I-864A, Contract Between Sponsor and Household Member

ALERT: On Oct. 11, 2019, judges in three separate cases before U.S. District Courts for the Southern District of New York, Northern District of California, and Eastern District of Washington enjoined DHS from implementing and enforcing the final rule related to the public charge ground of inadmissibility under section 212(a)(4) of the Immigration and Nationality Act and postponed the effective date of the final rule until there is final resolution in the cases. Two of the injunctions are nationwide and prevent USCIS from implementing the rule anywhere in the United States. Until final decisions in these cases are issued or the injunction is lifted, USCIS will accept the version of this form on this landing page.

Use this form if you are a household member and want to promise to make your income and/or assets available to help support sponsored immigrants.

Number of Pages

Form 8; instructions 10.

Edition Date

03/06/18. You can find the edition date at the bottom of the page on the form and instructions.

Where to File

File this form with Form I-864, Affidavit of Support.

Don’t forget to sign your form! We will reject any unsigned form.

Filing Fee

$0

Checklist of Required Initial Evidence (for informational purposes only)

Please do not submit this checklist with your Form I-864A. It is an optional tool to use as you prepare your form, but does not replace statutory, regulatory, and form instruction requirements. We recommend that you review these requirements before completing and submitting your form. Do not send original documents unless specifically requested in the form instructions or applicable regulations.

If you submit any documents (copies or original documents, if requested) in a foreign language, you must include a full English translation along with a certification from the translator verifying that the translation is complete and accurate, and that they are competent to translate from the foreign language to English.

Did you provide the following?

  • Your Internal Revenue Service (IRS) transcript or a copy of your federal income tax return for the most recent tax year. If you provide a copy, you must include a copy of every Form W-2 and Form 1099 that relates to your return. 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.

Special Instructions

You must submit a photocopy or an Internal Revenue Service-issued transcript of your complete federal income tax return for your most recent tax year, or an explanation if you do not submit it.

You may also, at your option, submit a photocopy or an Internal Revenue Service-issued transcript of your complete federal income tax returns for your second and third most recent tax years if you believe these additional tax returns may help you establish the ability to maintain your household income at the governing threshold set forth in Form I-864P, Poverty Guidelines.

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