I-864A, Contract Between Sponsor and Household Member

Alert: On Nov. 2, 2020, the U.S. District Court for the Northern District of Illinois vacated the Inadmissibility on Public Charge Grounds final rule (84 Fed. Reg. 41,292 (Aug. 14, 2019), as amended by Inadmissibility on Public Charge Grounds; Correction, 84 Fed. Reg. 52,357 (Oct. 2, 2019)) (Public Charge Final Rule) nationwide. That decision was stayed by the U.S. Court of Appeals for the Seventh Circuit. On March 9, 2021, the Seventh Circuit lifted its stay, and the U.S. District Court for the Northern District of Illinois’ order vacating the Public Charge Final Rule went into effect.

We immediately stopped applying the Public Charge Final Rule to all pending applications and petitions that would have been subject to the rule. USCIS continues to apply the public charge inadmissibility statute, including consideration of the statutory minimum factors in the totality of the circumstances, in accordance with the 1999 Interim Field Guidance, which was in place before the Public Charge Final Rule was implemented on Feb. 24, 2020, to the adjudication of any application for adjustment of status. In addition, USCIS will no longer apply the separate, but related, “public benefits condition” to applications or petitions for extension of nonimmigrant stay and change of nonimmigrant status.

On or after March 9, 2021, applicants and petitioners should not provide information required solely by the Public Charge Final Rule. That means that applicants for adjustment of status should not provide the Form I-944, Declaration of Self-Sufficiency, or any evidence or documentation required on that form with their Form I-485. Applicants and petitioners for extension of nonimmigrant stay and change of nonimmigrant status should not provide information related to the receipt of public benefits on prior editions of Form I-129 (Part 6), Form I-129CW (Part 6), Form I-539 (Part 5), and Form I-539A (Part 3).

If an applicant or petitioner has already provided such information, and USCIS adjudicates the application or petition on or after March 9, 2021, we will not consider any information provided that relates solely to the Public Charge Final Rule, including, for example, information provided on the Form I-944, evidence or documentation submitted with Form I-944, and information on the receipt of public benefits on prior editions of Form I-129 (Part 6), Form I-129CW (Part 6), Form I-539 (Part 5), and Form I-539A (Part 3).

If you received a Request for Evidence (RFE) or Notice of Intent to Deny (NOID) requesting information that is solely required by the Public Charge Final Rule, including but not limited to Form I-944, and your response is due on or after March 9, 2021, you do not need to provide the information solely required by the Public Charge Final Rule. However, you need to respond to the aspects of the RFE or NOID that otherwise pertain to the eligibility for the immigration benefit you are seeking. If USCIS requires additional information or evidence to make a public charge inadmissibility determination under the statute and consistent with the 1999 Interim Field Guidance, we will send you another RFE or NOID. For information about the relevant court decisions, please see the litigation summary.

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.

Forms and Document Downloads

Form Details

Edition Date

03/10/21. You can find the edition date at the bottom of the page on the form and instructions.

Dates are listed in mm/dd/yy format.

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.

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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