Form I-134 Declaration of Financial Support

Declaration of Financial Support

USCIS
Form I-134

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0014
Expires 11/30/2026

► START HERE - Type or print in black ink.

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Part 1. Basis for Filing
1.

I am filing this form on behalf of:

Myself as the beneficiary. (Complete Parts 2., 4., and 7 - 8. Skip Parts 3., 5., and 6.)

Another individual who is the beneficiary. (Complete Parts 2. - 3. and Parts 5. - 8. Skip Part 4.)

Part 2. Information About the Individual Agreeing to Financially Support the Beneficiary
All filers must complete Part 2.
1.

Current Legal Name (Do not provide a nickname.)
Family Name (Last Name)

2.

Given Name (First Name)

Middle Name (if applicable)

Other Names Used

Provide all other names the beneficiary has ever used, including aliases, maiden name, and nicknames. If you need extra space
to complete this section, use the space provided in Part 8. Additional Information.
Family Name (Last Name)

3.

Given Name (First Name)

Middle Name (if applicable)

Current Mailing Address

In Care Of Name (if any)

Street Number and Name

Apt.Ste. Flr. Number

City or Town

State

Province
4.

Postal Code

ZIP Code

Country

Is your current mailing address the same as your current physical address?

Yes

No

If you answered "No" to Item Number 4., provide your current physical address in Item Number 5.

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Part 2. Information About the Individual Agreeing to Financially Support the Beneficiary (continued)
5.

Current Physical Address
In Care Of Name (if any)
Street Number and Name

Apt.Ste. Flr. Number

City or Town

State

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Postal Code

Province
6.

Date of Birth (mm/dd/yyyy)

7.

Place of Birth
City or Town

ZIP Code

Country

State or Province

Country
8.

Alien Registration Number (A-Number) (if any)
► A-

10.

What is your current immigration status?

9.

USCIS Online Account Number (if any)
►

U.S. Citizen

U.S. National

Lawful Permanent Resident

Refugee

Parolee

TPS holder

Nonimmigrant

Asylee

Beneficiary of deferred action (including DACA) or Deferred Enforced Departure
Other (Explain):
11.

What is your relationship to the beneficiary?

12.

Employment Status
Employed (full-time, part-time, seasonal, self-employed) as a/an
Name of Employer
Self-Employed as a/an
Unemployed or Not Employed

Retired

Other (Explain):

Form I-134 Edition 11/09/23

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Part 2. Information About the Individual Agreeing to Financially Support the Beneficiary (continued)
Financial Information
Provide information about your dependents, income, and assets. If you need additional space to complete any Item Number in this
section, use the space provided in Part 8. Additional Information
13.

How many other Form I-134, Form I-134A, Form I-864, Form I-864EZ, and Form I-864A have you previously submitted on
behalf of a person (including yourself, if applicable) and your support obligation has not ended? Do not include the beneficiary
named in Part 3.

14.

How many other dependents do you support (including yourself)? Do not include individuals in Item Number 13. and the
beneficiary named in Part 3.

15.

Provide the information requested in the table below about all of your dependents and any other individuals you financially
support. Do not include yourself and the beneficiary named in Part 3.

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Full Name

Date of Birth
(mm/dd/yyyy)

Relationship to you

A-Number (if any) Receipt Number (if any)

16.

What is your current annual income?

17.

Provide information on the cash or assets available to you (do not include any assets from the individual named in Part 3.).
Attach evidence showing you have these assets.
Type of Asset

$

Amount (Cash Value)
(U.S. dollars)

TOTAL (U.S. dollars) $

Form I-134 Edition 11/09/23

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Part 2. Information About the Individual Agreeing to Financially Support the Beneficiary (continued)
Intent to Provide Specific Contributions to the Beneficiary
If you are filing this form on behalf of another individual who is the beneficiary, complete Item Numbers 18 - 19. If you are the
beneficiary, proceed to Part 4.
18.

In addition to providing financial support, I intend to make specific contributions to cover the
beneficiary's basic living needs.

19.

Describe the specific contributions you will provide to cover the beneficiary's basic living needs. This could include providing
safe and appropriate housing; securing employment opportunities, once authorized to work; enrolling in school; and enrolling in
any benefits for which they are eligible. If you intend to furnish room and board, provide the address where the beneficiary will
reside. If you need additional space, use Part 8. Additional Information.

