INSTRUCTIONS FOR IMMIGRANT VISA APPLICANTS SECOND … · Instructions for Immigrant Visa Applicants ... SECOND: Obtain the following ... Esta oficina ha recibido su caso para tramitar

Embajada de los Estados Unidos de America Sección Consular (Inmigración)

Avda. Colombia 4300 C1425GMN Buenos Aires, Argentina

E-Mail: [email protected]

Instructions for Immigrant Visa Applicants (1212)

INSTRUCTIONS FOR IMMIGRANT VISA APPLICANTS

This office has received your immigrant visa case. Although no assurance can be given regarding the date of your visa interview appointment, you should get prepared for the appointment following the steps described below: FIRST: Complete and RETURN IMMEDIATELY to this office: 1) Form DS-230 Part I & II , Application for Immigrant Visa and Alien Registration, Biographic data; 2) one recent color photograph 2x2 inches (5x5 centimeters), front view on a plain white/off-white background without a hat or other head covering, and 3) a copy of the1st page of your valid passport where it includes your personal information. If a question is not answered, it is incomplete or the photograph does not meet the requirements stipulated it will be returned to you and your case will be delayed. SECOND: Obtain the following documents on this checklist that are applicable to you. Please check the box on the left once you have gathered the document and send us by regular mail or private courier a copy of each of the documents requested together with these instructions. Once we have received and checked your copies, we will schedule your appointment with the Immigrant Visa Consul. On the day of the interview with the Consul, you will have to present ALL the ORIGINAL documents.

IMPORTANT: THE APPOINTMENT WILL NOT BE SCHEDULED UNTIL YOU SEND US THE COPIES OF ALL THE DOCUMENTS REQUESTED BELOW. Every copy that you submit will be included in the Immigration package that you will have to submit when you enter

the US.

IMMIGRANT VISA DOCUMENTS

/___/ 1. EVIDENCE OF RELATIONSHIP: We prefer to see many photos of the petitioner and the beneficiary at varying times throughout their life or relationship. Receipts of money sent from the petitioner to the beneficiary is also good proof of relationship, as well as cards and letters with the original post marked envelopes, and phone records. /___/ 2. PASSPORT: A Passport must be valid for travel to the United States and must have at least six months validity beyond the issuance date of the visa. People who were born outside Argentina must present their DNI as well as the passport PREVIOUS PASSPORTS: You must send us a copy of all previous passports and present the originals at the time of the visa application interview. /___/ 3 BIRTH ENTRY issued by the Civil Registry for each visa applicant. You must present the birth entries for all your unmarried children under 21 years even if they are not applying for the visa at the moment. Date and place of birth as well as parents’ name must be included in the birth entry. Unless it was issued by the City of Buenos Aires, the entry must be legalized by the Ministry of Internal Affairs of Argentina located at: 25 de Mayo 179, Capital Federal. Certificates of birth in the U.S. MUST be original certified long-form copies from the Office of Vital Records from the state where the birth took place. No other birth certificate will be accepted as proof of birth in the U.S. If you or any children were adopted, you must submit a certified copy of the final adoption decree. UNOBTAINABLE BIRTH CERTIFICATE: Under exceptional cases it may impossible to present the birth certificate. Therefore, in such cases, you should obtain a statement to that effect from the civil registrar's office and proceed to obtain secondary evidence of birth. In such cases, please bring any secondary evidence you might have concerning your birth. Under these circumstances, the Consular Officer may request a DNA test.. Under these circumstances, the Consular Officer may request a DNA test. /___/ 4. MARRIAGE ENTRY issued by the Civil Registry. All married persons or previously married people are required to present a certified copy of their marriage entry. Unless it was issued by the City of Buenos Aires, the entry must be legalized by the Ministry of Internal Affairs of Argentina located at: 25 de Mayo 179, Capital Federal. Certificates of marriage from the U.S. MUST be original certified long-form copies from the Office of Vital Records from the state where the marriage took place. No other marriage certificate will be accepted as proof of marriage in the U.S. /___/ 5.DIVORCE DECREE: Proof of the termination of any previous marriage must also be submitted. You must present the Divorce Decree; the marginal annotation entered in the Marriage certificate is not accepted. Unless it was issued by the City of Buenos Aires, the decree must be legalized by the Ministry of Internal Affairs of Argentina located at: 25 de Mayo 179, Capital Federal. /___/ 6. DEATH Entry of Spouse issued by the Civil Registry. Unless it was issued by the City of Buenos Aires, the entry must be legalized by the Ministry of Internal Affairs of Argentina located at: 25 de Mayo 179, Capital Federal. /___/ 7. POLICE CERTIFICATES: Each visa applicant aged 16 years or over is required to submit a police certificate from the police authorities of each locality in which the applicant has resided. The term "police certificate" as used in this paragraph means a certification





by appropriate police authorities stating what their records show concerning each applicant, including all arrests, the reasons for the arrests, and the disposition of each case of which there is a record. If there is a judicial judgment you must present it too) For further information please read the instructions attached and/ or consult this office. /___/ 8. COURT AND PRISON RECORDS: Persons who have been convicted of a crime must obtain a certified copy of each court record and of any prison or criminal record, regardless of the fact that they may have benefited subsequently from an amnesty, pardon, or other act of clemency. /___/ 9. MILITARY RECORDS: A certified copy of any military record, if applicable, is required. Submit your “Libreta de Enrolamiento” or the ORIGINAL DNI (National Identity Document) showing your name, photo, and the military stamps stating the period and place served. If you do not have your “Libreta de Enrolamiento” or your ORIGINAL DNI, please contact the appropriate Military authority in order to request a letter from them stating that your military situation is regularized. The duplicate, triplicate DNI is not accepted as it does not have the ORIGINAL military stamp stating whether the military service was done or not. /___/ 10. PHOTOGRAPHS: In addition to the photo requested in the First step, please bring TWO (2) identical recent photographs 2x2 inches (5x5 centimeters), FRONT VIEW, light white/ off-white background, on glossy paper, unretouched, and unmounted. No head covering or dark glasses should be worn. Photos are required of all applicants, regardless of age. Please see instructions attached.

/___/ 11. EVIDENCE OF SUPPORT: You need to present evidence which will show that you and members of your family who will accompany you are not likely to become public charge while in the United States. Visa petitioner (US Citizen/ LPR) will have to submit an affidavit of support on behalf of the Immigrant visa applicant, by completing form I-864. If the petitioner does not qualify as a sponsor, a Joint-Sponsor should ALSO be presented (any US Citizen living in the US or Legal Permanent Resident), who will also have to complete form I-864. Both, the Sponsor (Petitioner) as well as the Joint-Sponsor, will have to present the last year of income tax return (forms 1040 and W2), and proof of current and sustainable income (e.g. letter of employment on letterhead including salary and start date, most recent salary receipts, bank accounts, value of properties, etc.) If the sponsor and/ or joint sponsor already submitted the I-864 to the NVC (National Visa Center), he/ she does not have to submit it again. DV Visas applicants (lottery visa applicants), please contact this office for further information.

/___/ 12. COURT ORDER: If a minor is applying for an Immigrant Visa, a COURT ORDER or Authorization before a Notary Public must be submitted in order to acknowledge the minor’s parent’s consent to live in the US. Please read instructions attached. /___/ 13. TRANSLATIONS: All documents not in English or in Spanish must be translated into English by a Sworn English Translator registered at the School of Translators. Translations must be legalized by the School of Translators. /___/ 14. FEE: Please see attached FEE SCHEDULE. /___/ 15. LEGALIZATIONS: Any document issued in the Civil Register of any province or Buenos Aires Suburbs (Birth, Marriage, and Death Certificates) must be legalized by the Ministry of Internal Affairs of Argentina located at: Calle 25 de Mayo `179, Capital Federal.

PLEASE READ THE FOLLOWING CAREFULLY

THIRD: As soon as you have obtained all documents that apply to your case, carefully read the statement at the bottom of this page, and send us, via regular mail or private courier, these instructions together with the copies of the requested documents. As soon as we have received them and checked them, you will be scheduled for a visa interview at the earliest possible date. It is not possible to predict when this will be since it depends upon when the priority date for your visa category and country becomes current. ENCLOSURES:

• DS-2001 • Form DS-230 Part , I & II. Immigrant Visa Application, Biographic Data; • Photo requirements; • Police Certificate Instructions; • Military Certificate Instructions; • Court Order Instructions; • Affidavit of Support (I-864).

Please read the following statement:





I have in my possession and I am prepared to present ALL the documents listed in items 1 through 15 which apply to my case, and the

copies of which I am attaching. I fully realize that no advance assurance can be given as to when or whether a visa will actually be issued to me; and I also understand that I should NOT give up my job, dispose of property, or make any final travel arrangements until a visa is

actually issued to me.

IMPORTANT: Please note that if you have questions about the instructions or documents requested, either the petitioner or beneficiary may send us an email with all the questions. Please include your case number in the subject line. We will not respond to duplicate emails. Normal response time is 15 business days. NOTIFY THIS OFFICE IF YOU CHANGE YOUR DOMICILE AND/ OR YOUR CIVIL STATUS. FAILURE TO DO SO MAY RESULT IN TERMINATION OF YOUR REGISTRATION AS AN INTENDING IMMIGRANT.




Instrucciones para los Solicitantes de Visas de Inmigrante (1212)

INSTRUCCIONES PARA LOS SOLICITANTES DE VISAS DE INMIGRANTE Esta oficina ha recibido su caso para tramitar la visa de inmigrante. Aunque no podemos asegurarle la fecha en que será posible una cita para solicitar formalmente la visa, deberá prepararse para esa cita, cumpliendo los siguientes pasos: PRIMERO: Complete y envíe por correo INMEDIATAMENTE a esta oficina: 1) el formulario adjunto DS-230 I, SOLICITUD PARA VISA DE INMIGRANTE Y REGISTRO DE EXTRANJERO, PARTE I y II, DATOS BIOGRAFICOS ; 2) una foto reciente de 5 x 5 centímetros, de frente, a color y fondo blanco. La cabeza no debe estar cubierta, las orejas deben estar destapadas, y sin anteojos; y 3) una fotocopia de la hoja de su pasaporte válido donde figuran sus datos personales. Si alguna pregunta esta sin contestar o incompleta o si falta la foto o la foto no reune las características estipuladas, se le devolverá y su trámite sufrirá demora. SEGUNDO: OBTENGA LOS DOCUMENTOS DE ESTA LISTA QUE CORRESPONDAN A SU CASO. Al obtener cada uno de los documentos, tilde el casillero de la izquierda, y envíe por correo regular o correo privado una copia de cada uno de los mismos a esta oficina junto con estas instrucciones. Al recibir y chequear sus copias, se le programará la cita para solicitar la visa de inmigrante. El dia de la cita deberá presentar TODOS LOS ORIGINALES de los documentos requeridos.

IMPORTANTE: NO SE LE PODRÁ PROGRAMAR LA CITA CON LA CONSUL HASTA RECIBIR LAS COPIAS DE TODOS LOS DOCUMENTOS REQUERIDOS A CONTINUACIONCada copia presentada será incluida en el paquete de Inmigración que deberá

presentar al momento de ingresar a los Estados Unidos.

DOCUMENTOS PARA LA VISA DE INMIGRANTE /__/ 1. EVIDENCIA DE LA RELACION: Presentar evidencia de su relación es muy importante en el Proceso de la Visa de Inmigrante. Nos gustaría ver muchas fotos entre el peticionario y el beneficiario en distintos momentos a lo largo de su vida o relación. Las constancias de envío de dinero del peticionario al beneficiario también son prueba de la relación, como así también lo son tarjetas o cartas con el sobre original sellado por el Correo y el resumen del teléfono. /__/ 2. PASAPORTE: Un pasaporte debe ser válido para viajar a los Estados Unidos y debe tener por lo menos seis meses de validez con posterioridad a la fecha de emisión de la visa. Las personas no nacidas en Argentina deberán presentar D.N.I. argentino también. PASAPORTES ANTERIORES: Debe enviarnos una copia de todos sus pasaportes anteriores y presentar los originales el día de la entrevista de la solicitud de visa. /__/ 3. ACTA DE NACIMIENTO emitida por el Registro Civil para cada solicitante de la visa. Se deberá presentar el acta de nacimiento de todos los hijos solteros menores de 21 años, aunque no emigren con usted en este momento. (En caso de hijos fallecidos, indicar año de defunción). En el acta deberá constar la fecha y lugar de nacimiento y el nombre de los padres. A menos que sea emitida por algún Registro Civil de la Ciudad de Buenos Aires, el acta deberá ser legalizada en el Ministerio de Interior de la Republica Argentina en la calle 25 de Mayo #179 En el caso del certificado de nacimiento de los Estados Unidos debe ser la copia original del formulario certificado por la Oficina de Registros del estado donde ocurrió el nacimiento. No se aceptará otro certificado de nacimiento como evidencia de nacimiento en los Estados Unidos. En caso de que usted o cualquiera de sus hijos fuera adoptado, debe presentar una copia certificada del decreto final de adopción. CERTIFICADO DE NACIMIENTO NO OBTENIBLE: En casos excepcionales, resulta imposible obtener un certificado de nacimiento por haberse destruido los archivos o porque el Gobierno no otorga dichas copias. En tales casos, deberá presentar una constancia de este hecho, otorgada por el registro civil y presentar evidencia suplementaria que haga referencia a su nacimiento. En este tipo de casos, el oficial consular generalmente opta por solicitar un examen de ADN. /__/ 4. ACTA DE MATRIMONIO emitida por el Registro Civil: Todas las personas casadas o previamente casadas deben presentar el acta de matrimonio. A menos que sea emitida por algún Registro Civil de la Ciudad de Buenos Aires, el acta deberá ser legalizada en el Ministerio de Interior de la Republica Argentina en la calle 25 de Mayo #179. La libreta de matrimonio no es aceptada como evidencia. En el caso de haber contraído matrimonio en los Estados Unidos, el certificado de matrimonio de los Estados Unidos debe ser la copia original del formulario certificado por la Oficina de Registros del estado donde se llevó a cabo el matrimonio. No se aceptará otro certificado de matrimonio como evidencia de matrimonio en los Estados Unidos





