that they have adequate means of financial support and are not likely to become a public
charge. Certain classes of immigrants are exempt from the Form I-864 or Form I-864EZ requirement and therefore must
file Form I-864W instead.

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How Is Form I-864W Used?

You must use Form I-864W instead of Form I-864 or Form I-864EZ with your application for an immigrant visa or
adjustment of status if any of the following apply:
1. You have earned or can receive credit for 40 quarters of coverage under the Social Security Act (SSA). If you
have 40 quarters of SSA coverage, you are exempt from the requirement to file Form I-864 or Form I-864EZ.
You can acquire 40 qualifying quarters in the following ways:
A. Working in the United States for 40 quarters in which you received the minimum income established by the Social
Security Administration;
B. By being credited under section 213(a)(3)(B) of the Immigration and Nationality Act (INA) with quarters worked
by your spouse during the marriage or a parent during the time you were under 18 years of age; or
C. A combination of the above.

If you are claiming credit for quarters worked by a spouse or parent, you may not count any quarter in which your
spouse or parent was receiving means-tested public benefits. Include all SSA forms necessary to establish that you
have or can receive credit for 40 quarters of coverage.
2. The intending immigrant is a child who will become a U.S. citizen upon entry under section 320 of the
Immigration and Nationality Act (INA). Under section 320, some children become U.S. citizens immediately
upon admission to the United States or adjustment of status to that of a lawful permanent resident (LPR).
A child becomes a citizen under section 320 if :
A. At least one parent of the child is a U.S. citizen;
B. The child is under 18 years of age;
C. The child is residing in the United States in the legal and physical custody of the U.S. citizen parent after having
been lawfully admitted for permanent residence.
For this purpose, a child is “residing” with the parent in the United States if their principal actual home is at the same
address in the United States.
Section 320 applies to an adopted child if the child meets the requirements applicable to adopted children under
Section 101(b)(1)(E), (F) or (G) of the INA.
If the adopted child, after becoming an LPR, will be residing in the United States in the legal and physical custody of
the citizen parent, then a Form I-864W may be filed instead of a Form I-864 or Form I-864EZ if the child is classified:
Under section 101(b)(1)(E) of the INA on the basis of an approved Form I-130 ; OR

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Under section 101(b)(1(F) of the INA on the basis of an approved Form I-600, AND the child was adopted by the
petitioner (and spouse, if any) abroad AND at least one adoptive parent personally saw and observed the child
before or during the adoption proceeding; OR
Under section 101(b)(1)(G) of the INA on the basis of an approved Form I-800, if the child was adopted by the
petitioner (and spouse, if any) abroad.
A Form I-864 or Form I-864EZ is required, instead of a Form I-864W if the child is classified:
Under section 101(b)(1)(F) of the INA on the basis of an approved Form I-600, but the child will be adopted in
the United States (if the petitioner is married, this includes a child who will not be adopted by the spouse until
after the child’s admission to the United States); OR

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Under section 101(b)(1)(G) of the INA on the basis of an approved Form I-800, but the child will be adopted in
the United States (if the petitioner is married, this includes a child who will not be adopted by the spouse until
after the child’s admission to the United States).
If a child classified under section 101(b)(1)(F) of the INA was adopted by the petitioner (and spouse, if any) abroad,
but neither adoptive parent personally saw and observed the child before or during the adoption proceeding, the child
will be considered to be coming to be adopted in the United States unless the adoptive parents establish that, under the
law of the State of residence, the foreign adoption will be recognized without the need for a “re-adoption” or similar
formal court proceeding.
3. You are filing for an immigrant visa as a self-petitioning widow(er). If you are filing as a self-petitioning
widow(er) using Form I-360, Petition for Amerasian, Widow(er), or Special Immigrant, you are exempt from
the Form I-864 requirements if your Form I-360 is approved and you are applying for lawful permanent
residence.
4. You are filing for an immigrant visa as a self-petitioning battered spouse or child. If you are filing as a selfpetitioning battered spouse or child using Form I-360, you are exempt from the Form I-864 requirements if
your Form I-360 is approved and you are applying for lawful permanent residence.

