aos form .pdf



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

USCIS
Form I-864
OMB No. 1615-0075

Expires 10/10/2018

What is the Purpose of Form I-864
This affidavit is required for intending immigrants for the U.S. permanent residence. Employment-based preference
immigrants in cases only when a U.S. citizen, lawful permanent resident, or U.S. national 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.

How Is Form I-864 Used?
This affidavit is a contract between the intending immigrant and the U.S. Government. The submission of this affidavit
may make the immigrant eligible for certain Federal, state, or local means-tested public benefits.

Who Needs to Submit Form I-864?
All immigrant visa applicants 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:
1. All immediate relatives of U.S. citizens (spouses, unmarried children under 21 years of age, and parents of U.S.
citizens 21 years of age and older);
2. All family-based preference immigrants (unmarried sons and daughters of U.S. citizens, spouses and unmarried sons
and daughters of lawful permanent residents, married sons and daughters of U.S. citizens, and brothers and sisters of
U.S. citizens 21 years of age and older); and
3. Employment-based preference immigrants in cases only when a U.S. citizen, lawful permanent resident, or U.S.
national 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.

What Is the Filing Fee?
The filing fee of Form I-864 is $420.00
Requests for Interview. At the time of any interview appearance at a USCIS office, we may require that you provide
your fingerprints, photograph, and/or signature to verify your identity and/or update background and security checks.
Decision. The decision on Form I-864 is to establish eligibility for the immigration benefit you are seeking.
USCIS will notify you of the interview appearance in writing.

Where To File?
You should file Form I-864 with the USCIS for submission to the National Visa Center for documentation and petition
processing. For the Department of State information see, www.travel.state.gov.

Processing Information
Initial Processing. Once USCIS receives your affidavit we will check it for completeness. If you do not completely fill
out this affidavit, you will be contacted to complete it or the Department of State may reject or deny your application.

Checklist:
The following items must be submitted with Form I-864:
Receipt payment of Affidavit of Support fee.

□□
□□ Copies of supporting documents are required.

Part 8. Sponsor’s Contract, Statement, Contact Information, Certification, and Signature of Form I-864.

USCIS Privacy Act Statement
AUTHORITIES: The information requested on this affidavit is collected under the Immigration and Nationality
Act, section 213A(i).
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information may
result in denial of your petition. INA section 213A(i) requires the submission of this Affidavit of Support. Failure to
complete the Affidavit of Support may prevent USCIS from accepting and approving this application, and the intending
immigrant may not be able to immigrate to the United States.
ROUTINE USES: DHS may share the information you provide on this affidavit with other Federal, state, local, and
foreign government agencies and authorized organizations. DHS follows approved routine uses described in the
associated published system of records notices [DHS-USCIS-007 - Benefits Information System and DHS-USCIS-001-Alien
File, Index, and National File Tracking System of Records] which you can find at www.dhs.gov/privacy. DHS may also
share the information, as appropriate, for law enforcement purposes or in the interest of national security.
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 immigrant for breach of contract.

Paperwork Reduction Act
An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection
of information, unless it displays a currently valid OMB control number. The public reporting burden for this collection
of information is estimated at 6 hours per response, including the time for reviewing instructions, gathering the required
documentation and information, completing the affidavit, preparing statements, attaching necessary documentation, and
submitting the affidavit. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory
Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC 20529-2140; OMB
No. 1615-0075. Do not mail your completed Form I-864 to this address.

10/10/2014
10/10/2013
10/10/2013
10/102018
OMB No. 1615-0075; Expires:10/10/2013
10/10/2018
10/10/2016
10/31/2012
10/10/2017
10/10/2013
10/31/2011

I-864W, Intending Immigrant's
Affidavit of Support Exemption
(AOS)

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

Part 1. Information about the intending immigrant. (You or your adopted
AOS
AOS
Filing
child.)
Fee:
$340
AOSFiling
FilingFee:
Fee:$440
$440
$290
Last Name

1. Name

For Government
Use Only

First Name
2. Address

Middle Name

Street Number and Name (include apartment number)
City

State or Province

Country

Zip/Postal Code

3. Date of Birth

(mm/dd/yyyy)

4. Country of Birth
(city/country)
5. Telephone Number

(Include area code or country and city codes)

FEE:
$290
fee:
$290
AOS
Fee:
$290
AOS
Fee:
AOS
Fee:
$760
$410
AOS
Fee:
$420
AOS
$290
This
64W:
I-8
AOS
Fee:
Fee:
$460
$410
AOS Fee: $420

does not meet the
requirements of
exemption.

meets the
requirements of
exemption.

Reviewer

6. Social Security
Number (if any)
7. Alien Registration
Number (if any)

Location

Date (mm/dd/yyyy)

Part 2. Reason for exemption.
I am EXEMPT from filing a Form I-864 Affidavit of Support because:
I have earned (or can be credited with) 40 quarters (credits) of coverage under the Social
Security Act (SSA). (Attach SSA earnings statements. Do not count any quarters during
which you received a means-tested public benefit.)
I am under 18, unmarried, immigrating as the child of a U.S. citizen, and will automatically
become a U.S. citizen under the Child Citizenship Act of 2000 upon my admission to the
United States.
I am filing for an immigrant visa or adjustment of status as a self-petitioning widow(er)
using Form I-360.
under
the
Diversity
Visa
Program.
am
filing
for
an
immigrant
visa
under
under
thethe
the
Diversity
Diversity
visa
Visa
program.
Program
.
under
the
Diversity
Visa
Program.
amfiling
filingfor
for
an
immigrant
visa
orthe
adjustment
of
status
as
a battered
spouse or child using
under
Diversity
Visa
Program
Program.
an
immigrant
visa
under
the
diversity
visa
program.
IIIIam
am
filing
for
an
immigrant
visa
under
the
diversity
visa
prgram.
an
immigrant
visa
under
diversity
visa
program.
Form I-360.

Part 3. Concluding provision.
I,
of perjury under the laws of the United States that:

, certify under penalty

(a) I know the contents of this exemption request which I signed;
(b) All the statements in this exemption request are true and correct; and
(c) 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.
or of U.S. citizen parent
(Signature
of intending
immigrant,
if intending
immigrant
is less than 14 years old)

(Date--mm/dd/yyyy)
Form I-864W (Rev. 10/08/10)Y

NOTE:
MUST with
be submitted
with$420
the AOS fee: $420
Form This
must form
be submitted
the AOS fee:


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