Form I-864, Affidavit of Support Under INA Instructions
This form contains 260 fields organized into 42 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Additional Information | ||
| Part 11. Additional Information. 3. D. Enter Additional Information | Text |
Enter any additional information that is relevant to the affidavit.
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| Part 11. Additional Information. 6. A. Enter Page Number | Text |
Enter the page number where the additional information is located.
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| Part 11. Additional Information. 6. B. Enter Part Number | Text |
Enter the part number where the additional information is located.
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| Part 11. Additional Information. 6. C. Enter Item Number | Text |
Enter the item number where the additional information is located.
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| Part 11. Additional Information. 6. D. Enter Additional Information | Text |
Provide any additional information that is relevant to the affidavit. Use this space if you need to elaborate on any previous answers.
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| Part 11. Additional Information. 4. D. Enter Additional Information | Text |
Provide any additional information that is relevant to the affidavit. Use this space if you need to elaborate on any previous answers.
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| Part 11. Additional Information. 5. B. Enter Part Number | Text |
Enter the part number from the form that corresponds to the additional information you are providing.
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| Part 11. Additional Information. 5. C. Enter Item Number | Text |
Enter the item number from the form that corresponds to the additional information you are providing.
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| Part 11. Additional Information. 5. D. Enter Additional Information | Text |
Provide any additional information that is relevant to the form and not covered by other fields.
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| Part 11. Additional Information. 7. A. Enter Page Number | Text |
Enter the page number from the form that corresponds to the additional information you are providing.
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| Part 11. Additional Information. 7. B. Enter Part Number | Text |
Enter the part number from the form that corresponds to the additional information you are providing.
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| Part 11. Additional Information. 7. C. Enter Item Number | Text |
Enter the item number from the form that corresponds to the additional information you are providing.
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| Part 11. Additional Information. 7. D. Enter Additional Information | Text |
Provide any additional information that is relevant to the form and not covered by other fields.
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| Assets | ||
| Part 7. Use of Assets to Supplement Income (Optional). If your income, or the total income for you and your household, from Part 6., Item Numbers 20. or 24. A. through 24. C., exceeds the Federal Poverty Guidelines for your household size, YOU ARE NOT REQUIRED to complete this Part 7. Skip to Part 8. Your Assets (Optional). 1. Enter the balance of all savings and checking accounts | Text |
Enter the balance of all your savings and checking accounts. This is optional if your income exceeds the Federal Poverty Guidelines.
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| Part 7. Use of Assets to Supplement Income (Optional). Your Assets (Optional). 2. Enter the net cash value of real-estate holdings. (Net value means current assessed value minus mortgage debt.) | Text |
Enter the net cash value of your real-estate holdings. Net value means current assessed value minus mortgage debt.
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| Part 7. Use of Assets to Supplement Income (Optional). Your Assets (Optional). 4. Add together Item Numbers 1. through 3. and enter the number here. TOTAL | Text |
Add together the amounts from Item Numbers 1 through 3 and enter the total here.
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| Part 7. Use of Assets to Supplement Income (Optional). Assets from Form I - 8 64 A., Part 4., Item Number 3. D., for. 5. A. Enter Name of Relative | Text |
Enter the name of the relative whose assets are being included from Form I-864A, Part 4, Item Number 3D.
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| Part 7. Use of Assets to Supplement Income (Optional). 5. B. Enter Your household member's assets from Form I - 8 64. A. (optional) | Text |
Enter your household member's assets from Form I-864A. This is optional.
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| Part 7. Use of Assets to Supplement Income (Optional). Your Assets (Optional). 3. Enter the net cash value of all stocks, bonds, certificates of deposit, and any other assets not already included in Item Number 1. or Item Number 2 | Text |
Enter the net cash value of all stocks, bonds, certificates of deposit, and any other assets not already included in Item Number 1 or Item Number 2.
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| Part 7. Use of Assets to Supplement Income (Optional). Assets of the principal sponsored immigrant (optional). The principal sponsored immigrant is the person listed in Part 2., Item Numbers 1. A. through 1. C. Only include the assets if the principal immigrant is being sponsored by this affidavit of support. 6. Enter the balance of the sponsored immigrant's savings and checking accounts | Text |
Enter the balance of the sponsored immigrant's savings and checking accounts. This is optional and only if the principal immigrant is being sponsored by this affidavit of support.
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| Attorney or Accredited Representative Information | ||
| To be completed by an attorney or accredited representative (if any). Enter Attorney or State Bar Number (if applicable) | Text |
Enter the attorney or state bar number, if applicable.
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| To be completed by an attorney or accredited representative (if any). Enter Attorney or Accredited Representative Number U S C I S Online Account Number (if any). 12 characters | Text |
Enter the attorney or accredited representative's USCIS Online Account Number, if any. Maximum length is 12 characters.
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| To be completed by an attorney or accredited representative (if any). Select this box if Form G - 28 or Form G - 2 8I is attached | CheckBox |
Select this checkbox if Form G-28 or Form G-28I is attached.
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| Basis for Filing | ||
| Part 1. Basis For Filing Affidavit of Support. 1. C. I have ownership interest of at least 5 percent in (business or organization name will be entered here) which filed an alien worker petition on behalf of the intending immigrant, who is related to me as my (relationship will be entered) | Text |
Enter the name of the business or organization in which you have at least a 5% ownership interest, and which filed an alien worker petition on behalf of the intending immigrant. Also, specify your relationship to the intending immigrant.
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| Part 1. Basis For Filing Affidavit of Support. 1. C. Which filed an alien worker petition on behalf of the intending immigrant, who is related to me as my. Enter how you are related to the immigrant | Text |
Specify your relationship to the intending immigrant for whom the alien worker petition was filed.
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| Part 1. Basis For Filing Affidavit of Support. 1. F. The original petitioner is deceased. I am the substitute sponsor. I am the intending immigrant's. Enter your relationship to the immigrant | Text |
If you are a substitute sponsor because the original petitioner is deceased, specify your relationship to the intending immigrant.
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| Basis For Filing | ||
| Part 1. Basis For Filing Affidavit of Support. Select 1. C. I have an ownership interest of at least 5 percent (Name of business or organization to be entered later) | CheckBox |
Check this box if you have an ownership interest of at least 5 percent in a business or organization.
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| Part 1. Basis For Filing Affidavit of Support. Select 1. D. I am the only joint sponsor | CheckBox |
Check this box if you are the only joint sponsor.
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| Part 1. Basis For Filing Affidavit of Support. Select 1. E. I am the first or second of two joint sponsors | CheckBox |
Check this box if you are the first or second of two joint sponsors.
