I-134, Affidavit Of Support - Nice (Page 4 of 4) in pdf

These provisions do not apply to the SSI, TANF or Food

VII. Paperwork Reduction Act Notice.

Stamp eligibility of aliens admitted as refugees, granted

An agency may not conduct or sponsor a collection of

asylum or Cuban/ Haitian entrants as defined in section

information and a person is not required to respond to a

501(e) of P.L. 96-422, and to dependent children of the

collection of information unless it displays a currently valid

sponsor or sponsor's spouse.

OMB control number. We try to create forms and

instructions that are accurate, can be easily understood and

The provisions also do not apply to the SSI or Food Stamp

that impose the least possible burden on you to provide us

eligibility of an alien who becomes blind or disabled after

with information. Often this is difficult because some

admission to the United States for permanent residency.

immigration laws are very complex. The estimated average

time to complete and file this application is 30 minutes per

application, including the time to learn about the law and the

IV. Authority, Use and Penalties.

form, complete the form, and assemble and submit the

Affidavit. If you have comments regarding the accuracy of

Authority for the collection of the information requested on

this estimate or suggestions for making this form simpler,

this form is contained in 8 U.S.C. 1182(a)(15),1184(a) and

write to the Bureau of Citizenship and Immigration Services,

1258.

Regulations and Forms Services Division (HQRFS), 425 I

Street, N.W., Room 4034, Washington, D.C. 20529; OMB

The information will be used principally by the CIS, or by

No. 1615-0014. Do not mail your completed application to

any consular officer to whom it may be furnished, to

this address.

support an alien's application for benefits under the

Immigration and Nationality Act and specifically the

assertion that he or she has adequate means of financial

support and will not become a public charge. Submission of

the information is voluntary.

It may also, as a matter of routine use, be disclosed to other

federal, state, local and foreign law enforcement and

regulatory agencies, including the Department of Health

and Human Services, Department of Agriculture,

Department of State, Department of Defense and any

component thereof (if the deponent has served or is serving

in the armed forces of the United States), Central

Intelligence Agency, and individuals and organizations

during the course of any investigation to elicit further

information required to carry out CIS functions.

Failure to provide the information may result in the denial of

the alien's application for a visa or his or her removal from

the United States.

V. Information and CIS Forms.

For information on immigration laws, regulations and

procedures or to order CIS forms, call our National

Customer Service Center at 1-800-375-5283 or visit

our website at

VI. Privacy Act Notice.

We ask for the information on this form and associated

evidence to determine if you have established eligibility for

the immigration benefit you are seeking. Our legal right to

ask for this information is in 8 U.S.C. 1203 and 1225. We

may provide this information to other government agencies.

Failure to provide this information and any requested

evidence may delay a final decision or result in denial of

your request.

Form I-134 (Rev. 06/17/04)N (Prior versions may be used until 09/30/04) Page 2

I-134, Affidavit Of Support - Nice Page 4

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