Download Form I-864a

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Aug 1, 2017 - Even many immigration lawyers consider, Form I-864, Affidavit of. Need to prepare and submit Form I-864A along with the primary Form I-864.

Download a free Form I-864, Affidavit of Support Under Section 213A of the Act| Page 4 to make your document professional and perfect. Find other professionally designed templates in TidyForm.
HOW TO FILL OUT FORM I 864A (HOUSEHOLD MEMBER) USA MONDE. Unsubscribe from USA MONDE? Today I have another video for you guys which is how to fill out form I-864A. In this tutorial.

What is a Form I-864 ?

Form I-864, called Affidavit of Support Under Section 213A of the INA officially, is a USCIS form used to prove that immigrants who have families and jobs have adequate means of financial support and are not likely to ask the government for help. Fill fillable form I-864 Online, sign, save, fax, print or download online. At Handypdf.com, you can find the most convenient service to best suit your needs when dealing with a fillable form.

What is a Form I-864 ?

Form I-864

Page 1 of 12

Affidavit of Support Under Section 213A of the INA

U.S. Citizenship and Immigration Services

Form I-864

Expires 07/31/2017

Part 1. Basis For Filing Affidavit of Support

am the sponsor submitting this affidavit of support because

I am the petitioner. I filed or am filing for the

I filed an alien worker petition on behalf of the

1.c.

I have an ownership interest of at least 5 percent in

1.e.

I am the

substitute sponsor. I am the intending immigrant's

which filed an alien worker petition on behalf of the

1.b.

1.a.

(First Name)

Middle Name

2.d.City or Town

State

ZIP Code

2.h.

Street Number

2.b.

NOTE: If you select Item Number 1.a., 1.b., 1.c., 1.d., 1.e.,

or 1.f., you must include proof of your U.S. citizenship, U.S.

national status, or lawful permanent resident status.

Apt.Flr.Ste.

Petitioner

2nd Joint Sponsor

USCIS

Only

Date (mm/dd/yyyy):

Office:

5% Owner

MEETS

DOES NOT MEET

START HERE - Type or print in black ink.

In Care Of Name2.a.

Immigrant

(Last Name)

Page 2 of 12

►

USCIS ELIS Account Number (if any)6.

3.Country of Citizenship or Nationality

Date of Birth (mm/dd/yyyy)4.

Immigrant (continued)

Are Sponsoring

1.I am sponsoring the principal immigrant named in Part 2.

I am sponsoring the following family members

immigrating at the same time or within six months of

include anyrelativelisted on aseparatevisa petition.)

family members in Part 3. as the second

Yes

Middle Name

Given Name

8.b.

(Last Name)

Family Name

3.b.Given Name

3.c.

4.Relationship to Sponsored Immigrant

Alien Registration Number (A-Number) (if any)6.

Family Member 2

A-

Relationship to Sponsored Immigrant9.

►

USCIS ELIS Account Number (if any)12.

Alien Registration Number (A-Number) (if any)16.

(Last Name)

(First Name)

Middle Name

Date of Birth (mm/dd/yyyy)15.

►

USCIS ELIS Account Number (if any)17.

Middle Name

Given Name

18.b.

(Last Name)

Family Member 4

►

Page 3 of 12

Relationship to Sponsored Immigrant19.

Given Name

23.b.

(Last Name)

Middle Name

Family Member 5

A-

►

Part 3. Information About the Immigrants You

25.Date of Birth (mm/dd/yyyy)

►

USCIS ELIS Account Number (if any)27.

28.Enter the total number of immigrants you are sponsoring

Sponsor's Mailing Address

2.e.

2.f.

Country2.i.

Postal Code

and Name

2.c.

Province2.g.

NoYes

Is your current mailing address the same as your physical

If you answered 'No' to Item Number 3., provide your

Middle Name

Given Name

1.b.

(Last Name)

Sponsor's Full Name

Sponsor's Physical Address

4.h.Country

4.e.

4.d.

Postal Code

and Name

4.b.

4.f.Province

Page 4 of 12

Date of Birth (mm/dd/yyyy)6.

For

Use

City or Town of Birth

Country of Birth 9.

