Form I-864EZ, Instructions for Affidavit of Support Under Section 213A of the INA

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Instructions for Affidavit of Support Under
Section 213A of the INA
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-864EZ

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

What Is the Purpose of Form I-864EZ?
Form I-864EZ, Affidavit of Support Under Section 213A of the INA, is a shorter version of Form I-864, Affidavit of
Support Under Section 213A of the INA, designed for cases that meet certain criteria. Form I-864 or Form I-864EZ is
legally required for many family-based immigrants to show that the intending immigrant has adequate means of financial
support and is unlikely to become a public charge.

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Who May Use Form I-864EZ?

You may use Form I-864EZ if ALL the following conditions apply:

1. You are the person who filed or is filing Form I-129F, Petition for Alien Fiancé(e); Form I-130, Petition for Alien
Relative; Form I-600, Petition to Classify Orphan as an Immediate Relative; or Form I-800, Petition to Classify
Convention Adoptee as an Immediate Relative, for the relative you are sponsoring.
2. The relative you are sponsoring is the only person listed on Form I-130; and

3. The income you are using to qualify is based entirely on your salary or pension and is shown on one or more Internal
Revenue Service (IRS) Form W-2s provided by your employers or former employers.

When Not To Use Form I-864EZ?

Do not use Form I-864EZ if any of the following conditions apply. Instead, you must complete and submit Form I-864.
1. The relative you are sponsoring is not the only person immigrating based upon the underlying visa petition.
2. You filed or are filing Form I-140, Immigrant Petition for Alien Worker, for the immigrant you are sponsoring.
3. You are a joint sponsor.

4. You are a substitute sponsor filing because the original Form I-130 petitioner is deceased.
5. Your salary or pension is not enough to meet the income requirements as set by the Federal Poverty Guidelines.
6. You are exempt from, or otherwise not required to, submit an Affidavit of Support under Section 213A of the INA.
For more information, see Form I-864 Instructions, Are There Exceptions to Who Needs to Submit Form I-864,
and Other Applicants Not Required to Submit Form I-864.

How Is Form I-864EZ Used?
This affidavit is a contract between a sponsor and the U.S. Government. The person completing and signing this affidavit
is the sponsor. By signing Form I-864EZ, you are agreeing to use your income and resources to support the intending
immigrant named in this affidavit, if it becomes necessary. You must show on this affidavit that you have enough income
to ensure that the sponsored immigrant will not have to rely on means-tested public benefits for support in the United
States.

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In most cases, the submission of this affidavit will make the sponsored immigrant ineligible for Federal, state, or local
means-tested public benefits, because an agency that provides means-tested public benefits will consider your income and
resources available to the sponsored immigrant in determining eligibility for the program.
If the immigrant sponsored in this affidavit does receive a Federal, state, or local means-tested public benefit, the agency
providing the benefit may require you to repay the cost of those benefits. That agency can sue you if you do not repay the
cost of the benefits provided.
1. Who Completes Form I-864EZ?
Only the U.S. citizen, lawful permanent resident, or U.S. national who filed Form I-129F, Form I-130, Form I-600,
or Form I-800 for a family member, may complete this affidavit. A sponsor is required to be at least 18 years of age
and domiciled in the United States, its territories, or possessions. (See the Specific Instructions section of these
Instructions.)

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2. What Are the Income Requirements?

To qualify as a sponsor, you must demonstrate that you have an income of at least 125 percent of the current Federal
Poverty Guidelines for your household size. The Federal poverty line, for purposes of this affidavit, is updated
annually and can be found on Form I-864P, Poverty Guidelines, at www.uscis.gov/I-864P.
If you are on active duty in the U.S. Armed Forces or U.S. Coast Guard and you are sponsoring your spouse or minor
child, you only need to have an income of 100 percent of the Federal Poverty Guidelines for your household size.
3. How Do I Count Household Size?

Your household size includes yourself and the following individuals, no matter where they live:
A. Any spouse;

B. Any dependent children under 21 years of age;

C. Any other dependents listed on your most recent Federal income tax return;
D. The person being sponsored in this affidavit of support; and

E. Any immigrants previously sponsored with a Form I-864 or Form I-864EZ affidavit of support whom you are still
obligated to support.
4. How Long Does My Obligation as a Sponsor Continue?

Your obligation to support the immigrant you are sponsoring in this Form I-864EZ will continue until the sponsored
immigrant becomes a U.S. citizen, or can receive credit for 40 qualifying quarters of work in the United States.
Although 40 qualifying quarters (credits) of work generally equates to 10 years of work, in certain cases, the work
of a spouse or parent adds qualifying quarters toward eligibility. The Social Security Administration can provide
information on how to count qualifying quarters (credits) of work. The obligation also ends if you or the sponsored
immigrant dies or if the sponsored immigrant ceases to be a lawful permanent resident and departs the United States.
Divorce does not end the sponsorship obligation.

