Affidavit of Support Under Section 213A of the Act

Instructions for Affidavit of Support Under
Section 213A of the INA
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-864EZ

OMB No. 1615-0075
Expires 10/31/2021

What Is the Purpose of Form I-864EZ?
Form I-864EZ, Affidavit of Support Under Section 213A of the INA, is a shorter version of Form I-864, Affidavit of
Support Under Section 213A of the INA, designed for cases that meet certain criteria. Form I-864 or Form I-864EZ is
legally required for most family-based intending immigrants as part of the public charge inadmissibility determination
under section 212(a)(4) of the Immigration and Nationality Act (INA). Failure to submit a sufficient Form I-864 or
Form I-864EZ, when required, will result in a finding that the intending immigrant is inadmissible under section 212(a)(4)
of the INA.

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Who May Use Form I-864EZ?

You may use Form I-864EZ if ALL the following conditions apply:

1. You are the individual who filed or is filing Form I-130, Form I-129F, Petition for Alien Fiancé(e); Form I-600
Petition to Classify Orphan as an Immediate Relative; or Form I-800, Petition to Classify Convention Adoptee as an
Immediate Relative, for a relative being sponsored;
2. The relative you are sponsoring is the only individual listed on Form I-130, Form I-129F, Form I-600, or Form I-800;
and
3. The income you are using to qualify is based entirely on your salary or pension and is shown on one or more Internal
Revenue Service (IRS) Form W-2s provided by your employers or former employers.

When Not To Use Form I-864EZ?

Do not use Form I-864EZ if any of the following conditions apply. Instead, you must complete and submit Form I-864.
1. The relative you are sponsoring is not the only individual immigrating based upon the underlying visa petition.
2. You filed or are filing Form I-140, Immigrant Petition for Alien Worker, for the immigrant you are sponsoring.
3. You are a joint sponsor.
4. You are a substitute sponsor filing because the original Form I-130 petitioner is deceased.
5. Your salary or pension is not enough to meet the income requirements as set by the Federal Poverty Guidelines.

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How Is Form I-864EZ Used?
This affidavit is a contract between you, the sponsor, and the U.S. Government. Completing and signing Form I-864EZ
makes you the sponsor. You must show on this affidavit that you have enough income to maintain the intending
immigrant and the rest of your household at 125 percent of the Federal Poverty Guidelines (or at 100 percent of the
Federal Poverty Guidelines if you are an active duty member of the U.S. Armed Forces, other than active duty for training,
petitioning for your spouse or child). By signing Form I-864EZ, you are agreeing to use your income to support the
intending immigrant named in this affidavit, if it becomes necessary.
Means-tested Public Benefits

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The submission of this affidavit may make the sponsored immigrant ineligible for certain Federal, state, or local meanstested public benefits, because an agency that provides means-tested public benefits will consider your income available to
the sponsored immigrant in determining eligibility for the means-tested public benefit program.
If the immigrant sponsored in this affidavit receives any Federal, state, or local means-tested public benefits, the agency
providing the benefit may request that you reimburse for the cost of those benefits. That agency can sue you if, upon
request, you do not reimburse the benefit granting agency for the cost of the means-tested public benefits provided.
Not all benefits are considered as means-tested public benefits. See the contract in Part 7. Sponsor’s Contract,
Statement, Contact Information, Certification, and Signature of Form I-864EZ for a list of benefits that are not
considered means-tested public benefits.
Are There Exceptions to Who Needs to Submit Form I-864 or Form I-864EZ?

In general, an applicant for an immigrant visa or adjustment of status who is exempt from the public charge ground of
inadmissibility at the time of his or her immigrant visa interview or application for adjustment of status, is not required to
submit Form I-864 or Form I-864EZ.
In addition, the following intending immigrants do not need to file Form I-864 or Form I-864EZ.

1. Any intending immigrant who has earned or can receive credit for 40 qualifying quarters (credits) of work in the
United States. In addition to their own work, intending immigrants may be able to secure credit for work performed
by a spouse during marriage and by their parents while the immigrants were under 18 years of age. The Social
Security Administration (SSA) can provide information on how to count quarters of work earned or credited and how
to provide evidence of such. See the SSA website at https://www.ssa.gov/myaccount/ for more information;
2. Any intending immigrant who will, upon admission, acquire U.S. citizenship under the Immigration and Nationality
Act (INA) section 320, as amended by the Child Citizenship Act of 2000 (CCA); this includes certain children
immigration based on adoption;
3. A self-petitioning widow or widow(er) who has an approved Form I-360, Petition for Amerasian, Widow(er), or
Special Immigrant; and
4. Self-petitioning abused spouses and children who have an approved Form I-360, Petition for Amerasian, Widow(er),
or Special Immigrant.
NOTE: Self-petitioning abused parents of U.S. citizen sons and daughters who have an approved Form I-360 do not need
to file Form I-864.

