I-864 Form TOC

TABLE OF CHANGES – FORM

Form I-864, 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:

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Expires 03/31/2020

Edition Date 03/06/2018

Current Page Number and Section	Current Text	Proposed Text
Pages 2-3, Part 3. Information About the Immigrants You Are Sponsoring	[Page 2] Part 3. Information About the Immigrants You Are Sponsoring … [Page 3] 29. Enter the total number of immigrants you are sponsoring on this affidavit which includes the principal immigrant listed in Part 2., any immigrants listed in Part 3., Item Numbers 1. - 28. and (if applicable), any immigrants listed for these questions in Part 11. Additional Information. Do not count the principal immigrant if you are only sponsoring family members entering more than 6 months after the principal immigrant. … Military Service (To be completed by petitioner sponsors only.) 14. I am currently on active duty in the U.S. Armed Forces or U.S. Coast Guard. Yes No	[no changes] [Page 3] 29. Enter the total number of immigrants you are sponsoring on this affidavit which includes the principal immigrant listed in Part 2., any immigrants listed in Part 3., Item Numbers 1. - 28. and (if applicable), any immigrants listed for these questions in Part 12. Additional Information. Do not count the principal immigrant if you are only sponsoring family members entering more than 6 months after the principal immigrant. [no changes] Military Service (To be completed by petitioner sponsors only.) 14. I am currently on active duty (other than active duty for training) in the U.S. Armed Forces. Yes No
Page 4, Part 5. Sponsor’s Household Size	[Page 4] Part 5. Sponsor's Household Size NOTE: Do not count any member of your household more than once. Persons you are sponsoring in this affidavit: 1. Provide the number you entered in Part 3., Item Number 29. Persons NOT sponsored in this affidavit: 2. Yourself. 1 3. If you are currently married, enter "1" for your spouse. 4. If you have dependent children, enter the number here. 5. If you have any other dependents, enter the number here. 6. If you have sponsored any other persons on Form I-864 or Form I-864EZ who are now lawful permanent residents, enter the number here. 7. OPTIONAL: If you have siblings, parents, or adult children with the same principal residence who are combining their income with yours by submitting Form I-864A, enter the number here. 8. Add together Part 5., Item Numbers 1. - 7. and enter the number here. Household Size:	[Page 4] Part 5. Sponsor's Household Size NOTE: Do not count any member of your household more than once. Persons you are sponsoring in this affidavit: 1. Provide the number you entered in Part 3., Item Number 29. Persons NOT sponsored in this affidavit: 2. Yourself. 1 3. If you are currently married, enter "1" for your spouse. 4. If you have dependent children, enter the number here. 5. If you have any other dependents, enter the number here. 6. If you have sponsored any other persons on Form I-864, I-864A, or Form I-864EZ who either have pending applications for permanent residence or are now lawful permanent residents and for whom your support obligation has NOT ended, enter the number here. [deleted] 7. Add together Part 5., Item Numbers 1. - 6. and enter the number here. Household Size:
New	[New]	[Page x] Part 6. Previously Executed Form I-864, Form I-864EZ, or Form I-864A 1. I have executed a Form I-864, Form I-864EZ, or Form I-864A for any individuals other than those named on this form. Y/N 2. I executed a Form I-864, Form I-864EZ, or Form I-864A on behalf of the following individuals 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. A-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. A-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 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 12. Additional Information. Provide evidence that you have fully reimbursed the amount owed. 10. Have you ever had a judgment entered against you for failing to fulfill your obligation under Form I-864, Form I-864EZ, or Form I-864A? Y/N If you answered “Yes” to Item Number 10., provide a certified copy of the judgment against you.