General Instructions

USCIS provides forms free of charge through the USCIS Web site. In order to view, print, or fill out our forms, you
should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you
do not have Internet access, you may call the USCIS National Customer Service Center at 1-800-375-5283 and ask that
we mail a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Signature. Each request must be properly signed and filed. For all signatures on this request, USCIS will not accept a
stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal guardian may
sign the request on your behalf. A legal guardian may also sign for a mentally incompetent person.
If you are under guardianship, your legal guardian may print your name and sign Form I-864W for you. “Legal guardian”
includes any person who is appointed and authorized by law to protect your estate as a result of your incapacity. The
legal guardian must present proof of the appointment as legal guardian of your estate and a copy of an order from the
appointing court or agency specifically permitting the guardian to make your income and assets available for the support
of the sponsored immigrant.
Filing Fee. There is no filing fee to file this request with USCIS. For information on processing fees when filing with the
Department of State, see www.travel.state.gov.
Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the What Evidence
Should You Submit section of these Instructions.
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Copies. You may submit legible photocopies of documents requested, unless the instructions specifically state that you
must submit an original document. USCIS may request an original document at the time of filing or at any time during
processing of an application, petition, or request. If you submit original documents when not required, the documents
may remain a part of the record, and USCIS will not automatically return them to you.
Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation. The translator must sign a certification that the English language translation is complete and accurate, and that
he or she is competent to translate from the foreign language into English.
How To Fill Out Form I-864W
1. Type or print legibly in black ink.

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2. If you need extra space to complete any item within this request, use the space provided in Part 6. Additional
Information or attach a separate sheet of paper; type or print your name and Alien Registration Number (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.
3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been
married and the question asks “Provide the name of your current spouse”), type or print “N/A,” unless otherwise
directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many
children do you have” or “How many times have you departed the United States”), type or print “None,” unless
otherwise directed.
4. USCIS ELIS Account Number (if any). If you have previously filed an application, petition, or request using the
USCIS Electronic Immigration System (USCIS ELIS), provide the USCIS ELIS Account Number you were issued by
the system. The USCIS ELIS Account Number is not the same as an A-Number. If you were issued a USCIS ELIS
Account Number, enter it in the space provided.
5. Part 3. Requestor’s (Intending Immigrant’s) Statement, Contact Information, Certification, and Signature.
Select the appropriate box to indicate that you either read this request yourself or someone interpreted this request for
you from English to a language in which you are fluent. If applicable, select the box to indicate if someone prepared
this request for you. Further, you must sign and date your request and provide your daytime telephone number,
mobile telephone number (if any), and email address (if any). Every request MUST contain the signature of the
requestor (or parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not
acceptable.
6. Part 4. Interpreter’s Contact Information, Certification, and Signature. If you used anyone as an interpreter to
read the Instructions and questions on this request to you in a language in which you are fluent, the interpreter must
fill out this section, provide his or her name, the name and address of his or her business or organization (if any), his
or her daytime telephone number, and his or her email address (if any). The interpreter must sign and date the request.
7. Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this Request,
If Other Than the Requestor. This section must contain the signature of the person who completed your request,
if other than you, the requestor. If the same individual acted as your interpreter and your preparer, that person
should complete both Part 4. and Part 5. If the person who completed this request is associated with a business
or organization, that person should complete the business or organization name and address information. Anyone
who helped you prepare this request MUST sign and date the request. A stamped or typewritten name in place
of a signature is not acceptable. If the person who helped you prepare your request is an attorney or accredited
representative, he or she must also submit a completed Form G-28, Notice of Entry of Appearance as Attorney or
Accredited, along with your request.
8. Part 6. Additional Information. If you need extra space to provide any additional information within this request,
use the space provided in Part 6. Additional Information. If you need more space than what is provided in Part 6.,
you may make copies of Part 6. to complete and file with your request, or attach a separate sheet of paper. Include
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.
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We recommend that you print or save a copy of your completed application to review in the future and for
your records.

What Evidence Should You Submit?
You must submit all evidence requested in these instructions with your request.
If you fail to submit required evidence, USCIS or the Department of State may reject or deny your request for failure to
submit requested evidence or supporting documents in accordance with 8 CFR 103.2(b)(1) and these Instructions.

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What Is the Filing Fee?

There is no filing fee to file Form I-864W with USCIS. For information on processing fees when filing with the
Department of State, see www.travel.state.gov.

Where to File?

Please see our Web site at www.uscis.gov/I-864W or call our National Customer Service Center at 1-800-375-5283 for
the most current information about where to file this request. For TTY (deaf or hard of hearing) call:
1-800-7671833. For information on filing with the Department of State, see www.travel.state.gov.