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 your affidavit. USCIS will not accept a stamped or
typewritten name in place of any signature on this affidavit. A legal guardian may sign for a mentally incompetent person.
If your affidavit is not signed, or if the signature is not valid, we will reject your affidavit. 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.
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If you are under guardianship, your legal guardian may print your name and sign Form I-864EZ 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. See 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.

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Evidence. When you file your affidavit, you must submit all evidence and supporting documents listed in the What
Evidence Must You Submit and/or Specific Instructions sections of these Instructions.
Biometric Services Appointment. USCIS may require you to appear for an interview or provide 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 affidavit;

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

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 them after we
receive them.
Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation. 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, the signature date 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 800-767-1833). The USCIS Contact Center provides information in English and Spanish.
How To Complete Form I-864EZ
1. Type or print legibly in black ink.
2. If you need extra space to complete any item within this affidavit, 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.

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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
Form I-864EZ is divided into nine parts. The information below will help you fill out the affidavit.

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Part 1. Qualifying to Use Form I-864EZ

You may use Form I-864EZ if the statements in Item Numbers 1. - 3. are all true. If you do not select “Yes” for all
three boxes, you do NOT qualify to use Form I-864 EZ and therefore must use Form I-864. Submission of the incorrect
affidavit will delay processing.
Item Number l. Select “Yes” if you are the petitioner who is filing or who has already filed Form I-129F, Petition for
Alien Fiancé(e); Form I-130, Petition for Alien Relative; Form I-600, Petition to Classify Orphan as an Immediate
Relative; or Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative.
Item Number 2. Select “Yes” if you are using only your own earned or retirement income that you can document with an
IRS Form W-2. If you are self-employed, you must select “No” to the question and you cannot use Form I-864EZ.
Item Number 3. If the person you are sponsoring is an immediate relative (spouse, child, or certain parents of U.S.
citizens), you can automatically select “Yes” for this box because every immediate relative has his or her own visa
petition. If the person you are sponsoring is a family-based preference immigrant, and there are family members listed on
the same visa petition that are immigrating with or within six months of the sponsored immigrant, you must select “No”
for this box, and you cannot use Form I-864EZ.
Part 2. Information About You (Sponsor)

Item Number 1. Name of Sponsor. Provide your full name.

Item Number 2. Current Mailing Address. Provide the address where you would like to receive written
correspondence regarding this affidavit.
Item Number 4. Physical Address. Provide your physical address if it is different from your mailing address.
Item Number 5. Country of Domicile. Provide the name of the country where you maintain your principal residence
and where you plan to reside for the foreseeable future. If your mailing address and/or place of residence is not in
the United States, but your country of domicile is the United States, you must attach a typed or printed explanation
and documentary evidence indicating how you meet the domicile requirement. If you are not currently living in the
United States, you may meet the domicile requirement if you can submit evidence to establish that any of the following
conditions apply.
1. You are employed by a certain organization. Some individuals employed overseas are automatically considered to
be domiciled in the United States because of the nature of their employment. The qualifying types of employment
include employment by:
A. The U.S. Government;
B. An American institution of research recognized by the Secretary of Homeland Security (The list of qualifying
institutions may be found at 8 CFR 316.20);
C. A U.S. firm or corporation engaged in whole or in part in the development of foreign trade and commerce with the
United States, or a subsidiary of such a firm or corporation;
D. A public international organization in which the United States participates by treaty or statute;

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E. A religious denomination having a bona fide organization in the United States, if the employment abroad involves
the person’s performance of priestly or ministerial functions on behalf of the denomination; or
F. A religious denomination or interdenominational missionary organization having a bona fide organization in the
United States, if the person is engaged solely as a missionary.
2. You are living abroad temporarily. If you are not currently living in the United States, you must show that your trip
abroad is temporary and that you have maintained your domicile in the United States. You can show this by providing
proof of your voting record in the United States, proof of paying U.S. state or local taxes, proof of having property
in the United States, proof of maintaining bank or investment accounts in the United States, or proof of having a
permanent mailing address in the United States. Other proof could be evidence that you are a student studying abroad
or that a foreign government has authorized a temporary stay

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3. You intend in good faith to reestablish your domicile in the United States no later than the date of the intending
immigrant’s admission or adjustment of status. You must submit proof that you have taken concrete steps to
establish you will be domiciled in the United States at a time no later than the date of the intending immigrant’s
admission or adjustment of status. Concrete steps might include accepting a job in the United States, signing a lease
or purchasing a residence in the United States, or registering children in U.S. schools. Attach proof of the steps you
have taken to establish domicile as previously described.
Item Number 6. Date of Birth. Provide your date of birth in the mm/dd/yyyy format.
Item Number 7. Country of Birth. Provide your country of birth.