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Who Completes Form I-864EZ?
Only the U.S. citizen, lawful permanent resident, or U.S. national who filed Form I-130 for a family member may
complete this affidavit. A sponsor is required to be at least 18 years of age and domiciled in any of the several States
of the United States, the District of Columbia, or any territory or possession of the United States. (See the Specific
Instructions section of these Instructions.)
What Are the Income Requirements?
To qualify as a sponsor, you must demonstrate that your income is at least 125 percent of the current Federal Poverty
Guidelines for your household size. The Federal poverty line, for purposes of this affidavit, is updated annually and can
be found on Form I-864P, Poverty Guidelines, at www.uscis.gov/I-864P.

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If you are on active duty in the U.S. Armed Forces, including the Army, Marines, Navy, Air Force, or Coast Guard, and
you are sponsoring your spouse or minor child, you only need to have an income of 100 percent of the Federal Poverty
Guidelines for your household size.
How Do I Count Household Size?

Your household size includes yourself and the following individuals, no matter where they live:
1. Any spouse;

2. Any dependent children under 21 years of age;

3. Any other dependents listed on your most recent Federal income tax return;
4. The person being sponsored in this affidavit of support; and

5. Any immigrants previously sponsored with a Form I-864 or Form I-864EZ Affidavit of Support Under Section 213A
of the INA, whom you are still obligated to support.
How Long Does My Obligation as a Sponsor Continue?

Your obligation to support the sponsored immigrant you are sponsoring on this Form I-864EZ will continue until the
sponsored immigrant becomes a U.S. citizen, or has worked or can be credited with 40 qualifying quarters of work in the
United States under the Social Security Act.
Although 40 qualifying quarters (credits) of work generally equates to 10 years of work, in certain cases, the work of a
spouse or parent adds qualifying quarters toward eligibility. The Social Security Administration can provide information
on how to count qualifying quarters (credits) of work.
The obligation also ends if you or the sponsored immigrant dies, or if the sponsored immigrant abandons or loses lawful
permanent resident status and departs the United States, or if the sponsored immigrant obtains lawful permanent resident
status on a new basis in removal proceedings based on a new affidavit of support (if such an affidavit of support is
required). Divorce does not end your sponsorship obligation.
You may withdraw your affidavit of support at any time until a decision is issued on the applicant’s application for an
immigrant visa or adjustment of status. The withdrawal must be in writing, must include your signature, and must be
received before the final decision is issued. A withdrawal may not be retracted.
Sponsor and Beneficiary Liability
Under section 213A of the Act, if the individual you are sponsoring receives means-tested public benefits, upon request,
you must reimburse the agency that provides the benefits, and the agency that provides the benefits may be able to sue you
to recover the cost of the benefits provided if you do not reimburse.
In addition to that provision, your income may be combined with the income of the sponsored alien in determining
whether that individual is eligible for Food Stamps, 7 U.S.C. 2014(i)(1); Supplemental Security Income (SSI),
42 U.S.C. 1382j; and Temporary Assistance for Needy Families (TANF), 42 U.S.C. 608; or other means-tested public
benefits.

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Documentation of Income and Resources
A foreign national 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 the corresponding
application.
A foreign national applying for TANF or Food Stamps must make similar information available to the State public
assistance agency.
The U.S. Secretary of Health and Human Services and the U.S. Secretary of Agriculture are authorized to obtain copies
of any such documentation submitted to U.S. Citizenship and Immigration Services, (USCIS) or the U.S. Department of
State and to release such documentation to a State public assistance agency.

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Liability Due to Misinformation

Sections 1621(e) of the Social Security Act and subsection 5(i) of the Food Stamp Act also provide that a foreign national
and his or her sponsor shall be “jointly and severally liable” to reimburse any SSI, TANF, or Food Stamp benefits that are
incorrectly paid because of misinformation provided by a sponsor or because of a sponsor’s failure to provide information,
except where the sponsor was without fault or where good cause existed. This means the foreign national and sponsors
are each liable for the full amount of any reimbursement due because of misinformation as described above.
Incorrect payments that are not repaid will be withheld from any subsequent payments for which you or your sponsor are
otherwise eligible under the Social Security Act or Food Stamp Act.
These provisions do not apply to SSI, TANF, or Food Stamp eligibility of foreign nationals admitted as refugees, asylees,
or Cuban/Haitian entrants as defined in section 501(e) of P.L. 96-422, and to dependent children of the sponsor or
sponsor’s spouse.

