Public Charge Rule

Public Charge Bond
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-945

OMB No. 1615-xxxx
Expires xx/xx/xxxx

What Is The Purpose of Form I-945?
This public charge bond is posted as security for performance and fulfillment of the bonded alien’s obligations to the
government.

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General Instructions

How To Fill Out Form I-945

1. Type or print legibly in black ink.

2. 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.
Part 1. Obligor and Agent/Co-Obligor Information

Please read Part 1., Sections A and B on the form, and complete Sections C, D, and E with the information requested.
Part 2. Information About the Alien For Whom The Bond Is Furnished
Provide the biographic information of the alien requested in Part 2.

Item Number 2. Alien Registration Number (A-Number) (if any). An Alien Registration Number, otherwise known
as an “A-Number,” is typically issued to people who apply for, or are granted, certain immigration benefits. In addition to
U.S. Citizenship and Immigration Services (USCIS), U.S. Immigration and Customs Enforcement (ICE), U.S. Customs
and Border Protection (CBP), Executive Office of Immigration Review (EOIR), and the Department of State (DOS) may
also issue an A-Number to certain foreign nationals. If the alien for whom the bond is furnished was issued an A-Number,
type or print it in the spaces provided. If the alien was issued an Employment Authorization Document (EAD) indicating
the (c)(9) eligibility category based on a pending application for adjustment of status, this number may be listed as the
USCIS Number on the front of the card. If the alien has more than one A-Number, use the space provided in Part 4.
Additional Information to provide the information. If the alien does not have an A-Number or if he or she cannot
remember it, leave this space blank.
Item Number 2. Alien Registration Number (A-Number) (if any). An Alien Registration Number, otherwise known
as an “A-Number,” is typically issued to people who apply for, or are granted, certain immigration benefits. In addition to
U.S. Citizenship and Immigration Services (USCIS), U.S. Immigration and Customs Enforcement (ICE), U.S. Customs
and Border Protection (CBP), Executive Office of Immigration Review (EOIR), and the Department of State (DOS) may
also issue an A-Number to certain foreign nationals. If the alien for whom the bond is furnished was issued an A-Number,
type or print it in the spaces provided. If the alien was issued an Employment Authorization Document (EAD) indicating
the (c)(9) eligibility category based on a pending application for adjustment of status, this number may be listed as the
USCIS Number on the front of the card. If the alien has more than one A-Number, use the space provided in Part 4.
Additional Information to provide the information. If the alien does not have an A-Number or if he or she cannot
remember it, leave this space blank.

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Item Number 3. USCIS Online Account Number (if any). If the alien has previously filed an application or petition
using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide
the USCIS Online Account Number that was issued to the alien by the system. The alien can find the USCIS Online
Account Number by logging in to his or her account and going to the profile page. If he or she previously filed certain
applications or petitions on a paper form through a USCIS Lockbox facility, he or she may have received a USCIS Online
Account Access Notice issuing a USCIS Online Account Number. The alien may find the USCIS Online Account Number
at the top of the notice. The USCIS Online Account Number is not the same as an A-Number.
Item Number 4. Alien’s I-485 Receipt Number. Provide the alien’s receipt number for the pending Form I-485,
Application to Register Permanent Residence or Adjust Status.
Item Number 5. Physical Address. Provide the physical address where the alien is currently residing.

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Item Number 6. Mailing Address. Provide the alien’s current mailing address.

Item Number 7. Date of Birth. Enter the alien’s date of birth in mm/dd/yyyy format in the space provided. For
example, type or print October 5, 1967 as 10/05/1967.
Item Number 8. Place of Birth. Enter the name of the city or town, and country where the alien was born. Type or print
the name of the country as it was named when the alien was born, even if the country’s name has changed or the country
no longer exists.
Item Number 9. Country of Citizenship or Nationality. Enter the name of the country where the alien is a citizen.
This is not necessarily the country where the alien was born. If the alien was not stateless, type or print the name of the
country where the alien was last a citizen or national. If the alien is a citizen or national of more than one country, type or
print the name of the foreign country that issued the last passport.
Item Number 12. Information about the Alien’s Attorney or Accredited Representative. If the alien is represented
by an attorney or accredited representative, the alien’s attorney or accredited representative must submit a new Form
G-28, Notice of Entry of Appearance as Attorney or Accredited Representative for purposes of the bond. If the attorney
or accredited representative does not submit a Form G-28, USCIS will not be able to communicate with the attorney or
accredited representative on behalf of the bonded alien or send a copy of the communication concerning bonds to the
alien’s attorney or accredited representative (as outlined in the Public Charge Bond, Form I-945).
Part 3. Obligor or Agent/Co-Obligor’s Statement, Declaration, Certification, and Signature

