Form I-864A, Instructions for Contract Between Sponsor and Household Member

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Instructions for Contract Between Sponsor and
Household Member
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-864A

OMB No. 1615-0075
Expires 10/31/2027

What Is the Purpose of Form I-864A?
Form I-864A, Contract Between Sponsor and Household Member, is an attachment to Form I-864, Affidavit of Support
Under Section 213A of the INA. A separate Form I-864A must be used for each household member whose income and/
or assets are being used by a sponsor to qualify. Each Form I-864A must be completed and signed by two individuals:
the sponsor who is completing Form I-864 and a household member of the sponsor who is promising to make his or
her income and/or assets available to help support the sponsored immigrant(s). The combined signing of this contract
constitutes an agreement that the household member is jointly responsible, along with the sponsor, for the support of the
individual(s) named in this contract.

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Form I-864A must be submitted with Form I-864.

Form I-864A may only be used when a sponsor’s income and assets do not meet the income requirements of Form I-864
and the qualifying household member chooses to combine his or her resources with the income and/or assets of a sponsor
to meet the requirements. The obligations of the household member under this contract terminate when the obligations of
the sponsor under the Affidavit of Support terminate.
For additional information, see the Immigration and Nationality Act (INA) section 213A and part 213a of Title 8 of the
Code of Federal Regulations.
What Is a Sponsor?

A sponsor can be one of the following:
1. The petitioning relative;

2. A relative with a significant ownership interest in the petitioning entity;

3. A substitute in the case of a deceased petitioner, or another person accepting joint and several liability with the
sponsor; or
4. Another person accepting joint and several liability with the sponsor; AND

5. Someone who completes and files Form I-864 on behalf of an intending immigrant. A sponsor must be an individual
and may not be an enterprise, a business, or any other type of organization.
Who May Be Considered a Household Member for Purposes of Form I-864A?
For purposes of this contract, one or more of the following individuals may sign the Form I-864A as a household member
if at least 18 years of age:
1. The intending immigrant, if the sponsor seeks to rely on the intending immigrant’s continuing income to establish the
sponsor’s ability to support the intending immigrant’s spouse or children;
2. The spouse of the sponsor;
3. The parent, child, adult son or daughter, or sibling relative of the sponsor, if that relative has the same principal
residence as the sponsor; or
4. Any other individual whom the sponsor has lawfully claimed as a dependent on the sponsor’s most recent Federal
income tax return even if that person does not live at the same residence as the sponsor. If more than one individual
agrees to help support the sponsored immigrant, each individual must sign a separate Form I-864A.

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How Can the Intending Immigrant Be Considered a Household Member?
Listed below are two ways that the intending immigrant may be considered a household member for the purposes of
pooling income with the sponsor to meet the Affidavit of Support requirements:
1. The intending immigrant has the same principal residence as the sponsor and the intending immigrant can establish
that his or her income will continue from a lawful source, even after acquisition of lawful permanent residence; or
2. The intending immigrant is the sponsor’s spouse and the intending immigrant can show that his or her income will
continue from a lawful source after acquisition of lawful permanent residence.
Why Does a Household Member Complete Form I-864A?

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A household member completes this contract if the household member’s income and/or assets will be used to demonstrate
the sponsor’s ability to meet the income requirements and to maintain the sponsored immigrant at an annual income at the
level specified in INA section 213A(f)(l)(E) or section 213A(f)(3).
If the Intending Immigrant Is a Household Member, Must He or She Complete This Contract?

If you are the intending immigrant and the sponsor is including your income on Form I-864 to meet the eligibility
requirements, you need to complete this contract only if you have accompanying dependents. If you are the intending
immigrant and the sponsor is including only your assets on Form I-864, you do not need to complete this contract, even if
you have accompanying dependents.

