Fillable Form I-942 - Request For Reduced Fee (Page 3 of 9) in pdf

Form I-942 - Request For Reduced Fee Page 3

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Part 3. Household Income (continued)

8. Has anything changed since the date you filed your Federal tax returns? (For example, your marital status,

Yes

income, or number of dependents.)

If you answered "Yes" to Item Number 8., provide an explanation below. Provide documentation if available.

Part 4. Requestor's Statement, Contact Information, Certification, and Signature

NOTE: Read the Penalties section of the Form I-942 Instructions before completing this part.

Each person applying for a reduced fee must complete, sign, and date Form I-942 and provide the required documentation. This

includes family members identified in Part 2., Item Number 1. Signature fields for family members are at the end of this part. A

legal guardian may sign the request on behalf of the applicant. USCIS rejects any Form I-942 that is not signed by all individuals

requesting a reduced fee and may deny a request that does not provide the required documentation. If the information provided by the

requestor in Part 4. is not applicable to a family member identified in Part 2., that individual should complete Part 5.

Requestor's Statement

NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.

Requestor's Statement Regarding the Interpreter

I can read and understand English, and I have read and understand every question and instruction on this request, and my

answer to every question.

The interpreter named in Part 6. read to me every question and instruction on this request, and my answer to every

question in

, a language in which I am fluent,

and I understood everything.

Requestor's Statement Regarding the Preparer

At my request, the preparer named in Part 7.,

prepared this request for me based only upon information I provided or authorized.

Requestor's Contact Information

Requestor's Daytime Telephone Number

4. Requestor's Mobile Telephone Number (if any)

Requestor's Email Address (if any)

Requestor's Certification

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may

require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of

my records that USCIS may need to determine my eligibility for the immigration benefit I seek.

I further authorize release of information contained in this request, in supporting documents, and in my USCIS records to other entities

and persons where necessary for the administration and enforcement of U.S. immigration laws.

Form I-942 12/23/16

Page 3 of 9

Form I-942 - Request For Reduced Fee Page 3

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