Page 4, Part 6. Sponsor’s Employment and Income	[Page 4] Part 6. Sponsor's Employment and Income 1. Employed as a/an 2. Name of Employer 1 3. Name of Employer 2 (if applicable) 4. Self-Employed as a/an (Occupation) 5. Retired Since (mm/dd/yyyy) 6. Unemployed Since (mm/dd/yyyy) 7. My current individual annual income is: $ Income you are using from any other person who was counted in your household size, including, in certain conditions, the intending immigrant. (See Form I-864 Instructions.) Please indicate name, relationship, and income. Person 1 8. Name 9. Relationship 10. Current Income $ Person 2 11. Name 12. Relationship 13. Current Income $ Person 3 14. Name 15. Relationship 16. Current Income $ Person 4 17. Name 18. Relationship 19. Current Income $ [Page 5] For USCIS Use Only Household Size 1 2 3 4 5 6 7 8 9 Other Poverty Guideline Year: 20 Poverty Line: $ Remarks 20. My Current Annual Household Income (Total all lines from Part 6. Item Numbers 7., 10., 13., 16., and 19.; the total will be compared to Federal Poverty Guidelines on Form I-864P.) $ 21. The people listed in Item Numbers 8., 11., 14., and 17. have completed Form I-864A. I am filing along with this affidavit all necessary Form I-864As completed by these people. 22. One or more of the people listed in Item Numbers 8., 11., 14., and 17. do not need to complete Form I-864A because he or she is the intending immigrant and has no accompanying dependents. Name Federal Income Tax Return Information 23.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. 23.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 Internal Revenue Service (IRS) Form 1040EZ) as reported on my Federal income tax returns for the most recent three years was: 24.a. Most Recent Tax Year Total Income $ 24.b. 2nd Most Recent 24.c. 3rd Most Recent 25. I was not required to file a Federal income tax return as my income was below the IRS required level and I have attached evidence to support this.	[Page 4] Part 7. Sponsor's Employment and Income 1. Employed as a/an 2. Name of Employer 1 3. Name of Employer 2 (if applicable) 4. Self-Employed as a/an (Occupation) 5. Retired Since (mm/dd/yyyy) 6. Unemployed Since (mm/dd/yyyy) 7. My current individual annual income is: $ Income you are using from your spouse, and, in certain conditions, the intending immigrant. (See Form I-864 Instructions.) Please indicate name, relationship, and income. Person 1 8. Name 9. Relationship 10. Current Income $ Person 2 11. Name 12. Relationship 13. Current Income $ [deleted] [Page 5] For USCIS Use Only Household Size 1 2 3 4 5 6 7 8 9 Other Poverty Guideline Year: 20 Poverty Line: $ Remarks 14. My Current Annual Household Income (Total all lines from Part 6. Item Numbers 7., 10., and 13.; the total will be compared to Federal Poverty Guidelines on Form I-864P.) $ 15. My spouse has executed Form I-864A. I am filing along with this affidavit the necessary Form I-864A completed by my spouse. 16. One of the people listed in Item Numbers 8., and 11. does not need to execute Form I-864A because he or she is the intending immigrant and has no accompanying dependents. Name Federal Income Tax Return Information 17. 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 Internal Revenue Service (IRS) Form 1040EZ) as reported on my Federal income tax returns for the most recent three years was: 18.a. Most Recent Tax Year Total Income $ 18.b. 2nd Most Recent 18.c. 3rd Most Recent 19. I was not required to file a Federal income tax return as my income was below the IRS required level and I have attached evidence to support this. Sponsor’s Bank Account Information Account Type 20.a. Checking 20.b. Savings Account Holder 21.a. Family Name (Last Name) 21.b. Given Name (First Name) 21.c. Middle Name Joint Account Holder (if any) 22.a. Family Name (Last Name) 22.b. Given Name (First Name) 22.c. Middle Name 23. Institution Name 24. Account Number 25. Routing Number Means-Tested Public Benefits 26. I have received a means-tested public benefit within 36 months of executing this Form I-864 and I received that means-tested public benefit on or after [EFFECTIVE DATE OF RULE]. Y/N Credit Report and Credit Score Information Provide documentation as provided in the Instructions. 27. Do you have a U.S. credit report and credit score available? _ Yes. Provide a copy of a U.S. credit report and credit score generated within the last 12 months prior to the date of filing. __ No. Provide a credit agency report that demonstrates that you do not have a credit report or score.
