Form I-864 - Affidavit Of Support Under Section 213a Of The Act Page 3
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Bank statements covering the last 12 months, or a
possible burden on you to provide us with information. Often this
statement from an officer of the bank or other financial
is difficult because some immigration laws are very complex. The
institution in which you have deposits, including
reporting burden for this collection of information on Form I-864 is
deposit/withdrawal history for the last 12 months, and
computed as follows: 1) learning about the form, 63 minutes; 2)
current balance;
completing the form, 105 minutes; and 3) assembling and filing the
.
form, 65 minutes, for an estimated average of 3 hours and 48
Evidence of ownership and value of stocks, bonds,
minutes minutes per response. The reporting burden for collection
and certificates of deposit, and date(s) acquired;
.
of information on Form I-864A is computed as: 1) learning about
Evidence of ownership and value of other personal
the form, 20 minutes; 2) completing the form, 55 minutes; 3)
property, and date(s) acquired; and
assembling and filing the form, 30 minutes, for an estimated
.
average of 1 hour and 45 minutes per response. If you have
Evidence of ownership and value of any real estate,
comments regarding the accuracy of this estimates, or
and date(s) acquired.
suggestions for making this form simpler, you can write to the
Immigration and Naturalization Service, HQPDI, 425 I Street, N.W.,
Change of Sponsor's Address
Room 4034, Washington, DC 20536. DO NOT MAIL YOUR
You are required by 8 U.S.C. 1183a(d) and 8 CFR 213a.3 to
COMPLETED AFFIDAVIT OF SUPPORT TO THIS ADDRESS.
report every change of address to the Immigration and
Naturalization Service and the State(s) in which the sponsored
immigrant(s) reside(s). You must report changes of address to
INS on Form I-865, Sponsor's Notice of Change of Address,
CHECK LIST
within 30 days of any change of address. You must also report
The following items must be submitted with Form I-864, Affidavit
any change in your address to the State(s) in which the
of Support Under Section 213A:
sponsored immigrant(s) live.
For ALL sponsors:
Penalties
This form, the I-864, completed and signed before a notary
If you include in this affidavit of support any material
public or a Consular or Immigration Officer.
information that you know to be false, you may be liable for
Proof of current employment or self employment.
criminal prosecution under the laws of the United States.
Your individual Federal income tax returns for the most
If you fail to give notice of your change of address, as required
recent 3 tax years, or an explanation if fewer are
by 8 U.S.C. 1183a(d) and 8 CFR 213a.3, you may be liable for the
submitted. Your W-2s for any of the most recent 3 tax
civil penalty established by 8 U.S.C. 1183a(d)(2). The amount of
years for which you filed a joint tax return but are using
the civil penalty will depend on whether you failed to give this
only your own income to qualify. Forms 1099 or evidence
notice because you were aware that the immigrant(s) you
of other reported income if necessary to qualify.
sponsored had received Federal, State, or local means-tested
public benefits.
For SOME sponsors:
Privacy Act Notice
Authority for the collection of the information requested on this
If the immigrant you are sponsoring is bringing a spouse
form is contained in 8 U.S.C. 1182(a)(4), 1183a, 1184(a), and 1258.
or children, photocopies of the immigrant's affidavit of
The information will be used principally by the INS or by any
support for each spouse and/or child immigrating with the
Consular Officer to whom it is furnished, to support an alien's
immigrant you are sponsoring.
application for benefits under the Immigration and Nationality
Act and specifically the assertion that he or she has adequate
If you are on active duty in the U.S. Armed Forces and are
means of financial support and will not become a public charge.
sponsoring a spouse or child using the 100 percent of
Submission of the information is voluntary. Failure to provide
poverty level exception, proof of your active military
the information will result in denial of the application for an
status.
immigrant visa or adjustment of status.
If you are using the income of
persons in your household or
to qualify,
dependents
The information may also, as a matter of routine use, be
disclosed to other Federal, State, and local agencies or private
A separate Form I-864A for each person whose
entities providing means-tested public benefits for use in civil
income you will use. A sponsored
action against the sponsor for breach of contract. It may also be
immigrant/household member who is not
disclosed as a matter of routine use to other Federal, State,
immigrating with a spouse and/or child does not
local, and foreign law enforcement and regulatory agencies to
need to complete Form I-864A.
enable these entities to carry out their law enforcement
responsibilites.
Proof of their residency and relationship to you
if they are not listed as dependents on your
Reporting Burden
income tax return for the most recent tax year.
A person is not required to respond to a collection of
Proof of their current employment or self-
information unless it displays a currently valid OMB control
employment.
number. We try to create forms and instructions that are
accurate, can be easily understood, and which impose the least
Form I-864 Instructions (Rev. 11/05/01)Y Page 3
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