I-864A, Contract Between Sponsor and Household Member

ALERT: On Feb. 21, 2020, the Supreme Court stayed the statewide injunction issued by the U.S. District Court for the Northern District of Illinois affecting Illinois filers. USCIS will implement the Inadmissibility on Public Charge Grounds final rule nationwide, including in Illinois, on Feb. 24, 2020. USCIS will apply the Final Rule to all applications for adjustment of status, and applications and petitions for extension of nonimmigrant stay or change of nonimmigrant status postmarked (or, if applicable, submitted electronically) on or after that date. For applications and petitions that are sent by commercial courier (for example, UPS, FedEx, or DHL), the postmark date is the date reflected on the courier receipt. USCIS will reject any affected application or petition that does not adhere to the Final Rule, including those submitted by or on behalf of aliens living in Illinois, if postmarked on or after Feb. 24, 2020.

The Final Rule requires applicants for adjustment of status who are subject to the public charge ground of inadmissibility and certain applicants and petitioners seeking extension of stay and change of status to report certain information related to public benefits. Due to litigation-related delays in the Final Rule’s implementation, USCIS is applying this requirement as though it refers to Feb. 24, 2020, rather than Oct. 15, 2019. Please read all references to Oct. 15, 2019, as though they refer to Feb. 24, 2020

USCIS will not consider, and applicants for adjustment of status do not need to report, the application for, certification or approval to receive, or receipt of certain previously excluded non-cash public benefits (such as SNAP, most forms of Medicaid, and public housing) before Feb. 24, 2020. Similarly, USCIS will not consider as a heavily weighted negative factor receipt of previously included public benefits (such as SSI and TANF) before Feb. 24, 2020, in a public charge inadmissibility determination.

Certain classes of aliens are exempt from the public charge ground of inadmissibility (such as refugees, asylees, certain VAWA self-petitioners, U petitioners, and T applicants) and therefore, are not subject to the Final Rule.

Read the Final Rule (PDF).

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

10/15/19. 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.

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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