I-864 EZ Form TOC

TABLE OF CHANGES – FORM

Form I-864EZ, Affidavit of Support Under Section 213A of the INA

OMB Number: 1615-0075

08/17/2020

Reason for Revision: Affidavit of Support NPRM

Project Phase: DHSReview

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 03/31/2020

Edition Date 03/06/2018

Current Page Number and Section	Current Text	Proposed Text
Page 2, Part 3. Information About You (Sponsor)	[Page 2] Part 3. Information About You (Sponsor) … Military Service 15. I am currently on active duty in the United States Armed Forces or U.S. Coast Guard.	[Page 2] Part 3. Information About You (Sponsor) [no changes] Military Service 15. I am currently on active duty (other than active duty for training) in the United States Armed Forces.
Page 2, Part 4. Information About Your Household Size	[Page 2] Part 4. Information About Your Household Size NOTE: Do not count any household member more than once. 1.a. Yourself and the person you are sponsoring on this Form I-864EZ. 1.b. Your spouse. 1.c. Your dependent children under 21 years of age. 1.d. If you have sponsored any other persons on a Form I-864 who are now lawful permanent residents in the United States, enter the number here. 1.e. If you have any other dependents listed on your most recent Federal income tax return, enter the number here. 1.f. Add together Item Numbers 1.a. - 1.e. and enter the number here. This is your HOUSEHOLD SIZE for the purpose of this Form I-864EZ.	[Page 2] Part 4. Information About Your Household Size NOTE: Do not count any household member more than once. 1.a. Yourself and the person you are sponsoring on this Form I-864EZ. 1.b. Your spouse. 1.c. Your dependent children under 21 years of age. 1.d. If you have sponsored any other persons on a Form I-864 or Form I-864EZ who either have pending applications for permanent residence, or who are now lawful permanent residents in the United States, and for whom your support obligation has NOT ended, enter the number here. 1.e If you have executed a Form I-864A for persons who have pending applications for permanent residence or who are now lawful permanent residents and for whom your support obligation has NOT ended, enter the number here. 1.f. If you have any other dependents listed on your most recent Federal income tax return, enter the number here. 1.g. Add together Item Numbers 1.a. - 1.f. and enter the number here. This is your HOUSEHOLD SIZE for the purpose of this Form I-864EZ.
New		[Page x] Part 5. Previously Executed Form I-864, Form I-864EZ, or Form I-864A 1. I have executed Form I-864, Form I-864EZ, or Form I-864A for any individuals other than those named on this form. 2. I have sponsored the following individual(s) by submitting Form I-864, Form I-864EZ, or Form I-864A and my support obligation for these individuals has NOT ended: Sponsored Individual 1 3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name 4. Date of Birth 5. Alien Registration Number Sponsored Individual 2 6.a. Family Name (Last Name) 6.b. Given Name (First Name) 6.c. Middle Name 7. Date of Birth 8. Alien Registration Number 9. Have you ever had to reimburse an agency for any means-tested public benefits issued to a sponsored immigrant on whose behalf you executed a Form I-864, Form I-864EZ, or Form I-864A? Y/N If you answered “Yes” to Item Number 9., provide an explanation, including the name of the agency that you reimbursed and the amount you had to reimburse, in Part 10. Additional Information. Provide evidence that you have fully reimbursed the amount owed.
Page 3, Part 5. Information About Your Employment and Income	[Page 3] Part 5. Information About Your Employment and Income 1. I am currently: [] Employed (Complete Item Numbers 2.a. – 2.c.) [] Retired (Complete Item Numbers 3.a. – 3.b.) 2.a. Current Occupation 2.b. Name of Employer 1 2.c. Name of Employer 2 (if applicable) 3.a. Name of Former Employer 3.a. Name of Former Employer 3.b. Date of Retirement (mm/dd/yyyy) 4. My current individual annual income $ Federal Income Tax Information 5.a. Have you filed a Federal income tax return for each of the three most recent tax years? Yes/No NOTE: You MUST attach a photocopy or transcript of your Federal income tax return for only the most recent tax year. 5.b. (Optional) I have attached photocopies or transcripts of my Federal income tax returns for my second and third most recent tax years. My total income (adjusted gross income on IRS Form 1040EZ) as reported on my Federal income tax returns for the most recent three years was: Tax Year Total Income 6.a. Most Recent $ 6.b. 2nd Most Recent $ 6.c. 3rd Most Recent $ [New]	[Page 3] Part 6. Information About Your Employment and Income 1. I am currently: [] Employed (Complete Item Numbers 2.a. – 2.c.) [] Retired (Complete Item Numbers 3.a. – 3.b.) 2.a. Current Occupation 2.b. Name of Employer 1 2.c. Name of Employer 2 (if applicable) 3.a. Name of Former Employer 3.a. Name of Former Employer 3.b. Date of Retirement (mm/dd/yyyy) 4. My current individual annual income $ Federal Income Tax Information 5. Have you filed a Federal income tax return for each of the