Form I-361 Form I-361 Affadivit of Financial Support and Intent to Petition fo

OMB No. 1615-0021; Expires 03/31/09
Department of Homeland Security
U. S. Citizenship and Immigration Services

I -361, Affidavit of Financial Support and Intent to
Petition for Legal Custody of P.L. 97-359 Amerasian
Instructions

What Is the Purpose of This Form?
This affidavit may be used only to sponsor persons born in
Korea, Laos, Vietnam, Kampuchea and Thailand after
December 31, 1950 and before October 22, 1982, who were
fathered by U.S. citizens. It must be filed in support of Form
I-360, Petition for Amerasian, Widow(er) or Special
Immigrant.

In addition, an appropriate public, private or state agency
must arrange the Amerasian's placement with you in the
United States, and you must be able to accept the Amerasian
for care in you home under the laws of the state of the
Amerasian's intended residence.
Please see the instructions on Form I-360 concerning
placement of a beneficiary under 18 years old.

The sponsor must complete, sign and submit this form in
duplicate with Form I-360 to the district or suboffice of U.S
Citizenship and Immigration Services (USCIS) that has
jurisdiction over the sponsor's place of residence. Failure to
submit this form in duplicate may result in the rejection of
your petition.

Execution of Affidavit.

Sponsor Eligibility.

If you are outside the United States, the affidavit must be
sworn to or affirmed before a USCIS Officer or a U.S
Department of State Consular Officer.

In order to sponsor a Public Law 97-359 Amerasian, you
must be a U.S. citizen or lawful permanent resident 21 years
of age or older, and of good moral character.

Financial Sponsorship Requirements.
You must furnish financial support during the entire five-year
period, beginning:
On the date the Amerasian acquires the status of an alien
lawfully admitted for permanent residence, or
During the entire period, beginning on the date the
Amerasian acquires the status of an alien lawfully
admitted for permanent residence and ending on the date
when the Amerasian becomes 21 years of age, whichever
period is longer.
The financial support must be sufficient to maintain your
family, including the Amerasians in the United States, at a
level equal to at least 125 percent of the current official
poverty line (as established by the Director of the Office of
Management and Budget, under section 673(2) of the
Omnibus Budget Reconciliation Act of 1981 and as revised
by the Secretary of Health and Human Services under section
652 of that Act) for a family of the same size as your family
including the Amerasian.

Special Sponsorship Requirement.
You must agree to petition the court having jurisdiction
within 30 days of the Amerasian's arrival in the United States
to be awarded legal custody in accordance with the laws of
the state where the Amerasian will reside until the Amerasian
is 18 years of age.

You must sign the affidavit in your full, true and correct
name and affirm or make it under oath.
If you are in the United States, the affidavit must be sworn to
or affirmed before a USCIS Officer.

Supporting Evidence.
You must submit in duplicate evidence of income and
resources, as appropriate:
Statement from an officer of the bank or other financial
institution in which you have deposits, giving the
following details regarding you account:
Date the account was opened.
Total amount deposited for the past year.
Present balance.
Statement of your employer, preferably on business
stationery, showing:
Dates and nature of employment.
Salary paid.
Whether position is temporary or permanent.
If you are self-employed:
Copy of last income tax return filed or,
Report of commercial rating concern.
List containing the serial numbers and denominations of
bonds and name(s) of record of the owner(s).