Every form MUST contain the signature of the Obligor or the Agent/Co-Obligor. A stamped or typewritten name in place
of a signature is not acceptable.
Part 4. Additional Information
If you need extra space to provide any additional information within this Form I-945, Parts 1. and 2., use the space
provided in Part 4. Additional Information. If you need more space than what is provided in Part 4., you may make
copies of Part 4. to complete and submit with Form I-945. Type or print the Name of the Obligor, the Power of Attorney
Number and A-Number of the bonded alien 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. Do not use Part 4. to amend the terms of Part 3.
If you alter the text of Part 3. by adding terms and conditions in Part 4., USCIS will reject the bond.

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

What Is the Filing Fee?
The filing fee for Form I-945 is $25.

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Where To File?
Please see our website at www.uscis.gov/I-945 or call our National Contact Center at 1-800-375-5283 for the most current
information about where to file this form. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Processing Information
USCIS will reject any Form I-945 that is not signed or is incomplete.

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USCIS Forms and Information

To ensure you are using the latest version of this form, please 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 Contact 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 “Make 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.

Penalties

If you, the obligor or agent/co-obligor, knowingly and willfully falsify or conceal a material fact or submit a false
document with your Form I-945, we may reject the bond. In addition, you will face penalties provided by law and may be
subject to criminal prosecution.

USCIS Compliance Review and Monitoring

By signing this form, you, the obligor or agent/co-obligor acting on the obligor’s behalf has stated under penalty of
perjury (28 U.S.C. section 1746) that all information and documentation submitted with this form are complete, true, and
correct. You also authorize the release of any information from your records that USCIS may need to process the bond
and consent to USCIS verifying such information.
The Department of Homeland Security (DHS) has the authority to verify any information you submit to establish that the
bond should be accepted. USCIS’ legal authority to verify this information is in Title 8 U.S.C. sections 1103, 1182, and
1183, and 8 CFR Parts 103 and 213, as well as Title 26 U.S.C. 6109, Title 31 U.S.C. 7701 and Executive Order 9397.
To ensure compliance with applicable laws and authorities, USCIS may verify information before or after accepting and
processing the bond; this includes that USCIS may verify information as part of the adjudication of a cancellation request
or a breach determination.
Agency verification methods may include, but are not limited to: review of public records and information; contact
through written correspondence, the Internet, facsimile, other electronic transmission, or telephone; unannounced physical
site inspections of residences and locations of employment; and interviews. USCIS will use information obtained through
verification to assess compliance with the laws and to determine whether the bond should be cancelled.

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PRIVACY ACT NOTICE
Authority: The information requested on this form is collected under the Immigration and Nationality Act, as amended,
sections 103, 212(a)(4) and 213 ((8 U.S.C. 1103, 1183) and Title 31 U.S.C. 7701. The collection of the Taxpayer
Identification Number (TIN) (including Individual Taxpayer Identification Number (ITIN), Employer Identification
Number (EIN) or the Social Security Number (SSN)) is authorized by Internal Revenue Code (26 U.S.C. 6109) and
Executive Order 9397.
Purpose: The primary purpose for collecting this information is to provide for the posting, maintenance, cancellation,
and breach determination of a public charge bond, and for the associated financial management activities, including
collection of unpaid monies, and the calculation, payment, and reporting of interest.

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Disclosure: The information you provide is voluntary; however, a public charge bond cannot be accepted unless you
provide the information requested on this form. For bonds secured by cash equivalents such as money orders or cashier’s
checks, your deposit must equal the face amount of the bond and your TIN is necessary to pay interest through the U.S.
Treasury Department and to comply with Internal Revenue Service requirements to report interest payments. Your TIN
will also be used for the purposes of collecting and reporting information on any delinquent accounts arising out of your
relationship with the Government.
Routine Uses: DHS may share the information you provide on this form and any additional requested evidence 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-001 - Alien File, Index, and National
File Tracking System and DHS/USCIS-007 - Benefits Information System] and the published privacy impact assessments
[DHS/USCIS/PIA-016a Computer Linked Application Information Management System and Associated Systems,]
which you can find at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement
purposes or in the interest of national security.
For all others, as appropriate under United States law and U.S. Department of Homeland Security (DHS) policy, the
information you provide may be shared internally within DHS, as well as with federal, state, local, tribal, territorial,
and foreign law enforcement; other government agencies; and other parties as appropriate for collection, enforcement,
investigatory, litigation, or other purposes.

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 form, preparing statements, attaching
necessary documentation, 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 Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC
20529-2140; OMB No. 1615-XXXX. Do not mail your completed Form I-945 to this address.

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