three most recent tax years? Yes/No NOTE: You MUST attach Internal Revenue Service (IRS)-issued certified copies or transcripts of your Federal income tax return for the three most recent tax years. [deleted] My total income (adjusted gross income on IRS Form 1040EZ) as reported on my Federal income tax returns for the most recent three years was: Tax Year Total Income 6.a. Most Recent $ 6.b. 2nd Most Recent $ 6.c. 3rd Most Recent $ Sponsor’s Bank Account Information Account Type 7.a. Checking 7.b. Savings Account Holder 8.a. Family Name (Last Name) 8.b. Given Name (First Name) 8.c. Middle Name Joint Account Holder (if any) 9.a. Family Name (Last Name) 9.b. Given Name (First Name) 9.c. Middle Name 10. Institution Name 11. Account Number 12. Routing Number Credit Report Information Provide documentation as provided in the Instructions. 13. Do you have a U.S. credit report and credit score available? [ ] Yes [ ] No If you answered “Yes” to Item Number 13., provide a copy of a U.S. credit report and credit score generated within the last 12 months prior to the date of filing. If you answered “No” to Item Number 13., provide a credit agency report that demonstrates that you do not have a credit record or score.
Pages 3-4, Part 6. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature	[Page 3] Part 6. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature … What Does Signing Form I-864EZ Require Me to Do? If an intending immigrant becomes a lawful permanent resident in the United States based on a Form I-864EZ that you have signed, then, until your obligations under Form I-864EZ terminate, you must: A. Provide the intending immigrant any support necessary to maintain him or her at an income that is at least 125 percent of the Federal Poverty Guidelines for his or her household size (or 100 percent if you are the petitioning sponsor and are on active duty in the U.S. Armed Forces or U.S. Coast Guard and the person is your husband, wife, or unmarried child under 21 years of age.); and B. Notify U.S. Citizenship and Immigration Services (USCIS) of any change in your address, within 30 days of the change, by filing Form I-865. Please see the USCIS website at www.uscis.gov/I-865 for more information on filing a change of address as a sponsor. … Sponsor's Statement NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2. 1.a. [ ] I can read and understand English, and I have read and understand every question and instruction on this affidavit and my answer to every question. 1.b. [ ] The interpreter named in Part 7. read to me every question and instruction on this affidavit and my answer to every question in [fillable box], a language in which I am fluent, and I understood everything. 2. [ ] At my request, the preparer named in Part 8., [Fillable Filed], prepared this affidavit for me based only upon information I provided or authorized. …	[Page x] Part 7. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature [no changes] What Does Signing Form I-864EZ Require Me to Do? If an intending immigrant becomes a lawful permanent resident in the United States based on a Form I-864EZ that you have signed, then, until your obligations under Form I-864EZ terminate, you must: A. Provide the intending immigrant any support necessary to maintain him or her at an income that is at least 125 percent of the Federal Poverty Guidelines for his or her household size (or 100 percent if you are the sponsor and are on active duty in the U.S. Armed Forces and the person is your husband, wife, or unmarried child under 21 years of age.); and B. Notify U.S. Citizenship and Immigration Services (USCIS) of any change in your address, within 30 days of the change, by filing Form I-865. Please see the USCIS website at www.uscis.gov/I-865 for more information on filing a change of address as a sponsor. [no changes] Sponsor's Statement NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2. 1.a. [ ] I can read and understand English, and I have read and understand every question and instruction on this affidavit and my answer to every question. 1.b. [ ] The interpreter named in Part 8. read to me every question and instruction on this affidavit and my answer to every question in [fillable box], a language in which I am fluent, and I understood everything. 2. [ ] At my request, the preparer named in Part 9., [Fillable Filed], prepared this affidavit for me based only upon information I provided or authorized. [no changes]
Page 5, Part 7. Interpreter's Contact Information, Certification, and Signature	[Page 5] Part 7. Interpreter's Contact Information, Certification, and Signature …	[Page x] Part 8. Interpreter's Contact Information, Certification, and Signature [no changes]
Page 6, Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor	[Page 6] Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor …	[Page x] Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor [no changes]
Page 7, Part 9. Additional Information	[Page 7] Part 9. Additional Information …	[Page x] Part 10. Additional Information [no changes]

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