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Affidavit Of Support Under Section 213A Of The Act I-864EZ - Official Federal Forms
| Affidavit Of Support Under Section 213A Of The Act Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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OMB No. 1615-0075; Expires 03/31/2015 Department of Homeland Security U.S. Citizenship and Immigration Services I-864EZ, Affidavit of Support Under Section 213A of the Act Part 1. Qualifying to use Form I-864EZ. The answer must be "Yes" to all of the following statements to qualify to use Form I-864EZ. For Government Use Only a. I am the petitioner of the family member sponsored on this form. Yes No (Use I-864). This I-864EZ: does not meet the requirements of section 213A. meets the requirements of section 213A. b. I am using only my own earned or retirement income, which is documented using IRS Form W-2. Yes No (Use I-864). c. The sponsored immigrant is the only person immigrating based on the underlying visa petition. Yes No (Use I-864). Part 2. Information on the immigrant you are sponsoring. 1. Name of Immigrant Last Name First Name 2. Mailing Address Middle Name Reviewer Location Date (mm/dd/yyyy) Street Number and Name (include apartment number) City Country State or Province Zip/Postal Code 3. Telephone Number 4. Date of Birth (mm/dd/yyyy) 5. Social Security Number (if any) 6. Alien Registration Number (if any) (Include area code or country and city codes) A- Part 3. Information on the Sponsor (You). 7. Name of Sponsor Last Name First Name 8. Mailing Address Middle Name Street Number and Name (include apartment number) City Country State or Province Zip/Postal Code Form I-864EZ (03/22/13) Y American LegalNet, Inc. www.FormsWorkFlow.com Part 3. Information on the Sponsor (You). 9. Place of Residence (if different from mailing address) (Continued.) For Government Use Only Street Number and Name (include apartment number) City Country State or Province Zip/Postal Code 10. Country of Domicile Country 11. Date of Birth (mm/dd/yyyy) 12. Place of Birth 13.U.S. Social Security Number (required) 14.Citizenship/Residency I am a U.S. citizen I am a Lawful Permanent Resident. My alien registration number is A - City State or Province Country 15.Military Service I am currently on active duty in the U.S. armed services. Yes No Part 4. Sponsor's household size. 16. Your Household Size - Do not count anyone twice. a. Yourself and the person you are sponsoring on this form. b. Your spouse. c. Your dependent children under age 21. d. If you have sponsored any other persons on an I-864 who are now lawful permanent residents in the United States, enter the number here. e. If you have any other dependents listed on you most recent Federal Income tax return, enter the number here. 2 f. Add together lines a, b, c, d and e and enter the number here. This is your HOUSEHOLD SIZE for the purposes of this form. Form I-864EZ (03/22/13) Y Page 2 American LegalNet, Inc. www.FormsWorkFlow.com Part 5. Sponsor's income and employment. 17. I am currently: a. Employed as a/an Name of Employer (if applicable) Name of Second Employer (if applicable) For Government Use Only . . . . . b. Retired since (mm/dd/yyyy) Name of Former Employer 18. My individual annual income is currently: $ 19. Federal income tax information. I have filed a Federal tax return for each of the three most recent tax years. I have attached the required photocopy or transcript of my Federal tax return for only the most recent tax year. My total income (adjusted gross income on IRS Form 1040EZ) as reported on my Federal tax returns for the most recent three years was: Tax Year (most recent) $ Total Income (2nd most recent) $ (3rd most recent) $ (Optional) I have attached photocopies or transcripts of my Federal tax returns for my second and third most recent tax years. Part 6. Sponsor's Contract. Please note that, by signing this Form I-864EZ, you agree to assume certain specific obligations under the Immigration and Nationality Act and other Federal laws. The following paragraphs describe those obligations. Please read the following information carefully before you sign the Form I-864EZ. If you do not understand the obligations, you may wish to consult an attorney or accredited representative. What Is the Legal Effect of My Signing a Form I-864EZ? If you sign a Form I-864EZ on behalf of any person (called the "intending immigrant") who is applying for an immigrant visa or for adjustment of status to a permanent resident, and that intending immigrant submits the Form I-864EZ to the U.S. Government with his or her application for an immigrant visa or adjustment of status, under section 213A of the Immigration and Nationality Act these actions create a contract between you and the U. S. Government. The intending immigrant's becoming a permanent resident is the "consideration" for the contract. Under this contract, you agree that, in deciding whether the intending immigrant can establish that he or she is not inadmissible to the United States as an alien likely to become a public charge, the U.S. Government can consider your income and assets to be available for the support of the intending immigrant. Form I-864EZ (03/22/13) Y Page 3 American LegalNet, Inc. www.FormsWorkFlow.com Part 6. Sponsor's Contract. (Continued.) What If I Choose Not to Sign a Form I-864EZ? You cannot be made to sign a Form I-864EZ if you do not want to do so. But if you do not sign the Form I-864EZ, the intending immigrant may not be able to become a permanent resident in the United States. What Does Signing the Form I-864EZ Require Me to Do? If an intending immigrant becomes a permanent resident in the United States based on a Form I-864EZ that you have signed, then, until your obligations under the Form I-864EZ terminate, you must: -- Provide the intending immigrant any support necessary to maintain him or her at an income that is at least 125 percent of the Federal Poverty Guidelines for his or her household size (100 percent if you are the petitioning sponsor and are on active duty in the U.S. Armed Forces and the person is your husband, wife, unmarried child under 21 years old.) -- Notify USCIS of any change in your address, within 30 days of the change, by filing Form I-865. What Other Consequences Are There? If an intending immigrant becomes a permanent resident in the United States based on a Form I-864EZ that you have signed, then until your obligations under the Form I-864EZ terminate, your income and assets may be considered ("deemed") to be available to that person, in determining whether he or she is eligible for certain Federal means-tested public benefits and also for State or local means-tested public benefits, if the State or local government's rul
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