General Instructions

U.S. Citizenship and Immigration Services (USCIS) provides forms free of charge through the USCIS website. In order
to view, print, or fill out our forms, you should use the latest version of Adobe Reader, which you can download for free
at http://get.adobe.com/reader/. If you do not have internet access, you may order USCIS forms by calling the USCIS
Contact Center at 1-800-375-5283. The USCIS Contact Center provides information in English and Spanish. For TTY
(deaf or hard of hearing) call: 1-800-767-1833.
Signature. Form I-864EZ must be notarized by a notary public. Each affidavit must be properly signed before a notary
public and filed. For all signatures on this affidavit, USCIS will not accept a stamped or typewritten name in place of a
signature. You must be at least 18 years of age to act as a sponsor and sign Form I-864EZ. A legal guardian may also sign
for a mentally incompetent person.
If you are under a guardianship, your legal guardian may print your name and sign Form I-864 for you. A legal guardian
includes any individual who is appointed and authorized by law to protect your estate as a result of your incapacity. The
legal guardian must present proof of the appointment as legal guardian of your estate and a copy of an order from the
appointing court or agency specifically permitting the guardian to make your income available for the support of the
sponsored immigrant.
If the affidavit is not signed or if the requisite signature on the affidavit is not valid, USCIS will reject the request. See
8 CFR 103.2(a)(7)(ii)(A). If USCIS accepts a request for adjudication and determines that it has a deficient signature,
USCIS will deny the request.
Validity of Signatures. USCIS will consider a photocopied, faxed, or scanned copy of the original handwritten signature
valid for filing purposes. The photocopy, fax, or scan must be of the original document containing the handwritten ink
signature.
Filing Fee. There is no filing fee for Form I-864EZ with USCIS. For information on processing fees when filing with the
U.S. Department of State (DOS), see www.travel.state.gov.
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Evidence. At the time of filing, you must submit all evidence and supporting documents listed in these Instructions with
your affidavit. If you fail to submit required evidence, USCIS or DOS may reject or deny your affidavit for failure to
submit requested evidence or supporting documents in accordance with 8 CFR 103.2(b)(1) and these Instructions.
Biometric Services Appointment. USCIS may require that you appear for an interview or provide biometrics
(fingerprints, photograph, and/or signature) at any time to verify your identity, obtain additional information, and conduct
background and security checks, including a check of criminal history records maintained by the Federal Bureau of
Investigation (FBI), before making a decision on your application, petition, or request. After USCIS receives your
affidavit and ensures it is complete, we will inform you if you need to attend a biometric services appointment. If an
appointment is necessary, the notice will provide you the location of your local or designated USCIS Application Support
Center (ASC) and the date and time of your appointment or, if you are currently overseas, instruct you to contact a U.S.
Embassy, U.S. Consulate, or USCIS office outside the United States to set up an appointment.

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If you are required to provide biometrics, at your appointment you must sign an oath reaffirming that:
1. You provided or authorized all information in the affidavit;

2. You reviewed and understood all of the information contained in, and submitted with, your affidavit; and
3. All of this information was complete, true, and correct at the time of filing.

Copies. You should submit legible photocopies of documents requested, unless the Instructions specifically state that you
must submit an original document. USCIS may request an original document at the time of filing or at any time during
processing of an application, petition, or request. If USCIS requests an original document from you, it will be returned to
you after USCIS determines it no longer needs your original.
NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be
immediately destroyed after we receive them.
Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation. The translator must sign a certification that the English language translation is complete and accurate, and
that he or she is competent to translate from the foreign language into English. The certification must also include the
translator’s signature, printed name, the signature date, and the translator’s contact information.
How To Fill Out Form I-864EZ

1. Type or print legibly in black ink.

2. If you need extra space to complete any item within this affidavit, use the space provided in Part 10. Additional
Information or attach a separate sheet of paper. Type or print your name and Alien Registration Number (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.
3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been
married and the question asks “Provide the name of your current spouse”), type or print “N/A,” unless otherwise
directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many
children do you have” or “How many times have you departed the United States”), type or print “None,” unless
otherwise directed.

Specific Instructions
Form I-864EZ is divided into 10 parts. The information below will help you fill out the affidavit.