Page 5, Part 7. Use of Assets to Supplement Income (Optional)	[Page 5] Part 7. Use of Assets to Supplement Income (Optional) If your income, or the total income for you and your household, from Part 6., Item Numbers 20. or 24.a. - 24.c., exceeds the Federal Poverty Guidelines for your household size, YOU ARE NOT REQUIRED to complete this Part 7. Skip to Part 8. Your Assets (Optional) 1. Enter the balance of all savings and checking accounts. $ 2. Enter the net cash value of real-estate holdings. (Net value means current assessed value minus mortgage debt.) $ 3. Enter the net cash value of all stocks, bonds, certificates of deposit, and any other assets not already included in Item Number 1. or Item Number 2. $ 4. Add together Item Numbers 1. - 3. and enter the number here. TOTAL: $ Assets from Form I-864A, Part 4., Item Number 3.d., for: 5.a. Name of Relative 5.b. Your household member's assets from Form I-864A(optional). $ Assets of the principal sponsored immigrant (optional). The principal sponsored immigrant is the person listed in Part 2., Item Numbers 1.a. - 1.c. Only include the assets if the principal immigrant is being sponsored by this affidavit of support. 6. Enter the balance of the sponsored immigrant's savings and checking accounts. $ 7. Enter the net cash value of all the principal immigrant's real estate holdings. (Net value means investment value minus mortgage debt.) $ 8. Enter the current cash value of the principal immigrant's stocks, bonds, certificates of deposit, and other assets not included in Item Number 6. or Item Number 7. $ [Page 6] For USCIS Use Only Household Size 1 2 3 4 5 6 7 8 9 Other Poverty Guideline Year: 20 Poverty Line: $ Sponsor's Household Income (Page 5, Line 10) $ The total value of all assets, line 10, must equal 5 times (3 times for spouses and children of USC's, or 1 time for orphans to be formally adopted in the U.S.) the difference between the poverty guidelines and the sponsor's household income, line 10. Remarks 9. Add together Item Numbers 6. - 8. and enter the number here. $ Total Value of Assets 10. Add together Item Numbers 4., 5.b., and 9. and enter the number here. TOTAL: $	[Page 5] Part 8. Use of Assets to Supplement Income (Optional) If your income, or the total income for you and your household, from Part 7., Item Number 14, exceeds the Federal Poverty Guidelines for your household size, YOU ARE NOT REQUIRED to complete this Part 8. Skip to Part 9. Your Assets (Optional) 1. Enter the balance of all savings and checking accounts. $ 2. Enter the net cash value of real-estate holdings. (Net value means current assessed value minus mortgage debt.) $ 3. Enter the net cash value of all stocks, bonds, certificates of deposit, and any other assets not already included in Item Number 1. or Item Number 2. $ 4. Add together Item Numbers 1. - 3. and enter the number here. TOTAL: $ Assets from Form I-864A, Part 4., Item Number 3.d., for: 5.a. Name of Relative 5.b. Your household member's assets from Form I-864A(optional). $ Assets of the principal sponsored immigrant (optional). The principal sponsored immigrant is the person listed in Part 2., Item Numbers 1.a. - 1.c. Only include the assets if the principal immigrant is being sponsored by this affidavit of support. 6. Enter the balance of the sponsored immigrant's savings and checking accounts. $ 7. Enter the net cash value of all the principal immigrant's real estate holdings. (Net value means investment value minus mortgage debt.) $ 8. Enter the current cash value of the principal immigrant's stocks, bonds, certificates of deposit, and other assets not included in Item Number 6. or Item Number 7. $ [Page 6] For USCIS Use Only Household Size 1 2 3 4 5 6 7 8 9 Other Poverty Guideline Year: 20 Poverty Line: $ Sponsor's Household Income (Page 5, Line 10) $ The total value of all assets, line 10, must equal 5 times (3 times for spouses and children of USC's, or 1 time for orphans or Convention adoptee considered to be coming to the United States for adoption) the difference between the poverty guidelines and the sponsor's household income, line 10. Remarks 9. Add together Item Numbers 6. - 8. and enter the number here. $ Total Value of Assets 10. Add together Item Numbers 4., 5.b., and 9. and enter the number here. TOTAL: $
Page 6, Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature	[Page 6] Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature NOTE: Read the Penalties section of the Form I-864 Instructions before completing this part. Sponsor's Contract Please note that, by signing this Form I-864, you agree to assume certain specific obligations under the Immigration and Nationality Act (INA) and other Federal laws. The following paragraphs describe those obligations. Please read the following information carefully before you sign Form I-864. If you do not understand the obligations, you may wish to consult an attorney or accredited representative. What is the Legal Effect of My Signing Form I-864? If you sign Form I-864 on behalf of any person (called the intending immigrant) who is applying for an immigrant visa or for adjustment of status to a lawful permanent resident, and that intending immigrant submits Form I-864 to the U.S. Government with his or her application for an immigrant visa or adjustment of status, under INA section 