Yes

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No

Part 3. Information about the Beneficiary

Complete Part 3. if you are filing this form on behalf of another individual who is the beneficiary. If you are the beneficiary providing
financial support for yourself, you do not need to complete Part 3. Proceed to Part 4.
1.

Beneficiary's Current Legal Name (Do not provide a nickname.)
Family Name (Last Name)

2.

Given Name (First Name)

Middle Name (if applicable)

Other Names Used

Provide all other names the beneficiary has ever used, including aliases, maiden name, and nicknames. If you need extra space
to complete this section, use the space provided in Part 8. Additional Information.
Family Name (Last Name)

3.

Date of Birth (mm/dd/yyyy)

Given Name (First Name)

4.

Gender

Male

5.

Alien Registration Number (A-Number) (if any)
► A-

6.

Place of Birth
City or Town

Middle Name (if applicable)

Female

Another Gender Identity

State or Province

Country
7.

Country of Citizenship or Nationality

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Part 3. Information about the Beneficiary (continued)
8.

Marital Status
Single, Never Married

Married

Divorced

Widowed

Legally Separated

Marriage Annulled

Other (Explain):
9.

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Beneficiary's Current Mailing Address
In Care Of Name (if any)

Street Number and Name

Apt.Ste. Flr. Number

City or Town

State

Province
10.

Postal Code

ZIP Code

Country

Yes

Are the beneficiary's mailing address and physical address the same?

No

If you answered “No” to Item Number 10., provide the physical address in Item Number 11.
11.

Beneficiary's Current Physical Address
In Care Of Name (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

Beneficiary's Anticipated Length of Stay
12.

Beneficiary's Anticipated Period of Stay in the United States
From (mm/dd/yyyy)
To (select one):
(mm/dd/yyyy)
No End Date

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Part 4. Statement, Contact Information, Certification, and Signature of the Beneficiary (if filing Form
I-134 on his or her own behalf)
If you are the beneficiary and are filing Form I-134 on your own behalf, complete and sign Part 4.
NOTE: Read the Penalties section of the Form I-134 Instructions before completing this section.

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Beneficiary's Statement

NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.

I, as the beneficiary, certify the following:
A.
B.

I can read and understand English, and I have read and understand every question and instruction on this declaration
and my answer to every question.

The interpreter named in Part 6. read to me every question and instruction on this declaration and my answer to every
question in
, a language in which I am fluent and I understood
everything.

2.

At my request, the preparer named in Part 7.,
this declaration for me based only upon information I provided or authorized.

, prepared

Beneficiary's Contact Information
3.

Beneficiary's Daytime Telephone Number

5.

Beneficiary's Email Address (if any)

4.

Beneficiary's Mobile Telephone Number (if any)

Beneficiary's Certification

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS or the
Department of State may require that I submit original documents to USCIS or the Department of State at a later date. Furthermore, I
authorize the release of any information from any and all of my records that USCIS or the Department of State may need to determine
my eligibility for the immigration benefit I seek.
I further authorize release of information contained in this declaration, in supporting documents, and in my USCIS or the Department
of State records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or
signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and provided or authorized all of the information in my declaration;
2) I understood all of the information contained in, and submitted with, my declaration; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my declaration, I understand all of the
information contained in, and submitted with, my declaration, and that all of this information is complete, true, and correct.
That this declaration is made by me to assure the U.S. Government that I will be able to financially support myself while in the United
States.
That I am willing and able to pay for necessary expenses for the duration of my temporary stay in the United States.

Beneficiary's Signature
6.

Beneficiary's Signature

Form I-134 Edition 11/09/23

Date of Signature (mm/dd/yyyy)

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Part 5. Statement, Contact Information, Certification, and Signature of the Individual Agreeing to
Financially Support the Beneficiary
If you are filing Form I-134 on behalf of someone else (the beneficiary listed in Part 3.), complete and sign Part 5.
NOTE: Read the Penalties section of the Form I-134 Instructions before completing this section.

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Statement of Individual Agreeing to Financially Support the Beneficiary

NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.

I, as the individual agreeing to financially support the beneficiary, certify the following:
A.
B.

2.