►

I am a U.S. citizen.

11.a.

Military Service (To be completed by petitioner sponsors only.)

I am currently on active duty in the U.S. Armed Forces

14.

Sponsor's A-Number (if any)

A-

►

12.

NOTE: Do not count any member of your household more

Persons you are sponsoring in this affidavit:

Provide the number you entered in Part 3., Item Number

If you have dependent children, enter the number here.

If you are currently married, enter '1' for your spouse.

Persons NOT sponsored in this affidavit:

If you have any other dependents, enter the number here.

If you have sponsored any other persons on Form I-864

residents, enter the number here.

Add together Part 5., Item Numbers 1. - 7. and enter the

OPTIONAL: If you have siblings, parents, or adult

children with the same principal residence who are

combining their income with yours by submitting Form

Part 4. Information About You (Sponsor)

Household Size:

Page 5 of 12

USCIS

Only

Income you are using from any other person who was

counted in your household size, including, in certain

conditions, the intending immigrant. (See Form I-864

Instructions.) Please indicate name, relationship, and income.

Relationship

$Current Income5.

Name of Employer 2 (if applicable)

1.a.

I am currently:

1.a.2.

Name

Relationship

Person 2

Relationship10.

$11.

13.

Relationship

14.$

My Current Annual Household Income (Total all lines

from Part 6.,Item Numbers 2., 5., 8., 11., and 14.; the

total will be compared to Federal Poverty Guidelines on

15.

16.The people listed in Item Numbers 3., 6., 9., and 12.

have completed Form I-864A. I am filing along with

this affidavit all necessary Form I-864As completed

Self employed as a/an (Occupation)1.b.

Unemployed 1.d.

Page 6 of 12

One or more of the people listed in Item Numbers

I-864A because he or she is the intending immigrant

Name

Household Size

USCIS

Only

Year:20

Other

Poverty Guideline

789

I was not required to file a Federal income tax return

as my income was below the IRS required level and I

Part 6. Sponsor's Employment and Income

Have you filed a Federal income tax return for each of the

My total income (adjusted gross income on Internal Revenue

Service (IRS) Form 1040EZ) as reported on my Federal income

18.a.

NOTE: You MUST attach a photocopy or transcript of

your Federal income tax return for only the most recent

No Yes

19.b.

3rd Most Recent

Total Income

(Optional) I have attached photocopies or transcripts

of my Federal income tax returns for my second and

18.b.

19.c.$

Part 7. Use of Assets to Supplement Income

Enter the net cash value of real-estate holdings. (Net

value means current assessed value minus mortgage debt.)

If your income, or the total income for you and your

household, from Part 6., Item Numbers 19.a. -19.c., exceeds

the Federal Poverty Guidelines for your household size, YOU

ARE NOT REQUIRED to complete this Part 7. Skip to

Your Assets (Optional)

Enter the balance of all savings and checking accounts.

Enter the net cash value of all stocks, bonds, certificates

of deposit, and any other assets not already included in

Add together Item Numbers 1. - 3. and enter the

TOTAL:

Assets from Form I-864A, Part 4., Item Number 3.d., for:

Enter the balance of the sponsored immigrant's savings

5.b.

Your household member's assets from Form I-864A

Assets of the principal sponsored immigrant (optional).

The principal sponsored immigrant is the person listed in

Page 7 of 12

8.Enter the current cash value of the sponsored immigrant's

stocks, bonds, certificates of deposit, and other assets not

Enter the net cash value of all the sponsored immigrant's

real estate holdings. (Net value means investment value

10.Add together Item Numbers 4., 5.b., and 9. and enter

Total Value of Assets

number here.

$TOTAL:

For

Use

Remarks

Poverty Line:

The total value of all assets, line 10, must equal 5 times (3 times for spouses and children of

USC's, or 1 time for orphans to be formally adopted in the U.S.) the difference between the

poverty guidelines and the sponsor's household income, line 10.