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Part 1. Qualifying to Use Form I-864EZ
You may use Form I-864EZ if the statements in Item Numbers 1.a. - 1.c. are all true. If you do not select “Yes” for all
three boxes, you do NOT qualify to use Form I-864 EZ and therefore must use Form I-864. Submission of the incorrect
affidavit will delay processing.
Item Number l.a. Select “Yes” if you are the petitioner who is filing or who has already filed Form I-130, Petition for
Alien Relative; Form I-129F, Petition for Alien Fiancé(e); Form I-600, Petition to Classify Orphan as an Immediate
Relative; or Form I-800, Petition to Classify Convention Adoptee as an Immediate Relative.
Age Limitations for Spousal Relationships Involving a Minor
Form I-864EZ can only be signed by individuals who are 18 years of age or older at the time of submission. Even if your
spouse is filing an application to adjust status based on a Form I-130 you filed on your spouse’s behalf, you must be at
least 18 years of age in order to sponsor your spouse.

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Item Number l.b. Select “Yes” if you are using only your own earned or retirement income that you can document with
an IRS Form W-2. If you are self-employed, you must select “No” to the question and you cannot use Form I-864EZ.
Item Number l.c. If the individual you are sponsoring is an immediate relative (spouse, child, or certain parents of
U.S. citizens), you can automatically select “Yes” for this box because every immediate relative has his or her own visa
petition. If the individual you are sponsoring is a family-based preference immigrant, and there are family members listed
on the same visa petition that are immigrating with or within six months of the sponsored immigrant, you must select
“No” for this box, and you cannot use Form I-864EZ.
Part 2. Information About the Immigrant You Are Sponsoring (Intending Immigrant)

Item Numbers 1.a. - 1.c. Name of Immigrant. Provide the full name of the immigrant you are sponsoring.
Item Numbers 2.a. - 2.i. Mailing Address. Provide the mailing address of the immigrant you are sponsoring.
Item Number 3. Daytime Telephone Number. Provide the daytime telephone number of the immigrant you are
sponsoring.
Item Number 4. Date of Birth. Provide the date of birth of the immigrant you are sponsoring in mm/dd/yyyy format.
Item Number 5. Gender. Provide the gender of the immigrant you are sponsoring, male or female.
Item Number 6. Alien Registration Number (A-Number) (if any). Provide the A-Number (if any) of the immigrant
you are sponsoring. An “A-Number” is an Alien Registration Number assigned by the former Immigration and
Naturalization Service (INS) or USCIS. If the intending immigrants you are sponsoring have not previously been in the
United States or have only been in the United States as tourists, they probably do not have A-Numbers. Individuals with
A-Numbers can locate the number on their INS or USCIS-issued documentation.
Item Number 7. USCIS Online Account Number (if any). If the immigrant you are sponsoring has previously filed an
application, petition, or request using the USCIS online filing system (previously called USCIS Electronic Immigration
System (USCIS ELIS)), provide the USCIS Online Account Number he or she was issued by the system. The immigrant
you are sponsoring can find his or her USCIS Online Account Number by logging in to their account and going to the
profile page. If the immigrant you are sponsoring previously filed certain applications, petitions, or requests on a paper
form via a USCIS Lockbox facility, he or she may have received a USCIS Online Account Access Notice issuing him or
her a USCIS Online Account Number. If he or she received such a notice, his or her USCIS Online Account Number can
be found at the top of the notice. If he or she was issued a USCIS Online Account Number, enter it in the space provided.
The USCIS Online Account Number is not the same as an A-Number.
Item Number 8. U.S. Social Security Number (if any). Provide the U.S. Social Security Number (if any) of the
immigrant you are sponsoring.
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Part 3. Information About You (Sponsor)
Item Numbers 1.a. - 1.c. Name of Sponsor. Provide your full name.
Item Numbers 2.a. - 3. Mailing Address. Provide your mailing address.
Item Numbers 4.a. - 4.h. Physical Address. Provide your physical address (place of residence) if it is different from
your mailing address.
Item Number 5. Country of Domicile. Provide the name of the country where you maintain your principal residence
and where you plan to reside for the foreseeable future. If your mailing address and/or place of residence is not in
the United States, but your country of domicile is the United States, you must attach a typed or printed explanation
and documentary evidence indicating how you meet the domicile requirement. If you are not currently living in the
United States, you may meet the domicile requirement if you can submit evidence to establish that any of the following
conditions apply.

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1. You are employed by a certain organization. Some individuals employed overseas are automatically considered
to be domiciled in the United States because of the nature of their employment. The qualifying types of employment
include employment by:
A. The U.S. Government;

B. An American institution of research recognized by the Secretary of Homeland Security (The list of qualifying
institutions may be found at 8 CFR 316.20);
C. A U.S. firm or corporation engaged in whole or in part in the development of foreign trade and commerce with the
United States, or a subsidiary of such a firm or corporation;
D. A public international organization in which the United States participates by treaty or statute;
E. A religious denomination having a bona fide organization in the United States, if the employment abroad involves
the individual’s performance of priestly or ministerial functions on behalf of the denomination; or
F. A religious denomination or interdenominational missionary organization having a bona fide organization in the
United States, if the individual is engaged solely as a missionary.
2. You are living abroad temporarily.