Address Change

If you have filed with USCIS and have changed your address, you must inform USCIS of your new address within 30
days of the change. To do this, you must complete and file Form I-865, Sponsor’s Change of Address. For information
on filing Form I-865, go to the USCIS Web site at www.uscis.gov/I-865 or contact the National Customer Service Center
at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833. For information on reporting change of
address to the Department of State, see www.travel.state.gov.
NOTE: Do not complete Form I-865 at the same time that you complete Form I-864W. You should complete and
submit Form I-865 to USCIS only when the address you indicated on the original Form I-864W has changed.
If you are a lawful permanent resident sponsor, you must notify USCIS of your new address within 10 days of moving
from your previous residence. For information on filing a change of address go to the USCIS Web site at www.uscis.gov/
addresschange or contact the USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of
hearing) call: 1-800-767-1833.
NOTE: Do not submit a change of address request to USCIS Lockbox facilities because these facilities do not process
change of address requests.

Processing Information
Initial Processing. Once USCIS or the Department of State accepts your request we will check it for completeness. If
you do not completely fill out this request, you will not establish a basis for your eligibility and USCIS or the Department
of State may reject or deny your request.

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Requests for More Information. We may request that you provide more information or evidence to support your
request. We may also request that you provide the originals of any copies you submit. USCIS will return any requested
originals when they are no longer needed.
Requests for Interview. We may request that you appear at a USCIS office for an interview based on your request. At
the time of any interview or other appearance at a USCIS office, we may require that you provide your fingerprints,
photograph, and/or signature to verify your identity and/or update background and security checks.
Decision. The decision on Form I-864W involves a determination of whether you have established eligibility for the
immigration benefit you are seeking. USCIS will notify you of the decision in writing.

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USCIS Forms and Information

To ensure you are using the latest version of this request, visit the USCIS Web site at www.uscis.gov where you can
obtain the latest USCIS forms and immigration-related information. If you do not have Internet access, you may order
USCIS forms by calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by calling
the USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call:
1-800-767-1833.
Instead of waiting in line for assistance at your local USCIS office, you can now schedule an appointment through our
online system, InfoPass, at infopass.uscis.gov. 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. If filing with
the Department of State, see www.travel.state.gov.

Penalties

The Government may pursue verification of any information provided on or in support of this request. If you include in
this affidavit of support any information that you know to be false, you may be liable for criminal prosecution under the
laws of the United States.
If you fail to give notice of your change of address, as required by 8 U.S.C. 1183a(d) and 8 CFR 213a.3, you may be
liable for the civil penalty established by 8 U.S.C. 1183a(d)(2). The amount of the civil penalty will depend on whether
you failed to give this notice because you were aware that the immigrants you sponsored had received Federal, state, or
local means-tested public benefits.
If the failure to report your change of address occurs with knowledge that the sponsored immigrant received means-tested
public benefits (other than benefits described in section 401(b), 403(c)(2), or 4ll(b) of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996, which are summarized in the sponsor’s contract in Part 8. of Form I-864)
such failure may result in a fine of not less than $2,000 or more than $5,000. Otherwise, the failure to report your change
of address may result in a fine not less than $250 or more than $2,000.

USCIS Privacy Act Statement
AUTHORITIES: The information requested on this request, and the associated evidence, is collected under the
Immigration and Nationality Act, section 101, and in 8 U.S.C. 1182a(4), 1183a, 1184(a), and 1258.

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PURPOSE: The primary purpose for providing the requested information on this request is to determine if you have
established eligibility for the immigration benefit for which you are filing. The information will be used principally by an
immigration judge, USCIS, or a Consular Officer to whom it is furnished, to determine an alien’s eligibility for benefits
under the Immigration and Nationality Act, specifically whether he or she has adequate means of financial support and
will not become a public charge. DHS will use the information you provide to grant or deny the immigration benefit you
are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and
any requested evidence, may delay a final decision in your case or result in denial of your request.
ROUTINE USES: DHS may share the information you provide on this request with other Federal, state, local, and
foreign government agencies and authorized organizations. DHS follows approved routine uses described in the
associated published system of records notices [DHS-USCIS-007 - Benefits Information System and DHS-USCIS-001
- Alien File, Index, and National File Tracking System of Records] which you can find at www.dhs.gov/privacy. DHS
may also share the information, as appropriate, for law enforcement purposes or in the interest of national security.

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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 1 hour per response, including the time for reviewing instructions, gathering the required
documentation and information, completing the request, preparing statements, attaching necessary documentation,
and submitting the request. 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
Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC 20529-2140; OMB No.
1615-0075. Do not mail your completed Form I-864W to this address.

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