I-864A, Contract Between Sponsor and Household Member
Use this form if you are a household member and want to promise to make your income and/or assets available to help support a sponsored immigrant.
Form Details
Dates are listed in mm/dd/yy format.
If you complete and print this form to mail it in, make sure that the form edition date and page numbers are visible at the bottom of all pages and that all pages are from the same edition of the form. If any of the form’s pages are missing or are from a different edition of the form, we may reject your form.
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File this form with Form I-864, Affidavit of Support.
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.
- You may choose to 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.
Filing Tips: Go to our Tips for Filing Forms by Mail page for information on how to help ensure we will accept your application.
Don’t forget to sign your form. We will reject any unsigned form.