If you are not currently living in the United States, you must show that your trip abroad is temporary and that you
have maintained your domicile in the United States. Examples of proof include:
A. Your voting record in the United States;
B. Records of paying U.S. state or local taxes;
C. Having property in the United States;
D. Maintaining bank or investment accounts in the United States;
E. Having a permanent mailing address in the United States; or
F. Other proof such as evidence that you are a student studying abroad or that a foreign government has authorized a
temporary stay.
3. You intend in good faith to reestablish your domicile in the United States no later than the date of the intending
immigrant’s admission or adjustment of status. You must submit proof that you have taken concrete steps to
establish you will be domiciled in the United States at a time no later than the date of the intending immigrant’s
admission or adjustment of status. Concrete steps might include accepting a job in the United States, signing a lease
or purchasing a residence in the United States, or registering children in U.S. schools. Attach proof of the steps you
have taken to establish domicile as previously described.
Item Number 6. Date of Birth. Provide your date of birth in the mm/dd/yyyy format.
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Item Numbers 7. - 9. Place of Birth. Provide your city or town, state or province, and country of birth.
Item Number 10. U.S. Social Security Number (Required). You must provide your U.S. Social Security Number.
Item Number 11. USCIS Online Account Number (if any). If you have previously filed an application, petition, or
request using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)),
provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account
Number by logging in to your account and going to the profile page. If you previously filed certain applications, petitions,
or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice
issuing you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account Number can be
found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The
USCIS Online Account Number is not the same as an A-Number.

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Item Numbers 12. - 14. Citizenship or Residency. You must provide proof that you are a U.S. citizen, U.S. national,
or lawful permanent resident. Petitioning relatives who have already filed proof of their citizenship or immigration status
with Form I-129F, Form I-130, Form I-600, or Form I-800 do not need to submit proof of their status with this affidavit.
1. Proof of U.S. citizen or U.S. national status includes a copy of your birth certificate, certificate of naturalization,
certificate of citizenship, consular report of birth abroad to U.S. citizen parents, or a copy of the biographic data page
of your U.S. passport.
2. Proof of lawful permanent resident status includes a photocopy of both sides of your Permanent Resident Card or
Alien Registration Receipt Card (Form I-551), or a photocopy of your unexpired temporary Form I-551 stamp in
either a foreign passport or DHS Form I-94 Arrival-Departure Record.
Item Number 15. Military Service. Select “Yes” if you are the petitioning sponsor and on active duty in the U.S.
Army, Marines, Navy, Air Force, or Coast Guard, other than active duty for training. If you provide evidence that you are
currently on active duty in the U.S. Armed Forces and you are petitioning for your spouse and/or minor child, you will
need to demonstrate income at only 100 percent of the poverty level for your household size, instead of at 125 percent of
the poverty level. (See Form I-864P, Poverty Guidelines, for information on the poverty levels.) Select “No” if you are
not on active duty in the U.S. Armed Forces. This provision does not apply to joint and substitute sponsors.
Item Numbers 16.a. - 16.d. Sponsor’s Bank Account Information. Indicate whether you are providing information
about a checking or a savings account. Provide the account holder’s name, the name(s) of any joint account holders
(if any), the name of the banking institution, the number of your checking or savings account, and the corresponding
routing number for the account.
Part 4. Information About Your Household Size
This section asks you to add together the number of individuals for whom you are financially responsible. Some of these
individuals may not reside with you. Make sure you do not count any individual more than once, since, in some cases, the
same individuals could fit into two categories.
Item Number l.a. This line is already completed for you, and it includes the intending immigrant and you.
Item Number l.b. If you are married, and your spouse was not included in Item Number 1.a., enter “1” here.
Item Number l.c. Enter the number of unmarried children you have who are under 21 years of age, even if you do not
have legal custody of these children. You may exclude any unmarried children under 21 years of age, if these children
have reached majority under the law of their place of domicile, and you do not claim them as dependents on your Federal
income tax returns.

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Item Number l.d. Enter the number of lawful permanent residents whom you are currently obligated to support based
on your previous submissions of Form I-864 or Form I-864EZ as a petitioning, substitute, or joint sponsor. Include only
those persons who have already immigrated to the United States. Do not include anyone for whom your obligation to
support has ended through the sponsored immigrant’s acquisition of U.S. citizenship, death, abandonment of lawful
permanent residence in the United States, acquisition of 40 quarters of earned or credited work in the United States, or
obtaining a new grant of adjustment of status while in removal proceedings based on a new affidavit of support, if one is
required.
Item Number l.e. Enter the number of any other dependents. You must include every individual whom you have claimed
as a dependent on your most recent Federal income tax return, even if that individual is not related to you. Even if you are
not legally obligated to support that individual, you must include the individual if in fact you did support that individual
and claimed the individual as a dependent.