(Page 5, Line 10)

Please note that, by signing this Form I-864, you agree to

assume certain specific obligations under the Immigration and

Nationality Act (INA) and other Federal laws. The following

paragraphs describe those obligations. Please read the

following information carefully before you sign Form I-864. If

you do not understand the obligations, you may wish to consult

If you sign Form I-864 on behalf of any person (called the

intending immigrant) who is applying for an immigrant visa or

for adjustment of status to a lawful permanent resident, and that

intending immigrant submits Form I-864 to the U.S.

Government with his or her application for an immigrant visa or

adjustment of status, under INA section 213A, these actions

create a contract between you and the U.S. Government. The

intending immigrant becoming a lawful permanent resident is

What is the Legal Effect of My Signing Form I-864?

Information, Certification, and Signature

(Optional) (continued)

Under this contract, you agree that, in deciding whether the

intending immigrant can establish that he or she is not

inadmissible to the United States as a person likely to become a

public charge, the U.S. Government can consider your income

and assets as available for the support of the intending

The U.S. Government cannot make you sign Form 1-864 if you

do not want to do so. But if you do not sign Form I-864, the

intending immigrant may not become a lawful permanent

What If I Choose Not to Sign Form I-864?

If an intending immigrant becomes a lawful permanent resident

in the United States based on a Form I-864 that you have

signed, then, until your obligations under Form I-864 terminate,

necessary to maintain him or her at an income that is

Guidelines for his or her household size (100

percent if you are the petitioning sponsor and are on

active duty in the U.S. Armed Forces or U.S. Coast

unmarried child under 21 years of age); and

NOTE: Read the information on penalties in the Penalties

section of the Form I-864 Instructions before completing this

Sponsor's Contract

Page 8 of 12

Form I 864a Printable Form

If an intending immigrant becomes a lawful permanent resident

in the United States based on a Form I-864 that you have

signed, then, until your obligations under Form I-864 terminate,

the U.S. Government may consider (deem) your income and

assets as available to that person, in determining whether he or

she is eligible for certain Federal means-tested public benefits

and also for state or local means-tested public benefits, if the

state or local government's rules provide for consideration

(deeming) of your income and assets as available to the person.

(USCIS) of any change in your address, within 30

What Other Consequences Are There?

If you do not provide sufficient support to the person who

becomes a lawful permanent resident based on a Form I-864

that you signed, that person may sue you for this support.

If a Federal, state, local, or private agency provided any covered

means-tested public benefit to the person who becomes a lawful

permanent resident based on a Form I-864 that you signed, the

agency may ask you to reimburse them for the amount of the

benefits they provided. If you do not make the reimbursement,

the agency may sue you for the amount that the agency believes

If you are sued, and the court enters a judgment against you, the

person or agency that sued you may use any legally permitted

procedures for enforcing or collecting the judgment. You may

also be required to pay the costs of collection, including

If you do not file a properly completed Form I-865 within 30

days of any change of address, USCIS may impose a civil fine

This provision does not apply to public benefits specified in

section 403(c) of the Welfare Reform Act such as emergency

Medicaid, short-term, non-cash emergency relief; services

provided under the National School Lunch and Child Nutrition

Acts; immunizations and testing and treatment for

communicable diseases; and means-tested programs under the

No longer has lawful permanent resident status and has

Becomes a U.S. citizen;

Has worked, or can receive credit for, 40 quarters of

Your obligations under a Form I-864 that you signed will end if

the person who becomes a lawful permanent resident based on

Is subject to removal, but applies for and obtains, in

removal proceedings, a new grant of adjustment of status,

based on a new affidavit of support, if one is required; or

Download Form I-864a Uscis

NOTE: Divorce does not terminate your obligations under

Your obligations under a Form I-864 that you signed also end if

you die. Therefore, if you die, your estate is not required to

take responsibility for the person's support after your death.

However, your estate may owe any support that you

Sponsor's Statement

1.b.The interpreter named in Part 9. has also read to me

every question and instruction on this affidavit, as

a language in which I am fluent. I understand every

question and instruction on this affidavit as translated

to me by my interpreter, and have provided complete,

true, and correct responses in the language indicated

I can read and understand English, and have read and

understand every question and instruction on this

affidavit, as well as my answer to every question.

NOTE: Select the box for either Item Number 1.a. or 1.b.