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| Part 1. Basis For Filing Affidavit of Support. Select 1. F. The original petitioner is deceased. I am the substitute sponsor | CheckBox |
Check this box if the original petitioner is deceased and you are the substitute sponsor.
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| Part 1. Basis For Filing Affidavit of Support. 1. E. Select I am the first of two joint sponsors | CheckBox |
Check this box if you are the first of two joint sponsors.
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| Part 1. Basis For Filing Affidavit of Support. 1. E. Select I am the second of two joint sponsors | CheckBox |
Check this box if you are the second of two joint sponsors.
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| Part 1. Basis For Filing Affidavit of Support. Select 1. B. I filed an alien worker petition on behalf of the intending immigrant, who is related to me as my. Enter relationship | CheckBox |
Check this box if you filed an alien worker petition on behalf of the intending immigrant, who is related to you. Enter the relationship in the provided space.
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| Part 1. Basis For Filing Affidavit of Support. Select 1. A. I am the petitioner. I filed or am filing for the immigration of my relative | CheckBox |
Check this box if you are the petitioner and you filed or are filing for the immigration of your relative.
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| Start Here - Type or print in black ink. Part 1. Basis For Filing Affidavit of Support. I (Enter Your Name) am the sponsor submitting this affidavit of support | Text |
Enter your name as the sponsor submitting this affidavit of support.
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| Part 1. Basis For Filing Affidavit of Support. 1. B. I filed an alien worker petition on behalf of the intending immigrant, who is related to me as my. Enter how you are related to the immigrant | Text |
Enter how you are related to the intending immigrant for whom you filed an alien worker petition.
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| Contact Information | ||
| Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Contact Information. 3. Enter Sponsor's Daytime Telephone Number. Enter 10 digits for number | Text |
Enter the sponsor's daytime telephone number. This should be a 10-digit number.
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| Family Member 1 Information | ||
| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 1. 5. Enter Relationship to Principal Immigrant | Text |
Enter the relationship of Family Member 1 to the principal immigrant (e.g., spouse, child, parent).
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 1. 6. Enter Date of Birth. Enter as 2-digit Month, 2-digit Day and 4-digit Year | Text |
Enter the date of birth of Family Member 1 in the format MM/DD/YYYY.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 1. 8. Enter U S C I S Online Account Number, if any. 12 characters | Text |
Enter the USCIS Online Account Number for Family Member 1, if available. This number should be up to 12 characters long.
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| Family Member 2 Information | ||
| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 2. 9. C. Enter Middle Name | Text |
Enter the middle name of Family Member 2.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 2. 9. B. Enter Given Name (First Name) | Text |
Enter the given name (first name) of Family Member 2.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 2. 9. A. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of Family Member 2. This field can contain up to 30 characters.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 2. 10. Enter Relationship to Principal Immigrant | Text |
Enter the relationship of Family Member 2 to the principal immigrant (e.g., spouse, child, parent).
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 2. 11. Enter Date of Birth. Enter as 2-digit Month, 2-digit Day and 4-digit Year | Text |
Enter the date of birth of Family Member 2 in the format MM/DD/YYYY.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 2. 12. Enter Alien Registration Number (A. Number), if any. 9 digits | Text |
Enter the Alien Registration Number (A-Number) for Family Member 2, if available. This number should be 9 digits long.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 2. 13. Enter U S C I S Online Account Number, if any. 12 characters | Text |
Enter the USCIS Online Account Number for Family Member 2, if available. This number should be up to 12 characters long.
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| Family Member 3 Information | ||
| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 3. 14. A. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of Family Member 3. This field can contain up to 30 characters.
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| Financial Information | ||
| Part 7. Use of Assets to Supplement Income (Optional). 7. Enter the net cash value of all the sponsored immigrant's real estate holdings. (Net value means investment value minus mortgage debt.) | Text |
Enter the net cash value of all the sponsored immigrant's real estate holdings. This is the investment value minus any mortgage debt.
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| Part 7. Use of Assets to Supplement Income (Optional). 8. Enter the current cash value of the principal immigrant's stocks, bonds, certificates of deposit, and other assets not included in Item Number 6. or Item Number 7 | Text |
Enter the current cash value of the principal immigrant's stocks, bonds, certificates of deposit, and other assets not included in previous items.
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| Part 7. Use of Assets to Supplement Income (Optional). 9. Add together Item Numbers 6. through 8. and enter the number here | Text |
Add together the values from Item Numbers 6 through 8 and enter the total here.
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| Part 7. Use of Assets to Supplement Income (Optional). Total Value of Assets. 10. Add together Item Numbers 4., 5. B., and 9. and enter the number here. TOTAL | Text |
Add together the values from Item Numbers 4, 5B, and 9 and enter the total value of assets here.
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| Form Metadata | ||
| PDF417BarCode1 | Text |
This field contains a PDF417 barcode for the form. No input is required.
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| PDF417BarCode1 | Text |
This field contains a barcode that encodes specific information about the form version and type. It is automatically generated and should not be modified.
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| PDF417BarCode1 | Text |
This field contains a barcode for the form I-864, version 12/08/21.
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| PDF417BarCode1 | Text |
This field contains a barcode for the form I-864, version 12/08/21.
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| PDF417BarCode1 | Text |
This field contains a barcode for the form. No input is required.
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| PDF417BarCode1 | Text |
PDF417 Barcode containing form metadata.
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| PDF417BarCode1 | Text |
This field contains the PDF417 barcode information for the form.
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| General Information | ||
| PDF417BarCode1 | Text |
This field contains a barcode that encodes specific information about the form and its version.
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| PDF417BarCode1 | Text |
This field contains a barcode that encodes the form type and version. It is prepopulated and does not require user input.
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| Household Member's Income | ||
| Part 6. Sponsor's Employment and Income. 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 - 8 64 Instructions.) Please indicate name, relationship, and income. Person 1. 8. Enter Name | Text |
Enter the name of the first person whose income you are including in your household size.
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| Part 6. Sponsor's Employment and Income. Person 1. 9. Enter Relationship | Text |
Enter the relationship of the first person whose income you are including in your household size.
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| Part 6. Sponsor's Employment and Income. Person 1. 10. Enter Current Income | Text |
Enter the current income of the first person whose income you are including in your household size.
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| Part 6. Sponsor's Employment and Income. 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. Person 3. 14. Enter Name | Text |
Enter the name of the third person whose income you are including in your household size.
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| Part 6. Sponsor's Employment and Income. Person 2. 13. Enter Current Income | Text |
Enter the current income of the second person whose income you are including in your household size.