General Instructions

We provide free forms through the USCIS website. To view, print, or complete our forms, you should use the latest
version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you do not have internet
access, you may call the USCIS Contact Center and ask that we mail a form to you.
Signature. You (or your signing authority) must properly complete and sign your contract. USCIS will not accept
a stamped or typewritten name in place of any signature on this contract. A legal guardian may sign for a mentally
incompetent person. If your contract is not signed, or if the signature is not valid, we will reject your contract. See 8 CFR
103.2(a)(7)(ii)(A). If USCIS accepts a request for adjudication and determines that it has a deficient signature, USCIS
may reject or deny the request.
If you are under guardianship, your legal guardian may print your name and sign Form I-864A for you. “Legal guardian”
includes any person who is appointed and authorized by law to protect your estate as a result of your incapacity. The
legal guardian must present proof of the appointment as legal guardian of your estate and a copy of an order from the
appointing court or agency specifically permitting the guardian to make your income and assets available for the support
of the sponsored immigrant.
Validity of Signatures. USCIS will consider a photocopied, faxed, or scanned copy of an original benefit request with a
handwritten signature as valid for filing purposes. The photocopy, fax, or scan must be of the original request or document
containing the handwritten ink signature.
Filing Fee. TSee Form G-1055, available at www.uscis.gov/forms, for specific information about the fees applicable
to this form. For information on processing fees when filing with the U.S. Department of State (DOS), see www.travel.
state.gov.
Evidence. When you file your contract, you must submit all evidence and supporting documentation listed in the Specific
Instructions and/or What Evidence Must You Submit sections of these Instructions.

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Biometric Services Appointment. USCIS may require you to appear for an interview or provide biometrics (fingerprints,
photograph, and/or signature) at any time to verify your identity, obtain additional information, and conduct background
and security checks, including a check of criminal history records maintained by the Federal Bureau of Investigation
(FBI), before making a decision on your application or petition. If we determine that a biometric services appointment
is necessary, we will send you an appointment notice with the date, time, and location of your appointment. If you are
currently overseas, your notice will instruct you to contact a U.S. Embassy, U.S. Consulate, or USCIS office outside the
United States to schedule an appointment.
At your biometrics appointment, you must sign an oath reaffirming that:
1. You provided or authorized all information in the contract;

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2. You reviewed and understood all of the information contained in, and submitted with, your contract; and
3. All of this information was complete, true, and correct at the time of filing.

If you do not attend your biometric services appointment, we may deny your contract.

Copies. You should submit legible photocopies of requested documents unless the Instructions specifically instruct you to
submit an original document. USCIS may request an original document at any time during our process. If we request an
original document from you, we will return it to you after USCIS determines it no longer needs the original.
NOTE: If you submit original documents when they are not required or requested, USCIS may destroy the documents
after we receive them.
Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation of the document. The translator must sign a certification that the English language translation is complete and
accurate, and that they are competent to translate from the foreign language into English. The certification must include
their signature, printed name, and their contact information.
USCIS Contact Center. For additional information on the form and instructions about where to file, change of address,
and other questions, visit the USCIS Contact Center at www.uscis.gov/contactcenter or call at 800-375-5283 (TTY 800767-1833). The USCIS Contact Center provides information in English and Spanish.
How To Complete Form I-864A

1. Type or print legibly in black ink.

2. If you need extra space to complete any item within this contract, use the space provided in Part 9. 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; and sign and date each sheet.
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.

Specific Instructions
This contract is divided into nine parts. The sponsor completes Part 5. Sponsor’s Promise, Statement, Contact
Information, Declaration, Certification, and Signature of this contract and the household member completes Parts 1. 4., and 6. The information below provides detailed information to help you complete this contract.
Part 1. Information About You (the Household Member)
Item Number l. Full Name. Provide your full name.
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Item Numbers 2. - 3. Mailing Address. Provide the address where you receive mail.
Item Number 4. Physical Address. If you reside in a location different than where you receive mail, provide the address
in the space provided.
Item Number 5. Date of Birth. Provide your date of birth in the mm/dd/yyyy format.
Item Number 6. Country of Birth. Provide the country where you were born.
Item Number 7. U.S. Social Security Number (if any). Provide your U.S. Social Security number if you have one.
Item Number 8. Alien Registration Number (A-Number) (if any). Provide your A-Number. We use your A-Number to
identify your immigration records. It begins with an “A” and can be found on correspondence you have received from the
Department of Homeland Security (DHS) or USCIS. If you do not have an A-Number, type or print “N/A.”