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Item Number 1.f. Add together Item Numbers 1.a. - 1.e. and enter the number in the space provided.
Part 5. Previously Submitted Affidavits of Support

Item Number 1. If you submitted a Form I-864 or Form I-864EZ in the past for any individuals other than those named
on this Form I-864EZ, answer “Yes.” If you have never previously submitted a Form I-864 or Form I-864EZ for any
individual other than those names on this Form I-864EZ, answer “No.”
Item Number 2. If you answered “Yes” to Item Number 1., enter the total number of individuals for whom you have
submitted a Form I-864 or Form I-864EZ in the past. You do not need to include any individual for whom you previously
filed Form I-864 in this total if you know that he or she:
1. Has become a United States citizen;

2. Is currently a lawful permanent resident that has worked or can be credited with 40 qualifying quarters of coverage;
3. Has abandoned or lost his or her lawful permanent resident status;
4. Has died; or

5. Is obtaining a new grant of adjustment of status while in removal proceedings based on a new affidavit of support, if
one is required.
Item Number 3. For each individual you included in your answer to Item Number 2., you must provide the sponsored
individual’s name, date of birth, and Alien Registration Number.
Part 6. Information About Your Employment and Income
Item Number 1. Indicate if you are currently employed or retired.
Item Numbers 2.a. - 2.c. If you are currently employed, provide your occupation and employer information.
Item Numbers 3.a. - 3.b. If you are retired, provide the name of your former employer and the date you retired.
Item Number 4. Current Individual Annual Income. Enter your current individual earned or retirement annual income
that you are using to meet the requirements of this affidavit and indicate the total on this line. You may include evidence
supporting your claim about your expected income for the current year if you believe that submitting this evidence will
help you establish the ability to maintain sufficient income. You are not required to submit this evidence, however,
unless specifically instructed to do so by a Government official. For example, you may include a recent letter from your
employer showing your employer’s address and telephone number and indicating your annual salary. You may also
provide pay stubs showing your income for the previous six months.

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Item Numbers 5.a. - 6.c. Federal Income Tax Information. You must provide either an IRS transcript or a photocopy
from your own records of your Federal individual income tax return for the most recent tax year. If you believe additional
returns may help you to establish your ability to maintain sufficient income, you may submit transcripts or photocopies of
your Federal individual income tax returns for the three most recent years.
You are not required to have the IRS certify the transcript or photocopy unless specifically instructed to do so by a U.S.
Government official; a plain transcript or photocopy is acceptable.
Do not submit copies of your state income tax returns. Do not submit any tax returns that you filed with any foreign
government unless you claim that you were not required to file a Federal income tax return with the United States
government, and you wish to rely on the foreign return solely to establish the amount of your income that is not subject to
tax in the United States.

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If you provide a photocopy of your tax returns, you must include a copy of each and every Form W-2, Form 1099, and
Schedule that relates to your returns. Do not include copies of these forms if you provide an IRS transcript of your
Federal individual income tax returns rather than a photocopy unless you filed a joint Federal income tax return with your
spouse.
If you were required to file a Federal income tax return for the most recent tax year but did not do so, you must file
any and all late returns with the IRS and attach an IRS-generated tax return transcript documenting your late filing
before submitting the I-864EZ. If you were not required to file a Federal income tax return under U.S. tax law for any
other reason, attach a typed or printed explanation including evidence of the exemption and how you are subject to it.
Residence outside of the United States does not exempt U.S. citizens or lawful permanent residents from filing a U.S.
Federal income tax return. See “Filing Requirements” in the IRS Form 1040 Filing Instructions to determine whether
you were required to file.
For purposes of this affidavit, the line for Total income on IRS Forms 1040 and 1040A is considered when determining
income. For individuals filing IRS Form 1040EZ, the line for adjusted gross income is considered.
Obtaining Tax Transcripts. You may use IRS Form 4506-T to request tax transcripts from the IRS. Complete IRS
Form 4506-T with the ending date for each of your three most recent tax years listed in Part 6., Item Numbers 6.a. - 6.c.
Follow all instructions for completing and filing Form 4506-T with the IRS.
Item Number 5.a. Select the box if you filed a Federal income tax return for each of the three most recent tax years and
have attached the required photocopy or transcript of your Federal income tax return for only the most recent year.
Item Number 5.b. (Optional) If applicable, select the box indicating that you have attached photocopies or transcripts of
your Federal income tax returns for your second and third most recent tax years.
Item Numbers 6.a. - 6.c. Most Recent Tax Year Total Income. Indicate the most recent tax year and your total income
for that most recent tax year.
NOTE: Do not leave the boxes for Item Number 6.a. blank. Type or print the most recent tax year and your total
income for that most recent tax year.
Item Number 7. Credit Report (Optional). You may provide a recent U.S. credit report if you believe doing so may
help you to establish your ability to maintain sufficient income. Select the box for Item Number 7. if you are including a
credit report with your Form I-864EZ.
Part 7. Sponsor’s Contract, Statement, Contact Information, Certification, and Signature
The Form I-864EZ must be notarized by a notary public. Read the contract carefully and then sign and date the affidavit
before a notary public. If you do not sign and date your Form I-864EZ in Item Numbers 6.a. - 6.b., the immigrant you
are sponsoring cannot be issued a visa or be granted adjustment of status.