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| Part 6. Sponsor's Employment and Income. 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. Person 2. 11. Enter Name | Text |
Enter the name of the second person whose income you are including in your household size.
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| Part 6. Sponsor's Employment and Income. Person 2. 12. Enter Relationship | Text |
Enter the relationship of the second person whose income you are including in your household size.
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| Part 6. Sponsor's Employment and Income. Person 3. 15. Enter Relationship | Text |
Enter the relationship of the third person whose income you are including in your household size.
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| Immigrant Information | ||
| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 4. 23. Enter U S C I S Online Account Number, if any. 12 characters | Text |
Enter the USCIS Online Account Number for Family Member 4, if they have one. This number can be up to 12 characters long.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 5. 24. B. Enter Given Name (First Name) | Text |
Enter the given name (first name) of Family Member 5.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 5. 24. A. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of Family Member 5. This name can be up to 30 characters long.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 5. 24. C. Enter Middle Name | Text |
Enter the middle name of Family Member 5.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 5. 25. Enter Relationship to Principal Immigrant | Text |
Enter the relationship of Family Member 5 to the principal immigrant.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 5. 27. Enter Alien Registration Number (A. Number), if any. 9 digits | Text |
Enter the Alien Registration Number (A-Number) for Family Member 5, if they have one. This number can be up to 9 digits long.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 5. 26. Enter Date of Birth. Enter as 2-digit Month, 2-digit Day and 4- digit Year | Text |
Enter the date of birth for Family Member 5 in the format MM/DD/YYYY.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 3. 17. Enter your Alien Registration Number or A. Number, if any. 9 digits | Text |
Enter the Alien Registration Number (A-Number) for Family Member 3, if they have one. This number can be up to 9 digits long.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 5. 28. Enter U S C I S Online Account Number, if any. 12 characters | Text |
Enter the USCIS Online Account Number for Family Member 5, if they have one. This number can be up to 12 characters long.
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| Part 3. Information About the Immigrants You Are Sponsoring. 29. Enter the total number of immigrants you are sponsoring on this affidavit which includes the principal immigrant listed in Part 2., any immigrants listed in Part 3., Item Numbers 1. - 28. and (if applicable), any immigrants listed for these questions in Part 11. Additional Information. Do not count the principal immigrant if you are only sponsoring family members entering more than 6 months after the principal immigrant | Text |
Enter the total number of immigrants you are sponsoring on this affidavit. This includes the principal immigrant listed in Part 2, any immigrants listed in Part 3, and any additional immigrants listed in Part 11. Do not count the principal immigrant if you are only sponsoring family members entering more than 6 months after the principal immigrant.
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| Income | ||
| Part 6. Sponsor's Employment and Income. 20. Enter Your Current Annual Household Income (Total all lines from Part 6., Item Numbers 7., 10., 13., 16., and 19.; the total will be compared to Federal Poverty Guidelines on Form I - 8 64 P.) | Text |
Enter your current annual household income. Total all lines from Part 6, Item Numbers 7, 10, 13, 16, and 19. This total will be compared to the Federal Poverty Guidelines on Form I-864P.
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| Part 6. Sponsor's Employment and Income. 21. Select The people listed in Item Numbers 8., 11., 14., and 17. have completed Form I - 8 64 A. I am filing along with this affidavit all necessary Form I - 8 64 A's completed by these people | CheckBox |
Select this checkbox if the people listed in Item Numbers 8, 11, 14, and 17 have completed Form I-864A and you are filing all necessary Form I-864A's along with this affidavit.
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| Information About the Immigrants You Are Sponsoring | ||
| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 3. 14. B. Enter Given Name (First Name) | Text |
Enter the given name (first name) of Family Member 3 you are sponsoring.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 3. 14. C. Enter Middle Name | Text |
Enter the middle name of Family Member 3 you are sponsoring.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 3. 15. Enter Relationship to Principal Immigrant | Text |
Enter the relationship of Family Member 3 to the principal immigrant.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 3. 16. Enter Date of Birth. Enter as 2-digit Month, 2-digit Day and 4- digit Year | Text |
Enter the date of birth of Family Member 3 in the format MM/DD/YYYY.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 3. 18. Enter U S C I S Online Account Number, if any. 12 characters | Text |
Enter the USCIS Online Account Number of Family Member 3, if any. The number should be up to 12 characters long.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 4. 19. C. Enter Middle Name | Text |
Enter the middle name of Family Member 4 you are sponsoring.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 4. 19. B. Enter Given Name (First Name) | Text |
Enter the given name (first name) of Family Member 4 you are sponsoring.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 4. 19. A. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of Family Member 4 you are sponsoring. The name should be up to 30 characters long.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 4. 20. Enter Relationship to Principal Immigrant | Text |
Enter the relationship of Family Member 4 to the principal immigrant.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 4. 22. Enter Alien Registration Number (A. Number), if any. 9 digits | Text |
Enter the Alien Registration Number (A-Number) of Family Member 4, if any. The number should be 9 digits long.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 4. 21. Enter Date of Birth. Enter as 2-digit Month, 2-digit Day and 4- digit Year | Text |
Enter the date of birth of Family Member 4 in the format MM/DD/YYYY.
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| Internal Use | ||
| PDF417BarCode1 | Text |
This is a barcode field for internal use by the U.S. Citizenship and Immigration Services.
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| Interpreter's Contact Information | ||
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. E. Enter Zip Code | Text |
Enter the ZIP code of the interpreter's mailing address. This should be a 5-digit number.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. D. Select State from List of States | ComboBox |
Select the state from the provided list where the interpreter's mailing address is located.
MP
CA
WI
UT
GA
VT
WY
GU
OR
PW
RI
SC
IN
MT
IL
ME
LA
DE
OK
NH
AR
DC
WA
IA
MH
AP
VI
SD
FM
OH
PA
CT
AZ
ND
ID
CO
KY
MN
TX
MO
FL
MA
MI
MS
HI
NC
AK
TN
WV
AA
NV
MD
NY
PR
NM
VA
AE
NE
AL
KS
AS
NJ
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. H. Enter Country | Text |
Enter the country of the interpreter's mailing address.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. G. Enter Postal Code | Text |
Enter the postal code of the interpreter's mailing address. This can be up to 9 digits.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 6. Enter Interpreter's Email Address, if any | Text |
Enter the interpreter's email address, if available. This can be up to 38 characters long.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 4. Enter Interpreter's Daytime Telephone Number. Enter 10 digit number | Text |
Enter the interpreter's daytime telephone number. This should be a 10-digit number.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 5. Enter Interpreter's Mobile Telephone Number, if any. Enter 10 digit number | Text |
Enter the interpreter's mobile telephone number, if available. This should be a 10-digit number.
