Amazon-ի նախաձեռնության պաշտպանություն 213-ին
Առնչվող ձևեր
- Արհեստավորում եմ 1964-ին - ՄԻՍԻՈՆԵՐՆԵՐԻ ՀԱՐՑԵՐԻ ՊԱՏԱՍԽԱՆՆԵՐԸ
Instructions for Affidavit of Support Under
Section 213A of the INA
USCIS
Form I-864EZ
OMB No. 1615-0075
Expires 01/31/2026
Department of Homeland Security
U.S. Citizenship and Immigration Services
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 many family-based immigrants to show that the intending immigrant has adequate means of financial
support and is unlikely to become a public charge.
Who May Use Form I-864EZ?
You may use Form I-864EZ if ALL the following conditions apply:
1. You are the person who filed or is filing Form I-130, Petition for Alien Relative, for a relative being sponsored;
2. The relative you are sponsoring is the only person listed on Form I-130; 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 person 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.
How Is Form I-864EZ Used?
This affidavit is a contract between a sponsor and the U.S. Government. The person completing and signing this affidavit
is the sponsor. By signing Form I-864EZ, you are agreeing to use your income and resources to support the intending
immigrant named in this affidavit, if it becomes necessary. You must show on this affidavit that you have enough income
to ensure that the sponsored immigrant will not have to rely on means-tested public benefits for support in the United
States.
In most cases, the submission of this affidavit will make the sponsored immigrant ineligible for Federal, state, or local
means-tested public benefits, because an agency that provides means-tested public benefits will consider your income and
resources available to the sponsored immigrant in determining eligibility for the program.
If the immigrant sponsored in this affidavit does receive a Federal, state, or local means-tested public benefit, the agency
providing the benefit may require you to repay the cost of those benefits. That agency can sue you if you do not repay the
cost of the benefits provided.
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1. Who Is Required to File Form I-864W Instead of Form I-864 or Form I-864EZ?
The following types of intending immigrants must properly complete and submit Form I-864W, Request for
Exemption for Intending Immigrant’s Affidavit of Support, instead of a Form I-864 or Form I-864EZ:
A. An intending immigrant who has received, or can receive credit for 40 quarters of work. The Social Security
Administration can provide information on how to count and provide evidence of quarters of work;
B. An 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); and
C. A self-petitioning widow(er) or qualifying battered spouse or child.
2. 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 the United States, its
territories, or possessions. (See the Specific Instructions section of these Instructions.)
3. What Are the Income Requirements?
To qualify as a sponsor, you must demonstrate that you have an income of 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
If you are on active duty in the U.S. Armed Forces or U.S. 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.
4. How Do I Count Household Size?
Your household size includes yourself and the following individuals, no matter where they live:
A. Any spouse;
B. Any dependent children under 21 years of age;
C. Any other dependents listed on your most recent Federal income tax return;
D. The person being sponsored in this affidavit of support; and
E. Any immigrants previously sponsored with a Form I-864 or Form I-864EZ affidavit of support whom you are still
obligated to support.
5. How Long Does My Obligation as a Sponsor Continue?
Your obligation to support the immigrant you are sponsoring in this Form I-864EZ will continue until the sponsored
immigrant becomes a U.S. citizen, or can receive credit for 40 qualifying quarters of work in the United States.
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 ceases to be a lawful permanent resident and departs the United States.
Divorce does not end the sponsorship obligation.
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 call the USCIS National Customer Service
Center at 1-800-375-5283 and ask that we mail a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
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Signature. Each affidavit must be properly signed 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 guardianship, your legal guardian may print your name and sign Form I-864 for you. “Legal guardian”
includes any person 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 and assets available for the support
of the sponsored immigrant.
Filing Fee. There is no filing fee for Form I-864EZ with USCIS. For information on processing fees when filing with the
Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the Specific
Instructions and/or What Evidence Must You Submit sections of these Instructions.
Biometric Services Appointment. USCIS may require that you appear for an interview or provide 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 in writing 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.
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 upon receipt.
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 include the translator’s
signature. The Department of Homeland Security (DHS) recommends the certification contain the translator’s printed
name and the 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 9. 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.
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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 nine parts. The information below will help you fill out the affidavit.
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-600A, Application for Advance Processing of Orphan Petition.
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 person 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 person 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. 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. Persons with
A-Numbers can locate the number on their INS or USCIS-issued documentation.
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Item Number 6. 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 7. U.S. Social Security Number (if any). Provide the U.S. Social Security Number (if any) of the
immigrant you are sponsoring.
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.
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 person’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 person 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. You can show this by providing
proof of your voting record in the United States, proof of paying U.S. state or local taxes, proof of having property
in the United States, proof of maintaining bank or investment accounts in the United States, or proof of having a
permanent mailing address in the United States. Other proof could be evidence that you are a student studying abroad
or that a foreign government has authorized a temporary stay.
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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.
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.
Item Numbers 12. - 14. Citizenship or Nationality. Provide your citizenship or nationality.
Item Number 15. Military Service. Select “Yes” if you are the petitioning sponsor and on active duty in the U.S.
