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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.
What
Other Consequences Are There?
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, the U.S.
Government may consider (deem) your income and assets as available
to that person, in determining whether he or she is eligible for
certain Federal means-tested public benefits and also for state or
local means-tested public benefits, if the state or local
government's rules provide for consideration (deeming) of your
income and assets as available to the person.
This
provision does not
apply to public
benefits specified in section 403(c) of the Welfare Reform Act
such as emergency Medicaid, short-term, non-cash emergency relief;
services provided under the National School Lunch and Child
Nutrition Acts; immunizations and testing and treatment for
communicable diseases; and means-tested programs under the
Elementary and Secondary Education Act.
What
If I Do Not Fulfill My Obligations?
If
you do not provide sufficient support to the person who becomes a
lawful permanent resident based on a Form I-864 that you signed,
that person may sue you for this support.
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If
a Federal, state, local, or private agency provided any covered
means-tested public benefit to the person who becomes a lawful
permanent resident based on a Form I-864 that you signed, the
agency may ask you to reimburse them for the amount of the
benefits they provided. If you do not make the reimbursement, the
agency may sue you for the amount that the agency believes you
owe.
If
you are sued, and the court enters a judgment against you, the
person or agency that sued you may use any legally permitted
procedures for enforcing or collecting the judgment. You may also
be required to pay the costs of collection, including attorney
fees.
If
you do not file a properly completed Form I-865 within 30 days of
any change of address, USCIS may impose a civil fine for your
failing to do so.
When
Will These Obligations End?
Your
obligations under a Form I-864 that you signed will end if the
person who becomes a lawful permanent resident based on that
affidavit:
A.
Becomes a U.S. citizen;
B.
Has worked, or can receive credit for, 40 quarters of coverage
under the Social Security Act;
C.
No longer has lawful permanent resident status and has departed
the United States;
D.
Is subject to removal, but applies for and obtains, in removal
proceedings, a new grant of adjustment of status, based on a new
affidavit of support, if one is required; or
E.
Dies.
NOTE:
Divorce does
not terminate
your obligations under Form I-864.
Your
obligations under a Form I-864 that you signed also end if you
die. Therefore, if you die, your estate is not required to take
responsibility for the person's support after your death. However,
your estate may owe any support that you accumulated before you
died.
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.
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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.
Sponsor's
Contact Information
3.
Sponsor's Daytime Telephone Number
4.
Sponsor's Mobile Telephone Number (if any)
5.
Sponsor's Email Address (if any)
Sponsor's
Declaration and Certification
Copies
of any documents I have submitted are exact photocopies of
unaltered, original documents, and I understand that USCIS or the
U.S. Department of State (DOS) may require that I submit original
documents to USCIS or DOS at a later date. Furthermore, I
authorize the release of any information from any and all of my
records that USCIS or DOS may need to determine my eligibility for
the benefit that I seek.
I
furthermore authorize release of information contained in this
affidavit, in supporting documents, and in my USCIS or DOS
records, to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
I
certify, under penalty of perjury, that all of the information in
my affidavit and any document submitted with it were provided or
authorized by me, that I reviewed and understand all of the
information contained in, and submitted with, my affidavit and
that all of this information is complete, true, and correct.
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;
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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.
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