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Item Number 9. USCIS Online Account Number. You will only have a USCIS Online Account Number (OAN ) if
you previously filed a form that has a receipt number that begins with IOE. If you filed the form online, you can find your
OAN in your account profile. If you mailed us the form, you can find your OAN at the top of the Account Access Notice
we sent you. If you do not have a receipt number that begins with IOE, you do not have an OAN. The OAN is not the
same as an A-Number.
Part 2. Your (the Household Member’s) Relationship to the Sponsor

Item Numbers 1. - 3. Select the item which best reflects your relationship to the sponsor.

If you select Item Number 1. (married to the sponsor), you do not have to reside with the sponsor, but you must provide
proof that your income will continue from a lawful source after immigration.
If you select Item Number 2. (not married to the sponsor), you must provide proof that you currently have the same
principal residence as the sponsor and that your income will continue from a lawful source after immigration.
If you are the household member completing this contract, but are not the intending immigrant, select Item Number 3..,
and select the box below that describes your relationship to the sponsor. If you select “Other Dependent,” you must be
listed as a dependent on the sponsor’s most recent Federal income tax return. You do not have to provide proof that you
have the same principal residence as the sponsor. If you select any other relative except for spouse, you must provide
proof of the relationship and that you have the same principal residence as the sponsor.
Part 3. Your (the Household Member’s) Employment and Income

Item Numbers 1. - 6. Your (the Household Member’s) Employment. Select all boxes that apply to you. A sponsor
may not rely on a household member’s income from illegal activities, such as proceeds from illegal gambling or drug
sales, to meet the income requirements, even if the household member paid taxes on that income.
Item Number 7. Current Individual Annual Income. Enter your current individual earned or retirement annual income
that you are using to meet the requirements of this contract and type or print the total on this line.
You may include evidence supporting your claim about your expected income for the current year if you believe that
submitting this evidence will help you establish an ability to maintain sufficient income. You are not required to submit
this evidence, however, unless specifically instructed to do so by a government official. For example, you may include
a recent letter from your employer, showing your employer’s address and telephone number, and indicating your annual
salary. You may also provide pay stubs showing your income for the previous six months. If your claimed income
includes alimony, child support, dividend or interest income, or income from any other source, you may also include
evidence of ability to maintain that income. However, you may not include any means-tested public benefits as income
for the purposes of meeting the income requirement.

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Part 4. Your (the Household Member’s) Federal Income Tax Information and Assets
You must provide either an Internal Revenue Service (IRS) transcript or a photocopy from your own records of your
Federal individual income tax return for the most recent tax year. If you believe additional returns may help you to
establish your ability to maintain sufficient income, you may submit transcripts or photocopies of your Federal individual
income tax returns for the three most recent years.
You are not required to have the IRS certify the transcript or photocopy unless specifically instructed to do so by a
government official; a plain transcript or photocopy is acceptable.
Do not submit copies of your state income tax returns. Do not submit any tax returns that you filed with any foreign
government unless you are claiming that you were not required to file a Federal income tax return with the United States
government and you wish to rely on the foreign return solely to establish the amount of your income that was not subject
to tax in the United States.