Item Number 8. U.S. Social Security Number (Required). You must provide your U.S. Social Security Number.
Item Number 9. Immigration Status. Provide your immigration status.

Item Number 10. Sponsor’s Alien Registration Number (if any). Provide the sponsor’s 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.”
Item Number 11. 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.
Item Number 12. Military Service. Select “Yes” if you are the petitioning sponsor and on active duty in the U.S.
Armed Forces or U.S. Coast Guard other than for training. If you provide evidence that you are currently on active duty
in the U.S. Armed Forces or U.S. Coast Guard and you are petitioning for your spouse or minor child, you will need to
demonstrate income at only 100 percent of the Federal Poverty Guidelines for your household size, instead of at 125
percent of the Federal Poverty Guidelines. (See Form I-864P for information on the Federal Poverty Guidelines at
www.uscis.gov/I-864P.) Select “No” if you are not on active duty in the U.S. Armed Forces or U.S. Coast Guard.
Part 3. Information About the Immigrant You Are Sponsoring (Intending Immigrant)
Item Number 1. Name of Immigrant. Provide the full name of the immigrant you are sponsoring.
Item Number 2. Current Mailing Address. Provide the mailing address of the immigrant you are sponsoring.
Item Number 3. Country of Citizenship or Nationality. Provide the country of citizenship or nationality of the
principal immigrant.
Item Number 4. Date of Birth. Provide the date of birth of the immigrant you are sponsoring in mm/dd/yyyy format.

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Item Number 5. Alien Registration Number (A-Number) (if any). Provide the A-Number (if any) of the immigrant
you are sponsoring. An “A-Number” is an Alien Registration Number assigned by the former Immigration and
Naturalization Service (INS) or USCIS. If the intending immigrants you are sponsoring have not previously been in the
United States or have only been in the United States as tourists, they probably do not have A-Numbers. Persons with
A-Numbers can locate the number on their INS or USCIS-issued documentation.
Item Number 6. 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.

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Item Number 7. Daytime Telephone Number. Provide the daytime telephone number of the immigrant you are
sponsoring.
Part 4. Information About Your Household Size

Add together the number of persons for whom you are financially responsible. Some of these persons may not reside
with you. Make sure you do not count any individual more than once. In some cases, the same person could fit into two
categories.
Item Number l. This line is already completed for you, and it includes the intending immigrant and you.
Item Number 2. If you are married, and your spouse was not included in Item Number 1., enter “1” here. Type or print
“0” if you already counted your spouse in Item Number 1.
Item Number 3. Enter the number of unmarried children you have who are under 21 years of age, even if you do not
have legal custody of these children. You may exclude any unmarried children under 21 years of age, if these children
have reached majority under the law of their place of domicile, and you do not claim them as dependents on your Federal
income tax returns. Type or print “0” if you already counted your dependent children in Item Number 1.
Item Number 4. Enter the number of lawful permanent residents whom you are currently obligated to support based
on your previous submissions of Form I-864 or Form I-864EZ as a petitioning, substitute, or joint sponsor. Include only
those persons who have already immigrated to the United States. Do not include anyone for whom your obligation to
support has ended through the sponsored immigrant’s acquisition of U.S. citizenship, death, abandonment of lawful
permanent residence in the United States, acquisition of 40 quarters of earned or credited work in the United States, or
obtaining a new grant of adjustment of status while in removal proceedings based on a new affidavit of support, if one is
required. Type or print “0” if you already counted these persons in Item Number 1.
Item Number 5. Enter the number of any other dependents. You must include every person whom you have claimed as
a dependent on your most recent Federal income tax return, even if that person is not related to you. Even if you are not
legally obligated to support that person, you must include the person if in fact you did support that person and claimed the
person as a dependent on your Federal income tax returns. Type or print “0” if you already counted your other dependents
in Item Number 1.
Item Number 6. Add together Item Numbers 1. - 5. and enter the number in the space provided.
Part 5. Information About Your Employment and Income
Item Number 1. Indicate if you are currently employed or retired.
Item Number 2. If you are currently employed, provide your occupation and employer information.
Item Number 3. If you are retired, provide the date you retired.

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Item Number 4. Current Individual Annual Income. Enter your current individual earned or retirement annual income
that you are using to meet the requirements of this affidavit and indicate 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 the 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.
Item Numbers 5. - 6. Federal Income Tax Information. You must provide either an IRS transcript or a photocopy
from your own records of your Federal individual income tax return for the most recent tax year, counting from the date
of signing Form I-864EZ. 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.