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| Interpreter's Information | ||
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Certification. I certify that I am fluent in English and (enter language), which is the same language provided in Part 8., Item Number 1. B. and I have read to this sponsor in the identified language every question and instruction on this affidavit and his or her answer to every question. The sponsor informed me that he or she understands every instruction, question, and answer on the affidavit, including the Sponsor's Declaration and Certification, and has verified the accuracy of every answer. Enter Language | Text |
Enter the language in which the interpreter is fluent, which is the same language provided in Part 8, Item Number 1.B.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 1. B. Enter Interpreter's Given Name (First Name) | Text |
Enter the given name (first name) of the interpreter.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Provide the following information about the interpreter. Interpreter's Full Name. 1. A. Enter Interpreter's Family Name (Last Name) | Text |
Enter the family name (last name) of the interpreter.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Signature. 7. B. Enter Date of Signature. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of the interpreter's signature in the format MM/DD/YYYY.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Signature. 7. A. Interpreter's Signature. This form can not be signed electronically. The name of the applicant can not be typewritten into this space | Text |
Interpreter's Signature. This form cannot be signed electronically. The name of the applicant cannot be typewritten into this space.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. 2. Enter Interpreter's Business or Organization Name, if any | Text |
Enter the business or organization name of the interpreter, if any.
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| Interpreter's Mailing Address | ||
| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. C. Enter City or Town | Text |
Enter the city or town of the interpreter's mailing address. The city or town name can be up to 20 characters long.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. A. Enter Street Number and Name | Text |
Enter the street number and name of the interpreter's mailing address. The street number and name can be up to 25 characters long.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. B. Select designated Floor | CheckBox |
Select this checkbox if the interpreter's mailing address includes a designated floor.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. B. Select Suite | CheckBox |
Select this checkbox if the interpreter's mailing address includes a suite.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. B. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the interpreter's mailing address. The number can be up to 6 characters long.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. B. Select Apartment | CheckBox |
Select this checkbox if the interpreter's mailing address includes an apartment.
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| Part 9. Interpreter's Contact Information, Certification, and Signature. Interpreter's Mailing Address. 3. F. Enter Province | Text |
Enter the province of the interpreter's mailing address. The province name can be up to 20 characters long.
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| Other Information | ||
| Part 4. Information About You (Sponsor). Other Information. 6. Enter Date of Birth. Enter as 2-digit Month, 2-digit Day and 4-digit Year | Text |
Enter the sponsor's date of birth in the format MM/DD/YYYY.
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| Part 4. Information About You (Sponsor). Other Information. 5. Enter Country of Domicile | Text |
Enter the country where the sponsor is currently domiciled.
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| Part 4. Information About You (Sponsor). Other Information. 7. Enter City or Town of Birth | Text |
Enter the city or town where the sponsor was born. Maximum length is 20 characters.
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| Personal Information | ||
| Part 11. Additional Information. If you need extra space to provide any additional information within this affidavit, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this affidavit or attach a separate sheet of paper. Type or print your name and. A. -Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 1. A. Enter Family Name (Last Name) | Text |
Enter your family name (last name) as it appears on official documents.
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| Part 11. Additional Information. 1. B. Enter Given Name (First Name) | Text |
Enter your given name (first name) as it appears on official documents.
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| Part 11. Additional Information. 1. C. Enter Middle Name | Text |
Enter your middle name as it appears on official documents.
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| Part 11. Additional Information. 2. Enter Alien Registration Number. (A. Number), if any. 9 digits | Text |
Enter your Alien Registration Number (A-Number), if you have one. This number is 9 digits long.
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| Preparer's Contact Information | ||
| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Contact Information. 6. Enter Preparer's Email Address, if any | Text |
Enter the email address of the person who prepared this affidavit, if available.
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Contact Information. 4. Enter Preparer's Daytime Telephone Number. Enter 10 digit number | Text |
Enter the daytime telephone number of the person who prepared this affidavit. The number should be 10 digits long.
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Contact Information. 5. Enter Preparer's Mobile Telephone Number (if any). Enter 10 digit number | Text |
Enter the mobile telephone number of the person who prepared this affidavit, if available. The number should be 10 digits long.
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| Preparer's Information | ||
| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor. 2. Enter Preparer's Business or Organization Name, if any | Text |
Enter the business or organization name of the person preparing this affidavit, if other than the sponsor.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor. Provide the following information about the preparer. Preparer's Full Name. 1. A. Enter Preparer's Family Name (Last Name) | Text |
Enter the last name (family name) of the person who prepared this affidavit, if it is someone other than the sponsor.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor. Preparer's Full Name. 1. B. Enter Preparer's Given Name (First Name) | Text |
Enter the first name (given name) of the person who prepared this affidavit, if it is someone other than the sponsor.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor. Preparer's Statement. Select 7. B. Select I am an attorney or accredited representative and my representation of the sponsor in this case extends or does not extend beyond the preparation of this affidavit. NOTE: If you are an attorney or accredited representative, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, or G-28I, Notice of Entry of Appearance as Attorney In Matters Outside the Geographical Confines of the United States, with this affidavit | CheckBox |
Select this checkbox if you are an attorney or accredited representative and your representation of the sponsor in this case extends or does not extend beyond the preparation of this affidavit. Note: You may need to submit Form G-28 or G-28I with this affidavit.
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Statement. 7. B. Select I am an attorney or accredited representative and my representation of the sponsor in this case extends beyond the preparation of this affidavit | CheckBox |
Select this checkbox if you are an attorney or accredited representative and your representation of the sponsor in this case extends beyond the preparation of this affidavit.
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Statement. 7. B. Select for I am an attorney or accredited representative and my representation of the sponsor in this case does not extend beyond the preparation of this affidavit | CheckBox |
Select this checkbox if you are an attorney or accredited representative and your representation of the sponsor in this case does not extend beyond the preparation of this affidavit.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor. Preparer's Signature. 8. A. Preparer's Signature. This form can not be signed electronically. The name of the applicant can not be typewritten into this space | Text |
Provide the signature of the person preparing this affidavit, if other than the sponsor. Note: This form cannot be signed electronically, and the name cannot be typewritten into this space.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor. Preparer's Signature. 8. B. Enter Date of Signature. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of the preparer's signature in the format MM/DD/YYYY.
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| Preparer's Mailing Address | ||
| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Mailing Address. 3. C. Enter City or Town | Text |
Enter the city or town of the mailing address of the person who prepared this affidavit.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor. Preparer's Mailing Address. 3. A. Enter Street Number and Name | Text |
Enter the street number and name of the mailing address of the person who prepared this affidavit.
