Instructions For Form I-865 - Sponsor'S Notice Of Change Of Address

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OMB No. 1615-0076; Expires 07/31/07
I-865, Sponsor's Notice
Department of Homeland Security
of Change of Address
U.S. Citizenship and Immigration Services
Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a separate
sheet(s) of paper. Write your name and Alien Registration Number (A#), if any, at the top of each sheet and indicate the number of the
item that refers to your answer. Include the Part and letter or number of the item on the form relating to the additional information you
are providing (example: Part 2, Z). NOTE: U.S. Citizenship and Immigration Services (USCIS is comprised of offices of the former
Immigration and Naturalization Service (INS).
This form is divided into Parts 1 through 4. The following
Use Form I-865, Sponsor's Notice of Change of
information should help you fill out the form.
Address, to report a sponsor's new address.
Part 1 - Information about you, the sponsor.
You will need to give us a completed and signed
Family Name (Last name) - Give your legal name. If you
Form I-865.
have two last names, include both and use a hyphen (-)
between the names, if appropriate.
To file this notice see Step 2 for specific instructions.
Date of Birth - Use eight numbers to show your date of birth
(example: May 1, 1979, should be written 05/01/1979).
When Should I Use Form I-865?
Place of Birth - Give the name of the country where you were
If at any time in the past you completed a Form I-864,
born. Include also the city and state or province.
Affidavit of Support, to sponsor an immigrant, you are
required to report your change of address within 30 days
A # - This is your USCIS (or former INS) file number. If
of the change if the sponsorship agreement is still in force.
you do not have an Alien Registration Number (A#) or do
not know it, leave this blank or write "None".
The sponsorship agreement remains in force until the
U.S. Social Security # - This is your U.S. Social Security
sponsored immigrant:
number. If you do not have a U.S. Social Security number,
Becomes a U.S. citizen;
leave this blank.
Can be credited with 40 quarters of work;
U.S. Citizen - Check the appropriate box if you are a U.S.
Departs the United States permanently and either formally
citizen and provide proof of your citizenship if you became a
abandons lawful permanent resident status (by filing Form
U.S. citizen following the filing of your Form I-864, Affidavit
I-407) or is formally held in a removal proceeding to have
of Support, or submission of a prior Form I-865 address change.
abandoned that status;
Lawful Permanent Resident - Check the appropriate
In a removal proceeding, loses the lawful permanent
box if you are a permanent resident.
resident status that the sponsored immigrant obtained based
New Home Address - Give your new physical street address.
on your Form I-864; or
This must include a street number and name or a rural route
Dies.
number. Do not put a post office box (P.O. Box) number here.
New Mailing Address - Give your mailing address, if
How Do I File Form I-865?
different from your home address.
A separate Form I-865 must be submitted for each person
Telephone Number - Give a telephone number with area
who is filing a notice of address change. Follow the steps
code where you can be reached during the day.
below to complete the form:
Step 1 - Fill Out fhe Form I-865.
Part 2 - Information on sponsored immigrant(s).
Step 2 - Submit Your Notice.
Give the requested information about the sponsored
immigrant(s). If there is more than one immigrant, use a
If you give us false documents, misrepresent facts or
separate sheet(s) of paper to provide complete information.
otherwise engage in fraud, USCIS will take
appropriate action. This means you may lose current
Part 3 - Signature.
and future immigration benefits. You may also face
penalties, including criminal and/or civil prosecution
You, the sponsor, must sign and date the notice. If you do not
leading to fines and/or imprisonment.
sign the form, the notice will be returned as incomplete.
Step 1. Fill Out Form I-865.
Part 4 - Signature of person preparing form,
if other than the sponsor.
Use black ink. Type or print clearly using capital letters. If an
If you, the sponsor, did not fill out the Form I-865, the
item does not apply to you, write "N/A". If the answer is none,
preparer must also sign, date and give his or her address.
write "NONE".
Instructions I-865 (11/28/06) Y

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