Download Form I-864, Affidavit of Support Under Section 213A of the INA and more Lecture notes Nutrition in PDF only on Docsity!
For USCIS Use Only
Affidavit of Support Under Section 213A of the INA
Department of Homeland Security
U.S. Citizenship and Immigration Services
To be completed by an attorney or accredited representative (if any).
Part 1. Basis For Filing Affidavit of Support
am the sponsor submitting this affidavit of support because (Select only one box): I am the petitioner. I filed or am filing for the immigration of my relative.
I filed an alien worker petition on behalf of the intending immigrant, who is related to me as my
1.c.
1.d.
I have an ownership interest of at least 5 percent in
I am the only joint sponsor.
1.e.
1.f.
I am the The original petitioner is deceased. I am the substitute sponsor. I am the intending immigrant's
first second of two joint sponsors.
which filed an alien worker petition on behalf of the intending immigrant, who is related to me as my
1.b.
I,
1.a.
Mailing Address
2.d. City or Town
2.e. State 2.f. ZIP Code
2.i. Country
2.h. Postal Code
Street Number and Name
2.b.
NOTE: If you are filing this form as a sponsor, you must include proof of your U.S. citizenship, U.S. national status, or lawful permanent resident status.
2.c. (^) Apt. Ste. Flr.
Affidavit of Support Submitter Petitioner 1st Joint Sponsor 2nd Joint Sponsor
Remarks
Date (mm/dd/yyyy):
Reviewed By: Substitute Sponsor Office: 5% Owner
Section 213A Review MEETS requirements
DOES NOT MEET
requirements
START HERE - Type or print in black ink.
Number of Support Affidavits in File 1 2
2.g. Province
2.a. In Care Of Name
Attorney State Bar Number (if applicable)
Attorney or Accredited Representative USCIS Online Account Number (if any)
Select this box if Form G-28 or G-28I is attached.
1.b. Given Name (First Name)
1.c. Middle Name
Part 2. Information About the Principal
Immigrant
1.a. Family Name (Last Name)
5. Alien Registration Number (A-Number) (if any)
► A-
6. USCIS Online Account Number (if any) ► 3. Country of Citizenship or Nationality
Other Information
4. Date of Birth (mm/dd/yyyy) 7.^ Daytime Telephone Number
USCIS
Form I-
OMB No. 1615- Expires 12/31/
(USPS ZIP Code Lookup)
1. I am sponsoring the principal immigrant named in Part 2. 2. I am sponsoring the following family members immigrating at the same time or within six months of the principal immigrant named in Part 2. (Do not include any relative listed on a separate visa petition.)
No (Applicable only if you are sponsoring family members in Part 3. as the second joint sponsor or if you are sponsoring family members who are immigrating more than six months after the principal immigrant)
Yes
4.a. Family Name (Last Name)
4.b. Given Name (First Name)
4.c. Middle Name
5. Relationship to Principal Immigrant 6. Date of Birth (mm/dd/yyyy) 7. Alien Registration Number (A-Number) (if any)
Family Member 1
► A-
8. USCIS Online Account Number (if any)
►
9.c. Middle Name
Given Name (First Name)
9.b.
Family Name (Last Name)
9.a.
Family Member 2
11. Date of Birth (mm/dd/yyyy) 10. Relationship to Principal Immigrant 12. Alien Registration Number (A-Number) (if any)
► A-
13. USCIS Online Account Number (if any)
►
17. Alien Registration Number (A-Number) (if any)
14.a. Family Name (Last Name) 14.b. Given Name (First Name) 14.c. Middle Name
15. Relationship to Principal Immigrant 16. Date of Birth (mm/dd/yyyy)
Family Member 3
► A-
18. USCIS Online Account Number (if any) ►
19.c. Middle Name
Given Name (First Name)
19.b.
Family Name (Last Name)
19.a.
Family Member 4
21. Date of Birth (mm/dd/yyyy) 20. Relationship to Principal Immigrant 22. Alien Registration Number (A-Number) (if any)
► A-
23. USCIS Online Account Number (if any) ►
Given Name (First Name)
24.b.
Family Name (Last Name)
24.a.
24.c. Middle Name
Family Member 5
25. Relationship to Principal Immigrant 26. Date of Birth (mm/dd/yyyy) 27. Alien Registration Number (A-Number) (if any)
► A-
28. USCIS Online Account Number (if any) ►
Part 3. Information About the Immigrants You Are Sponsoring
3. I am sponsoring the following family members who are immigrating more than six months after the principal immigrant.
For USCIS Use Only
Part 5. Sponsor's Household Size
NOTE: Do not count any member of your household more than once.
Persons you are sponsoring in this affidavit:
1.
Provide the number you entered in Part 3. , Item Number 29.
If you have dependent children, enter the number here.
If you are currently married, enter "1" for your spouse.
Yourself.
Persons NOT sponsored in this affidavit:
If you have any other dependents, enter the number here.
If you have sponsored any other persons on Form I-864 or Form I-864EZ who are now lawful permanent residents, enter the number here.
Add together Part 5. , Item Numbers 1. - 7. and enter the number here.
7. (^) OPTIONAL: If you have siblings, parents, or adult children with the same principal residence who are combining their income with yours by submitting Form I-864A, enter the number here.
Household Size:
Part 6. Sponsor's Employment and Income
Name of Employer 1
I am currently:
3. Name of Employer 2 (if applicable)
Income you are using from any other person who was counted in your household size, including, in certain conditions, the intending immigrant. (See Form I- Instructions.) Please indicate name, relationship, and income.