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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 claim 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 is not subject to
tax in the United States.
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 tax return with your spouse.If you were required to file a Federal income tax return for
the most recent tax year but did not do so, you must file any and all late returns with the IRS and attach an IRS-generated
tax return transcript documenting your late filing before submitting the I-864EZ. 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 are subject to 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 affidavit, the line for Total income on IRS Forms 1040 and 1040A is considered when determining
income. For persons filing IRS Form 1040EZ, the line for adjusted gross income is 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. For more information see www.irs.gov/individuals/get-transcript.
Part 6. Sponsor’s Contract, Statement, Contact Information, Declaration, Certification, and Signature
Read the contract carefully and then sign and date the affidavit. If you do not sign and date your Form I-864EZ in Item
Number 6., the immigrant you are sponsoring cannot be issued a visa or be granted adjustment of status.
Item Numbers 1.a. - 6. Select the appropriate box to indicate whether you read this affidavit yourself or whether you
had an interpreter assist you. Further, you must sign and date your affidavit and provide your daytime telephone number,
mobile telephone number (if any), and email address (if any). Every affidavit 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 7. Interpreter’s Contact Information, Certification, and Signature
If you used anyone as an interpreter to read the Instructions and questions on this affidavit to you in a language in which
you are fluent, the interpreter must fill out this section and sign and date the affidavit.

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Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the
Sponsor
The person who completed your affidavit, if other than the sponsor, must sign this 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.
Part 9. Additional Information
Item Numbers 1. - 7. If you need extra space to provide any additional information within this affidavit, use the space
provided in Part 9. Additional Information. If you need more space than what is provided in Part 9., you may make
copies of Part 9. to complete and file with your affidavit, 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.

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We recommend that you print or save a copy of your completed contract to review in the future and for your
records.

What Evidence Must You Submit?

You must submit all evidence requested in these Instructions with your affidavit. If you fail to submit required evidence,
USCIS or DOS may reject or deny your affidavit for failure to submit requested evidence or supporting documents in
accordance with 8 CFR 103.2(b)(1) and these Instructions.

Where to File?

Please see our website at https://www.uscis.gov/i-864ez for the most current information about where to file this affidavit.
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 notify 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-864EZ. You should complete and
submit Form I-865 to USCIS only when the address you indicated on the original Form I-864EZ 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 to the USCIS Lockbox. For information on reporting a change of address to
DOS, see www.travel.state.gov.

Processing Information
Initial Processing. Once USCIS or DOS accepts your affidavit we will check it for completeness. If you do not properly
complete this affidavit, you will not establish a basis for your eligibility and USCIS or DOS may reject or deny your
affidavit.
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Requests for More Information. We may request that you provide more information or evidence to support your
affidavit. 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 affidavit.
During your interview USCIS we 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-864EZ 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 affidavit, 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-864EZ, we
will deny your Form I-864EZ and may deny any other immigration benefit. In addition, you will face severe penalties
provided by law and may be subject to criminal prosecution.
The U.S. Government may pursue verification of any information provided on or in support of this affidavit, including
employment, income, financial or other institutions, the IRS, or the Social Security Administration. If you include in this
Form I-864EZ 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 give this notice because you were aware that the sponsored immigrant 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 6.), 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 affidavit, 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 affidavit is for you, the sponsor,
to demonstrate that you meet the eligibility requirements to execute this contract between a sponsor and the U.S.
Government that imposes on the sponsor, a legally enforceable obligation to support a sponsored alien until the obligation
terminates. An alien applicant who fails to submit a sufficient Affidavit of Support Under Section 213A of the INA, when
statutorily required, will be found inadmissible under INA section 212(a)(4). DHS uses the information you provide as
part of determining whether or not the adjustment of status applicant or the immigrant visa applicant you are sponsoring is
eligible for the immigration benefit.

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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
affidavit is found sufficient to meet the requirements of INA section 213A, and may result in the affidavit being found
insufficient.
ROUTINE USES: DHS may share the information you provide on this affidavit 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, DHS/USCIS-007 Benefits Information System, DHS/USCIS-018
Immigration Biometric and Background Check (IBBC) System of Records] and the published privacy impact assessments
[DHS/USCIS/PIA-003(b) Integrated Digitization Document Management Program, DHS/USCIS/PIA-016a Computer
Linked Application Information Management System, Appendix B of DHS/USCIS/PIA-056(a) USCIS Electronic
Immigration System (ELIS), and DHS/USCIS/PIA-071 myUSCIS Account Experience], 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.

Draft
Not for
Production
07/28/2026

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 2 hours and 15 minutes per response, including the time
for reviewing instructions, gathering the required documentation and information, completing the affidavit, preparing
statements, attaching necessary documentation, and submitting the affidavit. 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-864EZ to this address.

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