Form I-361 (Rev. 03/17/06)Y

Sponsor and Alien Liability.
Public Law 97-359 provides that this guarantee of financial
support and intent to petition for legal custody may be enforced
with respect to the Amerasian against you in a civil suit brought
by the Secretary of Homeland Security in the United States
district court for the district in which you reside, except that you
or your estate will not be liable under this guarantee if you die or
are adjudicated as bankrupt under Title 11, United States Code.
If the Amerasian is under 18 years of age, you are responsible
for interim costs incurred by the Amerasian from the time he or
she is released for emigration by his or her mother or legal
guardian until you are awarded legal custody of the Amerasian
Furthermore, while all health costs incurred by the Amerasian
are your responsibility, note that some health insurance policies
may not cover persons who are not members of the policy
holder's immediate family.
Effective October 1, 1980, amendments to section 1614 (f) of
the Social Security Act and Part A of Title XVI of the Social
Security Act establish certain requirements for determining the
eligibility of aliens who apply for the first time for Supplemental
Security Income (SSI) benefits.
Effective October 1, 1981, amendments to section 415 of the
Social Security Act establish similar requirements for
determining the eligibility of aliens who apply for the first time
for Aid to Families with Dependent Children (AFDC) benefits.

The Secretary of Health and Human Services and the
Secretary of Agriculture are authorized to obtain copies
of any documentation of this type submitted to USCIS or
the Department of State and release this documentation
to a state public assistance agency.
Sections 1621(c) and 415(d) of the Social Security Act
and 5(i) of the Food Stamp Act also provide that an alien
and his or her sponsor will be jointly and severably liable
to repay any SSI, AFDC or food stamps benefits that are
incorrectly paid because of misinformation provided by a
sponsor or because of a sponsor's failure to provide
information.
Incorrect payments that are not repaid will be withheld
from any subsequent payments for which the alien or
sponsor are otherwise eligible under the Social Security
or Food Stamp Acts, except where the sponsor was
without fault or where good cause existed.
The provisions do not apply to the SSI, AFDC or food
stamp eligibility of aliens admitted as refugees or granted
asylum, and of dependent children of the sponsor's
spouse. The provisions also do not apply to the SSI
eligibility for an alien who becomes blind or disabled
after admission to the United States for permanent
residence.

Authority, Use and Penalties.

Effective December 22, 1981, amendments to the Food Stamp
Act of 1977 affect the eligibility of alien participation in the
Food Stamp Program.

Authority for the collection of the information requested
on this form is contained in 8 U.S.C. 1154(g) and 1182

These amendments require that the income and resources for
any person who, as the sponsor of an alien's entry into the
United States, executed an affidavit of support or similar
agreement on behalf of the alien, and the income and resources
of the sponsor's spouse (if living with the sponsor) will be
deemed to be the income and resources of the alien under
formulas for determining eligibility for SSI, AFDC and food
stamp benefits during the three years following the alien's entry
into the United States.

The information will be used principally by USCIS, or by
any officer to whom it may be furnished, to support a
petition for benefits under the Immigration and
Nationality Act in behalf of a Public Law 97-359
Amerasian. It may also, as a matter of routine use, be
disclosed to other Federal, state, local and foreign law
enforcement and regulatory agencies. Submission of the
information is voluntary. Failure to provide the
information may result in the denial of benefits to the
Amerasian.

An alien applying for SSI must make available to the Social
Security Administration documentation concerning his or her
income and resources and those of the sponsor, including
information that was provided in support of a petition for
immigration benefits. An alien applying for AFDC or food
stamps must make similar information available to the state
public assistance agency.

(a)(15).

This affidavit must be of recent date. The affidavit will
not be accepted if more than a year has elapsed from the
date of execution.

Form I-361 (Rev. 03/17/06)Y Page 2

USCIS Forms and Information.
To order USCIS forms call our toll-free forms line at
1-800-870-3676. You can also get USCIS forms and
information on immigration laws, regulations and procedures by
telephoning our National Customer Service Center at
1-800-375-5283 or visiting our intenet website at
www.uscis.gov.

Use InfoPass for Appointments.
As an alternative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
our internet-based system, InfoPass. To access the system, visit
our website at www.uscis.gov. Use the InfoPass appointment
scheduler and follow the screen prompts to set up your
appointment. InfoPass generates an electronic appointment
notice that appears on the screen. Print the notice and take it
with you to your appointment. The notice gives the time and
date of your appointment, along with the address of the USCIS
office.

