Affidavit of Support Under Section 213A of the Act

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

Affidavit of Support Under Section 213A of the INA

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-864EZ

OMB No. 1615-0075

Expires 12/31/2023

START HERE - Type or print in black ink.►

Part 1. Qualifying to Use Form I-864EZ

I am the petitioner of the family member sponsored on

this affidavit.

I am using my own earned or retirement income, which is

documented using Internal Revenue Service (IRS) Form

W-2.

1.c. The sponsored immigrant is the only person immigrating

based on the underlying visa petition.

1.b.

1.a.

Part 2. Information About the Immigrant You

Are Sponsoring (Intending Immigrant)

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

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

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

6.

►A-

USCIS Online Account Number (if any)

7.

►

No (Use Form I-864)Yes

No (Use Form I-864)

Yes

No (Use Form I-864)Yes

Mailing Address

►

U.S. Social Security Number (if any)

5.

This Form I-864EZ:

DOES NOT MEET

the requirements of

INA section 213A

MEETS the

requirements of

INA section 213A

For Government Use Only

Date (mm/dd/yyyy):

Reviewed By:

Location:

2.a. In Care Of Name

Street Number

and Name

2.b.

2.c. Apt. Flr.Ste.

2.d. City or Town

2.g. Province

2.i. Country

2.e. State 2.f. ZIP Code

2.h. Postal Code

Other Information

Daytime Telephone Number3.

Name of Immigrant

To be completed by an

attorney or accredited

representative (if any).

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.

Form I-864EZ Edition 12/08/21 Page 1 of 7

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