OMB No. 1615-0075; Expires 09/30/2012
I-864W, Intending Immigrant's
Department of Homeland Security
Affidavit of Support Exemption
U.S. Citizenship and Immigration Services
If you are claiming credit for quarters worked by a spouse or
How Should I Complete This Form?
parent, you may not count any quarter in which the spouse or
parent was receiving means-tested public benefits. Include all
Print clearly or type your answers using CAPITAL letters.
SSA forms necessary to establish that you have or can be
credited with 40 quarters of coverage.
Use black ink.
If you need extra spact to answer any item:
Intending immigrant is a child who will become a U.S.
citizen immediately upon entry under the Child
-- Attach a seperate sheet of paper (or more sheets if
Citizenship Act of 2000 (CCA). Under the CCA, some
children become U.S. citizens immediately upon admission
-- Write your name, Social Security number and the
to the United States or adjustment of status to that of a
words "Form I-864W" on the top right corner of the
lawful permanent resident. For this classification to apply:
sheet; and write the number and subject of each
question for which you are providing additional
At least one parent of the child is a U.S. citizen;
The child is under 18 years of age at the time of
What Is the Purpose of This Form?
admission or adjustment of status;
The child is residing permanently in the United States in
The Form I-864 is legally required for many family-based
the legal and physical custody of the U.S. parent; and
immigrants and some employment-based immigrants to show
that they have adequate means of financial support and that
If the child is an alien orphan child adopted abroad, the
they are not likely to become a public charge. Certain classes
adoption was legally finalized prior to admission to the
of immigrants are exempt from the I-864 requirement and
United States and both adoptive parents or the unmarried
therefore must file Form I-864W instead of Form I-864 or
U.S. citizen parent personally observed the alien orphan
Form I-864EZ. For more information abut Forms I-864,
before or during the adoption proceeding.
I-864EZ, or I-864W, or to obtain related forms please contact:
If the citizen parent(s) adopted the alien orphan abroad,
The USCIS Website ( );
but at least one of the adoptive parents or the unmarried
parent did not see and observe the alien orphan before or
The National Customer Service Center (NCSC) telephone
during the foreign adoption proceeding, then an affidavit
line at 1-800-375-5283 TTY: (1-800-767-1833); or
of support under this part is still required unless the
Your local USCIS office by using InfoPass.
citizen parent submits evidence that, under the law of the
state of the alien orphan's intended residence in the
How Is This Form Used?
United States, the foreign adoption decree is entitled to
recognition without the need for a formal administrative
You must use this form instead of Form I-864 with your
or judicial proceeding in the State of proposed residence.
application for an immigrant visa or adjustment of status if
Orphans whose adoptions are not legally finalized until
any of the following apply:
after admission to the United States will not qualify for
this exemption and must file a Form I-864.
(1) You have earned (or can be credited with) 40 quarters
of coverage under the Social Security Act (SSA). If you
You are filing for an immigrant visa as a self-
have 40 quarters or SSA coverage, you are exempt from
petitioning widow(er). If you are filing as a self-
the requirement to file Form I-864. You can acquire 40
petitioning widow(er) using Form I-360, you are exempt
qualifying quarters in the following ways:
from the Affidavit of Support requirements if your Form
I-360 is approved and you are applying for lawful
Working in the United States for 40 quarters in which
you received the minimum income established by the
Social Security Administration; or
You are filing for an immigrant visa as a self-petitioning
battered spouse or child. If you are filing as a self-
By being credited under section 213(a)(3)(B) of the
petitioning battered spouse or child using
Immigration and Nationality Act with quarters worked
Form I-360, you are exempt from the Affidavit of Support
by your spouse during the marriage or a parent during
requirements if your Form I-360 is approved and you are
the time you were under 18 years of age; or
applying for lawful permanent residence.
A combination of the above.
Form I-864W (09/19/11) Y