/__/ 5. SENTENCIA DE DIVORCIO: Se debe presentar evidencia de la terminación de cualquier matrimonio anterior. Debe presentarse la sentencia de divorcio ya que la nota marginal en el certificado de matrimonio no es válida como evidencia. A menos que sea emitida por la Ciudad de Buenos Aires, la sentencia de divorcio deberá ser legalizada en el Ministerio de Interior de la Republica Argentina en la calle 25 de Mayo #179 /__/ 6. ACTA DE DEFUNCION DEL CONYUGE emitida por el Registro Civil. A menos que sea emitida por algún Registro Civil de la Ciudad de Buenos Aires, el acta deberá ser legalizada en el Ministerio de Interior de la Republica Argentina en la calle 25 de Mayo #179. /__/ 7. CERTIFICADO DE POLICIA: Todo solicitante de visa que tenga 16 años o más deberá presentar un certificado de conducta emitido por las autoridades policiales de cada lugar en donde haya residido. El término “Certificado de Policía” según se usa en este párrafo, significa una certificación de las autoridades policiales correspondientes, indicando lo que consta en sus archivos referente al solicitante, incluyendo cualquier arresto que haya sufrido, los motivos del mismo, y lo dispuesto en cada caso del cual existan antecedentes. Si el arresto terminó en una sentencia judicial deberá adjuntar copia de la sentencia. Para mayor información lea las instrucciones adjuntas y/ o consulte esta oficina. /__/ 8. ANTECEDENTES JUDICIALES Y PENALES: Las personas que hayan sido condenadas por algún delito, deberán obtener una copia certificada de los autos judiciales o de cualquier antecedente penal, aunque luego se hayan beneficiado por una amnistía, indulto u otro acto de clemencia. /__/ 9. ANTECEDENTES MILITARES: Deberá obtener certificado de sus antecedentes militares, si corresponde y si es obtenible. Presente la libreta de enrolamiento militar o el Documento Nacional de Identidad (DNI) original donde conste el nombre, fotografía, filiación y sellos de la autoridad militar. Si no cuenta con dicho DNI original deberá contactar la autoridad militar correspondiente para que le emitan una carta donde conste que su situación militar está regularizada. NO se aceptará el DNI duplicado, triplicado, etc ya que no cuenta con el sello original estipulando el cumplimiento o no del servicio militar. /__/ 10. FOTOGRAFIAS: Además de la fotografía mencionada en el primer paso, deberá presentar 2 fotos COLOR, con BRILLO, FONDO BLANCO, sin retocar ni enmarcar. Las medidas deberán ser de 5 cm x 5 cm, de frente. Sin sombrero, ni anteojos, ni aros. TODOS LOS SOLICITANTES NECESITAN FOTOS, NO IMPORTA LA EDAD QUE TENGAN. Por favor lea las instrucciones adjuntas /__/ 11. EVIDENCIA DE MANUTENCION: Deberá presentar evidencia que indique que usted y los integrantes de su familia que lo acompañarán, no se convertirán en carga pública en los Estados Unidos. Para ello presentará una declaración de sostenimiento hecha por su sponsor usando el formulario I-864. Si el peticionario no califica como garante (sponsor), deberá presentar ADEMAS un co- garante (Joint-Sponsor) que puede ser cualquier ciudadano americano viviendo en los Estados Unidos or bien un Residente Legal Permanente (LPR), quien deberá presentar también el formulario I-864. Tanto el garante (peticionario) como el Co-garante deberán presentar el ULTIMO AÑO DE IMPUESTOS (formularios 1040 y W2) y evidencia de ingresos actuales (por ejemplo: una carta de su empleador donde conste su salario, la fecha de ingreso a dicha empresa o institución, los recibos de sueldo mas recientes, resumen de cuentas bancarias, valuaciones de propiedades, etc.) Si el garante y/o el co-garante del caso ya ha presentado este formulario al NVC (National Visa Center) NO debe volver a presentarlo. En el caso de las Visas por lotería, por favor consultenos. /__/ 12. TESTIMONIO JUDICIAL: En el caso de que uno de los hijos menores solicite una visa de inmigrante, debe obtener un TESTIMONIO JUDICIAL a fin de demostrar el consentimiento de los padres para que el menor viva en los Estados Unidos. Leer instrucciones adjuntas. /__/ 13. TRADUCCIONES: Todos los documentos que no estén en español o en Inglés, deberán ser traducidos al Inglés por Traductor Público matriculado y legalizados por el Colegio de Traductores Públicos. /__/ 14. ARANCEL: Por favor vea el cronograma de aranceles adjunto en el paquete de instrucciones /__/ 15. LEGALIZACIONES: Toda la documentación emitida en un registro civil de una provincia (partida de nacimiento, certificados de matrimonio y defunción), deberá ser legalizada en el Ministerio de Interior de la Republica Argentina en la calle 25 de Mayo #179.

LEA CUIDADOSAMENTE LO SIGUIENTE

TERCERO: Tan pronto haya obtenido todos los documentos que correspondan a su caso, lea cuidadosamente la declaración al pie de esta página y envíenos, por correo regular o correo privado, estas instrucciones junto con las copias de los documentos requeridos. Tan pronto las hayamos recibido y chequeado, se le programará la cita para su solicitud de visa de inmigrante. No es posible predecir cuando será, ya que depende de cuando estarán autorizados los números de visa para su categoría de visa y bajo la limitación numérica correspondiente al país que se esté considerando para su caso en particular y según su fecha de prioridad.





ADJUNTOS:

• DS-2001 • DS-230 I y II: Solicitud de Visa de Inmigrante, Parte I y II, Datos Biográficos; • Instrucciones para las fotos; • Instrucciones del certificado policial; • Certificado de antecedentes militares; • Instrucciones del Testimonio Judicial. • Formulario I-864 Affidavit of Support;

Por favor lea la siguiente declaración: Tengo en mi posesión y estoy preparado/a para presentar TODOS los documentos en los puntos 1 al 15 que corresponden a mi caso, y cuyas copias adjunto. Comprendo que no se me puede asegurar de antemano si ni cuando efectivamente se me otorgará una visa y también comprendo que NO debo dejar mi empleo, disponer de mi propiedad, ni concretar arreglos definitivos de viaje hasta que se me otorgue la visa. IMPORTANTE: Si tiene preguntas sobre las instrucciones o documentos solicitados, el peticionario o el beneficiario puede enviarnos un email con todas las preguntas. Por favor incluya su número de caso en el asunto del email. No responderemos los emails por duplicado. El tiempo normal de respuesta es de 15 días hábiles. NOTIFIQUE ESTA OFICINA CUALQUIER CAMBIO DE DOMICILIO Y/O CAMBIO DE SU ESTADO CIVIL O FAMILIAR. SI NO LO HACE, PUEDE RESULTAR EN LA CANCELACION DE SU REGISTRO PARA INMIGRACION.

U.S. Department of State

NOTIFICATION OF APPLICANT READINESS

Introduction You, or your agent, may notify United States Embassy or Consulate listed on

the cover letter that you a ready for an interview by using this Form DS-2001.

The form indicates that you and your family members (if applicable) have

obtained all the necessary documents for the immigrant visa interview.

NOTE: Please read the Instructions for Immigrant Visa Applicants before

completing this form.

Document Please obtain the original documents or certified copies listed in

Requirements Instructions for Immigrant Visa Applicants from an appropriate authority for

yourself and each family member who will accompany you to the United States.

All documents that pertain to your petition are required, even if they were

previously submitted to the Immigration and Naturalization Service (INS) with

your petition.

Signature Please fill out the information below and sign

Case Number Complete Name – Please Type or Print

Mailing Address for Appointment Letter

Date (mm-dd-yyyy) Applicant’s daytime Telephone Number

I attest that I have all of the documents specified in the Instructions for Visa

Applicants and other instructions, which are applicable in my case, and I am

prepared for immigrant visa interview.

Signature

Where to send Please send this form, along with Form DS-230 Part 1 (for each applicant), to the

address of the United States Embassy or Consulate listed on the cover letter of

this information packet.

DS-2001 (Formerly OF-169)

06-2010

Embassy of the United States of America. Avenida Colombia 4300

1425 Buenos Aires, Argentina [email protected]

IV Fees May 2012

IMMIGRANT VISA FEES

Immediate relative/Family based Immigrant Visas – IR1, IR2, IR5, CR1, CR2 -- (if it has not been

paid in the US): U$D 230 for each applicant;

Special Immigrant Visas – SR1, SB1, IW-1 -- (if it has not been paid in the US): U$D 220 for each

applicant;

Visa Lottery (DV) cases: U$D 330 for each applicant;

Employment-based Immigrant Visas – E1, E2, E3, EW – (if it has not been paid in the US):

U$D 405 for each applicant;

Copies: The requested photocopies of originals are MANDATORY. Applicants who do not bring

the copies listed in the OF-169 form will be required to pay an additional fee of U$D 1 per copy. If

you do not bring the required photocopies listed, your visa interview will be delayed.

PAYMENT OPTIONS: Fees may be paid with an international credit card (VISA, MASTERCARD, DINERS CLUB, AMEX, DISCOVERY) or in cash (in ONE currency, either US dollars or Argentina pesos)

ARANCELES VISA DE INMIGRANTE

Visas de inmigrante basadas en una petición de familiares directos – categorías IR1, IR2, IR5,

CR1, CR2 -- (solo si no fue abonado en EEUU): U$D 230 por cada solicitante;

Visas de Inmigrante especiales - SR1, SB1, IW-1 -- (si no fue abonado en EEUU): U$D 220 por

cada solicitante;

Programa de Lotería de Visas (DV): U$D 330 para cada solicitante;

Visas de inmigrante basadas en una petición de empleo – E1, E2, E3, EW – (si no fue abonado

en EEUU): U$D 405 por cada solicitante;

Fotocopias: Las fotocopias solicitadas de los documentos originales son OBLIGATORIAS. Los

solicitantes que no presenten las fotocopias solicitadas en el formulario OF-169 deberán abonar

un arancel adicional de US$ 1 por cada copia. Si no presenta las fotocopias solicitadas, su

entrevista para solicitar la visa será demorada.

FORMA DE PAGO: Los aranceles pueden abonarse con tarjeta de crédito (VISA, MASTERCARD, DINERS CLUB, AMEX, DISCOVERY) o en efectivo pero en una misma moneda (ya sea todo en dolares estadounidenses o todo en pesos argentinos).

CONS

United States Embassy Consular Section - Immigrant Visa Unit

Buenos Aires, Argentina E-MAIL: [email protected]

http://usembassy.state.gov/buenosaires/

VISA PHOTO REQUIREMENTS /REQUISITOS PARA FOTOS TO APPLY FOR AN IMMIGRANT VISA, PLEASE BRING TWO (2) IDENTICAL RECENT PHOTOGRAPHS 2 X 2 INCHES (5 X 5 centimeters) Photos should be taken in everyday attire showing applicant without a hat or other head covering. Photographs must be in color and they must show a front view of the face on a plain light white/off-white background. These photos will be used for the visa. PARA SOLICITAR UNA VISA DE INMIGRANTE, DEBE TRAER DOS (2) FOTOS DE 5 x 5 CENTIMETROS RECIENTES E IDENTICAS Las fotos deberan ser tomadas con ropa normal y la cabeza no tiene que estar cubierta . Las fotos deben ser de frente, color y fondo blanco. Estas fotos seran usadas para la visa.

BA/CONS/IV Photo Requirements

(08-04)

mailto:[email protected]

http://usembassy.state.gov/buenosaires/

The following photographers are able to take the required photographs:

Las fotografías pueden ser obtenidas en las siguientes direcciones:

Gamma Color (Palermo area)

J.L. Borges 2487, 1425 Buenos Aires

King Color (Palermo area)

Av. Santa Fe 3709, 1425 Buenos Aires

Fotografía Super Foco (Barrio Norte) Tel: 4813-1052

Rodriguez Peña 1516, 1021 Buenos Aires

Fotos Ideal (downtown) Tel: 4326-0489

Suipacha 356, 1355 Buenos Aires

Linuxity (downtown)

Lavalle 897, 1387 Buenos Aires

Casa Jose (downtown)

Lavalle 544, 1387 Buenos Aires. Tel: 4394-4204/ 4328-9486

Av. Pueyrredon 1033, Buenos Aires. Tel: 4961-9663

BIG “G” S.A. (Villa Urquiza area) Tel: 4523-3864

Monroe 4999, 1431 Buenos Aires.