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Mailing Address. 3. B. Select designated Floor | CheckBox |
Select this checkbox if the mailing address of the person who prepared this affidavit includes a designated floor.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor. Preparer's Mailing Address. 3. B. Select Suite | CheckBox |
Select this checkbox if the mailing address of the person who prepared this affidavit includes a suite.
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Mailing Address. 3. B. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the preparer's mailing address.
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| Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the Sponsor. Preparer's Mailing Address. 3. B. Select Apartment | CheckBox |
Select this checkbox if the preparer's mailing address includes an apartment.
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Mailing Address. 3. E. Enter Zip Code | Text |
Enter the ZIP code of the preparer's mailing address.
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Mailing Address. 3. D. Select State from List of States | ComboBox |
Select the state from the list of states for the preparer's mailing address.
MP
CA
WI
UT
GA
VT
WY
GU
OR
PW
RI
SC
IN
MT
IL
ME
LA
DE
OK
NH
AR
DC
WA
IA
MH
AP
VI
SD
FM
OH
PA
CT
AZ
ND
ID
CO
KY
MN
TX
MO
FL
MA
MI
MS
HI
NC
AK
TN
WV
AA
NV
MD
NY
PR
NM
VA
AE
NE
AL
KS
AS
NJ
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Mailing Address. 3. G. Enter Postal Code | Text |
Enter the postal code of the preparer's mailing address.
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Mailing Address. 3. H. Enter Country | Text |
Enter the country of the preparer's mailing address.
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| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Mailing Address. 3. F. Enter Province | Text |
Enter the province of the preparer's mailing address.
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| Preparer's Statement | ||
| Part 10. Contact Information, Declaration, Statement, Certification, and Signature of the Person Preparing this Affidavit, If Other Than the Sponsor. Preparer's Statement. Select 7. A. Select I am not an attorney or accredited representative but have prepared this affidavit on behalf of the sponsor and with the sponsor's consent | CheckBox |
Select this checkbox if you are not an attorney or accredited representative but have prepared this affidavit on behalf of the sponsor and with the sponsor's consent.
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| Principal Immigrant Information | ||
| Part 2. Information About the Principal Immigrant. Mailing Address. 2. D. Enter City or Town | Text |
Enter the city or town of the principal immigrant's mailing address.
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. B. Enter Street Number and Name | Text |
Enter the street number and name of the principal immigrant's mailing address.
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. C. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the principal immigrant's mailing address.
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. H. Enter Postal Code | Text |
Enter the postal code of the principal immigrant's mailing address.
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. F. Enter Zip Code | Text |
Enter the zip code of the principal immigrant's mailing address.
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. E. Select State from List of states | ComboBox |
Select the state from the provided list for the principal immigrant's mailing address.
MP
CA
WI
UT
GA
VT
WY
GU
OR
PW
RI
SC
IN
MT
IL
ME
LA
DE
OK
NH
AR
DC
WA
IA
MH
AP
VI
SD
FM
OH
PA
CT
AZ
ND
ID
CO
KY
MN
TX
MO
FL
MA
MI
MS
HI
NC
AK
TN
WV
AA
NV
MD
NY
PR
NM
VA
AE
NE
AL
KS
AS
NJ
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. I. Enter Country | Text |
Enter the country of the principal immigrant's mailing address.
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. G. Enter Province | Text |
Enter the province of the principal immigrant's mailing address. Maximum length is 20 characters.
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. C. Select Apartment | CheckBox |
Select this checkbox if the principal immigrant's mailing address includes an apartment.
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. C. Select Suite | CheckBox |
Select this checkbox if the principal immigrant's mailing address includes a suite.
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. C. Select Designated Floor | CheckBox |
Select this checkbox if the principal immigrant's mailing address includes a designated floor.
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| Part 2. Information About the Principal Immigrant. Mailing Address. 2. A. Enter In Care Of Name | Text |
Enter the name of the person in care of the principal immigrant's mailing address. Maximum length is 34 characters.
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| Part 2. Information About the Principal Immigrant. 1. B. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the principal immigrant.
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| Part 2. Information About the Principal Immigrant. 1. C. Enter Middle Name | Text |
Enter the middle name of the principal immigrant.
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| Part 2. Information About the Principal Immigrant. 1. A. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the principal immigrant. Maximum length is 30 characters.
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| Part 2. Information About the Principal Immigrant. Other Information. 5. Enter your Alien Registration Number. A. Number, if any. 9 digits | Text |
Enter the Alien Registration Number (A-Number) of the principal immigrant, if any. This number should be 9 digits long.
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| Part 2. Information About the Principal Immigrant. Other Information. 6. Enter U S C I S Online Account Number, if any. 12 characters | Text |
Enter the U.S. Citizenship and Immigration Services (USCIS) Online Account Number of the principal immigrant, if available. This number can be up to 12 characters long.
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| Part 2. Information About the Principal Immigrant. Other Information. 4. Enter Date of Birth. Enter as 2-digit Month, 2-digit Day and 4-digit Year | Text |
Enter the date of birth of the principal immigrant in the format MM/DD/YYYY.
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| Part 2. Information About the Principal Immigrant. Other Information. 3. Enter Country of Citizenship or Nationality | Text |
Enter the country of citizenship or nationality of the principal immigrant.
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| Part 2. Information About the Principal Immigrant. Other Information. 7. Enter Daytime Telephone Number. Enter 10 digits for number | Text |
Enter the daytime telephone number of the principal immigrant. The number should be exactly 10 digits long.
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| Part 2. Information About the Principal Immigrant. Other Information. 7. Enter your Alien Registration Number. A. Number, if any. 9 digits | Text |
Enter the Alien Registration Number (A-Number) for the principal immigrant, if they have one. This number can be up to 9 digits long.
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| Reference Information | ||
| Part 11. Additional Information. 3. A. Enter Page Number | Text |
Enter the page number of the form where the additional information is referenced.
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| Part 11. Additional Information. 3. B. Enter Part Number | Text |
Enter the part number of the form where the additional information is referenced.
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| Part 11. Additional Information. 3. C. Enter Item Number | Text |
Enter the item number of the form where the additional information is referenced.
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| Part 11. Additional Information. 4. A. Enter Page Number | Text |
Enter the page number of the form where the additional information is referenced.
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| Part 11. Additional Information. 4. B. Enter Part Number | Text |
Enter the part number of the form where the additional information is referenced.
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| Part 11. Additional Information. 4. C. Enter Item Number | Text |
Enter the item number of the form where the additional information is referenced.
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| Part 11. Additional Information. 5. A. Enter Page Number | Text |
Enter the page number of the form where the additional information is referenced.
