Information Collection

Contract Between Sponsor and Household Member

IC 204184 under ICR 202008-1615-016 · OMB 1615-0075.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0075 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-864A Contract Between Sponsor and Household Member	Form
I864A-INS-PCInjRollback-08072020.pdf www.uscis.gov/i-864a	Instruction
I-864A Contract Between Sponsor and Household Member I864A-FRM-PCInjRollback-08072020.pdf www.uscis.gov/i-864a	Form

IC Title:

Contract Between Sponsor and Household Member

Agency IC Tracking Number:

I-864A

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 213A (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	I-864A	Contract Between Sponsor and Household Member	I864A-FRM-PCInjRollback-08072020.pdf	https://www.uscis.gov/i-864a	Yes	No	Fillable Printable
Instruction			I864A-INS-PCInjRollback-08072020.pdf	https://www.uscis.gov/i-864a	Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title: USCIS Benefits Information System

FR Citation: 81 FR 72069

Number of Respondents: 215,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	215,800	215,800
Annual IC Time Burden (Hours)	377,650	377,650
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.