Laboratorio Gonzalez (suburban area)

Av. Centenario 1836, 1643 Beccar. Tel: 4743-7044

Perú 154, 1640 Acassuso. Tel: 4743-8699

Av. Fleming 1959, 1640 Martinez. Tel:4836-1472

Ricardo Gutierrez 1226, 1636 Olivos. Tel: 4790-5620

Photographics

Juan S. Fernandez 29, L3, Lomas de San Isidro. Tel:4723-4832

Eduardo Gomez (suburban area)

Ituzaingo 818, 1629 Pilar

Foto Damianovich (Prov. De Buenos Aires)

Balcarce 229, 2930 San Pedro

Laboratorio Gromos (Prov.of Santa Fe). Tel: 0341-448-5386

Corrientes 1347, 2000 Rosario

Julio Cesar

España esq. Pueyrredón, 4400 Salta

Police Certificate 07/10

UNITED STATES EMBASSY BUENOS AIRES CONSULAR SECTION

Avda. Colombia 4300 C1425GMN Buenos Aires, Argentina E-Mail: [email protected]

P O L I C E C E R T I F I C A T E S

All applicants over the age of sixteen must have a police certificate from Argentina. You must obtain the nationally produced “Certificado de Antecedentes Penales” issued by the “Registro Nacional de Reincidencia” of the Federal Ministry of Justice and Human Rights at Tucumán 1353, Ciudad Autónoma de Buenos Aires. The petition must specifically mention that the certificate is requested “con excepción al artículo 51 del Código Penal” For further information, please contact the above mentioned office by phone: 4374-5611/ 12/ 13. or visit the web site where you will find additional information at: http://www.dnrec.jus.gov.ar/Atencion_Particular.aspx In addition, applicants need to present a police clearance certificate from each country in which they have lived outside of Argentina for more than one year since reaching the age of sixteen. For more information on obtaining police certificates from other countries, see: http://www.travel.state.gov/visa/fees/fees_3272.html *Police certificates from countries in which you formerly resided and have not returned to, since the police certificate was issued, are valid indefinitely. You are not required to obtain a police certificate from the U.S. If you have ever been arrested, we request a police certificate from the place of your arrest, REGARDLESS OF HOW LONG you lived in that area. The police certificate must indicate charges and disposition of the case. In addition to police record, the court record will also be required.


http://www.dnrec.jus.gov.ar/Atencion_Particular.aspx

http://www.travel.state.gov/visa/fees/fees_3272.html

Police Certificate 07/10


Avda. Colombia 4300 C1425GMN Buenos Aires, Argentina E-Mail: [email protected]

C E R T I F I C A D O S P O L I C I A L E S

Todo solicitante de visa de inmigrante que tenga 16 años o más, deberá obtener un certificado policial de la Argentina. Debe solicitar un Certificado de Antecedentes Penales emitido por el “Registro Nacional de Reincidencia” del Ministerio de Justicia y Derechos Humanos en Tucumán 1353, Ciudad Autónoma de Buenos Aires. La solicitud debe mencionar específicamente que se solicita el certificado “con excepción al artículo 51 del Código Penal” Para mayor información, por favor contacte la oficina mencionada por teléfono al 4374-5611/ 12/ 13; o bien visite la página Web: http://www.dnrec.jus.gov.ar/Atencion_Particular.aspx Asimismo, todo solicitante debe obtener un certificado policial de cada país donde haya residido durante un año o más desde que cumpliera los 16 años. Para obtener mayor información sobre certificados policiales de otros países, por favor visite la siguiente página Web: http://www.travel.state.gov/visa/fees/fees_3272.html *Los certificados policiales de los países donde vivió anteriormente y a donde no regresó desde que se emitieron, son válidos indefinidamente, No necesita solicitar un certificado policial de los Estados Unidos. Si ha sido arrestado alguna vez, debe presentar un certificado policial del lugar donde fue arrestado, mas allá de cuanto tiempo haya residido en dicho lugar. En el certificado policial deben constar los motivos, cargos, disposiciones al respecto. Además de los certificados policiales también deberá presentar la sentencia judicial.


http://www.dnrec.jus.gov.ar/Atencion_Particular.aspx

http://www.travel.state.gov/visa/fees/fees_3272.html

Military Record 07/10

UNITED STATES EMBASSY BUENOS AIRES

CONSULAR SECTION Avda. Colombia 4300

C1425GMN Buenos Aires, Argentina E-Mail: [email protected]

MILITARY RECORD All male applicants born prior to 1977 must present evidence that they have complied

with the military service requirement.

Applicants may present either:

The ORIGINAL DNI where the military authority stamped that the person has

complied with the regulations and therefore, the military service requirement was

abided; or

A certificate issued by the Military Authority stating that the applicant is in

compliance with the requirement.

In order to request this certificate, you must contact the Army at Av. Azopardo 250,

Capital Federal, on Mondays, Wednesdays and Fridays from 8.00am to 12.00pm.

Requisites:

You need to take your DNI and a copy of the first and second page.

You must do this in person; however, if you are from another province you may

contact the office to do it by regular mail.

There is no fee for the certificate.

For further information, please call 011-4346-6100 extension 1001 or visit the web

site at: http://www.ejercito.mil.ar


http://www.ejercito.mil.ar/

Military Record 07/10

UNITED STATES EMBASSY BUENOS AIRES

CONSULAR SECTION Avda. Colombia 4300

C1425GMN Buenos Aires, Argentina E-Mail: [email protected]

SERVICIO MILITAR Todo solicitante hombre nacido antes de 1977 debe presentar evidencia que ha

cumplido con el servicio militar.

Los solicitantes pueden presentar lo siguiente como evidencia:

El DNI ORIGINAL, donde la autoridad militar selló que la persona ha cumplido

con el servicio militar obligatorio y por lo tanto está en regla; o

Un certificado emitido por la Autoridad Militar estipulando que el solicitante está

en cumplimiento con el requisito del Servicio Militar.

A fin de obtener este certificado debe contactar el Ejército: Av. Azopardo 250,

Capital Federal, los días Lunes, Miércoles y Viernes de 8 a 12 hs.

Requisitos:

Debe presentar su DNI y una fotocopia de la primera y segunda hoja.

El trámite es personal; Sin embargo, si vive en el interior debe contactar dicha

oficina a fin de solicitar este certificado por correo regular.

El trámite es sin costo.

Para mayor información, por favor llame al 011-4346-6100 interno 1001 o visite la

página web: http://www.ejercito.mil.ar


http://www.ejercito.mil.ar/




TESTIMONIO JUDICIAL/ COURT ORDER En los casos en que un hijo menor está solicitando una visa de inmigrante para vivir en los Estados Unidos con alguno de sus padres biológicos, y si el otro padre biológico permanence viviendo en la Argentina, se debe presentar un TESTIMONIO JUDICIAL (o en su defecto una AUTORIZACION ANTE ESCRIBANO PUBLICO) donde expresamente conste que el padre o madre autoriza o consiente que el hijo/ hija viva en los Estados Unidos. In cases where a minor child is applying for an Immigrant Visa in order to live in the U.S. with one of his/her biological parent while the other biological parent still lives in Argentina, a COURT ORDER granting the petitioning parent custody (or an AUTHORIZATION BEFORE A NOTARY PUBLIC) must be submitted. The COURT ORDER or AUTHORIZATION must explicitly state that the father or mother in Argentina consents and/or authorizes the minor child to live in the United States.


I-864A, Contract Between Sponsor and Household Member

OMB No. 1615-0075; Expires 09/30/2012

Part 1. Information on the Household Member. (You.)

Middle Name

1. Name Last Name

First Name

State or Province

2. Mailing Address Street Number and Name (include apartment number)

City

Zip/Postal CodeCountry

4. Telephone Number (Include area code or country and city codes)

5. Date of Birth (mm/dd/yyyy)

7. U.S. Social Security Number (if any)

This I-864A relates to a household member

who:

is the intending immigrant.

is not the intending immigrant.

Reviewer

Location

Date (mm/dd/yyyy)

State or Province

3. Place of Residence Street Number and Name (include apartment number)

City


(if different from mailing address)

6. Place of Birth City State/Province Country

8.

a. I am the intending immigrant and also the sponsor's spouse.

Relationship to Sponsor (Check either a, b or c.)

b. I am the intending immigrant and also a member of the sponsor's household.

c. I am not the intending immigrant. I am the sponsor's household member. I am related to the sponsor as his/her.

Spouse

Son or daughter (at least 18 years old)

Other dependent (specify)

Parent

Brother or sister

Form I-864A (09/19/11) Y

Department of Homeland Security U.S. Citizenship and Immigration Services

For Government Use Only

$___________________________.

Form I-864A (09/19/11) Y Page 2


9. I am currently:

Employed as a/an .a.Name of Employer # 1 (if applicable) .

Name of Employer #2 (if applicable) .

Self-employed as a/an .b.

Retired from c.

Unemployed since d.

since .(Company Name) (mm/dd/yyyy)

(mm/dd/yyyy)

My current individual annual income is: $__________________________________________.10.

11. Federal income tax information.

12. My assets (complete only if necessary).

Enter the balance of all cash, savings, and checking accounts.a.

Enter the net cash value of real-estate holdings. (Net means assessed value minus mortgage debt.)

b.$___________________________.

Enter the cash value of all stocks, bonds, certificates of deposit, and other assets not listed on line a or b.

c.$___________________________.

Add together Lines a, b, and c and enter the number here.d. $___________________________.

(Optional) I have attached photocopies or transcripts of my Federal tax returns for my second and third most recent tax years.

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.

Tax Year

$(most recent)

My total income (adjusted gross income on IRS Form 1040EZ) as reported on my Federal tax returns for the most recent three years was:

$(2nd most recent)

$(3rd most recent)

Total Income

Certify under penalty under the laws of the United States that all the information provided on this form is true and correct to the best of my knowledge and belief and that the Federal income tax returns submitted in support of the contract are true copies or unaltered tax transcripts filed with the Internal Revenue Service.

Form I-864A (09/19/11) Y Page 3


13. I, THE SPONSOR, (Print Name)

b.

c.

d.

a.

U.S. Social Security Number (if any)

Date of Birth (mm/dd/yyyy) A-number (if any)Name

e.

(Sponsor's Signature) (Date--mm/dd/yyyy)

Part 2. Sponsor's Promise.

Part 3. Household Member's Promise.I, THE HOUSEHOLD MEMBER,

15.(Print Name)

a. Promise to provide any and all financial support necessary to assist the sponsor in maintaining the sponsored immigrant(s) at or above the minimum income provided for in section 213A(a)(1)(A) of the Act (not less than 125 percent of the Federal Poverty Guidelines) during the period in which the affidavit of support is enforceable;

b.

c.

d. Consideration where the household member is also the sponsored immigrant: I understand that if I am the sponsored immigrant and a member of the sponsor's household that this promise relates only to my promise to be jointly and severally liable for any obligation owed by the sponsor under the affidavit of support to any of my dependents, to any agency of the Federal Government, to any agency of a State or local government, and to provide any and all financial support necessary to assist the sponsor in maintaining any of my dependents at or above the minimum income provided for in section 213A(s)(1)(A) of the Act (not less than 125 percent of the Federal poverty line) during the period which the affidavit of support is enforceable.

(Household Member's Signature) (Date--mm/dd/yyyy)

I authorize the Social Security Administration to release information about me in its records to the Department of State and U.S. Citizenship and Immigration Services.

e.

14.

16.

Agree to be jointly and severally liable for payment of any and all obligations owed by the sponsor under the affidavit of support to the sponsored immigrant(s), to any agency of the Federal Government, to any agency of a State or local government, or to any other private entity that provides means-tested public benefit;

in consideration of the household member's promise to support the following intending immigrant(s)

and to be jointly and severally liable for any obligations I incur under the affidavit of support, promise

to complete and file an affidavit of support on behalf of the following

immigrant(s) (see Step-by-Step instructions).

in consideration of the sponsor's promise to complete and file an affidavit of support on behalf of the

above named intending immigrant(s):

(Indicate Number) named intending

(Number from line 13)

Middle NameFirst Name14. Spouse's Maiden or Family Name

15. Date (mm-dd-yyyy) and Place of Birth of Spouse

13. Present Address (Street Address) (City or Town) (Province) (Country)

10. Permanent address in the United States where you intend to live, if known (street address including ZIP code). Include the name of a person who currently lives there.

PART I - BIOGRAPHIC DATA

28. If Deceased, Give Year of Death

First Name24. Mother's Family Name at Birth

11. Address in the United States where you want your Permanent Resident Card (Green Card) mailed, if different from address in item #10 (include the name of a person who currently lives there).

17. Spouse's Occupation

This Form May be Obtained Free at Consular Offices of the United States of AmericaPrevious Editions Obsolete

16. Address of Spouse (If different from your own)

E-mail AddressTelephone Number (Home)

18. Date of Marriage (mm-dd-yyyy)

23. If Deceased, Give Year of Death

22. Current Address

9. Marital Status8. Gender

2. Other Names Used or Aliases (If married woman, give maiden name)

Instructions: Complete one copy of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please print or type your answers to all questions. Mark questions that are Not Applicable with "N/A". If there is insufficient room on the form, answer on a separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form.

