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 07/31/2017

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 the Immigration and Nationality Act (INA) section 213A(a)(3)(B) 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 INA section 320. Under INA
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 INA 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.
INA Section 320 applies to an adopted child if the child meets the requirements applicable to adopted children under
INA Section 101(b)(1)(E), (F) or (G).
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 Form I-864W may be filed instead of Form I-864 or Form I-864EZ if the child is classified:
A. Under INA section 101(b)(1)(E) on the basis of an approved Form I-130;

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B. Under INA section 101(b)(1)(F) 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
C. Under INA section 101(b)(1)(G) on the basis of an approved Form I-800, if the child was adopted by the
petitioner (and spouse, if any) abroad.
Form I-864 or Form I-864EZ is required, instead of Form I-864W if the child is classified:
A. Under INA section 101(b)(1)(F) 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);

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B. Under INA section 101(b)(1)(G) 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); or
C. If a child classified under INA section 101(b)(1)(F) 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 “readoption” 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 self-petitioning
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

U.S. Citizenship and Immigration Services (USCIS) provides forms free of charge through the USCIS website. 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 Form I-864W with USCIS. For information on processing fees when filing with
the U.S. Department of State (DOS), see www.travel.state.gov.
Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the What Evidence
Must You Submit section of these Instructions.

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Copies. You should 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 USCIS requests an original document from you, it will be returned to
you after USCIS determines it no longer needs your original.
NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be
immediately destroyed upon receipt.
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. The certification must include the translator’s
signature. The Department of Homeland Security (DHS) recommends the certification contain the translator’s printed
name and the date and the translator’s contact information.

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How To Fill Out Form I-864W

1. Type or print legibly in black ink.

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 Online Account Number (if any). If you have previously filed an application, petition, or request using the
USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the
USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account Number
by logging in to your account and going to the profile page. If you previously filed certain applications, petitions,
or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access
Notice issuing you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account
Number can be found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the
space provided. The USCIS Online Account Number is not the same as an A-Number.
5. Part 3. Requestor’s (Intending Immigrant’s) Contract, Statement, Contact Information, Declaration,
Certification, and Signature. Select the appropriate box to indicate whether you read this request yourself or
whether you had an interpreter assist you. If someone assisted you in completing the request, select the box indicating
that you used a preparer. 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, his or her mobile telephone number (if any), and his or her email address (if any).
The interpreter must sign and date the request.

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7. Part 5. Contact Information, Declaration, 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 complete 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 may be obliged
to also 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,
along with your request.

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We recommend that you print or save a copy of your completed request to review in the future and for
your records.

What Evidence Must You Submit?

You must submit all evidence requested in these Instructions with your request. If you fail to submit required evidence,
USCIS or DOS 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.

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 DOS, see
www.travel.state.gov.

Where to File?

Please see our website 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: 1-800-767-1833. For
information on filing with DOS, see www.travel.state.gov.

Processing Information
Initial Processing. Once USCIS or DOS 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 DOS may reject or deny
your request.
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. If USCIS requests an original
document from you, it will be returned to you after USCIS determines it no longer needs your original.
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.

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USCIS Forms and Information
To ensure you are using the latest version of this request, visit the USCIS website 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 the Forms Request Line 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 schedule an appointment online at
www.uscis.gov. Select “Schedule an Appointment” and follow the screen prompts to set up your appointment. Once you
finish scheduling an appointment, the system will generate an appointment notice for you.

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USCIS Privacy Act Statement

AUTHORITIES: The information requested on this request, and the associated evidence, is collected under the
Immigration and Nationality Act section 213A.
PURPOSE: The primary purpose for providing the requested information on this request is to show that the applying
immigrant has adequate means of financial support without concern of becoming reliant on the U.S. Government for
financial support. 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. INA section 213A(i)
requires the collection of your Social Security number. Failure to provide the requested information, and any requested
evidence, may prevent USCIS from accepting and approving this affidavit, and the intending immigrant may not be able
to immigrate to the United States.
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.

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 Office of Management and Budget (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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