Reporting Burden.
A person is not required to respond to a collection of
information unless it displays a currently valid OMB control
number.
Public reporting burden for this collection of information is
estimated to average 30 minutes per response, including the time
for reviewing instructions, searching existing data sources
gathering and maintaining the data needed, and completing and
reviewing the collection of information.
Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions
for reducing this burden to: U.S. Citizenship and Immigration
Services, Regulatory Management Division, 111 Massachusetts
Avenue, N. W., Washington, DC 20529; OMB No. 1615-0021
Do not mail your completed application to this address.

Form I-361 (Rev. 03/17/06)Y Page 3

OMB No. 1615-0021; Expires 03/31/09

I -361, Affidavit of Financial Support and Intent to
Petition for Legal Custody of P.L. 97-359 Amerasian

Department of Homeland Security
U. S. Citizenship and Immigration Services

NOTE: Use only to sponsor a Public Law 97-359 Amerasian. (Answer all items. Type or print legibly in black ink.)

I,

residing at
(Street and number)

(Name)

(City)

(State)

(Country)

(Zip Code if in U.S.)

Being Duly Sworn Depose and Say:
1. That I was born on

at

(Date)
(City)
If you are not a native born U.S. citizen, answer the following as appropriate:

(Country)

If a U.S. citizen through naturalization, give certificate of naturalization number
If a U.S. citizen through parent(s) or marriage, give citizenship certificate number
If U.S. citizenship was derived by some other method, attach a statement of explanation.
If a lawfully admitted permanent resident of the United States, give "A" number
2.

That I am

years of age and have resided in the United States since (date)

3.

That this affidavit is executed on behalf of the following person:

Name

Born in (Country)

Presently Resides at:

Gender

Alien Registration Number

(Street and Number)

(City)

Marital Status

(State)

Date of Birth (mm/dd/yyyy)

Relationship to Deponent

(Country)

4.

That this affidavit is made by me for the purpose of assuring the U.S. Government that the person named in item 3 will not
become a public charge in the United States.

5.

That I am willing and able to receive, maintain and support the person named in item 3 and that I agree to furnish financial
support during the entire five-year period beginning on the date the named person acquires the status of an alien lawfully
admitted for permanent residence and ending on the date on which the named person becomes 21 years of age, whichever period
is longer. The financial support which I furnish must be sufficient to maintain my family, including the named person in the
United States, at a level equal to at least 125 percent of the current official poverty line (as established by the Director of the
Office of Management and Budget, under Section 673(2) of the Omnibus Budget Reconciliation Act of 1981 and as revised by
the Secretary of Health and Human and Services under section 652 of that Act) for a family size as my family, including the
named person.

6.

That, if the person named in item 3 is under 18 years of age, I agree to petition the court having jurisdiction within 30 days of
the named person's arrival in the United States to be awarded legal custody in accordance with the laws of the state where he or
she will reside until he or she is 18 years of age.

Submit This Form in Duplicate.

Form I-361 (Rev. 03/17/06)Y

7.

That, if the person named in item 3 is under 18 years of age, I agree to pay the interim costs incurred by that person from the
time he or she is released for immigration by his or her mother or legal guardian until I am awarded legal custody of him or her.

8.

That, if the person named in item 3 is 18 years of age or older, I agree to pay the interim costs involved in his or her travel to the
United States.

9.

That I understand that this guarantee of financial support and intent to petition for legal custody may be enforced with respect to
the person named in item 3 against me in a civil suit brought by the Secretary of Homeland Security in the United States district
court of the district in which I reside, except that I or my estate will not be liable under this guarantee if I die or am adjudicated
as bankrupt under Title 11, United States Code.