213A, these actions create a contract between you and the U.S. Government. The intending immigrant becoming a lawful permanent resident is the consideration for the contract. Under this contract, you agree that, in deciding whether the intending immigrant can establish that he or she is not inadmissible to the United States as a person likely to become a public charge, the U.S. Government can consider your income and assets as available for the support of the intending immigrant. What If I Choose Not to Sign Form I-864? The U.S. Government cannot make you sign Form 1-864 if you do not want to do so. But if you do not sign Form I-864, the intending immigrant may not become a lawful permanent resident in the United States. What Does Signing Form I-864 Require Me To Do? If an intending immigrant becomes a lawful permanent resident in the United States based on a Form I-864 that you have signed, then, until your obligations under Form I-864 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 (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. … 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 9. read to me every question and instruction on this affidavit and my answer to every question in [Language], a language in which I am fluent, and I understood everything. 2. At my request, the preparer named in Part 10., [Name], prepared this affidavit for me based only upon information I provided or authorized. … A. I know the contents of this affidavit of support that I signed; B. I have read and I understand each of the obligations described in Part 8., and I agree, freely and without any mental reservation or purpose of evasion, to accept each of those obligations in order to make it possible for the immigrants indicated in Part 3. to become lawful permanent residents of the United States; C. I agree to submit to the personal jurisdiction of any Federal or state court that has subject matter jurisdiction of a lawsuit against me to enforce my obligations under this Form I-864; [Page 8] D. Each of the Federal income tax returns submitted in support of this affidavit are true copies, or are unaltered tax transcripts, of the tax returns I filed with the IRS; E. I understand that, if I am related to the sponsored immigrant by marriage, the termination of the marriage (by divorce, dissolution, annulment, or other legal process) will not relieve me of my obligations under this Form I-864; and F. I authorize the Social Security Administration to release information about me in its records to USCIS and DOS. Sponsor's Signature 6.a. Sponsor's Signature 6.b. Date of Signature (mm/dd/yyyy) NOTE TO ALL SPONSORS: If you do not completely fill out this affidavit or fail to submit required documents listed in the Instructions, USCIS or DOS may deny your affidavit.	[Page 6] Part 9. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature NOTE: Read the Penalties section of the Form I-864 Instructions before completing this part. Sponsor's Contract Please note that, by signing this Form I-864, you agree to assume certain specific obligations under the Immigration and Nationality Act (INA) and other Federal laws. The following paragraphs describe those obligations. Please read the following information carefully before you sign Form I-864. If you do not understand the obligations, you may wish to consult an attorney or accredited representative. What if I have received a means-tested public benefit in the past 36 months of filing this Form I-864? In general, if you are a sponsor and have received a means-tested public benefit within 36 months of filing this Form I-864, you will be not be able to meet the income requirements of a sponsor under INA 213A(f)(1)(E). If you are the petitioning sponsor or substitute sponsor, you are still required to execute Form I-864, but the intending immigrant must submit Form I-864 executed by a joint sponsor who has not received any means-tested public benefit within 36 months of the joint sponsor completing that Form I-864 in order for the intending immigrant to avoid being found inadmissible. NOTE: This requirement to have a joint sponsor execute a Form I-864 due to receipt of means-tested public benefits only applies to means-tested public benefits that you, the petitioning sponsor, received on or after [EFFECTIVE DATE OF RULE]. If a petitioning sponsor who is on active duty (other than active duty for training) in the U.S. Armed Forces received means-tested public benefits within 36 months of submitting Form I-864, but is sponsoring his or her spouse or child under section 204 of the INA, a joint sponsor is not required due to receipt of means-tested public benefits. A joint sponsor would be required if the petitioning sponsor cannot demonstrate the means to maintain income at least 100 percent of the FPG. What if I have had a judgment entered against me for failing to fulfill my obligations under a previous Form I-864, Form I-864EZ, or Form I-864A? If you have previously defaulted on a support obligation, as shown by a court judgment ordering you to repay a means-tested public benefit paid to an alien to whom you have or had a support obligation as a sponsor or household member, you will be considered unable to meet the income requirements of a sponsor for purposes of this Form I-864. If you are the petitioning sponsor or a