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If you provide a photocopy of your tax returns, you must include a copy of each and every FormW-2 and Form 1099 that
relates to your returns. Do not include copies of these forms if you provide an IRS transcript of your returns rather than a
photocopy unless you filed a joint Federal income tax return with your spouse.
If you selected Item Number 4. in Part 3., that you are self-employed, you should have completed one of the following
forms with your Federal income tax return: Schedule C (Profit or Loss from Business), Schedule D (Capital Gains),
Schedule E (Supplemental Income or Loss), or Schedule F (Profit or Loss from Farming). You must include each and
every Form 1040 Schedule, if any, that you filed with your Federal income tax return.
As stated previously, you must submit an IRS transcript or copy of your Federal individual income tax return for the most
recent tax year. If you choose to rely on income from the three most recent tax years, you must submit an IRS transcript
or copy of your Federal individual income tax return. If you were required to file a Federal income tax return for that tax
year but did not do so, you must file any and all late returns with the IRS and attach an IRS transcript or copy of your late
return and submit it with Form I-864A. If you were not required to file a Federal income tax return under U.S. tax law
because your income was too low, attach a typed or printed explanation.
If you were not required to file a Federal income tax return under U.S. tax law for any other reason, attach a typed or
printed explanation including evidence of the exemption and how you qualified for it. Residence outside of the United
States does not exempt U.S. citizens or lawful permanent residents from filing a U.S. Federal income tax return. See
Filing Requirements in the IRS Form 1040 Filing Instructions to determine whether you were required to file.
For purposes of this contract, the line for Total Income on IRS Forms 1040 and 1040A will be considered when
determining income. For persons filing IRS Form 1040 EZ, the line for Adjusted Gross Income will be considered.
Obtaining Tax Transcripts. You may use IRS Form 4506-T to request tax transcripts from the IRS. Complete IRS
Form 4506-T with the ending date for each of your three most recent tax years listed on line 9. Follow all instructions for
completing and filing Form 4506-T with the IRS.
Item Number 1. Select the box if you filed a Federal income tax return for each of the three most recent tax years and
have attached the required photocopy or transcript of your Federal income tax return for only the most recent year.
Item Number 2. Most Recent Tax Year Total Income. Indicate the most recent tax year and your Total Income for that
most recent tax year. If that amount was zero, enter “zero” or “N/A” for non-applicable. If applicable, select the Optional
box indicating that you have attached photocopies or transcripts of your Federal income tax returns for your second and
third most recent tax years.
Item Numbers 3. - 5. Assets. Complete this item only if the sponsor is using the value of your assets to help meet the
requirements of the affidavit of support. If you are using only your income to help the sponsor meet the requirements, do
not complete this item.
If you are the intending immigrant and have no accompanying dependents, then do not list your assets on this contract.
Instead, you must list your assets in Part 7., Item Numbers 6. - 10. of the Form I-864 and do not need to complete this
form.

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Only assets that can be converted into cash within one year and without considerable hardship or financial loss to the
owner may be included. The owner of the asset must include a description of the asset, proof of ownership, and the basis
for the owner’s claim of its net cash value.
You may include the net value of your home as an asset. The net value of the home is the appraised value of the home,
minus the sum of any and all loans secured by a mortgage, trust deed, or other lien on the home.
If you wish to include the net value of your home, you must include documentation demonstrating that you own it, a
recent appraisal by a licensed appraiser, and evidence of the amount of any and all loans secured by a mortgage, trust
deed, or other lien on the home. You may not include the net value of an automobile unless you show that you have more
than one automobile, and at least one automobile is not included as an asset.