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| Sponsor Citizenship or Residency | ||
| Part 4. Information About You (Sponsor). Other Information. Citizenship or Residency. 11. B. Select I am a U.S. national | CheckBox |
Select this checkbox if the sponsor is a U.S. national. This is part of the sponsor's citizenship or residency information.
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| Part 4. Information About You (Sponsor). Other Information. Citizenship or Residency. 11. A. Select I am a U.S. citizen | CheckBox |
Select this checkbox if the sponsor is a U.S. citizen. This is part of the sponsor's citizenship or residency information.
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| Part 4. Information About You (Sponsor). Other Information. Citizenship or Residency. 11. C. Select I am a lawful permanent resident | CheckBox |
Select this checkbox if the sponsor is a lawful permanent resident. This is part of the sponsor's citizenship or residency information.
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| Part 4. Information About You (Sponsor). Other Information. Citizenship or Residency. 12. Enter Sponsor's. A. Number, if any. 9 digits | Text |
Enter the sponsor's Alien Registration Number (A-Number), if any. This number is 9 digits long and is used to identify the sponsor's immigration status.
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| Part 4. Information About You (Sponsor). Other Information. Citizenship or Residency. 13. Enter Sponsor's U S C I S Online Account Number, if any. 12 characters | Text |
Enter the sponsor's USCIS Online Account Number, if any. This number is 12 characters long and is used for online account identification.
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| Part 4. Information About You (Sponsor). Other Information. Citizenship or Residency. Military Service (To be completed by petitioner sponsors only.) 14. Select No | CheckBox |
Select this checkbox if the sponsor is not currently on active duty in the U.S. Armed Forces or U.S. Coast Guard. This is to be completed by petitioner sponsors only.
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| Part 4. Information About You (Sponsor). Other Information. Citizenship or Residency. Military Service (To be completed by petitioner sponsors only.) 14. I am currently on active duty in the U.S. Armed Forces or U.S. Coast Guard. Select Yes | CheckBox |
Select this checkbox if the sponsor is currently on active duty in the U.S. Armed Forces or U.S. Coast Guard. This is to be completed by petitioner sponsors only.
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| Sponsor Information | ||
| Part 4. Information About You (Sponsor). Sponsor's Full Name. 1. C. Enter Middle Name | Text |
Enter the middle name of the sponsor. If the sponsor does not have a middle name, leave this field blank.
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| Part 4. Information About You (Sponsor). Sponsor's Full Name. 1. B. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the sponsor.
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| Part 4. Information About You (Sponsor). Sponsor's Full Name. 1. A. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the sponsor. The maximum length for this field is 30 characters.
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| Part 4. Information About You (Sponsor). Other Information. 8. Enter State or Province of Birth | Text |
Enter the state or province where the sponsor was born. This information is required to identify the sponsor's place of birth.
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| Part 4. Information About You (Sponsor). Other Information. 9. Enter Country of Birth | Text |
Enter the country where the sponsor was born. This information is required to identify the sponsor's place of birth.
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| Part 4. Information About You (Sponsor). Other Information. 10. Enter U.S. Social Security Number (Required). 9 digits | Text |
Enter the sponsor's U.S. Social Security Number. This number is required and must be 9 digits long.
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| Sponsor Mailing Address | ||
| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. D. Enter City or Town | Text |
Enter the city or town of the sponsor's mailing address. The maximum length for this field is 20 characters.
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| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. B. Enter Street Number and Name | Text |
Enter the street number and name of the sponsor's mailing address. The maximum length for this field is 25 characters.
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| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. C. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the sponsor's mailing address. The maximum length for this field is 6 characters.
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| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. H. Enter Postal Code | Text |
Enter the postal code of the sponsor's mailing address. The maximum length for this field is 9 characters.
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| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. F. Enter Zip Code | Text |
Enter the zip code of the sponsor's mailing address. The maximum length for this field is 5 characters.
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| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. E. Select State from List of States | ComboBox |
Select the state from the provided list of states for the sponsor's mailing address.
MP
CA
WI
UT
GA
VT
WY
GU
OR
PW
RI
SC
IN
MT
IL
ME
LA
DE
OK
NH
AR
DC
WA
IA
MH
AP
VI
SD
FM
OH
PA
CT
AZ
ND
ID
CO
KY
MN
TX
MO
FL
MA
MI
MS
HI
NC
AK
TN
WV
AA
NV
MD
NY
PR
NM
VA
AE
NE
AL
KS
AS
NJ
|
| Sponsor's Contact Information | ||
| Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Contact Information. 4. Enter Sponsor's Mobile Telephone Number, if any. Enter 10 digits for number | Text |
Enter the sponsor's mobile telephone number. Ensure it is a 10-digit number.
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| Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Contact Information. 5. Enter Sponsor's Email Address, if any | Text |
Enter the sponsor's email address, if available. The email address can be up to 38 characters long.
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| Sponsor's Employment and Income | ||
| Part 6. Sponsor's Employment and Income. 2. Enter Name of Employer 1 | Text |
Enter the name of your first employer. Maximum length is 34 characters.
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| Part 6. Sponsor's Employment and Income. I am currently. 1. Enter what your are employed as | Text |
Enter your current job title or occupation.
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| Part 6. Sponsor's Employment and Income. 3. Enter Name of Employer 2 (if applicable) | Text |
Enter the name of your second employer, if you have one.
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| Part 6. Sponsor's Employment and Income. I am currently. 4. Self Employed. Enter Occupation | Text |
If you are self-employed, enter your occupation.
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| Part 6. Sponsor's Employment and Income. 7. My current individual annual income is. Enter your current individual annual income | Text |
Enter your current individual annual income.
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| Part 6. Sponsor's Employment and Income. 6. Enter Unemployed Since Date. Enter as 2-digit Month, 2-digit Day and 4-digit Year | Text |
Enter the date you became unemployed in the format MM/DD/YYYY.
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| Part 6. Sponsor's Employment and Income. Person 3. 16. Enter Current Income | Text |
Enter the current income of Person 3 as part of the sponsor's employment and income details.
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| Part 6. Sponsor's Employment and Income. 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. Person 4. 17. Enter Name | Text |
Enter the name of Person 4, whose income is being used and who is counted in the household size. Include their relationship and income.
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| Part 6. Sponsor's Employment and Income. Person 4. 18. Enter Relationship | Text |
Enter the relationship of Person 4 to the sponsor.
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| Part 6. Sponsor's Employment and Income. Person 4. 19. Enter Current Income | Text |
Enter the current income of Person 4 as part of the sponsor's employment and income details.