3. Full Name in Native Alphabet (If Roman letters not used)

DS-230 Part I 07-2012

7. Nationality (If dual national, give both.)

Page 1 of 4

12. Present Occupation

4. Date of Birth (mm-dd-yyyy) 5. Age 6. Place of Birth (City or Town) (Province) (Country)

Telephone number


APPLICATION FOR IMMIGRANT VISA AND ALIEN REGISTRATION

Telephone Number (Office)

Telephone number

Male

Female Single (Never Married) Married Widowed Divorced Separated

Including my present marriage, I have been married times.

26. Place of Birth 27. Current Address25. Mother's Date of Birth (mm-dd-yyyy)

First Name Middle Name19. Father's Family Name

21. Place of Birth 20. Father's Date of Birth (mm-dd-yyyy)

Middle Name

Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States.This form (DS-230 Part I) is the first of two parts. This part, together with Form DS-230 Part II, constitutes the complete Application for Immigrant Visa and Alien Registration.1. Family Name First Name Middle Name

OMB APPROVAL NO. 1405-0015EXPIRES: 06/30/2015ESTIMATED BURDEN: 1 HOUR*(See Page 2)

*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless thiscollection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: A/GIS/DIR, Room 2400 SA-22, U.S. Department of State, Washington, DC 20522-2202. Please do not send Visa Applications to this address. Send Visa Applications to your nearest U.S Embassy or Consulate for processing.

DS-230 Part I

Name29. List Names, Dates and Places of Birth, and Addresses of ALL Children.

Date (mm-dd-yyyy) Address (If different from your own)

Page 2 of 4

Place of Birth

Privacy Act and Paperwork Reduction Act Statements

30. List below all places you have lived for at least six months since reaching the age of 16, including places in your country of nationality. Begin with your present residence.

City or Town Province Country From/To or "Present"

31b. Person(s) named in 14 and 29 who will follow you to the United States at a later date.

31a. Person(s) named in 14 and 29 who will accompany you to the United States now.

32. List below all employment for the last ten years.Employer Location Job Title

In what occupation do you intend to work in the United States?

33. List below all educational institutions attended.School and Location From/To (mm-yyyy) Course of Study Degree or Diploma

Languages spoken or read

Professional associations to which you belong

34. Previous Military Service

35. List dates of all previous visits to or residence in the United States. (If never, write "never") Give type of visa status, if known. Give DHS "A" number if any.

Branch Dates of Service (mm-dd-yyyy)Rank/Position Military Speciality/Occupation

LocationFrom/To (mm-yyyy) Type of Visa "A" Number (If known)

Yes No

The information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. The U.S. Department of State uses the facts you provideon this form primarily to determine your classification and eligibility for a U.S. immigrant visa. Individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Department of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate, the Social Security Administration will use the information to issue you a social security number and card.

Signature of Applicant Date (mm-dd-yyyy)

(mm-yyyy)

From/To or "Present"(mm-yyyy)

38. Full Name in Native Alphabet (If Roman letters not used)

37. Other Names Used or Aliases (If married woman, give maiden name)

36. Family Name

*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless thiscollection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: A/GIS/DIR, Room 2400 SA-22, U.S. Department of State, Washington, DC 20522-2202. Please do not send Visa Applications to this address. Send Visa Applications to your nearest U.S Embassy or Consulate for processing.

First Name Middle Name

39. Name and Address of Petitioner Telephone number

Previous Editions Obsolete

APPLICATION FOR IMMIGRANT VISA AND ALIEN REGISTRATION

PART II - SWORN STATEMENT

Except as Otherwise Provided by Law, Aliens Within the Following Classifications are Ineligible to Receive a Visa. Do Any of the Following Classes Apply to You?

DS-230 Part II

40.

Page 3 of 4

a.

Privacy Act and Paperwork Reduction Act StatementsThe information asked for on this form is requested pursuant to Section 222 of the Immigration and Nationality Act. The U.S. Department of State uses the facts you provideon this form primarily to determine your classification and eligibility for a U.S. immigrant visa. Individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Department of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate, the Social Security Administration will use the information to issue you a social security number and card.

Instructions: Complete one copy of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please print or type your answers to all questions. Mark questions that are Not Applicable with "N/A". If there is insufficient room on the form, answer on a separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form. The fee should be paid in United States dollars or local currency equivalent, or by bank draft.

Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States. Even if youare issued an immigrant visa and are subsequently admitted to the United States, providing false information on this form could be groundsfor your prosecution and/or deportation.

This form (DS-230 Part II), together with Form DS-230 Part I, constitutes the complete Application for Immigrant Visa and Alien Registration.

OMB APPROVAL NO. 1405-0015EXPIRES: 06/30/2015ESTIMATED BURDEN: 1 HOUR*

An alien convicted of, or who admits having committed, a crime involving moral turpitude or violation of any law relating to a controlled substance or who is the spouse, son or daughter of such a trafficker who knowingly has benefited from the trafficking activities in the past five years; who has been convicted of 2 or more offenses for which the aggregate sentences were 5 years or more; who is coming to the United States to engage in prostitution or commercialized vice or who has engaged in prostitution or procuring within the past 10 years; who is or has been an illicit trafficker in any controlled substance; who has committed a serious criminal offense in the United States and who has asserted immunity from prosecution; who, while serving as a foreign government official, was responsible for or directly carried out particularly severeviolations of religious freedom; or whom the President has identified as a person who plays a significant role in a severe formof trafficking in persons, who otherwise has knowingly aided, abetted, assisted or colluded with such a trafficker in severe forms of trafficking in persons, or who is the spouse, son or daughter of such a trafficker who knowingly has benefited from the trafficking activities within the past five years.An alien who seeks to enter the United States to engage in espionage, sabotage, export control violations, terrorist activities, the overthrow of the Government of the United States or other unlawful activity; who is a member of or affiliated with the Communist or other totalitarian party; who participated, engaged or ordered genocide, torture, or extrajudicial killings; or who is a member or representative of a terrorist organization as currently designated by the U.S. Secretary of State.

An alien who is likely to become a public charge.

An alien who seeks to enter for the purpose of performing skilled or unskilled labor who has not been certified by the Secretary of Labor; who is a graduate of a foreign medical school seeking to perform medical services who has not passed the NBME exam or its equivalent; or who is a health care worker seeking to perform such work without a certificate from the CGFNS or from an equivalent approved independent credentialing organization.

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No


An alien who failed to attend a hearing on deportation or inadmissibility within the last 5 years; who seeks or has sought a visa, entry into the United States, or any immigration benefit by fraud or misrepresentation; who knowingly assisted any otheralien to enter or try to enter the United States in violation of law; who, after November 30, 1996, attended in student (F) visa status a U.S. public elementary school or who attended a U.S. public secondary school without reimbursing the school; or who is subject to a civil penalty under INA 274C.

E-mail Address

United States laws governing the issuance of visas require each applicant to state whether or not he or she is a member of any class of individualsexcluded from admission into the United States. The excludable classes are described below in general terms. You should read carefully the following list and answer Yes or No to each category. The answers you give will assist the consular officer to reach a decision on your eligibility to receive a visa.

An alien who has a communicable disease of public health significance; who has failed to present documentation of having received vaccinations in accordance with U.S. law; who has or has had a physical or mental disorder that poses or is likely topose a threat to the safety or welfare of the alien or others; or who is a drug abuser or addict.

b.

c.

d.

e.

f.

41. Have you ever been charged, arrested or convicted of any offense or crime? (If answer is Yes, please explain)

DO NOT WRITE BELOW THE FOLLOWING LINEThe consular officer will assist you in answering item 45.

DO NOT SIGN this form until instructed to do so by the consular officer45. I claim to be:

This Form May be Obtained Free at Consular Offices of The United States of America

DS-230 Part II Page 4 of 4

I understand that I am required to surrender my visa to the United States Immigration Officer at the place where I apply to enter the United States, and that the possession of a visa does not entitle me to enter the United States if at that time I am found to be inadmissible under the immigration laws. I understand that any willfully false or misleading statement or willful concealment of a material fact made by me herein may subject me to permanent exclusion from the United States and, if I am admitted to the United States, may subject me to criminal prosecution and/or deportation. I, the undersigned applicant for a United States immigrant visa, do solemnly swear (or affirm) that all statements which appear in this application, consisting of Form DS-230 Part I and Part II combined, have been made by me, including the answers to items 1 through 45 inclusive, and that they are true and complete to the best of my knowledge and belief. I do further swear (or affirm) that, if admitted into the United States, I will not engage in activities which would be prejudicial to the public interest, or endanger the welfare, safety, or security of the United States; in activities which would be prohibited by the laws of the United States relating to espionage, sabotage, public disorder, or in other activities subversive to the national security; in any activity a purpose of which is the opposition to or the control, or overthrow of, the Government of the United States, by force, violence, or other unconstitutional means. I understand that completion of this form by persons required by law to register with the Selective Service System (males 18 through 25 years of age) constitutes such registration in accordance with the Military Selective Service Act. I understand all the foregoing statements, having asked for and obtained an explanation on every point which was not clear to me.

Signature of Applicant

Subscribed and sworn to before me this day of at:

Consular Officer

An alien who is permanently ineligible for U.S. citizenship; or who departed the United States to evade military service in time of war.

42. Have you ever been refused admission to the United States at a port-of-entry? (If answer is Yes, please explain)

Yes No

43a. Have you ever applied for a Social Security Number (SSN)?

Yes

Give the number

43b. Consent to Disclosure: I authorize disclosure of information from this form to the Department of Homeland Security (DHS), the Social Security Administration (SSA), such other U.S. Government agencies as may be required for the purpose of assigning me an SSN and issuing me a Social Security card, and I authorize the SSA to sharemy SSN with the INS.

No

44. Were you assisted in completing this application? Yes No(If answer is Yes, give name and address of person assisting you, indicating whether relative, friend, travel agent, attorney, or other)

A Family-Sponsored ImmigrantAn Employment-Based ImmigrantA Diversity ImmigrantA Special Category (Specify)

I derive foreign state chargeabilityunder Sec. 202(b) through my

(Returning resident, Hong Kong, Tibetan, Private Legislation, etc.)

Preference

Numerical limitation(foreign state)

An alien who is coming to the United States to practice polygamy; who withholds custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court or intentionally assists another person to do so; who has voted in the United States in violation of any law or regulation; or who renounced U.S. citizenship to avoid taxation. An alien who is a former exchange visitor who has not fulfilled the 2-year foreign residence requirement.

An alien who has ordered, carried out or materially assisted in extrajudicial and political killings and other acts of violence against the Haitian people; who has directly or indirectly assisted or supported any of the groups in Colombia known as FARC, ELN, or AUC; who through abuse of a governmental or political position has converted for personal gain, confiscated or expropriated property in Cuba, a claim to which is owned by a national of the United States, has trafficked in such property or has been complicit in such conversion, has committed similar acts in another country, or is the spouse, minor child or agent of an alien who has committed such acts; who has been directly involved in the establishment or enforcement of population controls forcing a woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or her free choice; or who has disclosed or trafficked in confidential U.S. business information obtained in connection with U.S. participation in the Chemical Weapons Convention or is the spouse, minor child or agent of such a person; or who has ever engaged in the recruitment of or the use of child solders.

An alien who was previously ordered removed within the last 5 years or ordered removed a second time within the last 20 years; who was previously unlawfully present and ordered removed within the last 10 years or ordered removed a second time within the last 20 years; who was convicted of an aggravated felony and ordered removed; who was previously unlawfully present in the United States for more than 180 days but less than one year who voluntarily departed within the last 3 years; or who was unlawfully present for more than one year or an aggregate of one year within the last 10 years.

Yes No

Yes No

NoYes

Yes No

Yes No

Yes No

Yes No

Yes No

The applicant's response does not limit or restrict the Government's ability to obtain his or her SSN, or other information on this form, for enforcement or other purposes as authorized by law. NoYes

g.

Would you like to receive a replacement card? (You must answer YES to question 43b. to receive a card.)

Do you want the Social Security Administration to assign you a SSN and issue a card? (You must answer YES to question 43b. to receive a number and a card.)

Yes No

h.

i.

j.

k. An alien determined by the Attorney General to have knowingly made a frivolous application for asylum.

l.

Department of Homeland Security U.S.Citizenship and Immigration Services

* These poverty guidelines remain in effect for use with Form I-864, Affidavit of Support, from March 1, 2012 until new guidelines go into effect in 2013.

For the 48 Contiguous States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and the Commonwealth of the Northern Mariana Islands:

Form I-864P 03/01/12 N

I-864P, 2012 HHS Poverty Guidelines for Affidavit of Support

2012 HHS Poverty Guidelines*

Sponsor's Household Size 125% of HHS Poverty Guidelines*

For Alaska: For Hawaii:

2 3 4 5 6 7 8

$18,912 $23,862 $28,812 $33,762 $38,712 $43,662 $48,612

Add $4,950 for each

OMB No. 1615-0116; Expires 10/31/2012

Minimum Income Requirements for Use in Completing Form I-864

For sponsors on active duty in the U.S. Armed Forces who are petitioning

for their spouse or child

100% of HHS Poverty Guidelines*

$15,130 $19,090 $23,050 $27,010 $30,970 $34,930 $38,890

Add $3,960 for eachadditional person.