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Part 5. Sponsor’s Promise, Statement, Contact Information, Declaration, Certification, and Signature
Item Numbers 1. - 10. If the sponsor you are promising to make your income available to is sponsoring the principal
intending immigrant (the sponsor should have “Yes” as his or her answer to Part 4., Item Number 1. of his or her Form
I-864), you should list the intending immigrant in Part 5., Item Number 1. and then list any spouse and any and all
children that are listed in the sponsor’s Form I-864 in the spaces that follow in Part 5. of Form I-864A.
If the sponsor you are promising to make your income available to is not sponsoring the intending immigrant (this should
be true only in cases with two joint sponsors, with “No” selected on Part 4., Item Number 1. of his or her Form I-864), in
Part 5., Item Number 1., list any spouse and any and all children that appear on the sponsor’s Form I-864, in the spaces
that follow in Part 5. of Form I-864A.
Select the appropriate box to indicate whether you read this contract yourself or whether you had an interpreter assist you.
If someone assisted you in completing the contract, select the box indicating that you used a preparer. Further, you must
sign and date your contract and provide your daytime telephone number, mobile telephone number (if any), and email
address (if any). Every contract MUST contain the signature of the sponsor (or parent or legal guardian, if applicable). A
stamped or typewritten name in place of a signature is not acceptable.
Part 6. Your (the Household Member’s) Promise, Statement, Contact Information, Declaration, Certification, and
Signature
Item Numbers 1. - 7. Read the household member’s promise carefully, type or print your name in the spaces provided in
Part 6. then sign and date the contract. If you do not type or print your name in the Signature section and sign and date
the contract, the intending immigrant cannot be issued a visa or be granted adjustment of status based upon the income
and/or assets listed on this contract.
If you are under guardianship, your legal guardian may type or print your name on Form I-864A for you to sign. See
General Instructions for definition of “legal guardian.”
Select the appropriate box to indicate whether you read this contract yourself or whether you had an interpreter assist you.
If someone assisted you in completing the contract, select the box indicating that you used a preparer. Further, you must
sign and date your contract and provide your daytime telephone number, mobile telephone number (if any), and email
address (if any). Every contract MUST contain the signature of the household member (or parent or legal guardian, if
applicable). A stamped or typewritten name in place of a signature is not acceptable.
Part 7. Interpreter’s Contact Information, Certification, and Signature
Item Numbers 1. - 6. If you used anyone as an interpreter to read the Instructions and questions on this contract to you in
a language in which you are fluent, the interpreter must fill out this section and sign and date the contract.
Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Contract, if Other Than the
Household Member
Item Numbers 1. - 6. This person who completed your contract, if other than you, the sponsor or household member,
must sign the section. If the same individual acted as your interpreter and your preparer, then that person should complete
both Part 7. and Part 8. A stamped or typewritten name in place of a signature is not acceptable.
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We recommend that you print or save a copy of your completed contract for your records.

What Evidence Must You Submit?
You must submit all evidence requested in these Instructions with your contract. If you fail to submit required evidence,
USCIS may reject or deny your contract in accordance with 8 CFR 103.2(b)(1) and these Instructions.

Where to File?

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This contract MUST be filed with Form I-864.

Please see our website at www.uscis.gov/I-864 for the most current information about where to file this contract. For
information on filing with DOS, see www.travel.state.gov.

Address Change

If you are a sponsor and are not a U.S. citizen, you must inform USCIS of your new address within 10 days of moving
from your previous residence. To do this, you must complete and file Form I-865, Sponsor’s Change of Address. For
information on filing Form I-865, go to our website at www.uscis.gov/I-865 or call the USCIS Contact Center.
NOTE: Do not complete Form I-865 at the same time that you complete Form I-864A. You should complete and submit
Form I-865 to USCIS only when the address you indicated on the original Form I-864A has changed.
This requirement does not relieve a lawful permanent resident sponsor from filing a change of address within 10 days of
the change. For information on changing your address, go to our website at www.uscis.gov/addresschange, or call the
USCIS Contact Center.
NOTE: Do not submit a change of address request to the USCIS Lockbox. For information on reporting a change of
address to the Department of State during consular processing, see www.travel.state.gov.