10. That I understand that the information and documentation provided by me may be made available to the Secretary of Health and
Human Services, the Secretary of Agriculture or the Food and Nutrition Service, who may make it available to a public
assistance agency.
11. That I have read the instructions to this form and am aware of my responsibilities under the Social Security Act as amended, the
Food Stamp Act and Public Law 97-359.
12. That I am employed as or engaged in the business of

with
(Type of Business)

(Name of Concern)

at
(Street and Number)

(City)

(State)

I derived an annual income of (if self-employed, I have
attached a copy of my last income tax return or report of
commercial rating concern which I certify to be true and
correct to the best of my knowledge and belief.)

$

I have on deposit in savings banks in the United States.

$

I have other personal property, the reasonable value of which is

$

I have stocks and bonds with the following market value, as
indicated on the attached list which I certify to be true and
correct to the best of my knowledge and belief.

$

I have life insurance in the sum of

$

With a cash surrender value of

$

(Zip Code)

$

I own real estate valued at

$

With mortgages or other encumbrances on it amounting to
Which is located at
(Street and Number)

Submit This Form in Duplicate.

(City)

(State)

(Zip Code)

Form I-361 (Rev. 03/17/06)Y Page 2

13. That the following persons are dependent upon me for support: (Place a check in the appropriate column to indicate whether
the person named is wholly or partially dependent upon you for support.)
Wholly
Dependent

Name of Person

14.

Age

Relationship to Me

That I have previously submitted or am submitting affidavit(s) of support for the following person(s). If none, state "None."
Name

15.

Partially
Dependent

Relationship

Date Submitted

That I have submitted visa petition(s) to USCIS on behalf of the following person(s). If none, state "None."
Name

Relationship

Date Submitted

Oath or Affirmation of Deponent

I swear (affirm) that I know the contents of this affidavit signed by me and the statements are true and correct.
Signature of deponent
Subscribed and sworn to (affirmed) before me this

day of

at
Signature of immigration or consular office administering oath
Title

Submit This Form in Duplicate.

Form I-361 (Rev. 03/17/06)Y Page 3

If the affidavit was prepared by other than the deponent, please complete the following:
I declare that this document was prepared by me at the request of the deponent and it is based on all information of which I have any
knowledge.

(Signature)

(Print or Type Name)

(Date)

Address (Street Number and Name, Suite/Room, City, State, Zip Code)

Telephone Number

Submit This Form in Duplicate.

E-Mail Address (If any.)

Form I-361 (Rev. 03/17/06)Y Page 4

OMB No. 1615-0021; Expires 03/31/09

I -361, Affidavit of Financial Support and Intent to
Petition for Legal Custody of P.L. 97-359 Amerasian

Department of Homeland Security
U. S. Citizenship and Immigration Services

NOTE: Use only to sponsor a Public Law 97-359 Amerasian. (Answer all items. Type or print legibly in black ink.)

I,

residing at
(Street and number)

(Name)

(City)

(State)

(Country)

(Zip Code if in U.S.)

Being Duly Sworn Depose and Say:
1. That I was born on

at

(Date)
(City)
If you are not a native born U.S. citizen, answer the following as appropriate:

(Country)

If a U.S. citizen through naturalization, give certificate of naturalization number
If a U.S. citizen through parent(s) or marriage, give citizenship certificate number
If U.S. citizenship was derived by some other method, attach a statement of explanation.
If a lawfully admitted permanent resident of the United States, give "A" number
2.

That I am

years of age and have resided in the United States since (date)

3.

That this affidavit is executed on behalf of the following person:

Name

Born in (Country)

Presently Resides at:

Gender

Alien Registration Number

(Street and Number)

(City)

Marital Status

(State)

Date of Birth (mm/dd/yyyy)

Relationship to Deponent

(Country)

4.

That this affidavit is made by me for the purpose of assuring the U.S. Government that the person named in item 3 will not
become a public charge in the United States.

5.