For all other sponsors

Sponsor's Household Size

For sponsors on active duty in the U.S. Armed

Forces who are petitioning for their

spouse or child




Sponsor's Household Size

For sponsors on active duty in the U.S. Armed

Forces who are petitioning for their

spouse or child




2 3 4 5 6 7 8

$23,650 $29,837 $36,025 $42,212 $48,400 $54,587 $60,775

Add $6,187 for each

$18,920 $23,870 $28,820 $33,770 $38,720 $43,670 $48,620

Add $4,950 for each

2 3 4 5 6 7 8

$21,762 $27,450 $33,137 $38,825 $44,512 $50,200 $55,887

Add $5,687 for each

$17,410 $21,960 $26,510 $31,060 $35,610 $40,160 $44,710

Add $4,550 for each

additional person.

additional person. additional person. additional person. additional person.

Means - Tested Public Benefits

Programs Not Included: The following Federal and State programs are not included as means-tested benefits: emergency Medicaid; short-term, non-cash emergency relief; services provided under the National School Lunch and Child Nutrition Acts; immunizations and testing and treatment for communicable diseases; student assistance under the Higher Education Act and the Public Health Service Act; certain forms of foster-care or adoption assistance under the Social Security Act; Head Start Programs; means-tested programs under the Elementary and Secondary Education Act; and Job Training Partnership Act programs.

Federal Means-Tested Public Benefits. To date, Federal agencies administering benefit programs have determined that Federal means-tested public benefits include Food Stamps, Medicaid, Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), and the State Child Health Insurance Program (SCHIP).

State Means-Tested Public Benefits. Each State will determine which, if any, of its public benefits are means-tested. If a State determines that it has programs which meet this definition, it is encouraged to provide notice to the public on which programs are included. Check with the State public assistance office to determine which, if any, State assistance programs have been determined to be State means-tested public benefits.

I-864, Affidavit of Support Under Section 213A of the Act

Form I-864 Instructions (09/19/11) Y

Instructions

The following immigrants are required by law to submit Form I-864 completed by the petitioner to obtain an immigrant visa overseas or to adjust status to that of a lawful permanent resident in the United States:

What Is the Purpose of This Form?

How Should I Complete This Form?


OMB No. 1615-0075; Expires 09/30/2012

Print clearly or type your answers using CAPITAL letters.

Attach a separate sheet of paper (or more sheets if necessary);

This form is required for most family-based immigrants and some employment-based immigrants to show that they have adequate means of financial support and that they are not likely to become a public charge. For more information about Form I-864, or to obtain related forms please contact:

How Is This Form Used?This form is a contract between a sponsor and the U.S. Government. Completing and signing this form makes you the sponsor. You must show on this form that you have enough income and/or assets to maintain the intending immigrant(s) and the rest of your household at 125 percent of the Federal Poverty Guidelines. By signing Form I-864, you are agreeing to use your resources to support the intending immigrant(s) named in this form, if it becomes necessary.

Who Needs This Form?

Are There Exceptions to Who Needs This Form?The following types of intending immigrants do not need to file this form:

Use black ink.

If you need extra space to answer any item:

--

Write your name, U.S. Social Security number and the words "Form I-864" on the top right corner of the sheet; and

--

Write the number and subject of each question for which you are providing additional information.

--

The USCIS website (www.uscis.gov);

The National Customer Service Center (NCSC) telephone line at 1-800-375-5283 TTY: (1-800-767-1833); or

Your local USCIS office by using Infopass.

The submission of this form may make the sponsored immigrant ineligible for certain Federal, State, or local means-tested public benefits, because an agency that provides means-tested public benefits will consider your resources and assets as available to the sponsored immigrant in determining his or her eligibility for the program.

All family-based preference immigrants (unmarried sons and daughters of U.S. citizens, spouses and unmarried sons and daughters of permanent resident aliens, married sons and daughters of U.S. citizens, and brothers and sisters of U.S. citizens age 21 and older); and

All immediate relatives of U.S. citizens (spouses, unmarried children under age 21, and parents of U.S. citizens age 21 and older);

Employment-based preference immigrants in cases only when a U.S. citizen or lawful permanent resident relative filed the immigrant visa petition or such relative has a significant ownership interest (five percent or more) in the entity that filed the petition.

Any intending immigrant who has earned or can be credited with 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 parent(s) 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 www.ssa.gov/mystatement/credits for more information;

Not all benefits are considered to be means-tested public benefits. See Form I-864P, Poverty Guidelines, for more information on which benefits may be covered by this definition, or the contract on Page 6 of this form for a list of benefits explicitly not considered means-tested public benefits.

If the immigrant sponsored in this affidavit does receive one of the designated Federal, State or local means-tested public benefits, the agency providing the benefit may request that you repay the cost of those benefits. That agency can sue you if the cost of the benefits provided is not repaid.

Any intending immigrant who will, upon admission, acquire U.S. citizenship under section 320 of the Immigration and Nationality Act, as amended by the Child Citizenship Act of 2000 (CCA);

Self-petitioning widow/ers who have an approved Petition for Amerasian, Widow(er), or Special Immigrant, Form I-360; and

Form I-864 Instructions (09/19/11) Y Page 2

Self-petitioning battered spouses and children who have an approved Petition for Amerasian, Widow(er), or Special Immigrant, Form I-360.

NOTE: If you qualify for one of the exemptions listed above, submit Form I-864W, Intending Immigrant's I-864 Exemption, instead of Form I-864.

If you are on active duty in the U.S. Armed Forces, including the Army, Navy, Air Force, Marines 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 line for your household size. This provision does not apply to joint or substitute sponsors.

A sponsor completes and signs Form I-864. A sponsor is required to be at least 18 years old and domiciled in the United States, or its territories or possessions (see Step-by-step Instructions for more information on domicile). The petitioning sponsor must sign and complete Form I-864, even if a joint sponsor also submits an I-864 to meet the income requirement. The list below identifies who must become sponsors by completing and signing a Form I-864.

Who Completes and Signs Form I-864?

The U.S. citizen or lawful permanent resident who filed a Form I-130 for a family member, Form I-129F for a fiance(e), or Form I-600 or I-600A for an orphan.

The U.S. citizen or permanent resident alien who filed an employment-based immigrant visa petition (Form I-140) for a spouse, parent, son, daughter, or sibling who: (1) has a significant ownership interest (five percent or more) in the business which filed the employment-based immigrant visa petition; or (2) is related to the intending immigrant as a spouse, parent, son, daughter, or sibling.

To qualify as a sponsor, you must demonstrate that your income is at least 125 percent of the current Federal poverty guideline for your household size. The Federal poverty line, for purposes of this form, is updated annually and can be found on Form I-864P, Poverty Guidelines.

What Are the Income Requirements?

If your income alone is not sufficient to meet the requirement for your household size, the intending immigrant will be ineligible for an immigrant visa or adjustment of status, unless the requirement can be met using any combination of the following:

What If I Cannot Meet the Income Requirements?

Income from the intending immigrant, if that income will continue from the same source after immigration, and if the intending immigrant is currently living in your residence. If the intending immigrant is your spouse, his or her income can be counted regardless of current residence, but it must continue from the same source after he or she becomes a lawful permanent resident.

Income from any relatives or dependents living in your household or dependents listed on your most recent Federal tax return who signed a Form I-864A;

A joint sponsor whose income and/or assets equal at least 125 percent of the Poverty Guidelines. See question below for more information on joint sponsors.

The value of your assets, the assets of any household member who has signed a Form I-864A, or the assets of the intending immigrant;

You may use the income of your spouse and/or any other relatives living in your residence if they are willing to be jointly responsible with you for the intending immigrant(s) you are sponsoring. If you have any unrelated dependents listed on your income tax return you may include their income regardless of where they reside.

How Can My Relatives and Dependents Help Me Meet the Income Requirements?

Your household size includes yourself and the following individuals, no matter where they live: any spouse, any dependent children under the age of 21, any other dependents listed on your most recent Federal income tax return, all persons being sponsored in this affidavit of support, and any immigrants previously sponsored with a Form I-864 or Form I-864 EZ affidavit of support whom you are still obligated to support. If necessary to meet the income requirements to be a sponsor, you may include additional relatives (adult children, parents, or siblings) as part of your household size as long as they have the same principle residence as you and promise to use their income and resources in support of the intending immigrant(s).

How Do I Count Household Size?

The income of such household members and dependents can be used to help you meet the income requirements if they complete and sign Form I-864A, Contract Between Sponsor and Household Member, and if they are at least 18 years of age when they sign the form.

Can the Intending Immigrant Help Me Meet the Income Requirements?If certain conditions are met, the intending immigrant's income can help you meet the income requirement. If the intending immigrant is your spouse, his or her income can be included if it will continue from the same source after he or she obtains lawful permanent resident status. If the intending immigrant is another relative, there are two requirements. First, the income must be continuing from the same source after he or she obtains lawful permanent resident status, and second, the intending immigrant must currently live with you in your residence. Evidence must be provided to support both requirements.


However, an intending immigrant whose income is being used to meet the income requirement does not need to complete Form I-864A, Contract Between Sponsor and Household Member, unless the intending immigrant has a spouse and/or children immigrating with him or her. In this instance, the contract relates to support for the spouse and/or children.

Does Receipt of Means-Tested Public Benefits Disqualify me From being a Sponsor?

Assets may supplement income if the consular or immigration officer is convinced that the monetary value of the asset could reasonably be made available to support the sponsored immigrant and converted to cash within one year without undue harm to the sponsor or his or her family members. You may not include an automobile unless you show that you own at least one working automobile that you have not included.

How Can I Use Assets to Qualify?

No. Receipt of means-tested public benefits does not disqualify anyone from being a sponsor. However, means-tested public benefits cannot be accepted as income for the purposes of meeting the income requirement.

If the first joint sponsor completes Form I-864 for some rather than all the family members, a second qualifying joint sponsor will be required to sponsor the remaining family members. There may be no more than two joint sponsors. A joint sponsor must be able to meet the income requirements for all the persons he or she is sponsoring without combining resources with the petitioning sponsor or a second joint sponsor. Any dependents applying for an immigrant visa or adjustment of status more than six months after immigration of the intending immigrants must be sponsored by the petitioner but may be sponsored by an original joint sponsor or a different joint sponsor. Even if one or more I-864s are submitted for an intending immigrant, the petitioning sponsor remains legally accountable for the financial support of the sponsored alien along with the joint sponsor(s).

If the person who is seeking the immigration of one or more of his or her relatives cannot meet the income requirements, a "joint sponsor" who can meet the requirements may submit a Form I-864 to sponsor all or some of the family members. A joint sponsor can be any U.S. citizen, U.S. national, or lawful permanent resident who is at least 18 years old, domiciled in the United States, or its territories or possessions, and willing to be held jointly liable with the petitioner for the support of the intending immigrant. A joint sponsor does not have to be related to the petitioning sponsor or the intending immigrant.

A substitute sponsor is a sponsor who is completing a Form I-864 on behalf of an intending immigrant whose original I-130 petitioner has died after the Form I-130 was approved, but before the intending immigrant obtained permanent residence. The substitute sponsor must be related to the intending immigrant in one of the following ways: spouse, parent, mother-in-law, father-in-law, sibling, child (at least 18 years of age), son, daughter, son-in-law, daughter-in-law, brother-in-law, sister-in-law, grandparent, grandchild or legal guardian. The substitute sponsor must also be a U.S. citizen or lawful permanent resident.

If you are a substitute sponsor, you must indicate that that you are related to the intending immigrant in one of the ways listed above and include evidence proving that relationship. The beneficiary must also file this form along with a written statement explaining the reasons why the Form I-130 visa petition should be reinstated, having been revoked following the petitioner's death. The beneficiary must also include a copy of the Form I-130 approval notice.

What Is a Substitute Sponsor?

What Is a Joint Sponsor?

Your obligation to support the immigrant(s) you are sponsoring in this affidavit of support will continue until the sponsored immigrant becomes a U.S. citizen, or can be credited with 40 qualifying quarters of work in the United States. Although 40 qualifying quarters of work (credits) generally equate to ten years of work, in certain cases the work of a spouse or parent adds qualifying quarters. 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.

How Long Does My Obligation as a Sponsor Continue?

You must submit a Form I-864 affidavit of support for each intending immigrant you are sponsoring. You may submit photocopies if you are sponsoring more than one intending immigrant listed on the same affidavit of support. Separate affidavits of support are required for intending immigrants for whom different Form I-130 family-based petitions were filed. For instance, if you are sponsoring both parents, each will need an original affidavit of support and accompanying documentation since you were required to submit separate Form I-130 visa petitions for each parent.

Do I Need to Submit a Separate Affidavit for Each Family Member?


Often a spouse or minor children obtain visas or adjust status as dependents of a relative, based on the same visa petition. If you are sponsoring such dependents, you only need to provide a photocopy of the original Form I-864, as long as these dependents are immigrating at the same time as the principal immigrant or within six months of the time he or she immigrates to the United States. You do not need to provide copies of the supporting documents for each of the photocopied Forms I-864.

If the intending immigrant will apply for an immigrant visa at a U.S. Embassy or Consulate overseas: Complete Form I-864 when it is mailed to you from the National Visa Center (NVC). Different instructions apply to some cases so follow the instructions provided by the National Visa Center for your particular case. The instructions on when and where to submit Form I-864 are included in the information packet that is mailed to you with Form I-864. Form I-864 and all accompanying documentation must be submitted to the government within one year of when you sign Form I-864.

When Do I Complete Form I-864 and Where Do I Send It?