8. Name
Person 1
9. Relationship 10. Current Income $
14. Name
Name
Relationship
Current Income
Person 2
Person 3
15. Relationship 16. Current Income $
Name
Relationship
Person 4
19. Current Income $
Employed as a/an
Self-Employed as a/an (Occupation)
5. Retired Since (mm/dd/yyyy) 6. Unemployed Since (mm/dd/yyyy) 7. My current individual annual income is:
For USCIS Use Only
Enter the net cash value of all the principal immigrant's real estate holdings. (Net value means investment value minus mortgage debt.)
Enter the balance of the principal immigrant's savings and checking accounts.
Your household member's assets from Form I-864A (optional).
Add together Item Numbers 1. - 3. and enter the number here.
Enter the net cash value of all stocks, bonds, certificates of deposit, and any other assets not already included in Item Number 1. or Item Number 2.
22. One or more of the people listed in Item Numbers 8. , 11. , 14. , and 17. do not need to complete Form I-864A because he or she is the intending immigrant and has no accompanying dependents. Name
Federal Income Tax Return Information
Household Size 1 4
Remarks
Year: 2 0
Poverty Line: Other
Poverty Guideline
I was not required to file a Federal income tax return as my income was below the IRS required level and I have attached evidence to support this.
Have you filed a Federal income tax return for each of the three most recent tax years?
My total income (adjusted gross income on Internal Revenue Service (IRS) Form 1040EZ) as reported on my Federal income tax returns for the most recent three years was:
23.a.
NOTE: You MUST attach a photocopy or transcript of your Federal income tax return for only the most recent tax year.
Yes No
24.a.
24.b. 2nd Most Recent
3rd Most Recent
Most Recent
Total Income
(Optional) I have attached photocopies or transcripts of my Federal income tax returns for my second and third most recent tax years.
23.b.
Tax Year
24.c. $
Enter the net cash value of real-estate holdings. (Net value means current assessed value minus mortgage debt.) $
If your income, or the total income for you and your household, from Part 6. , Item Numbers 20. or 24.a. - 24.c. , exceeds the Federal Poverty Guidelines for your household size, YOU ARE NOT REQUIRED to complete this Part 7. Skip to Part 8.
Your Assets (Optional) Enter the balance of all savings and checking accounts.
TOTAL: $
Assets from Form I-864A , Part 4. , Item Number 3.d. , for: Name of Relative
5.b.
5.a.
Assets of the principal sponsored immigrant (optional).
My Current Annual Household Income (Total all lines from Part 6. Item Numbers 7. , 10. , 13. , 16. , and 19. ; the total will be compared to Federal Poverty Guidelines on Form I-864P.)
21. The people listed in Item Numbers 8. , 11. , 14. , and 17. have completed Form I-864A. I am filing along with this affidavit all necessary Form I-864As completed by these people.
Enter the current cash value of the principal immigrant's stocks, bonds, certificates of deposit, and other assets not included in Item Number 6. or Item Number 7.
Part 6. Sponsor's Employment and Income (continued)
Part 7. Use of Assets to Supplement Income (Optional)
The principal sponsored immigrant is the person listed in Part
2. , Item Numbers 1.a. - 1.c. Only include the assets if the principal immigrant is being sponsored by this affidavit of support.
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.
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
a language in which I am fluent, and I understood everything.
2. At my request, the preparer named in^ Part 10. ,
prepared this affidavit for me based only upon information I provided or authorized.
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:
Sponsor's Daytime Telephone Number
Sponsor's Contact Information
3.
Sponsor's Mobile Telephone Number (if any)
Sponsor's Email Address (if any)
A. Becomes a U.S. citizen; Has worked, or can receive credit for, 40 quarters of coverage under the Social Security Act;
B.
No longer has lawful permanent resident status and has departed the United States;
C.
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
D.
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 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.
Sponsor's Statement
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.a.
NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.
I know the contents of this affidavit of support that I signed;
A.
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;
C.
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;
B.
Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature (continued)
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;
D.
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
E.
F. I authorize the Social Security Administration to release information about me in its records to USCIS and DOS.
3.h.
Interpreter's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
3.g.
Province
Street Number and Name
3.a.
Country
3.b. Apt. Ste. Flr.
Postal Code
Interpreter's Contact Information
4. Interpreter's Daytime Telephone Number 6. Interpreter's Email Address (if any) 5. Interpreter's Mobile Telephone Number (if any)
Sponsor's Signature
6.b. Date of Signature (mm/dd/yyyy)
6.a. Sponsor's Signature
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.
Interpreter's Certification
I certify, under penalty of perjury, that:
which is the same language specified in Part 8. , Item Number 1.b. , and I have read to this sponsor in the identified language every question and instruction on this affidavit and his or her answer to every question. The sponsor informed me that he or she understands every instruction, question, and answer on the affidavit, including the Sponsor's Declaration and Certification , and has verified the accuracy of every answer.
I am fluent in English and (^) ,
1.b. Interpreter's Given Name (First Name)
Provide the following information about the interpreter.
1.a. Interpreter's Family Name (Last Name)
Interpreter's Full Name
Interpreter's Signature
7.b. Date of Signature (mm/dd/yyyy)
7.a. Interpreter's Signature
2. Interpreter's Business or Organization Name (if any)
Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature (continued)
Part 9. Interpreter's Contact Information, Certification, and Signature
3.d.
6.a. Page Number 6.b. Part Number 6.c. Item Number
6.d.
Part 11. Additional Information
If you need extra space to provide any additional information within this affidavit, 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 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.
1.a. Family Name (Last Name)
1.b. Given Name (First Name)
1.c. Middle Name
2. A-Number (if any)
3.a. Page Number 3.b. Part Number 3.c. Item Number
► A-
4.d.
4.a. Page Number 4.b. Part Number 4.c. Item Number
5.a. Page Number 5.b. Part Number 5.c. Item Number
5.d.
7.a. Page Number 7.b. Part Number 7.c. Item Number
7.d.