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| Part 6. Sponsor's Employment and Income. 5. Enter Retired Since Date. Enter as 2-digit Month, 2-digit Day and 4-digit Year | Text |
Enter the date since the sponsor has been retired. Use the format MM/DD/YYYY.
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| Part 6. Sponsor's Employment and Income. I am currently. 1. Select Employed | CheckBox |
Select this checkbox if the sponsor is currently employed.
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| Part 6. Sponsor's Employment and Income. I am currently. 4. Select Self-Employed | CheckBox |
Select this checkbox if the sponsor is currently self-employed.
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| Part 6. Sponsor's Employment and Income. I am currently. 5. Select Retired | CheckBox |
Select this checkbox if the sponsor is currently retired.
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| Part 6. Sponsor's Employment and Income. I am currently. 6. Select Unemployed | CheckBox |
Select this checkbox if the sponsor is currently unemployed.
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| Part 6. Sponsor's Employment and Income. 22. Enter Name of intending immigrant who has no accompanying dependents | Text |
Enter the name of the intending immigrant who has no accompanying dependents.
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| Part 6. Sponsor's Employment and Income. Select 22. One or more of the people listed in Item Numbers 8., 11., 14., and 17. do not need to complete Form I - 8 64. A. because he or she is the intending immigrant and has no accompanying dependents | CheckBox |
Select this checkbox if one or more of the people listed in Item Numbers 8, 11, 14, and 17 do not need to complete Form I-864 because they are the intending immigrant and have no accompanying dependents.
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| Part 6. Sponsor's Employment and Income. Federal Income Tax Return Information. 25. Select I was not required to file a Federal income tax return as my income was below the I R S required level and I have attached evidence to support this | CheckBox |
Select this checkbox if you were not required to file a Federal income tax return because your income was below the IRS required level. You must attach evidence to support this claim.
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| Part 6. Sponsor's Employment and Income. Federal Income Tax Return Information. 23. A. Select No | CheckBox |
Select this checkbox if you did not file a Federal income tax return for each of the three most recent tax years.
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| Part 6. Sponsor's Employment and Income. Federal Income Tax Return Information. 23. A. Have you filed a Federal income tax return for each of the three most recent tax years? Select Yes. NOTE: You MUST attach a photocopy or transcript of your Federal income tax return for only the most recent tax year | CheckBox |
Select this checkbox if you have filed a Federal income tax return for each of the three most recent tax years. You must attach a photocopy or transcript of your Federal income tax return for the most recent tax year.
|
| Part 6. Sponsor's Employment and Income. Federal Income Tax Return Information. My total income (adjusted gross income on Internal Revenue Service (I R S) Form 10 40 E Z) as reported on my Federal income tax returns for the most recent three years was. 24. A. Enter Most Recent Tax Year | Text |
Enter the most recent tax year for which you filed a Federal income tax return.
|
| Part 6. Sponsor's Employment and Income. Federal Income Tax Return Information. 24. C. Enter Third Most Recent Tax Year | Text |
Enter the third most recent tax year for which you filed a Federal income tax return.
|
| Part 6. Sponsor's Employment and Income. Federal Income Tax Return Information. 24. C. Enter Third Most Recent Total Income | Text |
Enter the total income (adjusted gross income) as reported on your Federal income tax return for the third most recent tax year.
|
| Part 6. Sponsor's Employment and Income. Federal Income Tax Return Information. 24. B. Enter Second Most Recent Total Income | Text |
Enter the total income (adjusted gross income) as reported on your Federal income tax return for the second most recent tax year.
|
| Part 6. Sponsor's Employment and Income. Federal Income Tax Return Information. 24. B. Enter Second Most Recent Tax Year | Text |
Enter the second most recent tax year for which you filed a Federal income tax return.
|
| Part 6. Sponsor's Employment and Income. Federal Income Tax Return Information. 24. A. Enter Most Recent Total Income | Text |
Enter the total income (adjusted gross income) as reported on your Federal income tax return for the most recent tax year.
|
| Part 6. Sponsor's Employment and Income. Federal Income Tax Return Information. 23. B. Select (Optional) I have attached photocopies or transcripts of my Federal income tax returns for my second and third most recent tax years | CheckBox |
Select this checkbox if you have attached photocopies or transcripts of your Federal income tax returns for your second and third most recent tax years. This is optional.
|
| Sponsor's Household Size | ||
| Part 5. Sponsor's Household Size. NOTE: Do not count any member of your household more than once. Persons you are sponsoring in this affidavit. No Entry. 1. The number you entered in Part 3., Item Number 28 is prepopulated here | Text |
This field is prepopulated with the number of persons you are sponsoring as entered in Part 3, Item Number 28.
|
| Part 5. Sponsor's Household Size. Persons NOT sponsored in this affidavit. 2. Yourself. The number one is entered in this space for you | Text |
This field is prepopulated with the number '1' to represent yourself.
|
| Part 5. Sponsor's Household Size. Persons NOT sponsored in this affidavit. 3. If you are currently married, enter the number 1 for your spouse | Text |
Enter '1' if you are currently married to include your spouse in the household size.
|
| Part 5. Sponsor's Household Size. Persons NOT sponsored in this affidavit. 4. If you have dependent children, enter the number here | Text |
Enter the number of dependent children you have.
|
| Part 5. Sponsor's Household Size. Persons NOT sponsored in this affidavit. 5. If you have any other dependents, enter the number here | Text |
Enter the number of other dependents you have.
|
| Part 5. Sponsor's Household Size. Persons NOT sponsored in this affidavit. 6. If you have sponsored any other persons on Form I - 8 64 or Form I - 8 64 E Z who are now lawful permanent residents, enter the number here | Text |
Enter the number of persons you have previously sponsored on Form I-864 or Form I-864EZ who are now lawful permanent residents.
|
| Part 5. Sponsor's Household Size. Persons NOT sponsored in this affidavit. 7. OPTIONAL: If you have siblings, parents, or adult children with the same principal residence who are combining their income with yours by submitting Form I - 8 64. A., enter the number here | Text |
OPTIONAL: Enter the number of siblings, parents, or adult children with the same principal residence who are combining their income with yours by submitting Form I-864A.
|
| Part 5. Sponsor's Household Size. Persons NOT sponsored in this affidavit. 8. Add together Part 5., Item Numbers 1. through 7. and enter the number here. Household Size | Text |
Add together the numbers from Part 5, Item Numbers 1 through 7, and enter the total household size here.
|
| Sponsor's Information | ||
| Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Signature. 6. A. Sponsor's Signature. This form can not be signed electronically. The name of the applicant can not be typewritten into this space. NOTE TO ALL SPONSORS: If you do not completely fill out this affidavit or fail to submit required documents listed in the Instructions, U S C I S or D O S may deny your affidavit | Text |
Sponsor's Signature. This form cannot be signed electronically. The name of the applicant cannot be typewritten into this space.
