Sponsor's Notice of Change of Address

• Legal Form Number: I-865
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Page 1 of 5Form I-865 11/10/20

For

USCIS

Use

Only

Sponsor's Notice of Change of Address

Department of Homeland Security

U.S. Citizenship and Immigration Services

START HERE - Type or print in black ink.►

USCIS

Form I-865

Action Block

Resubmitted Remarks

Part 1.

Information About You (Sponsor)

CSID Number:

Date

Date

Returned

Date

Date

Your New Physical Address

1.b.

1.c.

1.a. Family Name

(Last Name)

Given Name

(First Name)

Middle Name

Your Full Name

City or Town3.c.

Street Number

and Name

3.a.

3.b. Apt. Flr.

Ste.

3.f.

3.h.

Province

Country

3.g. Postal Code

ZIP Code

3.e.

State

3.d.

Other Information

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

(mm/dd/yyyy)

(mm/dd/yyyy) (mm/dd/yyyy)

(mm/dd/yyyy)

Effective Date of Change of Address (mm/dd/yyyy)4.

City or Town6.d.

Street Number

and Name

6.b.

6.c. Apt. Flr.Ste.

6.g.

6.i.

Province

Country

6.h. Postal Code

ZIP Code

6.f.

State

6.e.

Effective Date of Change of Address (mm/dd/yyyy)7.

1.b.

1.c.

1.a. Family Name

(Last Name)

Given Name

(First Name)

Middle Name

Part 2. Information About the Sponsored

Immigrants

Provide the requested information on the persons you are

sponsoring.

In Care Of Name (if any)6.a.

Your New Mailing Address

Is your new physical address the same as your new

mailing address?

5.

NoYes

If you answered "No" to Item Number 5., provide your

new mailing address in Item Numbers 6.a. - 7.

Sponsored Immigrant 1

Alien Registration Number (A-Number) (if any)2.

A-

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