Part 8. Sponsor's Contract, Statement, Contact

(continued)

Page 9 of 12

Sponsor's Contact Information

Sponsor's Mobile Telephone Number (if any)

2.I have requested the services of and consented to

representative, preparing this affidavit for me.

who

Copies of any documents I have submitted are exact

photocopies of unaltered, original documents, and I understand

that USCIS or the Department of State may require that I submit

original documents to USCIS or the Department of State at a

later date. Furthermore, I authorize the release of any

information from any and all of my records that USCIS or the

Department of State may need to determine my eligibility for

I furthermore authorize release of information contained in this

affidavit, in supporting documents, and in my USCIS or

Department of State records to other entities and persons where

necessary for the administration and enforcement of U.S.

I certify, under penalty of perjury, that the information in my

affidavit and any document submitted with my affidavit were

provided by me and are complete, true, and correct, and:

I agree to submit to the personal jurisdiction of any

jurisdiction of a lawsuit against me to enforce my

Each of the Federal income tax returns submitted in

support of this affidavit are true copies, or are

unaltered tax transcripts, of the tax returns I filed

F.I authorize the Social Security Administration to

release information about me in its records to the

Sponsor's Signature

Sponsor's Signature6.a.

NOTE TO ALL SPONSORS: If you do not completely fill

out this affidavit or fail to submit required documents listed in

the Instructions, USCIS or the Department of State may deny

I understand that, if I am related to the sponsored

marriage (by divorce, dissolution, annulment, or

obligations under this Form I-864; and

Part 8. Sponsor's Contract, Statement, Contact

(continued)

I have read and I understand each of the obligations

described in Part 8., and I agree, freely and without

accept each of those obligations in order to make it

possible for the immigrants indicated in Part 3. to

States;

I know the contents of this affidavit of support that I

Download Form I-864 Affidavit Of Support

Page 10 of 12

Interpreter's Mailing Address

Download Affidavit Of Support Form I-864a

3.d.State3.e.ZIP Code

3.g.

Street Number

3.a.

3.b.Apt.

Postal Code

4.Interpreter's Daytime Telephone Number

Part 9. Interpreter's Contact Information,

Interpreter's Business or Organization Name (if any)2.

Interpreter's Signature

Interpreter's Signature6.a.

Preparer's Business or Organization Name (if any)2.

1.a. Preparer's Family Name (Last Name)

Part 10. Contact Information, Statement,

Preparing this Affidavit, If Other Than the

Provide the following information about the preparer.

The sponsor has informed me that he or she understands every

instruction and question on the affidavit, as well as the answer

to every question, and the sponsor verified the accuracy of

Interpreter's Certification

I have read to this sponsor every question and instruction on

this affidavit, as well as the answer to every question, in the

language provided in Part 8., Item Number 1.b.; and

which is the same language provided in Part 8., Item Number

I am fluent in English and

Provide the following information about the interpreter.

Interpreter's Full Name

Uscis Form I 864a Pdf

Page 11 of 12

I am not an attorney or accredited representative but

have prepared this affidavit on behalf of the sponsor

7.a.

6.Preparer's Email Address (if any)

4.Preparer's Daytime Telephone Number

Preparer's Mailing Address

3.d.State3.e.ZIP Code

and Name

3.b.Apt.

3.h.

Postal Code 3.g.

Province

8.b.Date of Signature (mm/dd/yyyy)

By my signature, I certify, swear, or affirm, under penalty of

perjury, that I prepared this affidavit on behalf of, at the request

of, and with the express consent of the sponsor. I completed

this affidavit based only on responses the sponsor provided to

me. After completing the affidavit, I reviewed it and all of the

responses with the sponsor, who agreed with every answer on

Download Form I-864a

Download Form I-864a Uscis

the affidavit. If the sponsor supplied additional information

concerning a question on the affidavit, I recorded it on the

Preparer's Signature

I am an attorney or accredited representative and my

7.b.

preparation of this affidavit.

I 864a Pdf 2018

representative whose representation extends beyond

completed Form G-28, Notice of Entry of

Representative, with this affidavit.

Certification, and Signature of the Person

Sponsor (continued)

25 Feb, 2018

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