|
| Sponsor's Mailing Address | ||
| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. I. Enter Country | Text |
Enter the country of the sponsor's mailing address.
|
| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. G. Enter Province | Text |
Enter the province of the sponsor's mailing address. Maximum length is 20 characters.
|
| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. C. Select Apartment | CheckBox |
Select this checkbox if the sponsor's mailing address includes an apartment.
|
| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. C. Select Suite | CheckBox |
Select this checkbox if the sponsor's mailing address includes a suite.
|
| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. C. Select designated Floor | CheckBox |
Select this checkbox if the sponsor's mailing address includes a designated floor.
|
| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 2. A. Enter In Care Of Name | Text |
Enter the name of the person in care of the sponsor's mailing address. Maximum length is 34 characters.
|
| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 3. Select No. If you answered "No" to Item Number 3., provide your physical address in Item Numbers 4. A. - 4. H | CheckBox |
Select this checkbox if the sponsor's current mailing address is not the same as their physical address.
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| Part 4. Information About You (Sponsor). Sponsor's Mailing Address. 3. Is your current mailing address the same as your physical address? Select Yes | CheckBox |
Select this checkbox if the sponsor's current mailing address is the same as their physical address.
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| Sponsor's Physical Address | ||
| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. C. Enter City or Town | Text |
Enter the city or town of the sponsor's physical address. Maximum length is 20 characters.
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| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. A. Enter Street Number and Name | Text |
Enter the street number and name of the sponsor's physical address.
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| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. B. Enter Apartment, Suite or Floor Number | Text |
Enter the apartment, suite, or floor number of the sponsor's physical address. Maximum length is 6 characters.
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| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. G. Enter Postal Code | Text |
Enter the postal code of the sponsor's physical address. Maximum length is 9 characters.
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| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. E. Enter Zip Code | Text |
Enter the 5-digit zip code of the sponsor's physical address.
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| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. D. Select State from List of States | ComboBox |
Select the state from the provided list where the sponsor's physical address is located.
MP
CA
WI
UT
GA
VT
WY
GU
OR
PW
RI
SC
IN
MT
IL
ME
LA
DE
OK
NH
AR
DC
WA
IA
MH
AP
VI
SD
FM
OH
PA
CT
AZ
ND
ID
CO
KY
MN
TX
MO
FL
MA
MI
MS
HI
NC
AK
TN
WV
AA
NV
MD
NY
PR
NM
VA
AE
NE
AL
KS
AS
NJ
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| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. H. Enter Country | Text |
Enter the country of the sponsor's physical address.
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| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. F. Enter Province | Text |
Enter the province of the sponsor's physical address, if applicable. Maximum length is 20 characters.
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| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. B. Select Apartment | CheckBox |
Select this checkbox if the sponsor's physical address includes an apartment.
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| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. B. Select Suite | CheckBox |
Select this checkbox if the sponsor's physical address includes a suite.
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| Part 4. Information About You (Sponsor). Sponsor's Physical Address. 4. B. Select designated Floor | CheckBox |
Select this checkbox if the sponsor's physical address includes a designated floor.
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| Sponsor's Signature | ||
| Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Signature. 6. B. Enter Date of Signature. Enter as 2-digit Month, 2-digit Day, and 4-digit Year | Text |
Enter the date of the sponsor's signature in the format MM/DD/YYYY.
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| Sponsor's Statement | ||
| Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Statement. 1. B. Select The interpreter named in Part 9. read to me every question and instruction on this affidavit and my answer to every question, in a language in which I am fluent and I understood everything | CheckBox |
Select this checkbox if the interpreter named in Part 9 read every question and instruction on this affidavit to you in a language you are fluent in, and you understood everything.
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| Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Statement. 1. B. Enter language in which I am fluent and understood everything | Text |
Enter the language in which you are fluent and understood everything read by the interpreter named in Part 9.
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| Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Statement. 2. Select At my request, the preparer named in Part 10., prepared this affidavit for me based only upon information I provided or authorized | CheckBox |
Select this checkbox if the preparer named in Part 10 prepared this affidavit for you based only on information you provided or authorized.
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| Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Statement. 2. Enter Name of Preparer | Text |
Enter the name of the preparer who prepared this affidavit for you.
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| Part 8. Sponsor's Contract, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Statement. NOTE: Select the box for either Item Number 1. A. or 1. B. If applicable, select the box for Item Number 2. 1. A. Select 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 | CheckBox |
Select this checkbox if the sponsor can read and understand English and has read and understood every question and instruction on the affidavit.
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| Sponsored Family Member Information | ||
| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 1. 4. A. Enter Family Name (Last Name) | Text |
Enter the family name (last name) of the first family member you are sponsoring.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 1. 4. B. Enter Given Name (First Name) | Text |
Enter the given name (first name) of the first family member you are sponsoring.
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| Part 3. Information About the Immigrants You Are Sponsoring. Family Member 1. 4. C. Enter Middle Name | Text |
Enter the middle name of the first family member you are sponsoring.
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| Sponsoring Information | ||
| Part 3. Information About the Immigrants You Are Sponsoring. 2. Select I am sponsoring the following family members immigrating at the same time or within 6 months of the principal immigrant named in Part 2. (Do not include any relative listed on a separate visa petition) | CheckBox |
Select this checkbox if you are sponsoring family members who are immigrating at the same time or within 6 months of the principal immigrant named in Part 2. Do not include any relative listed on a separate visa petition.
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| Part 3. Information About the Immigrants You Are Sponsoring. 1. I am sponsoring the principal immigrant named in Part 2. Select Yes | CheckBox |
Select this checkbox if you are sponsoring the principal immigrant named in Part 2.
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| Part 3. Information About the Immigrants You Are Sponsoring. 1. Select No. (Applicable only if you are sponsoring family members in Part 3. as the second joint sponsor or if you are sponsoring family members who are immigrating more than six months after the principal immigrant) | CheckBox |
Select this checkbox if you are not sponsoring the principal immigrant named in Part 2. This is applicable only if you are sponsoring family members in Part 3 as the second joint sponsor or if you are sponsoring family members who are immigrating more than six months after the principal immigrant.
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| Sponsorship Information | ||
| Part 3. Information About the Immigrants You Are Sponsoring. 3. Select I am sponsoring the following family members who are immigrating more than 6 months after the principal immigrant | CheckBox |
Select this checkbox if you are sponsoring family members who are immigrating more than 6 months after the principal immigrant.
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