Processing Information

Initial Processing. Once USCIS or the Department of State accepts your contract, we will check it for completeness. If
you do not properly complete this contract, you will not establish a basis for your eligibility and USCIS or the Department
of State may reject or deny your contract.
Requests for More Information. USCIS may request that you provide more information or evidence to support
your contract. We may also request that you provide the originals of any copies you submit. If we request an original
document from you, we will return it to you after USCIS determines it is no longer needed.
Requests for Interview. We may request that you appear at a USCIS office for an interview based on your contract.
During your interview, USCIS may require you to provide your biometrics to verify your identity and/or update
background and security checks.
Decision. The decision on the sufficiency of Form I-864 involves a determination of whether you have established
that you can maintain the intending immigrants and the rest of your household at 125 percent of the Federal Poverty
Guidelines (or 100 percent if you are on active duty in the U.S. Armed Forces or U.S. Coast Guard and sponsoring your
spouse or child).

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USCIS Forms and Information
To ensure you are using the latest version of this contract, visit www.uscis.gov.

Penalties
If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-864A, we
will deny your Form I-864A and may deny any other immigration benefit. In addition, you will face severe penalties
provided by law and may be subject to criminal prosecution.

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The government may pursue verification of any information provided on or in support of this contract, including
employment, income, or assets with the employer, financial or other institutions, the IRS, or the Social Security
Administration. If you include in this contract any information that you know to be false, you may be liable for criminal
prosecution under the laws of the United States.
If you fail to give notice of your change of address, as required by 8 U.S.C. 1183a(d) and 8 CFR 213a.3, you may be
liable for the civil penalty established by 8 U.S.C. 1183a(d)(2). The amount of the civil penalty will depend on whether
you failed to provide this notice because you were aware that the immigrants you sponsored had received Federal, state, or
local means-tested public benefits.
If the failure to report your change of address occurs with knowledge that the sponsored immigrant received means-tested
public benefits (other than benefits described in section 401(b), 403(c)(2), or 4ll(b) of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996, which are summarized in the contract in Part 8. of Form I-864,) such
failure may result in a fine of not less than $2,000 or more than $5,000. Otherwise, the failure to report your change of
address may result in a fine not less than $250 or more than $2,000.

DHS Privacy Notice

AUTHORITIES: The information requested on this contract, and the associated evidence, is collected under the
Immigration and Nationality Act (INA) sections 212(a)(4) and 213A.
PURPOSE: The primary purpose for providing the requested information on this contract is to demonstrate that you, the
household member, meet the eligibility requirements to execute this contract between a household member and a sponsor
that imposes a legally enforceable obligation on the household member to assist the sponsor in supporting a sponsored
alien until the obligation terminates. DHS uses the information you provide as part of determining whether or not the
adjustment of status applicant or the immigrant visa applicant that you have agreed to help support is eligible for the
immigration benefit.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information,
including your Social Security number (if applicable), and any requested evidence, may delay a decision on whether the
sponsor’s Affidavit of Support Under Section 213A of the INA is found sufficient to meet the requirements of INA section
213A, or may result in the sponsor’s Affidavit of Support Under Section 213A of the INA being found insufficient.

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ROUTINE USES: DHS may share the information you provide on this contract and any additional requested evidence
with other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved
routine uses described in the associated published system of records notices [DHS/USCIS/ICE/CBP-001 Alien File, Index,
and National File Tracking System of Records and DHS/USCIS-018 Immigration Biometric and Background Check]
and the published privacy impact assessments [DHS/USCIS/PIA-003(b) Integrated Digitization Document Management
Program] which you can find at www.dhs.gov/privacy. DHS may also share the information, as appropriate, for law
enforcement purposes or in the interest of national security.

Paperwork Reduction Act

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USCIS may not conduct or sponsor an information collection, and you are 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 1 hour and 30 minutes per response, including the time
for reviewing instructions, gathering the required documentation and information, completing the contract, preparing
statements, attaching necessary documentation, and submitting the contract. 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. 1615-0075. Do not mail your completed
Form I-864A to this address.

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