Federal law requires that every sponsor report every change of address to the USCIS within 30 days of the change. To do this, send a completed Form I-865, Sponsor's Change of Address, to the Service Center having jurisdiction over your new address. Do not complete Form I-865 at the same time that you complete the I-864.

If the intending immigrant will adjust status in the United States: Complete Form I-864 when the intending immigrant is ready to submit his or her Form Application to Register Permanent Residence or Adjust Status. Then give the completed Form I-864 along with any Forms I-864A and all supporting documentation to the intending immigrant to submit with his or her application for adjustment of status. To be valid, Form I-864 and all supporting documentation must be submitted within one year of when you sign Form I-864. For privacy, you may enclose these documents in a sealed envelope marked "Form I-864: To Be Opened Only by a U.S. Government Official." You may be requested to submit updated information if there is a significant delay in processing.

Do I Have to Report My Change of Address If I Move?

You should complete and submit Form I-865 to USCIS only when the address you indicated on the original I-864 Affidavit of Support has changed. Please see Form I-865 for further directions on filing the Sponsor's Change of Address. This requirement does not relieve a sponsor who is a lawful permanent resident from submitting Form AR-11 within ten days of a change of address.


Step-by-Step Instructions Form I-864 is divided into nine parts. The information below will help you fill out the form.

Check box "f" if you are the substitute sponsor. A substitute sponsor is a sponsor who is completing a Form I-864 on behalf of an intending immigrant whose original Form I-130 petitioner has died after the Form I-130 was approved, but before the intending immigrant obtained permanent residence. The substitute sponsor must be related to the intending immigrant in one of the following ways: spouse, parent, mother-in-law, father-in-law, sibling, child (at least 18 years of age), son, daughter, son-in-law, daughter-in-law, brother-in-law, sister-in-law, grandparent, grandchild or legal guardian. The substitute sponsor must also be a U.S. citizen or lawful permanent resident. If you are a substitute sponsor, you must sponsor each intending immigrant.

Check box "a" if you are the petitioner who is filing or who has already filed Form I-130, Petition for Alien Relative; Form I-600, Petition to Classify Orphan as an Immediate Relative; or Form I-600A, Application for Advance Processing of Orphan Petition. If you are the petitioner, you must sponsor each intending immigrant.

Part 1. Basis for Filing Affidavit of Support.

Check box "d" if you are the only joint sponsor or box "e" if you are either of two joint sponsors. A joint sponsor must be a person, and may not be a corporation, organization, or other entity. A joint sponsor does not have to be related to the intending immigrant. Indicate whether you are the only joint sponsor or one of two joint sponsors. Check with the petitioning sponsor or the intending immigrant if you are not certain.

Check box "b" if you are filing or have filed Form I-140, Immigrant Petition for Alien Worker, for your husband, wife, father, mother, child, adult son or daughter, brother, or sister.

Check box "c" if you have an ownership interest of at least five percent in a business, corporation or other entity that filed or is filing a Form I-140 for your husband, wife, father, mother, child, adult son or daughter, brother, or sister.

6. Alien Registration Number. An "A-number" is an Alien Registration Number assigned by the former Immigration and Naturalization Service (INS) or U.S. Citizenship and Immigration Services (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.

Part 2. Information on the Principal Immigrant. The principal immigrant is the intending immigrant who is the primary beneficiary of the visa petition.

8. Indicate whether you are sponsoring the principal immigrant listed in item 2 in this Form I-864. This only applies to cases with two joint sponsors. Check "No" only if you are sponsoring only intended immigrants listed in 9 (a through e) and not the principal immigrant listed in item 2.

15. Country of Domicile. This question is asking you to indicate 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 written 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:

9. Accompanying Family Members You are Sponsoring. The immigrant you are sponsoring may be bringing a spouse and/or children to the United States. If the spouse and/or children will be traveling with the immigrant, or within six months of the immigrant's entry to the United States and you are sponsoring them, you should list the names and other requested information on the lines provided. If any dependents are not immigrating, will be immigrating more than 6 months after the sponsored alien arrives in the United States, or you are not sponsoring them, do not list their names here. A separate Form I-864 will be required for them when they apply for their immigrant visas.

Part 4. Information on the Sponsor.

Part 3. Information on Immigrants You Are Sponsoring.


A public international organization in which the United States participates by treaty or statute;

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;

--

--

B. 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.

C. 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. Please attach proof of the steps you have taken to establish domicile as described above.

Proof of U.S. citizen, national, or permanent resident status is required for joint and substitute sponsors and for relatives of employment-based immigrants who file this form. Petitioning relatives who have already filed proof of their citizenship or immigration status with Forms I-130, Form I-129F, I-600 and I-600A do not need to submit proof of their status with this form.

19. Citizenship/Residency.

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

--

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.

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18. U.S. Social Security Number.

Every sponsor's Social Security number is required by law. If you do not currently have a Social Security number you must obtain one before submitting this Form I-864.

Proof of permanent resident status includes a photocopy of both sides of the "green card," Form I-551, Alien Registration Receipt Card/Permanent Resident Card; or a photocopy of an unexpired temporary I-551 stamp in either a foreign passport or a DHS Form I-94, Arrival/Departure Document.

Proof of U.S. citizen or national status includes a copy of your birth certificate, certificate of naturalization, certificate of citizenship, consular report of birth abroad to citizen parents, or a copy of the biographic data page of your U.S. passport.

Check "yes" if you are the petitioning sponsor and on active duty in the U.S. Army, Navy, Air Force, Marines,or Coast Guard, other than for training. If you provide evidence that you are currently on active duty in the military and you are petitioning for your spouse 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 for information on the poverty levels.) Check "no" if you are not on active duty in the U.S. military. This provision does not apply to joint and substitute sponsors.

20. Military Service.

This section asks you to add together the number of persons for whom you are financially responsible. Some of these persons may not be residing 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. For example, your spouse (whom you would enter on line 21c) might also be a lawful permanent resident whom you have already sponsored using Form I-864 (line 21f). If you included your spouse on line 21c, do not include him or her again on line 21f.

Part 5. Sponsor's Household Size.

A. 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:

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);

--

The U.S. government;--


21f - Enter the number of lawful permanent residents whom you are currently obligated to support based on your previous submission of Form I-864 as a petitioning, substitute, or joint sponsor, or of Form I-864EZ as a petitioning 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.

21d - Enter the number of unmarried children you have who are under age 21, even if you do not have legal custody of these children. You may exclude any unmarried children under 21, if these children have reached majority under the law of their place of domicile and you do not claim them as dependents on your income tax returns.

21e - Enter the number of any other dependents. You must include each and 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.

21g - This question gives you the option of including certain other non-dependent relatives who are living in your residence as part of your household size. Such relatives may include your mother, father, sister, brother or adult children, if they are living in your residence. However, the only reason to include these family members in your household size is if you need to include their income when you calculate your household income for purposes of meeting the income requirement for this form. To be considered, any relative indicated in this category must sign and submit Form I-864A.

Part 6. Sponsor's Income and Employment.

Check the box (a through d) that applies to you.

22. Job Classification.

This section is used to determine the sponsor's household income. Take your annual individual income from line 23 and enter it on line 24a. If this amount is greater than 125 percent (or 100 percent if you are on active duty in the U.S. military and sponsoring your spouse or child) of the Federal Poverty Guidelines for your household size from line 21h, you do not need to include any household member's income. See Form I-864P for reference on the Poverty Guidelines.

24. Annual Household Income.

If you included the income of your spouse listed in 21c, or any child listed in 21d, or any dependent listed in 21e, or any other relative listed in 21g, each one of these individuals must be over 18 years of age and must complete Form I-864A.

To determine the filing requirements for your relatives included in item 24b, follow these instructions:

If you included the income of the intending immigrant who is your spouse (he or she would be counted on line 21a), evidence that his/her income will continue from the current source after obtaining lawful permanent resident status must be provided. He/she does not need to complete Form I-864A unless he/she has accompanying children.

If you included the income of the intending immigrant who is not your spouse, (he or she would be counted on line 21a), evidence that his or her income will continue from the current source after obtaining lawful permanent resident status must be provided and the intending immigrant must provide evidence that he/she is living in your residence. He or she does not need to complete Form I-864A, Contract Between Sponsor and Household Member, unless he or she has an accompanying spouse or children.

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 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 stub(s) showing your income for the previous six months. If your claimed income includes alimony, child support, dividend or interest income, or income from any other source, you may also include evidence of that income.

Enter your current individual earned or retirement annual income that you are using to meet the requirements of this form and indicate the total on this line.

23. Current Individual Annual Income.


If you provide a photocopy of your tax return(s), you must include a copy of each and every FormW-2 and Form 1099 that relates to your return(s). Do not include copies of these Forms if you provide an IRS transcript of your return(s) rather than a photocopy.

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.

25. Federal Income Tax Information.

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 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 checked box 22(b) (self-employed), you should have completed one of the following forms with your Federal income tax return: Schedule C (Profit or Loss from Business), Schedule D (Capital Gains), Schedule E (Supplemental Income or Loss) or Schedule F (Profit or Loss from Farming). You must include each and every Form 1040 Schedule, if any, that you filed with your Federal tax return.

If you were required to file a Federal income tax return during any of the previous three tax years but did not do so, you must file any and all late returns with IRS and attach an IRS-generated tax return transcript documenting your late filing before submitting the I-864 Affidavit of Support. If you were not required to file a Federal income tax return under U.S. tax law because your income was too low, attach a written explanation. If you were not required to file a Federal income tax return under U.S. tax law for any other reason, attach a written 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

Only complete this Part if you need to use the value of assets to meet the income requirements. If your Total Household Income (indicated on Line 24c) is equal to or more than needed to meet the income requirement as shown by the current Poverty Guidelines (Form I-864P) for your household size (indicated on Line 21h), you do not need to complete this Part. If your total household income does not meet the requirement, you may submit evidence of the value of your assets, the sponsored immigrant's assets, and/or assets of a household member that can be used, if necessary, for the support of the intending immigrant(s). The value of assets of all of these persons may be combined in order to meet the necessary requirement.

For purposes of this affidavit, the line for gross (total) income on IRS Forms 1040 and 1040A will be considered when determining income. For persons filing IRS Form 1040 EZ, the line for adjusted gross income will be considered.

Part 7. Use of Assets to Supplement Income.

You may include the net value of your home as an asset. The net value of the home is the appraised value of the home, minus the sum of any and all loans secured by a mortgage, trust deed, or other lien on the home. If you wish to include the net value of your home, this, you must include documentation demonstrating that you own it, a recent appraisal by a licensed appraiser, and evidence of the amount of any and all loans secured by a mortgage, trust deed, or other lien on the home. You may not include the net value an automobile unless you show that you have more than one automobile, and at least one automobile is not included as an asset.

Only assets that can be converted into cash within one year and without considerable hardship or financial loss to the owner may be included. The owner of the asset must include a description of the asset, proof of ownership, and the basis for the owner's claim of its net cash value.

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. Telefile tax records are not acceptable proof of filing.

Obtaining Tax Transcripts. You may use Internal Revenue Service (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.

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.


In order to qualify based on the value of your assets, the total value of your assets must equal at least five times the difference between your total household income and the current poverty guidelines for your household size. However, if you are a U.S. citizen and you are sponsoring your spouse or minor child, the total value of your assets must only be equal to at least three times the difference. If the intending immigrant is an alien orphan who will be adopted in the United States after the alien orphan acquires permanent residence, and who will, as a result, acquire citizenship under section 320 of the Act, the total value of your assets need only equal the difference.

To use the assets of a relative (spouse, adult son or daughter, parent or sibling), the relative must reside with you and have completed a Form I-864A, Contract Between Sponsor and Household Member, with accompanying evidence of assets. The Form I-864A and accompanying evidence of assets is submitted with Form I-864. You may use the assets of more than one relative who resides with you so long as you submit a complete Form I-864A with evidence of assets for each such relative.

27. Household Member's Assets.

You may use the assets of the intending immigrant regardless of where he or she resides. The intending immigrant must provide evidence of such assets with this form. Form I-864A is not required to document the intending immigrant's assets.

28. Assets of the Intending Immigrant.

29. Total Value of Assets.

Example of How to Use Assets: If you are petitioning for a parent and the poverty line for your household size is $22,062 and your current income is $18,062, the difference between your current income and the poverty line is $4,000. In order for assets to help you qualify, the combination of your assets, plus the assets of any household member who is signing Form I-864A, plus any available assets of the sponsored immigant, would have to equal five times this difference (5 x $4,000). In this case, you would meet the income requirements if the net value of the assets equaled at least $20,000.

The Government may pursue verification of any information provided on or in support of this form, including employment, income, or assets with the employer, financial or other institutions, the Internal Revenue Service, or the Social Security Administration. If you include in this affidavit of support any information that you know to be false, you may be liable for criminal prosecution under the laws of the United States.

Penalties.

Read the contract carefully, print your name, and then sign and date the form. If you do not print your name on line 30 and sign and date the form on line 31, the intending immigrant you are sponsoring cannot be issued a visa or be granted adjustment of status.

Part 8. Sponsor's Contact.To use your own assets, you must complete lines 26a through 26d and submit corresponding evidence with this form. Supporting evidence must be attached to establish location, ownership, date of acquisition, and value of any real estate holding.

26. Assets.

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 immigrant(s) 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, which are summarized in the contract in Part 8) 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.

