Pages 1-2,
General
Instructions
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[Page 1]
General Instructions
…
How To Fill Out Form I-942
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 8. 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.
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.
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[Page 1]
General Instructions
…
How To Fill Out Form I-942
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 7. 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.
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.
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Pages 2-5,
Specific
Instructions
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[Page 2]
Specific
Instructions
…
Part 3. Household Income
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[Page 3]
Item Number 3. Your Household
Size. Indicate whether you are providing the primary
financial support for your household.
Complete the table with the
information requested about the members of your household
including their names, dates of birth, relationship to you,
whether the person is married, whether the person is a full-time
student, and whether the person earns income counted towards the
household income.
For the last column (Is any income
earned by this person counted towards the household income?),
select yes if income is received consistently or regularly as
wages or salary from these household members’ employment or
business.
At the end of the table, provide the
total number of household members. Include the following people,
who are dependent on your income, your spouse’s income, or
the head of household’s income, as part of your household
size:
1.
You;
2.
The head of your household (if not you);
A.
You are the head of household if you filed the most recent
Federal tax return for your household (includes filing as head of
household) or earned the majority of the income for your
household.
B.
If you are not the head of household, the head of household is
the person who filed the most recent Federal tax return on which
you are listed as a dependent or the person who provides the
majority of your household’s income.
…
[Page 4]
Part 4. Requestor’s
Statement, Contact Information, Certification, and Signature
Item Numbers 1. - 6.
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.
[Page 5]
Item Numbers 7. - 10.
Each person applying for a reduced fee must sign and date Form
I-942. This includes family members identified in Part 2.
A legal guardian may sign the request on behalf of the applicant.
USCIS will reject any Form I-942 that is not signed by all
individuals requesting a reduced fee.
If the information provided by the
requestor in Part 4. is not applicable to a family member
identified in Part 2. (for example, the family member used
a different interpreter or speaks a different language), that
individual should complete Part 5.
Part 5. Family Member’s
Statement, Contact Information, Certification, and Signature
NOTE: If the information
provided by the requestor in Part 4. is not applicable to a
family member identified in
Part 2., (for example, the
family member used a different interpreter or speaks a different
language) that individual should complete Part 5. Make
additional copies of Part 5. for each family member to
sign, as applicable, and include the pages with your completed
Form I-942. USCIS will reject any Form I-942 that is not signed
by all individuals requesting a reduced fee.
Item Numbers 1. - 6.
Select the appropriate box to indicate that you, the family
member, either read this request yourself or someone interpreted
this request for you from English to a language in which you are
fluent. If applicable, select the box to indicate if someone
prepared this request for you. 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.
Part 6. Interpreter’s
Contact Information, Certification, and Signature
NOTE for Family Members: If
you used a different interpreter than the one used by the
requestor, make additional copies of Part 6., provide the
following information, and include the pages with your completed
Form I-942.
Item Numbers 1. - 9.
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.
Part 7. Contact Information,
Declaration, and Signature of the Person Preparing this Request,
if Other Than the Requestor
NOTE for Family Members: If
you used a different preparer than the one used by the requestor,
make additional copies of Part 7., provide the following
information, and include the pages with your completed Form I-942.
Item Numbers 1. - 10.
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 6. and Part
7. 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 Form
G-28I, Notice of Entry of Appearance as Attorney In Matters
Outside the Geographic Confines of the United States, along with
your request.
Part 8. Additional Information
Item Numbers 1. - 6.
If you need extra space to provide any additional information
within this request, use the space provided in Part 8.
Additional Information. If you need more space than what is
provided in Part 8., you may make copies of Part 8. to
complete and file with your request, or attach a separate sheet of
paper. Type or print your name and A-Number (if any) at the top
of each sheet; indicate the Page Number, Part Number,
and Item Number to which your answer refers.
[Page 6]
We recommend that you print or
save a copy of your completed request to review in the future and
for your records.
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[Page 2]
Specific
Instructions
…
Part 3. Household Income
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[Page 3]
Item Number 3. Your Household
Size. Indicate whether you are providing the primary
financial support for your household.
Complete the table with the
information requested about the members of your household
including their names, dates of birth, relationship to you,
whether the person is married, whether the person is a full-time
student, and whether the person earns income counted towards the
household income.
For the last column (Does
Person Earn Income Counted Toward Household Income?),
select yes if income is received consistently or regularly as
wages or salary from these household members’ employment or
business.
At the end of the table, provide the
total number of household members. Include the following people,
who are dependent on your income, your spouse’s income, or
the head of household’s income, as part of your household
size:
1.
Type or print your name on the line marked “Self” in
the table;
2. The head of your
household (if not you);
A.
You are the head of household if you filed the most recent
Federal tax return for your household (includes filing as head of
household) or earned the majority of the income for your
household.
B. If you are not the head
of household, the head of household is the person who filed the
most recent Federal tax return on which you are listed as a
dependent or the person who provides the majority of your
household’s income. Type or print
that name in the line below yours.
…
Part 4. Requestor’s
Contact Information,
Certification, and Signature
Item
Numbers 1. – 4.
You must sign and date your request and,
if applicable, provide your daytime telephone number, mobile
telephone number, and email address. The signature of a parent or
legal guardian, if applicable, is acceptable. A stamped or
typewritten name in place of a signature is not acceptable.
[delete]
[delete]
Part 5.
Interpreter’s Contact Information,
Certification, and Signature
NOTE for Family Members: If
you used a different interpreter than the one used by the
requestor, make additional copies of Part 5.,
provide the following information, and include the pages with your
completed Form I-942.
Item
Numbers 1. – 6.
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 and sign and
date the request.
Part 6.
Contact Information, Declaration, and Signature of
the Person Preparing this Request, if Other Than the Requestor
NOTE for Family Members: If
you used a different preparer than the one used by the requestor,
make additional copies of Part 6.,
provide the following information, and include the pages with your
completed Form I-942.
Item
Numbers 1. – 6.
The person who completed your request, if other than the
requestor, must sign this section. If
the same individual acted as your interpreter and
your preparer, then
that person should complete both Part
5.
and Part
6.
A stamped or typewritten name in place of a signature is not
acceptable.
Part 7.
Additional Information
Item Numbers 1. - 6.
If you need extra space to provide any additional information
within this request, use the space provided in Part 7.
Additional Information. If you need more space than what is
provided in Part 7.,
you may make copies of Part 7.
to complete and file with your request, or attach a separate sheet
of paper. Type or print your name and A-Number (if any) at the
top of each sheet; indicate the Page Number, Part
Number, and Item Number to which your answer refers.
[Page 6]
We recommend that you print or
save a copy of your completed request to review in the future and
for your records.
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Pages 7,
Paperwork
Reduction Act
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[Page 7]
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 45 minutes 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, Office of Policy and Strategy, Regulatory Coordination
Division, 5900 Capital Gateway Drive, Mail Stop #2140, Camp
Springs, MD 20588-0009; OMB No. 1615-0133. Do not mail your
completed Form I-942 to this address.
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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 35 minutes 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, Office of Policy and
Strategy, Regulatory Coordination Division, 5900 Capital Gateway
Drive, Mail Stop #2140, Camp Springs, MD 20588-0009; OMB No.
1615-0133. Do not mail your completed Form I-942 to this
address.
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