substitute sponsor, you are still required to execute the affidavit of support, but a joint sponsor who has not previously defaulted on an affidavit of support obligation and who can demonstrate the means to maintain income at the applicable threshold must execute an additional affidavit of support for the intending immigrant to avoid being found inadmissible. What is the Legal Effect of My Signing Form I-864? If you sign Form I-864 on behalf of any person (called the intending immigrant) who is applying for an immigrant visa or for adjustment of status to a lawful permanent resident, and that intending immigrant submits Form I-864 to the U.S. Government with his or her application for an immigrant visa or adjustment of status, under INA section 213A, these actions create a contract between you and the U.S. Government. The intending immigrant becoming a lawful permanent resident is the consideration for the contract. Under this contract, you agree that, in deciding whether the intending immigrant can establish that he or she is not inadmissible to the United States as a person likely to become a public charge, the U.S. Government can consider your income and assets as available for the support of the intending immigrant. What If I Choose Not to Sign Form I-864? The U.S. Government cannot make you sign Form 1-864 if you do not want to do so. But if you do not sign Form I-864, the intending immigrant may not become a lawful permanent resident in the United States. What Does Signing Form I-864 Require Me To Do? If an intending immigrant becomes a lawful permanent resident in the United States based on a Form I-864 that you have signed, then, until your obligations under Form I-864 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 (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. [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 10. read to me every question and instruction on this affidavit and my answer to every question in [Language], a language in which I am fluent, and I understood everything. 2. At my request, the preparer named in Part 11., [Name], prepared this affidavit for me based only upon information I provided or authorized. [no changes] A. I know the contents of this affidavit of support that I signed; B. I have read and I understand each of the obligations described in Part 9., and I agree, freely and without any mental reservation or purpose of evasion, to accept each of those obligations in order to make it possible for the immigrants indicated in Part 3. to become lawful permanent residents of the United States; C. I agree to submit to the personal jurisdiction of any Federal or state court that has subject matter jurisdiction of a lawsuit against me to enforce my obligations under this Form I-864; [Page 8] D. Each of the Federal income tax returns submitted in support of this affidavit are true copies, or are unaltered tax transcripts, of the tax returns I filed with the IRS; E. I understand that, if I am related to the sponsored immigrant by marriage, the termination of the marriage (by divorce, dissolution, annulment, or other legal process) will not relieve me of my obligations under this Form I-864; and F. I authorize the Social Security Administration to release information about me in its records to USCIS and DOS. Sponsor's Signature 6.a. Sponsor's Signature 6.b. Date of Signature (mm/dd/yyyy) NOTE TO ALL SPONSORS: If you do not completely fill out this affidavit or fail to submit required documents listed in the Instructions, USCIS or DOS may deny your affidavit.
Page 8, Part 9. Interpreter's Contact Information, Certification, and Signature	[Page 8] Part 9. Interpreter's Contact Information, Certification, and Signature … I am fluent in English and [Language], which is the same language specified in Part 8., Item Number 1.b., and I have read to this sponsor in the identified language every question and instruction on this affidavit and his or her answer to every question. The sponsor informed me that he or she understands every instruction, question, and answer on the affidavit, including the Sponsor's Declaration and Certification, and has verified the accuracy of every answer. Interpreter's Signature 7.a. Interpreter's Signature 7.b. Date of Signature (mm/dd/yyyy)	[Page 8] Part 10. Interpreter's Contact Information, Certification, and Signature [no changes] I am fluent in English and [Language], which is the same language specified in Part 9., Item Number 1.b., and I have read to this sponsor in the identified language every question and instruction on this affidavit and his or her answer to every question. The sponsor informed me that he or she understands every instruction, question, and answer on the affidavit, including the Sponsor's Declaration and Certification, and has verified the accuracy of every answer. Interpreter's Signature 7.a. Interpreter's Signature 7.b. Date of Signature (mm/dd/yyyy)
Page 9, Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor	[Page 9] Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor …	[Page 9] Part 11. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor [no changes]
Page 10, Part 11. Additional Information	[Page 10] Part 11. Additional Information …	[Page 10] Part 12. Additional Information [no changes]

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