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

OMB No. 1615-0021; Expires 04/30/2012

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, and 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.
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.

Who May Sponsor?
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.

What Are the Financial Sponsorship
Requirements?
You must furnish financial support during an entire five-year
period, beginning:
1. On the date the Amerasian acquires the status of an
alien lawfully admitted for permanent residence; or
2. 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 according to the laws of the State
where the Amerasian will reside until the Amerasian is 18
years of age.

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 your home under the laws of the State of the
Amerasian's intended residence.
See the instructions on Form I-360 concerning placement of a
beneficiary under 18 years of age.

Execution of Affidavit
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.
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.

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

Form I-361 (Rev. 04/28/09)Y

Sponsor and Alien Liability
Public Law 97-359 provides that the Secretary of Homeland
Security may seek to enforce this guarantee of financial support
and intent to petition for legal custody with respect to the
Amerasian against you in a civil suit in the U.S. district court for
the district in which you reside. However, 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, you should be aware 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.
Effective December 22, 1981, amendments to the Food Stamp
Act of 1977 affect the eligibility of alien participation in the
Food Stamp Program.
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
considered as 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.
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.

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. This means the sponsor would be
fully responsible if the alien is unable to pay.
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.

USCIS Forms and Information
To order USCIS forms, call our toll-free number 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 Internet Web site at
www.uscis.gov.
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 Web site. 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.

Penalties
If you knowingly and willfully falsify or conceal a material
fact or submit a false document with Form I-361, we will deny
your Form I-361 and may deny any other immigration benefit.
In addition, you will face severe penalties provided by law and
may be subject to criminal prosecution.
This will not be accepted if more than a year has elapsed from
the date of execution.

Form I-361 (Rev. 04/28/09)Y Page 2

Privacy Act Notice
We ask for the information on this form, and associated
evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies. Failure
to provide this information, and any requested evidence, may
delay a final decision or result in denial of your Form I-361.

Paperwork Reduction Act
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a currently valid
OMB control number. The public reporting burden for this
collection of information is estimated at 30 minutes per
response, including the time for reviewing instructions and
completing and submitting the form. 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 Products Division, 111 Massachusetts Avenue, N.
W., 3rd Floor, Suite 3008, Washington, DC 20529-2210.
OMB No. 1615-0021. Do not mail your application to this
address.

Form I-361 (Rev. 04/28/09)Y Page 3

OMB No. 1615-0021; Expires 04/30/2012

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)

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

That I am

3.

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

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

Name

Born in (Country)
Presently Resides at:

A

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 to assure 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 that 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 the size of 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 according to 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. 04/28/09)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 the Secretary of Homeland Security may enforce this guarantee of financial support and intent to petition
for legal custody for the person named in item 3 against me in a civil suit in the United States district court of the district in
which I reside. However, 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)

A. 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.)

$

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

$

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

$

D. 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:

$

E. I have life insurance in the sum of:

$

With a cash surrender value of:

$

(Zip Code)

$

F. 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. 04/28/09)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.)
Name of Person

14.

Wholly
Dependent

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. 04/28/09)Y Page 3

If the affidavit was prepared by other than the deponent, 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. 04/28/09)Y Page 4

OMB No. 1615-0021; Expires 04/30/2012

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)

(Country)

If you are not a native born U.S. citizen, answer the following as appropriate:
A. If a U.S. citizen through naturalization, give certificate of naturalization number:
B. If a U.S. citizen through parent(s) or marriage, give citizenship certificate number:
C. If U.S. citizenship was derived by some other method, attach an explanation.
D. If a lawfully admitted permanent resident of the United States, give A-Number:
2.

That I am

3.

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

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

Name

Born in (Country)
Presently Resides at:

A

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 to assure 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 that 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 the size of 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 according to 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. 04/28/09)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 the Secretary of Homeland Security may enforce this guarantee of financial support and intent to petition
for legal custody for the person named in item 3 against me in a civil suit in the United States district court of the district in
which I reside. However, 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)

A. 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.)

$

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

$

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

$

D. 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:

$

E. I have life insurance in the sum of:

$

With a cash surrender value of:

$

(Zip Code)

$

F. 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. 04/28/09)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.)
Name of Person

14.

Wholly
Dependent

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. 04/28/09)Y Page 3

If the affidavit was prepared by other than the deponent, 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. 04/28/09)Y Page 4