Authority for the collection of the information requested on this form is contained in 8 U.S.C. 1182a(4), 1183a, 1184(a), and 1258. The information will be used principally by an immigration judge, USCIS or a Consular Officer to support an alien's application for benefits under the Immigration and Nationality Act and specifically the assertion that he or she has adequate means of financial support and will not become a public charge. Submission of the information is voluntary. Failure to provide the information will result in denial of the application for an immigrant visa or adjustment of status.

Privacy Act Notice.

Other Information.


A person is not required to respond to a collection of information unless it displays a currently valid OMB control number. We try to create forms and instructions that are accurate, can be easily understood, and which impose the least burden on you to provide us with information. Often this is difficult because some immigration laws are very complex. The estimated average time to complete and file this form is as follows: (1) 75 minutes to learn about the law and form; (2) 90 minutes to complete the form; and (3) 3 hour and 15 minutes to assemble and file the form; for a total estimated average of 6 hours per form.

If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, write to U.S. Citizenship and Immigration Services, Regulatory Products Division, Office of the Executive Secretariat, 20 Massachusetts Avenue N.W., Washington, D.C. 20529-2020. OMB No. 1615-0075. This form expires September 30, 2012. Do not mail your completed affidavit of support to this address.

Reporting Burden.

The information may also, as a matter of routine use, be disclosed to other Federal, State and local agencies providing means-tested public benefits for use in civil action against the sponsor for breach of contract. Social Security numbers may be verified with the Social Security Administration consistant with the consent signed as part of the contract in Part 8 of the Form I-864. It may also be disclosed as a matter of routine use to other Federal, State, local, and foreign law enforcement and regulatory agencies to enable these entities to carry out their law enforcement responsibilities.

To order USCIS forms, call our toll-free forms line at 1-800-870-3676. You can also obtain forms and information on immigration laws, regulations and procedures by telephoning our National Customer Service Center at 1-800-375-5283 or visiting our internet website at www.uscis.gov.

USCIS Forms and Information.

Use InfoPass for Appointments.As an alternative to waiting in line for assistance at your local USCIS office, you can now schedule an appointment through our internet-based system, InfoPass. To access the system, visit our website at www.uscis.gov. 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. Print the notice and take it with you to your appointment. The notice gives the time and date of your appointment, along with the address of the USCIS office.

If you use your assets or the assets of a household member to qualify,

If you are a joint sponsor, substitute sponsor, or the relative of an employment-based immigrant requiring an affidavit of support, proof of your citizenship status, U.S. national status or lawful permanent resident status.

A separate Form I-864A for each household member using assets other than for the intending immigrant.

Documentation of assets establishing location, ownership, date of acquisition and value. Evidence of any liens or liabilities against these assets.

Check List

For U.S. citizens or nationals, a copy of your birth certificate, passport, or certificate of naturalization or citizenship.


The following items must be submitted with Form I-864:For ALL sponsors:

If you are currently self-employed, a copy of your Schedule C, D, E or F from your most recent Federal Tax Return which establishes your income from your business.

For SOME 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 most recent three tax years , pay stub(s) from the most recent six months, and/or a letter from your employer if you believe any of these items will help you qualify.

___

___

If you are sponsoring more than one intending immigrant listed on the same affidavit of support, photocopies of the original affidavit of support may be submitted for any additional intending immigrants listed. Copies of supporting documentation are not required for these family members.

___

If you are the petitioning sponsor and on active duty in the U.S. Armed Forces and are sponsoring your spouse or child using 100 percent of governing poverty guideline, proof of your active military status.

___

If you are using the income of persons in your household or dependents to qualify,___

A separate Form I-864A for each person whose income you will use. However, an intending immigrant whose income is being used needs to complete Form I-864A only if his or her spouse and/or children are immigrating with him or her.

___

Proof of their residency in your household and relationship to you if they are not the intending immigrants or are not listed as dependents on your Federal income tax return for the most recent tax year.

___

Proof that the intending immigrant's current employment will continue from the same source if his or her income is being used.

___

A copy of their individual Federal income tax return, including W-2s and 1099s, for the most recent tax year, or evidence that they were not required to file. You may submit this information for the most recent three years if you believe it will help you qualify.

___

___

___

___

___

___

For lawful permanent residents, a copy of both sides of your Form I-551, Permanent Resident Card.___


which filed an alien worker petition on behalf of the intending immigrant, who is related to me as my

I-864, Affidavit of Support Under Section 213A of the Act

Location

Date (mm/dd/yyyy)

1. I,

Part 2. Information on the principal immigrant.

3. Mailing Address Street Number and Name (Include Apartment Number)

This I-864 is from:

Reviewer

Number of Affidavits of Support in file:

Form I-864 (09/19/11) Y

does not meet the requirements of section 213A.

meets the requirements of section 213A.

This I-864:

the Petitioner

a Joint Sponsor # ______________

the Substitute Sponsor


5% Owner

First Name

OMB No. 1615-0075; Expires 09/30/2012

Part 1. Basis for filing Affidavit of Support.

Middle Name2. Last Name

City State/Province Zip/Postal Code Country

4. Country of Citizenship 5. Date of Birth (mm/dd/yyyy)

6. Alien Registration Number (if any)

A-

7. U.S. Social Security Number (if any)

Part 3. Information on the immigrant(s) you are sponsoring.

8.

b.

c.

d.

a.

U.S.Social Security Number (if any)

Date of Birth (mm/dd/yyyy)

A-Number (if any)Name Relationship to

Sponsored Immigrant

e.

10. Enter the total number of immigrants you are sponsoring on this form from Part 3, Items 8 and 9.

I am sponsoring the principal immigrant named in Part 2 above.

9. I am sponsoring the following family members immigrating at the same time or within six months of the principal immigrant named in Part 2 above. Do not include any relative listed on a separate visa petition.

Yes No (Applicable only in cases with two joint sponsors)

1 2

I am the only joint sponsor.

a. I am the petitioner. I filed or am filing for the immigration of my relative.I filed an alien worker petition on behalf of the intending immigrant, who is related to me as my

b.

I have an ownership interest of at least 5 percent inc.

d.I am thee.

The original petitioner is deceased. I am the substitute sponsor. I am the intending immigrant's

f.

am the sponsor submitting this affidavit of support because (Check only one box):,

,

.

first second of two joint sponsors. (Check appropriate box.)

I am a lawful permanent resident. My alien registration number is A-

Part 4. Information on the Sponsor.

Middle Name

Form I-864 (09/19/11) Y Page 2

Last Name

First Name

11. Name

16. Date of Birth (mm/dd/yyyy)

City

Street Number and Name (Include Apartment Number)

Country

13. Place of Residence(if different from mailing address)

14. Telephone Number (Include Area Code or Country and City Codes)

15. Country of Domicile

19. Citizenship/Residency

If you checked box (b), (c), (d), (e) or (f) in line 1 on Page 1, you must include proof of your citizen, national, or permanent resident status.

Zip/Postal Code

State or Province

20. Military Service (To be completed by petitioner sponsors only.)

12. Mailing Address

Street Number and Name (Include Apartment Number)

City State or Province


17. Place of Birth (City) CountryState or Province

I am currently on active duty in the U.S. armed services.


18. U.S. Social Security Number (Required)

I am a U.S. citizen.

I am a U.S. national (for joint sponsors only).

No Yes

(Date)

21. Your Household Size - DO NOT COUNT ANYONE TWICE

Part 5. Sponsor's household size.

Persons you are sponsoring in this affidavit:

a. Enter the number you entered on line 10.

Persons NOT sponsored in this affidavit:b. Yourself.

Part 6. Sponsor's income and employment.

22. I am currently:

e. If you have any other dependents, enter the number here.

c. If you are currently married, enter "1" for your spouse.

d. If you have dependent children, enter the number here.

Form I-864 (09/19/11) Y Page 3

1


23. My current individual annual income is: $

(Company Name)

(Date)

OPTIONAL: If you have siblings, parents, or adult children with the same principal residence who are combining their income with yours by submitting Form I-864A, enter the number here.

If you have sponsored any other persons on an I-864 or I-864 EZ who are now lawful permanent residents, enter the number here.

f.

g.

Add together lines and enter the number here. Household Size:h.

(See Step-by-Step Instructions)

Employed as a/ana.

Name of Employer #1 (if applicable)

Name of Employer #2 (if applicable)

Self-employed as a/anb.

Retired fromc.

Unemployed sinced.

since

.

.

.

.

.

.


c. Total Household Income: $

Form I-864 (09/19/11) Y Page 4

Poverty line for year _______________ is:

$

Household Size =

(Name)

(Total all lines from 24a and 24b. Will be Compared to Poverty Guidelines -- See Form I-864P.)

The persons listed above have completed Form I-864A. I am filing along with this form all necessary Forms I-864A completed by these persons.

d.

The person listed above,e.

complete Form I-864A because he/she is the intending immigrant and has no accompanying dependents.

Name

24. My current annual household income:

$

b.

$

a. List your income from line 23 of this form.

Income you are using from any other person who was counted in your household size, including, in certain conditions, the intending immigrant. (See step-by-step instructions.) Please indicate name, relationship and income.

$

$

$

25. Federal income tax return 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.

(Optional) I have attached photocopies or transcripts of my Federal tax returns for my second and third most recent tax years.

Tax Year

$(most recent)

My total income (adjusted gross income on IRS Form 1040EZ) as reported on my Federal tax returns for the most recent three years was:

$(2nd most recent)

$(3rd most recent)

Total Income

does not need to

Relationship Current Income

Add together lines 28a, b, and c, and enter the number here.


Form I-864 (09/19/11) Y Page 5

Poverty line for year _______________ is:

$

Household Size =

Enter the net cash value of real-estate holdings. (Net means current assessed value minus mortgage debt.)

Part 7. Use of assets to supplement income. (Optional)

a.

If your income, or the total income for you and your household, from line 24c exceeds the Federal Poverty Guidelines for your household size, YOU ARE NOT REQUIRED to complete this Part. Skip to Part 8.

26. Your assets (Optional)

TOTAL:

$

$

$

b.

Add together lines 26 a, b and c and enter the number here.

d.

28. Assets of the principal sponsored immigrant. (Optional)

Assets from Form I-864A, line 12d for

$

27. Your household member's assets from Form I-864A. (Optional)

The principal sponsored immigrant is the person listed in line 2.

Add together lines 26d, 27 and 28d and enter the number here. TOTAL:

(Name of Relative)

$

$

$

$

$

Enter the current cash value of the sponsored immigrant's stocks, bonds, certificates of deposit, and other assets not included on line a or b.

Enter the net cash value of all the sponsored immigrant's real estate holdings. (Net means investment value minus mortgage debt.)

b.

c.

Enter the balance of the sponsored immigrant's savings and checking accounts.

a.

d.

29. Total value of assets.

The total value of all assests, line 29, must equal

5 times (3 times for spouses and children of

USCs, or 1 time for orphans to be formally adopted in the U.S.) the difference between the

poverty guidelines and the sponsor's household

income, line 24c.

Enter the net cash value of all stocks, bonds, certificates of deposit, and any other assets not already included in lines 26(a) or (b).

$c.

Enter the balance of all savings and checking accounts.

This provision does not apply to public benefits specified in section 403(c) of the Welfare Reform Act such as, but not limited to, emergency Medicaid, short-term, non-cash emergency relief; services provided under the National School Lunch and Child Nutrition Acts; immunizations and testing and treatment for communicable diseases; and means-tested programs under the Elementary and Secondary Education Act.

Form I-864 (09/19/11) Y Page 6

Please note that, by signing this Form I-864, 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-864. If you do not understand the obligations, you may wish to consult an attorney or accredited representative.

Part 8. Sponsor's Contract.

If you sign a Form I-864 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-864 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.

What is the Legal Effect of My Signing a Form I-864?

You cannot be made to sign a Form 1-864 if you do not want to do so. But if you do not sign the Form I-864, the intending immigrant may not be able to become a permanent resident in the United States.

What If I choose Not to Sign a Form I-864?

If an intending immigrant becomes a permanent resident in the United States based on a Form I-864 that you have signed, then until your obligations under the Form I-864 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 rules provide for consideration ("deeming”) of your income and assets as available to the person.

What Does Signing the Form I-864 Require Me to do?

If an intending immigrant becomes a permanent resident in the United States based on a Form I-864 that you have signed, then, until your obligations under the Form I-864 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?

Contract continued on following page.

All the factual statements in this affidavit of support are true and correct.

No longer has lawful permanent resident status, and has departed the United States;

Form I-864 (09/19/11) Y Page 7

If you are sued, and the court enters a judgment against you, the person or agency that sued you may use any legally permitted procedures for enforcing or collecting the judgment. You may also be required to pay the costs of collection, including attorney fees.

If a Federal, State or local agency, or a private agency provides any covered means-tested public benefit to the person who becomes a permanent resident based on the Form I-864 that you signed, the agency may ask you to reimburse them for the amount of the benefits they provided. If you do not make the reimbursement, the agency may sue you for the amount that the agency believes you owe.

If you do not file a properly completed Form I-865 within 30 days of any change of address, USCIS may impose a civil fine for your failing to do so.

Becomes a U.S. citizen;

When Will These Obligations End?

