Instructions For Form I-864 - Affidavit Of Support Under Section 213a Of The Ina (Page 15 of 16) in pdf

USCIS Privacy Act Statement

AUTHORITIES: The information requested on this affidavit, and the associated evidence, is collected under the

Immigration and Nationality Act, section 213A(i).

PURPOSE: The primary purpose for providing the requested information on this affidavit is to show that the applying

immigrant has enough financial support to live without concern of becoming reliant on U.S. Government welfare.

DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and

any requested evidence, may delay a final decision in your case or result in denial of your affidavit. INA section 213A(i)

requires the collection of your Social Security number. Failure to provide the requested information, and any requested

evidence, may prevent USCIS from accepting and approving this application, and the intending immigrant may not be

able to immigrate to the United States.

ROUTINE USES: DHS may share the information you provide on this affidavit with other Federal, state, local,

and foreign government agencies and authorized organizations. DHS follows approved routine uses described in the

associated published system of records notices [DHS-USCIS-007 - Benefits Information System and DHS-USCIS-001-

Alien File, Index, and National File Tracking System of Records] which you can find at DHS

may also share the information, as appropriate, for law enforcement purposes or in the interest of national security.

The information may also, as a matter of routine use, be disclosed to other Federal, state and local agencies providing

means-tested public benefits for use in civil action against the sponsor for breach of contract. Social Security numbers

may be verified with the Social Security Administration consistent with the consent signed as part of the contract in

Part 8. Sponsor’s Contract, Statement, Contact Information, Certification, and Signature of Form I-864.

Paperwork Reduction Act

An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection

of information, unless it displays a currently valid OMB control number. The public reporting burden for this collection

of information is estimated at 6 hours per response, including the time for reviewing instructions, gathering the required

documentation and information, completing the affidavit, preparing statements, attaching necessary documentation,

and submitting the affidavit. Send comments regarding this burden estimate or any other aspect of this collection of

information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory

Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC 20529-2140; OMB No.

1615-0075. Do not mail your completed Form I-864 to this address.

Form I-864 Instructions 07/02/15 N

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