That I am willing and able to receive, maintain and support the person named in item 3 and that I agree to furnish financial
support during the entire five-year period beginning on the date the named person acquires the status of an alien lawfully
admitted for permanent residence and ending on the date on which the named person becomes 21 years of age, whichever
period is longer. The financial support which I furnish must be sufficient to maintain my family, including the named person in
the United States, at a level equal to at least 125 percent of the current official poverty line (as established by the Director of the
Office of Management and Budget, under Section 673(2) of the Omnibus Budget Reconciliation Act of 1981 and as revised by
the Secretary of Health and Human and Services under section 652 of that Act) for a family size as my family, including the
named person.

6.

That, if the person named in item 3 is under 18 years of age, I agree to petition the court having jurisdiction within 30 days of
the named person's arrival in the United States to be awarded legal custody in accordance with the laws of the state where he or
she will reside until he or she is 18 years of age.

Submit This Form in Duplicate.

Form I-361 (Rev. 03/17/06)Y

7.

That, if the person named in item 3 is under 18 years of age, I agree to pay the interim costs incurred by that person from the
time he or she is released for immigration by his or her mother or legal guardian until I am awarded legal custody of him or her.

8.

That, if the person named in item 3 is 18 years of age or older, I agree to pay the interim costs involved in his or her travel to the
United States.

9.

That I understand that this guarantee of financial support and intent to petition for legal custody may be enforced with respect to
the person named in item 3 against me in a civil suit brought by the Secretary of Homeland Security in the United States district
court of the district in which I reside, except that I or my estate will not be liable under this guarantee if I die or am adjudicated
as bankrupt under Title 11, United States Code.

10. That I understand that the information and documentation provided by me may be made available to the Secretary of Health and
Human Services, the Secretary of Agriculture or the Food and Nutrition Service, who may make it available to a public
assistance agency.
11. That I have read the instructions to this form and am aware of my responsibilities under the Social Security Act as amended, the
Food Stamp Act and Public Law 97-359.
12. That I am employed as or engaged in the business of

with
(Type of Business)

(Name of Concern)

at
(Street and Number)

(City)

(State)

I derived an annual income of (if self-employed, I have
attached a copy of my last income tax return or report of
commercial rating concern which I certify to be true and
correct to the best of my knowledge and belief.)

$

I have on deposit in savings banks in the United States.

$

I have other personal property, the reasonable value of which is

$

I have stocks and bonds with the following market value, as
indicated on the attached list which I certify to be true and
correct to the best of my knowledge and belief.

$

I have life insurance in the sum of

$

With a cash surrender value of

$

(Zip Code)

$

I own real estate valued at

$

With mortgages or other encumbrances on it amounting to
Which is located at
(Street and Number)

Submit This Form in Duplicate.

(City)

(State)

(Zip Code)

Form I-361 (Rev. 03/17/06)Y Page 2

13. That the following persons are dependent upon me for support: (Place a check in the appropriate column to indicate whether
the person named is wholly or partially dependent upon you for support.)
Wholly
Dependent

Name of Person

14.

Age

Relationship to Me

That I have previously submitted or am submitting affidavit(s) of support for the following person(s). If none, state "None."
Name

15.

Partially
Dependent

Relationship

Date Submitted

That I have submitted visa petition(s) to USCIS on behalf of the following person(s). If none, state "None."
Name

Relationship

Date Submitted

Oath or Affirmation of Deponent

I swear (affirm) that I know the contents of this affidavit signed by me and the statements are true and correct.
Signature of deponent
Subscribed and sworn to (affirmed) before me this

day of

at
Signature of immigration or consular office administering oath
Title

Submit This Form in Duplicate.

Form I-361 (Rev. 03/17/06)Y Page 3

If the affidavit was prepared by other than the deponent, please complete the following:
I declare that this document was prepared by me at the request of the deponent and it is based on all information of which I have any
knowledge.

(Signature)

(Print or Type Name)

(Date)

Address (Street Number and Name, Suite/Room, City, State, Zip Code)

Telephone Number

Submit This Form in Duplicate.

E-Mail Address (If any.)

Form I-361 (Rev. 03/17/06)Y Page 4