Armed Forces or U.S. Coast Guard other than for training. If you provide evidence that you are currently on active duty
in the U.S. Armed Forces or U.S. Coast Guard and you are petitioning for your spouse or minor child, you will need to
demonstrate income at only 100 percent of the Federal Poverty Guidelines for your household size, instead of at 125
percent of the Federal Poverty Guidelines. (See Form I-864P for information on the Federal Poverty Guidelines at
www.uscis.gov/I-864P.) Select “No” if you are not on active duty in the U.S. Armed Forces or U.S. Coast Guard.
Part 4. Information About Your Household Size
This section asks you to add together the number of persons for whom you are financially responsible. Some of these
persons may not reside with you. Make sure you do not count any individual more than once, since, in some cases, the
same person 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.
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.
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Item Number l.e. Enter the number of any other dependents. You must include every person whom you have claimed as
a dependent on your most recent Federal income tax return, even if that person is not related to you. Even if you are not
legally obligated to support that person, you must include the person if in fact you did support that person and claimed the
person as a dependent.
Item Number 1.f. Add together Item Numbers 1.a. - 1.e. and enter the number in the space provided.
Part 5. 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.
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
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.
If you provide a photocopy of your tax returns, you must include a copy of each and every FormW-2 and Form 1099 that
relates to your returns. Do not include copies of these forms if you provide an IRS transcript of your returns rather than a
photocopy unless you filed a joint 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 persons 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 on line 9. Follow all instructions for
completing and filing Form 4506-T with the IRS.
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Part 6. Sponsor’s Contract, Statement, Contact Information, Declaration, Certification, and Signature
Read the contract carefully and then sign and date the affidavit. 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.
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. 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 7. Interpreter’s Contact Information, Certification, and Signature
Item Numbers 1.a. - 7.b. If you used anyone as 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.
Part 8. 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 person who completed your affidavit, if other
than you, the sponsor. If the same individual acted as both your interpreter and preparer, that person should complete
both Part 7. and Part 8. If the person who completed this affidavit is associated with a business or organization, that
person 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 person who helped you complete your affidavit is an attorney or accredited representative, he or she may be obliged to
also 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 9. 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 9. Additional Information. If you need more space than what is provided in Part 9., you may make
copies of Part 9. 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 Evidence Must You Submit?
You must submit all evidence requested 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.
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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
Where to File?
Please see the USCIS website at www.uscis.gov/l-864EZ or call our USCIS National Customer Service Center at
1-800-375-5283 for the most current information about where to file this affidavit. For TTY (deaf or hard of hearing) call:
Address Change
A sponsor who is not a U.S. citizen must notify USCIS of his or her new address within 10 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 contact the USCIS National Customer Service
Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
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.
If you are a lawful permanent resident sponsor, you must notify USCIS of your new address within 10 days of moving
from your previous residence. For information on filing a change of address go to the USCIS website at
www.uscis.gov/addresschange or contact the USCIS National Customer Service Center at 1-800-375-5283. For TTY
(deaf or hard of hearing) call: 1-800-767-1833. For information on reporting a change of address to the Department of
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.
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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 Forms Request Line at 1-800-870-3676. You may also obtain forms and information by
calling the USCIS National Customer Service Center at 1-800-375-5283. 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 “Schedule an Appointment” 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.
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.
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.
USCIS Privacy Act Statement
AUTHORITIES: The information requested on this affidavit, and the associated evidence, is collected under the
Immigraation and Nationality Act section 213A.
PURPOSE: The primary purpose for providing the requested information on this affidavit is to show that the applying
immigrant has adequate means of financial support without concern of becoming reliant on the U.S. Government for
financial support. DHS will use the information you provide to grant or deny the immigration benefit you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and
any requested evidence, may delay a final decision in your case or result in denial of your affidavit. INA section 213A(i)
requires the collection of your Scocial Security number. Failure to provide the requested information, and any requested
evidence, may prevent USCIS from accepting and approving this affidavit, and the intending immigrant may not be able
to immigrate to the United States.
Form I-864EZ Instructions 12/08/21 E
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ROUTINE USES: DHS may share the information you provide on this affidavit 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-007- Benefits Information System and DHS/USCIS-001-
Alien File, Index, and National File Tracking System of Records] which you can find at www.dhs.gov/privacy. DHS
may also share the information, as appropriate, for law enforcement purposes or in the interest of national security.
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 2 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, Office of Policy and Strategy, Regulatory Coordination Division, 5900 Capital
Gateway Drive, Mail Stop #2140, Camp Springs, MD 20588-0009; OMB No. 1615-0075. Do not mail your completed
Form I-864EZ to this address.
Checklist
The following items must be submitted with Form I-864EZ:
For ALL sponsors:
A copy of your individual Federal income tax return, including W-2s for the most recent tax year, or a statement
and/or evidence describing why you were not required to file. Also include a copy of each and every Form 1099,
Schedule, and any other evidence of reported income. You may submit this information for the three most recent
tax years, pay stubs from the most recent six months, and/or a letter from your employer if you believe any of these
items will help you qualify.
For SOME sponsors:
If you are on active duty in the U.S. Armed Forces or U.S. Coast Guard and are sponsoring your spouse or child
using the 100 percent of the Federal Poverty Guidelines, provide proof of your active military status.
If your legal guardian is signing this Form I-864EZ for you, 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 legal guardian to make your
income and assets available for the support of the sponsored immigrant.
Form I-864EZ Instructions 12/08/21 E
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