Affidavit of Support Under Section 213A of the INA

• Legal Form Number: I-864
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form I-864 Edition 12/08/21

For

USCIS

Use

Only

Affidavit of Support Under Section 213A of the INA

Department of Homeland Security

U.S. Citizenship and Immigration Services

Page 1 of 10

To be completed by an

attorney or accredited

representative (if any).

►

Part 1. Basis For Filing Affidavit of Support

am the sponsor submitting this affidavit of support because

(Select only one box):

I am the petitioner. I filed or am filing for the

immigration of my relative.

I filed an alien worker petition on behalf of the

intending immigrant, who is related to me as my

1.c.

1.d.

I have an ownership interest of at least 5 percent in

I am the only joint sponsor.

1.e.

1.f.

I am the

The original petitioner is deceased. I am the

substitute sponsor. I am the intending immigrant's

first second of two joint sponsors.

which filed an alien worker petition on behalf of the

intending immigrant, who is related to me as my

1.b.

I,

1.a.

Mailing Address

2.d. City or Town

2.e. State 2.f. ZIP Code

Country2.i.

2.h. Postal Code

Street Number

and Name

2.b.

NOTE: If you are filing this form as a sponsor, you must

include proof of your U.S. citizenship, U.S. national status,

or lawful permanent resident status.

2.c. Apt. Flr.Ste.

Affidavit of Support Submitter

Petitioner

1st Joint Sponsor

2nd Joint Sponsor Remarks

Date (mm/dd/yyyy):

Reviewed By:

Office:

Substitute Sponsor

5% Owner

Section 213A Review

MEETS

requirements DOES NOT MEET

requirements

START HERE - Type or print in black ink.

Number of Support Affidavits in File

12

,

Province2.g.

In Care Of Name2.a.

Attorney State Bar Number

(if applicable) Attorney or Accredited Representative

USCIS Online Account Number (if any)

Select this box if

Form G-28 or

G-28I is attached.

1.b. Given Name

(First Name)

1.c. Middle Name

Part 2. Information About the Principal

Immigrant

1.a. Family Name

(Last Name)

Alien Registration Number (A-Number) (if any)5.

►A-

USCIS Online Account Number (if any)6.

►

3. Country of Citizenship or Nationality

Other Information

Date of Birth (mm/dd/yyyy)4.

Daytime Telephone Number

7.

USCIS

Form I-864

OMB No. 1615-0075

Expires 12/31/2023

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