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Item Numbers 1.a. - 6.b. Select the appropriate box to indicate whether you read this affidavit yourself or whether you
had an interpreter assist you. If someone assisted you in completing the affidavit, select the box indicating that you used
a preparer. Further, you must sign and date your affidavit and provide your daytime telephone number, mobile telephone
number (if any), and email address (if any). Every affidavit MUST contain the signature of the sponsor (or parent or legal
guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.
If you are under guardianship, your legal guardian may print your name and sign Form I-864EZ for you. See General
Instructions for definition of “legal guardian.”
Part 8. Interpreter’s Contact Information, Certification, and Signature
Item Numbers 1.a. - 7.b. If you used an interpreter to read the Instructions and questions on this affidavit to you in a
language in which you are fluent, the interpreter must fill out this section, provide his or her name, the name and address
of his or her business or organization (if any), his or her daytime telephone number, his or her mobile telephone number
(if any), and his or her email address (if any). The interpreter must sign and date the affidavit.

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Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Affidavit, if Other Than the
Sponsor
Item Numbers 1.a. - 8.b. This section must contain the signature of the individual who completed your affidavit, if other
than you, the sponsor. If the same individual acted as both your interpreter and preparer, that individual should complete
both Part 8. and Part 9. If the individual who completed this affidavit is associated with a business or organization, that
individual should complete the business or organization name and address information. Anyone who helped you prepare
this affidavit MUST sign and date the affidavit. A stamped or typewritten name in place of a signature is not acceptable.
If the individual who helped you complete your affidavit is an attorney or accredited representative, he or she may also
need 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,
along with your affidavit.
Part 10. Additional Information

Item Numbers 1.a. - 7.d. If you need extra space to provide any additional information within this affidavit, use the
space provided in Part 10. Additional Information. If you need more space than what is provided in Part 10., you may
make copies of Part 10. to complete and file with your 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.
We recommend that you print or save a copy of your completed contract to review in the future
and for your records.

What Is the Filing Fee?
There is no filing fee for Form I-864EZ with USCIS. For information on processing fees when filing with DOS, see
www.travel.state.gov.

Where to File?
Please see our website at https://www.uscis.gov/i-864ez or visit the USCIS Contact Center at www.uscis.gov/
contactcenter to connect with a USCIS representative for the most current information about where to file this form. The
USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing)
call: 1-800-767-1833. For information on filing with DOS, see www.travel.state.gov.
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NOTE: If you are petitioning for a child who will be admitted to the United States based on an approved Form I-600,
Petition to Classify Orphan as an Immediate Relative, and will not acquire U.S. citizenship under section 320 of the INA,
you should file Form I-864EZ with the visa-issuing post at the Department of State, rather than with USCIS.

Address Change
A sponsor must notify USCIS of his or her new address within 30 days of moving from his or her previous residence. To
do this you must complete and file Form I-865, Sponsor’s Change of Address. For information on filing Form I-865, go to
the USCIS website at www.uscis.gov/I-865 or visit the USCIS Contact Center at www.uscis.gov/contactcenter for help.
The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call:
1-800-767-1833. For information on reporting a change of address to the Department of State, see www.travel.state.gov.

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NOTE: Do not complete Form I-865 at the same time that you complete Form I-864EZ. You should complete and
submit Form I-865 to USCIS only when the address you indicated on the original Form I-864EZ has changed.
This requirement does not relieve a lawful permanent resident sponsor from filing a change of address within 10 days of
the change. For information on filing a change of address go to the USCIS website at www.uscis.gov/addresschange
or visit the USCIS Contact Center at www.uscis.gov/contactcenter for help. The USCIS Contact Center provides
information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
NOTE: Do not submit a change of address to the USCIS Lockbox facilities because the Lockbox does not process
change of address requests.

