Instruksi untuk Formulir I-865, Pemberitahuan Sponsor Perubahan Alamat
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- Formulir I-865, Pemberitahuan Sponsor Perubahan Alamat - Pemberitahuan Sponsor Perubahan Alamat
Instructions for Sponsor’s Notice of Change of Address
USCIS
Form I-865
Department of Homeland Security
U.S. Citizenship and Immigration Services
What Is The Purpose of Form I-865?
The purpose of Form I-865, Sponsor’s Notice of Change of Address, is to report a sponsor’s new address. If you, as a
sponsor, change your address, you must submit a completed and signed Form I-865 to U.S. Citizenship and Immigration
Services (USCIS).
When Should I Use Form I-865?
If at any time in the past you completed Form I-864, Affidavit of Support, to sponsor an immigrant, you are required to
report your change of address within 30 days of the change if the sponsorship agreement is still in force.
The sponsorship agreement remains in force until the sponsored immigrant:
1. Becomes a U.S. citizen;
2. Receives credit for 40 quarters of work;
3. Departs the United States permanently and either formally abandons lawful permanent resident status (by filing Form
I-407, Record of Abandonment of Lawful Permanent Resident Status) or is formally held in a removal proceeding to
have abandoned that status;
4. In a removal proceeding, loses the lawful permanent resident status that the sponsored immigrant obtained based on
your Form I-864; or
5. Dies.
NOTE: Each sponsor must submit a separate Form I-865 to report an address change, even if sponsors share the same
address.
General Instructions
USCIS provides forms free of charge through the USCIS Web site. 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.
Signature. Each notice must be properly signed and filed. For all signatures on this notice, USCIS will not accept a
stamped or typewritten name in place of a signature. If you are under guardianship, your legal guardian may print your
name and sign Form I-865 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 this notice.
Copies. You may 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 you submit original documents when not required, the documents
may remain a part of the record, and USCIS will not automatically return them to you.
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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.
How To Fill Out Form I-865
1. Type or print legibly in black ink.
2. If you need extra space to complete any item within this notice, use the space provided in Part 6. Additional
Information or attach a separate sheet of paper; type or print your name 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-865 is divided into Parts 1. through 6. The following information should help you fill out the notice.
Part 1. Information About You (Sponsor)
Item Number 1.a. - 1.c. Your Full Name. Provide your Family Name (Last Name), Given Name (First Name), and
Middle Name.
Item Number 2. Date of Birth. Provide your date of birth in the mm/dd/yyyy format.
Item Numbers 3.a. - 5. Your New Physical Address. Provide your new physical address in the spaces provided. Do
not provide a post office box (PO Box) number in the spaces. Also, include the date that your physical address change
became effective in the mm/dd/yyyy format and indicate if your physical address is the same as your mailing address.
Item Numbers 6.a. - 7. Your New Mailing Address. Provide your new mailing address, including “In Care Of Name,”
if applicable. Also, include the date that your mailing address change became effective in the mm/dd/yyyy format.
NOTE: You do not need to complete these Item Numbers if your new mailing address is the same as your new physical
address.
Part 2. Information on the Sponsored Immigrants
Item Numbers 1.a. - 8. Provide the names and Alien Registration Numbers (A-Number) (if any) of the immigrants you
are sponsoring. If you are sponsoring more than four immigrants, provide the requested information for each additional
immigrant in the space provided in Part 6. Additional Information.
Part 3. Sponsor’s Statement, Contact Information, Certification and Signature.
Item Numbers 1.a. - 6.b. Select the appropriate box to indicate that you either read this notice yourself or someone
interpreted this notice for you from English to a language in which you are fluent. If applicable, select the box to indicate
if someone prepared this notice for you. Further, you must sign and date your notice and provide your daytime telephone
number, mobile telephone number (if any), and email address (if any). Every notice MUST contain the signature of the
sponsor (or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.
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Part 4. Interpreter’s Contact Information, Certification, and Signature.
Item Numbers 1.a. - 6.b. If you used anyone as an interpreter to read the Instructions and questions on this notice 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, and his or her email address
(if any). The interpreter must sign and date the notice.
Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this Notice, If Other
Than the Sponsor.
Item Numbers 1.a. - 8.b. This section must contain the signature of the person who completed your notice, if other than
you, the sponsor. If the same individual acted as your interpreter and your preparer, that person should complete both
Part 4. and Part 5. If the person who completed this notice 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 notice
MUST sign and date the notice. A stamped or typewritten name in place of a signature is not acceptable. If the person
who helped you prepare your notice is an attorney or accredited representative, he or she must also submit a completed
Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with your notice.
Part 6. Additional Information
Item Numbers 1.a. - 6.d. If you need extra space to provide any additional information within this notice, use the space
provided in Part 6. Additional Information. If you need more space than what is provided in Part 6., you may make
copies of Part 6. to complete and file with your notice, or attach a separate sheet of paper. Include your name 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 notice to review in the future and for your
records.
You should retain in your records:
1. A copy of the completed Form I-865; and
2. Evidence that you sent the original Form I-865 to the correct USCIS office and USCIS received that Form I-865.
USCIS will accept this documentation as proof that you complied with the requirement to file Form I-865. For
example, if you send Form I-865 using the U.S. Postal Service (USPS), you should keep with your file copy of
Form I-865, the USPS certified mail receipt or Express Mail shipping label along with a return receipt, both bearing
postmarks and the address where you mailed Form I-865. If you send Form I-865 by a commercial delivery service,
you should keep a photocopy of the shipping label and signature proof of delivery.
What Is the Filing Fee?
There is no fee to file Form I-865.
How To Check If the Fees Are Correct
Form I-865 filing fee is current as of the edition date in the lower left corner of this page. However, because USCIS fees
change periodically, you can verify that the fees are correct by following one of the steps below.
2. Call the USCIS National Customer Service Center at 1-800-375-5283 and ask for fee information. For TTY (deaf or
hard of hearing) call: 1-800-767-1833.
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Where To File?
Please see our Web site at www.uscis.gov/I-865 or call our National Customer Service Center at 1-800-375-5283 for the
most current information about where to file this notice. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Address Change (For Lawful Permanent Resident Sponsors)
If the sponsor is a lawful permanent resident, he or she must file Form I-865 AND comply with the change of address
requirement in 8 CFR 265.1 He or she must notify USCIS of his or her new address within 10 days of moving from his or
her previous residence. For information on filing a change of address go to the USCIS Web site 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.
Processing Information
Initial Processing. Once USCIS accepts your notice, we will check it for completeness. If you do not completely fill out
this notice, USCIS may reject your notice.
Requests for More Information. We may request that you provide more information or evidence to support your notice.
We may also request that you provide the originals of any copies you submit. USCIS will return any requested originals
when they are no longer needed.
Decision. The decision on Form I-865 involves a determination of whether you have provided the required information to
update your address in USCIS records. USCIS will notify you in writing if your notice is rejected.
USCIS Forms and Information
To ensure you are using the latest version of this notice, visit the USCIS Web site 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 our toll-free number 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 now schedule an appointment through the
USCIS Internet-based system, InfoPass, at https://my.uscis.gov/en/appointment/v2. 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 your Form I-865, we will
reject your Form I-865, and may deny any other immigration benefit. In addition, you will face severe penalties provided
by law and may be subject to criminal prosecution.
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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 immigrants you sponsored had 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, 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 notice of change of address, and the associated evidence, is
collected under Section 213A(d) the Immigration and Nationality Act (INA).
PURPOSE: The primary purpose for providing the requested information on this notice is to document your address
change with USCIS within 30 days of the change during the period in which an affidavit of support is enforceable.
DISCLOSURE: Failure to report a change of address may result in a civil penalty pursuant to INA Section 213A(d)(2).
ROUTINE USES: DHS may share the information you provide on this benefit application with other Federal, state,
local, and foreign government agencies and authorized organizations. DHS follows approved routine uses as described in
the associated published system of records notices [DHS-USCIS-007 - Benefits Information System] which you can find
at www.dhs.gov/privacy. DHS may also make the information available, as appropriate, for law enforcement purposes or
in the interest of national security.
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