Has worked, or can be credited with, 40 quarters of coverage under the Social Security Act;

Your obligations under a Form I-864 will end if the person who becomes a permanent resident based on a Form I-864 that you signed:

Becomes subject to removal, but applies for and obtains in removal proceedings a new grant of adjustment of status, based on a new affidavit of support, if one is required; orDies.

Note that divorce does not terminate your obligations under this Form I-864.

If you do not provide sufficient support to the person who becomes a permanent resident based on the Form I-864 that you signed, that person may sue you for this support.

What If I Do Not Fulfill My Obligations?

(Print Sponsor's Name)

I know the contents of this affidavit of support that I signed.

I,30.

certify under penalty of perjury under the laws of the United States that:

a.

b.

Your obligations under a Form I-864 also end if you die. Therefore, if you die, your Estate will not be required to take responsibility for the person's support after your death. Your Estate may, however, be responsible for any support that you owed before you died.

I have read and I understand each of the obligations described in Part 8, and I agree, freely and without any mental reservation or purpose of evasion, to accept each of those obligations in order to make it possible for the immigrants indicated in Part 3 to become permanent residents of the United States;

I agree to submit to the personal jurisdiction of any Federal or State court that has subject matter jurisdiction of a lawsuit against me to enforce my obligations under this Form I-864;

c.

d.

Each of the Federal income tax returns submitted in support of this affidavit are true copies, or are unaltered tax transcripts, of the tax returns I filed with the U.S. Internal Revenue Service; and

e.

Sign on following page.

,

I authorize the Social Security Administration to release information about me in its records to the Department of State and U.S. Citizenship and Immigration Services.

Form I-864 (09/19/11) Y Page 8

(Sponsor's Signature) (Date-- mm/dd/yyyy)31.

f.

Any and all other evidence submitted is true and correct. g.

Telephone Number:

Part 9. Information on Preparer, if prepared by someone other than the sponsor.

I certify under penalty of perjury under the laws of the United States that I prepared this affidavit of support at the sponsor's request and that this affidavit of support is based on all information of which I have knowledge.

Signature:

Printed Name:

Firm Name:

Address:

Date:

Business State ID # (if any)

(mm/dd/yyyy)

E-Mail Address :

Instructions

I-864A, Contract Between Sponsor and Household Member

Form I-864A Instructions (09/19/11) Y

What Is This Form?

How Should I Complete This Form?

OMB No. 1615-0075; Expires 09/30/2012

Print clearly or type your answers using CAPITAL letters.

Attach a separate sheet of paper (or more sheets if necessary);

Form I-864A, Contract Between Sponsor and Household Member, is an attachment to Form I-864, Affidavit of Support Under Section 213A of the Immigration and Nationality Act. It is an optional form, completed and signed by two individuals: a sponsor who is completing Form I-864, and a household member who is promising to make his or her income and/or assets available to the sponsor to help support the sponsored immigrant(s). The combined signing of this form constitutes an agreement that the household member is responsible along with the sponsor for the support of the individual(s) named in this form. A separate Form I-864A must be used for each household member whose income and/or assets are being used by a sponsor to qualify. This form must be submitted simultaneously with Form I-864.

Use black ink.

If you need extra space to answer any item:

--

Write your name, U.S. Social Security number and the words "Form I-864A" on the top right corner of the sheet; and

--

Write the number and subject of each question for which you are providing additional information.

--

The USCIS website (www.uscis.gov);

The National Customer Service Center (NCSC) telephone line at 1-800-375-5283 TTY: (1-800-767-1833); or

Your local USCIS office by using InfoPass.

Form I-864A may only be used when a sponsor's income and assets do not meet the income requirements of Form I-864 and the qualifying household member chooses to combine his or her resources with the income and/or assets of a sponsor to meet the requirements. The obligations of the household member under this contract terminate when the obligations of the sponsor under the Affidavit of Support terminate. For additional information, see section 213A of the Immigration and Nationality Act, and part 213a of title 8 of the Code of Federal Regulations. For more information about Form I-864, or to obtain related forms please contact:

What Is a Sponsor?A ''sponsor'' is a person, either the petitioning relative, a relative with a significant ownership interest in the petitioning entity, a substitute in the case of a deceased petitioner, or another person accepting joint and several liability with the sponsor, who completes and files Form I-864, Affidavit of Support under Section 213A of the Act on behalf of an intending immigrant. A sponsor must be an individual and may not be an enterprise, a business, or any other type of organization.

Who May Be Considered a "Household Member" for Purposes of This Form?

A relative who has the same principal residence as the sponsor and is related to the sponsor as a spouse, adult child, parent, or sibling;

A relative or other person whom the sponsor has lawfully claimed as a dependent on the sponsor's most recent Federal income tax return even if that person does not live at the same residence as the sponsor;

The intending immigrant, in certain circumstances. (See "How Can the Intending Immigrant Be Considered a Household Member"?)

For purposes of this form, a "household member" is:

How Can the Intending Immigrant Be Considered a Household Member?

The intending immigrant has the same principal residence as the sponsor and the intending immigrant can establish that his or her income will continue from the same source, even after acquisition of permanent residence.

The intending immigrant is the sponsor's spouse and the intending immigrant can show that his or her income will continue from the same source after acquisition of permanent residence.

Listed below are two ways that the intending immigrant may be considered to be a household member for the purposes of pooling income with the sponsor to meet the Affidavit of Support requirements:

A household member completes this form if the household member's income and/or assets will be used to demonstrate the sponsor's ability to meet the income requirements and to maintain the sponsored immigrant at an annual income at the level specified in section 213A(f)(1)(E) or 213A(f)(3) of the Act.

Why Does a Household Member Complete This Form?


Form I-864A Instructions (09/19/11) Y Page 2

If you are the intending immigrant and the sponsor is including your income on Form I-864 to meet the eligibility requirements, you need to complete this form only if you have accompanying dependents. If you are the intending immigrant and the sponsor is including only your assets on Form I-864, you do not need to complete this form, even if you have accompanying dependents.

If the Intending Immigrant Is a Household Member, Must He or She Complete This Form?

This form is divided into three parts. The sponsor completes Part 2 of this form and gives it to the household member. The household member completes Parts 1 and 3 of this form. The information below gives detailed information on completing this form. The Privacy Act Notice and information on penalties for misrepresentation or fraud are included on the instructions to Form I-864.

Step-by-Step Instructions.

If you, the household member, are also the sponsored immigrant, check box (a) or (b) as applicable.

If you check box (a) (married to the sponsor), you do not have to reside with the sponsor, but you must provide proof that your income will continue from the same source after immigration. If you check box (b) (not married to the sponsor), you must provide proof that you currently have the same principal residence as the sponsor and that your income will continue from the same source after immigration.

Household Member's Relationship to the Sponsor. 8.

Household Member's Federal Income Tax Information.

11.

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 are claiming that you were not required to file a Federal 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 was not subject to tax in the United States.

Part 1. Information on the Household Member.

If you are the household member completing this form, but are not the intending immigrant, check box (c), and check the box below that describes your relationship to the sponsor. If you check "dependent," you must be listed as a dependent on the sponsor's most recent Federal tax return. You do not have to provide proof that you have the same principal residence as the sponsor. If you check any other relative except for spouse, you must provide proof of the relationship and that you have the same principal residence as the sponsor.

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 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 stub(s) showing your income for the previous six months. If your claimed income includes alimony, child support, dividend or interest income, or income from any other source, you may also include evidence of ability to maintain that income.

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. Telefile tax records are not acceptable proof of filing.

Check all boxes that apply to you. A sponsor may not rely on a household member's income from illegal activities, such a proceeds from illegal gambling or drug sales, to meet the income requirements, even if the household member paid taxes on that income.

Household Member's Employment. 9.

Current Individual Annual Income.10.Enter your current individual earned or retirement annual income that you are using to meet the requirements of this form and indicate the total on this line.

If you provide a photocopy of your tax return(s), you must include a copy of each and every FormW-2 and Form 1099 that relates to your return(s). Do not include copies of these Forms if you provide an IRS transcript of your return(s) rather than a photocopy.

If you checked box 9(b) (self-employed), you should have completed one of the following forms with your Federal income tax return: Schedule C (Profit or Loss from Business), Schedule D (Capital Gains), Schedule E (Supplemental Income or Loss) or Schedule F (Profit or Loss from Farming). You must include each and every Form 1040 Schedule, if any, that you filed with your Federal tax return.


Complete this item only if the sponsor is using the value of your assets to help meet the requirements of the affidavit of support. If you are using only your income to help the sponsor meet the requirements, do not complete this item. If you are the intending immigrrant and have no accompanying dependents, then do not list your assets on this form. Instead, your assets must be listed on item 24 of Form I-864. Only assets that can be converted into cash within 1 year and without considerable hardship or financial loss to the owner may be included. The owner of the asset must include a description of the asset, proof of ownership, and the basis for the owner's claim of its net cash value. You may include the net value of your home as an asset. The net value of the home is the appraised value of the home, minus the sum of any and all loans secured by a mortgage, trust deed, or other lien on the home.

Assets.12.

The Government may pursue verification of any information provided on or in support of this form, including employment, income, or assets with the employer, financial or other institutions, the Internal Revenue Service, or the Social Security Administration. If you include in this form any information that you know to be false, you may be liable for criminal prosecution under the laws of the United States.

Penalties

Read the household member's promise carefully, print your name, and then sign and date the form. If you do not print your name on line 15 and sign and date the form on line 16, the intending immigrant cannot be issued a visa or be granted adjustment of status based upon the income and/or assets listed on this form.

Part 3. Household Member's Promise

If the sponsor you are promising to make your income available to is sponsoring the the principal intending immigrant (the sponsor should have “Yes” as his or her answer to item number 8 of his or her Form I-864), you should list the intending immigrant on line “a” of Item 13 and then list on lines “b” through “f” any spouse and any and all children that appear on lines 9a through 9e of the sponsor's Form I-864. If the sponsor you are promising to make your income available to is not sponsoring the intending immigrant (this should be true only in cases with two joint sponsors, with “No” checked on item 8 of the sponsor's Form I-864), then do not list the intending immigrant on line “a” of Item 13 on this form. Instead, list on lines “a” through “f” any spouse and any and children that appear on lines 9a through 9e of the sponsor's Form I-864.

Part 2. Sponsor's Promise

If you were required to file a Federal income tax return during any of the previous three tax years but did not do so, you must file any and all late returns with IRS and attach an IRS-generated tax return transcript documenting your late filing before submitting the Form I-864A. If you were not required to file a Federal income tax return under U.S. tax law because your income was too low, attach a written explanation . If you were not required to file a Federal income tax return under U.S. tax law for any other reason, attach a written explanation including evidence of the exemption and how you qualified for 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 form, the line for gross (total) income on IRS Forms 1040 and 1040A will be considered when determining income. For persons filing IRS Form 1040 EZ, the line for adjusted gross income will be considered. Obtaining Tax Transcripts. You may use Internal Revenue Service (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.

If you wish to include the net value of your home, this, you must include documentation demonstrating that you own it, a recent appraisal by a licensed appraiser, and evidence of the amount of any and all loans secured by a mortgage, trust deed, or other lien on the home. You may not include the net value an automobile unless you show that you have more than one automobile, and at least one automobile is not included as an asset.

Other Information


A person is not required to respond to a collection of information unless it displays a currently valid OMB control number. We try to create forms and instructions that are accurate, can be easily understood, and which impose the least burden on you to provide us with information. Often this is difficult because some immigration laws are very complex. The estimated average time to complete and file this form is as follows: (1) 20 minutes to learn about the law and form; (2) 55 minutes to complete the form; and (3) 30 minutes to assemble and file the form; for a total estimated average of 1 hour and 45 minutes per form. If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, write to U.S. Citizenship and Immigration Services, Regulatory Products Division, Office of the Executive Secretariat, 20 Massachusetts Avenue N.W., Washington, D.C. 20529-2020. OMB No. 1615-0075. This form expires September 30, 2012. Do not mail your completed form to this address.

Reporting Burden.

To order USCIS forms, call our toll-free forms line at 1-800-870-3676. You can also obtain forms and information on immigration laws, regulations and procedures by telephoning our National Customer Service Center at 1-800-375-5283 or visiting our internet website at www.uscis.gov.

USCIS Forms and Information

Use InfoPass for Appointments.

As an alternative to waiting in line for assistance at your local USCIS office, you can now schedule an appointment through our internet-based system, InfoPass. To access the system, visit our website at www.uscis.gov. 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. Print the notice and take it with you to your appointment. The notice gives the time and date of your appointment, along with the address of the USCIS office.

Authority for the collection of the information requested on this form is contained in 8 U.S.C. 1182a(4), 1183a, 1184(a), and 1258. The information will be used principally by USCIS, a Consular Officer, or an immigration judge to whom it is furnished, to accompany a sponsor's Form I-864, Affidavit of Support, which supports an alien's application for benefits under the Immigration and Nationality Act, specifically the assertion that he or she has adequate means of financial support and will not become a public charge. Submission of the information is voluntary. Failure to provide the information may result in denial of the application for an immigrant visa or adjustment of status. The information may as a matter of routine use be disclosed to other Federal, State and local agencies providing means-tested public benefits for use in civil action against the sponsor for breach of contract. Social Security numbers may be verified with the Social Security Administration. It may also be disclosed as a matter of routine use to other Federal, State, local, and foreign law enforcement and regulatory agencies to enable these entities to carry out their law enforcement responsibilities.

Privacy Act Notice.

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