Processing Information

Initial Processing. Once USCIS or DOS accepts your affidavit we will check it for completeness. If you do not
completely fill out this affidavit, you will not establish a basis for your eligibility and USCIS or DOS may reject or deny
your affidavit.
Requests for More Information. We may request that you provide more information or evidence to support your
affidavit. We may also request that you provide the originals of any copies you submit. If USCIS requests an original
document from you, it will be returned to you after USCIS determines it no longer needs your original.
Requests for Interview. We may request that you appear at a USCIS office for an interview based on your affidavit.
At the time of any interview or other appearance at a USCIS office, we may require that you provide your fingerprints,
photograph, and/or signature to verify your identity and/or update background and security checks.

USCIS Forms and Information
To ensure you are using the latest version of this affidavit, visit the USCIS website at www.uscis.gov where you can
obtain the latest USCIS forms and immigration-related information. If you do not have internet access, you may order
USCIS forms by calling the USCIS Contact Center at 1-800-375-5283. The USCIS Contact Center provides information
in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at
www.uscis.gov. Select “Tools,” then under “Self Service Tools,” select “Appointments” and follow the screen prompts to
set up your appointment. Once you finish scheduling an appointment, the system will generate an appointment notice for
you.

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Penalties
If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-864EZ, we
will deny your Form I-864EZ and may deny any other immigration benefit. In addition, you will face severe penalties
provided by law and may be subject to criminal prosecution.
The Government may pursue verification of any information provided on or in support of this affidavit, including
employment, income, financial or other institutions, the IRS, or the Social Security Administration. If you include in this
Form I-864EZ any information that you know to be false, you may be liable for criminal prosecution under the laws of the
United States. If you fail to give notice of your change of address, as required by 8 U.S.C. 1183a(d) and 8 CFR 213a.3,
you may be liable for the civil penalty established by 8 U.S.C. 1183a(d)(2). The amount of the civil penalty will depend
on whether you failed to give this notice because you were aware that the sponsored immigrant received Federal, state, or
local means-tested public benefits.

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If the failure to report your change of address occurs with knowledge that the sponsored immigrant received means-tested
public benefits (other than benefits described in section 401(b), 403(c)(2), or 4ll(b) of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996, which are summarized in the contract in Part 6.), such failure may result in
a fine of not less than $2,000 or more than $5,000. Otherwise, the failure to report your change of address may result in a
fine not less than $250 or more than $2,000.

DHS Privacy Notice

AUTHORITIES: The information requested on this affidavit, and the associated evidence, is collected under the
Immigraation and Nationality Act (INA) sections 212(a)(4) and 213A.
PURPOSE: The primary purpose for providing the requested information on this affidavit is for you, the sponsor, to
demonstrate that you meet the eligibility requirements to execute this contract between a sponsor and the U.S. government
that imposes on the sponsor a legally enforceable obligation to support a sponsored alien until the obligation terminates.
An alien applicant who fails to submit a sufficient Affidavit of Support Under Section 213A of the INA, when statutorily
required, will be found inadmissible under section 212(a)(4) of the INA. DHS uses the information you provide as part of
determining whether or not the adjustment of status or the immigrant visa applicant you are sponsoring is eligible for the
immigration benefit.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information,
including your Social Security number (if applicable), and any requested evidence, may delay a decision on whether
the affidavit is found sufficient to meet the requirements of INA section 213A, or may result in the affidavit being found
insufficient.
ROUTINE USES: DHS may share the information you provide on this affidavit and any additional requested evidence
with other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved
routine uses described in the associated published system of records notices [DHS/USCIS/ICE/CBP-001 Alien File, Index,
and National File Tracking System, DHS/USCIS-007- Benefits Information System, and DHS/USCIS-018 Immigration
Biometric and Background Check] and the published privacy impact assessments [DHS/USCIS/PIA-016a Computer
Linked Application Information Management System and Associated Systems] which you can find at www.dhs.gov/
privacy. DHS may also share the this information, as appropriate, for law enforcement purposes or in the interest of
national security.

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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 Office of Management and Budget (OMB) control number. The public
reporting burden for this collection of information is estimated at 3 hours and 30 minutes per response, including the time
for reviewing instructions, gathering the required documentation and information, completing the affidavit, preparing
statements, attaching necessary documentation, and submitting the affidavit. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S.
Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts
Ave NW, Washington, DC 20529-2140; OMB No. 1615-0075. Do not mail your completed Form I-864EZ to this
address.

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