I can read and understand English, and I have read and understand every question and instruction on this declaration
and my answer to every question.

The interpreter named in Part 6. read to me every question and instruction on this declaration and my answer to every
question in
, a language in which I am fluent and I understood

At my request, the preparer named in Part 7.,
declaration for me based only upon information I provided or authorized.

, prepared this

Contact Information of Individual Agreeing to Financially Support the Beneficiary
3.

Daytime Telephone Number

5.

Email Address (if any)

4.

Mobile Telephone Number (if any)

Certification of Individual Agreeing to Financially Support the Beneficiary

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS or the
Department of State may require that I submit original documents to USCIS or the Department of State at a later date. Furthermore, I
authorize the release of any information from any and all of my records that USCIS or the Department of State may need to determine
my eligibility for the immigration benefit I seek.
I further authorize release of information contained in this declaration, in supporting documents, and in my USCIS or the Department
of State records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law.
I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or
signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and provided or authorized all of the information in my declaration;
2) I understood all of the information contained in, and submitted with, my declaration; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my declaration, I understand all of the
information contained in, and submitted with, my declaration, and that all of this information is complete, true, and correct.
That this declaration is made by me to assure the U.S. Government that the person named in Part 3. will be financially supported
while in the United States.
That I am willing and able to receive, maintain, and support the person named in Part 3. to better ensure that such persons will have
sufficient financial resources or financial support to pay for necessary expenses for the period of his or her temporary stay in the
United States.
I acknowledge that I have read this section, and I am aware of my responsibilities as an individual agreeing to financially support the
beneficiary.

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Part 5. Statement, Contact Information, Certification, and Signature of the Individual Agreeing to
Financially Support the Beneficiary (continued)
Signature of Individual Agreeing to Financially Support the Beneficiary
6.

Signature

Date of Signature (mm/dd/yyyy)

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NOTE TO ALL INDIVIDUALS AGREEING TO FINANCIALLY SUPPORT THE BENEFICIARY: If you do not completely
fill out this declaration or if you fail to submit required documents listed in the Instructions, USCIS or the Department of State may
deny or not consider your declaration.

Part 6. Interpreter's Contact Information, Certification, and Signature
Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

2.

Interpreter's Business or Organization Name

Interpreter's Given Name (First Name)

Interpreter's Contact Information
3.

Interpreter's Daytime Telephone Number

5.

Interpreter's Email Address (if any)

4.

Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification

I certify, under penalty of perjury, that:
I am fluent in English and

, and I have interpreted every question on the

declaration and Instructions and interpreted the individual agreeing to financially support the beneficiary's answers to the questions in
that language, and the individual agreeing to financially support the beneficiary informed me that they understood every instruction,
question, and answer on the declaration.
6.
Interpreter's Signature
Date of Signature (mm/dd/yyyy)

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Part 7. Contact Information, Certification, and Signature of the Person Preparing this Declaration, if
Other Than the Individual Agreeing to Financially Support the Beneficiary
Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name

Preparer's Given Name (First Name)

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Preparer's Contact Information
3.

Preparer's Daytime Telephone Number

5.

Preparer's Email Address (if any)

4.

Preparer's Mobile Telephone Number

Preparer's Certification and Signature

I certify, under penalty of perjury, that I prepared this declaration for the individual agreeing to financially support the beneficiary at
their request and with express consent and that all of the responses and information contained in and submitted with the declaration
are complete, true, and correct and reflects only information provided by the individual agreeing to financially support the beneficiary.
The individual agreeing to financially support the beneficiary reviewed the responses and information and informed me that they
understand the responses and information in or submitted with the declaration.
6.

Preparer's Signature

Form I-134 Edition 11/09/23

Date of Signature (mm/dd/yyyy)

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Part 8. Additional Information
If you need extra space to provide any additional information within this declaration, use the space below. If you need more space than
what is provided, you may make copies of this page to complete and file with this declaration 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; and sign and date each sheet.
1.

Family Name (Last Name)

2.

A-Number (if any) ► A-

3.

Page Number

Part Number

Item Number

4.

Page Number

Part Number

Item Number

5.

Page Number

Part Number

Item Number

6.

Page Number

Part Number

Item Number

Given Name (First Name)

Middle Name (if applicable)

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