Fillable Printable Sample Form for Affidavit of Support
Fillable Printable Sample Form for Affidavit of Support
Sample Form for Affidavit of Support
Form I-134 Instructions 02/19/14 Y Page 1
Department of Homeland Security
U.S. Citizenship and Immigration Services
Instructions for Form I-134, Affidavit of Support
What Is the Purpose of This Form?
Section 212(a)(4) of the Immigration and Nationality Act (the
Act) bars the admission into the United States any alien who,
in the opinion of the U.S. Department of State officer
adjudicating a visa application, a Department of Homeland
Security officer, or an immigration judge adjudicating an
application for admission, is likely at any time to become a
public charge.
If you are sponsoring more than one alien, you must submit a
separate Form I-134 for each alien. Form I-134 must be
signed in your full name. (Note: Signing Form I-134 is under
penalty of perjury under U.S. law). For this reason, it is not
necessary to sign Form I-134 before a notary, nor to have your
signature notarized after you sign it.
OMB No. 1615-0014
; Expires 02/29/2016
Read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet of paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet of
paper and indicate the part and number of the item to which the answer refers.
Instructions
Execution of Affidavit
For aliens seeking admission or adjustment as permanent
residents as immediate relatives, family-based immigrants,
and certain employment based immigrants, as specified in
sections 212(a)(4)(C) and 213A of the Act and 8 CFR Part
213a, the petitioning relative must file Form I-864.
Form I-134 may be used in any case in which you are
inadmissible on public charge grounds, but in which you are
not required to have Form I-864 filed on his or her behalf.
Section 213 of the Act (not section 213A) permits the
admission of an alien who is inadmissible on public charge
grounds, in the discretion of the Secretary of Homeland
Security (or, for immigration judge cases, the discretion of the
Attorney General) upon the posting of a bond or other
undertaking (method). Form I-134, is the “undertaking”
prescribed in section 213 of the Act.
2. If extra space is needed to complete any item, attach a
continuation sheet, indicate the item number, and date and
sign each sheet.
Do not use Form I-134 if the alien whom you are sponsoring
is required to have Form I-864 instead.
A. Statement from an officer of the bank or other financial
institutions with deposits, identifying the following details
regarding the account:
As the sponsor, you must show you have sufficient income
or financial resources to assure that the alien you are
sponsoring will not become a public charge while in the
United States.
Evidence should consist of copies of any of the
documents listed below that apply to your situation.
Failure to provide evidence of sufficient income or
financial resources may result in the denial of the alien's
application for a visa or his or her removal from the United
States.
Submit in duplicate evidence of income and resources,
as appropriate:
1. Date account opened;
Supporting Evidence
2. Total amount deposited for the past year; and
3. Present balance.
B. Statement(s) from your employer on business stationery
showing:
1. Date and nature of employment;
2. Salary paid; and
3. Whether the position is temporary or permanent.
Fill Out Form I-134
General Instructions
1. Type or print legibly in black ink.
1. Copy of last income tax return filed; or
C. If self-employed:
2. Report of commercial rating concern.
Form I-134 Instructions 02/19/14 Y Page 2
Where To File?
What Is the Filing Fee?
There is no filing fee for Form I-134.
Where you submit the form depends on whether the alien you
are sponsoring is in or outside the United States and what type
of application is being submitted. See the instructions
provided with the corresponding application for detailed
information on where to submit this affidavit of support.
In addition to that provision, your income and assets may be
combined with the income and assets of the person you are
sponsoring in determining whether that person is eligible for
Food Stamps, 7 U.S.C. 2014(i)(1), Supplemental Security
Income (SSI), 42 U.S.C. 1382j, and Temporary Assistance for
Needy Families (TANF), 42 U.S.C. 608.
An alien applying for SSI must make available to the Social
Security Administration documentation concerning his or her
income and resources and those of the sponsor, including
information that was provided in the corresponding
application.
Documentation of Income and Resources
The U.S. Secretary of Health and Human Services and the
U.S. Secretary of Agriculture are authorized to obtain copies
of any such documentation submitted to U.S. Citizenship and
Immigration Services, (USCIS) or the U.S. Department of
State and to release such documentation to a State public
assistance agency.
An alien applying for TANF or Food Stamps must make
similar information available to the State public assistance
agency.
Sections 1621(e) of the Social Security Act and
subsection 5(i) of the Food Stamp Act also provide that an
alien and his or her sponsor shall be "jointly and severally
liable" to repay any SSI, TANF, or Food Stamp benefits that
are incorrectly paid because of misinformation provided by a
sponsor or because of a sponsor's failure to provide
information, except where the sponsor was without fault or
where good cause existed. "Jointly and severally liable" means
the alien and sponsors are each liable up to the full amount of
any repayment due.
Joint and Several Liability Issues
Address Changes
Incorrect payments that are not repaid will be withheld from
any subsequent payments for which you or your sponsor are
otherwise eligible under the Social Security Act or Food
Stamp Act.
Any document containing a foreign language submitted to
USCIS shall be accompanied by a full English language
translation which the translator has certified as complete and
accurate, and by the translator's certification that he or she is
competent to translate from the foreign language into English.
D. List containing serial numbers and denominations of bonds
and name of record owner(s).
Under section 213 of the Act, if the person you are sponsoring
becomes a public charge, the agency that provides assistance
may be able to sue you to recover the cost of the assistance.
Sponsor and Alien Liability
Unless specifically required that an original document be filed
with an application or petition, a legible photocopy may be
submitted. Original documents submitted when not required
may remain a part of the record.
If you have changed your address, you must inform USCIS of
your new address. For information on filing a change of
address go to the USCIS Web site at
www.uscis.gov/
addresschange or contact the USCIS National Customer
Service Center at 1-800-375-5283. For TDD (hearing
impaired) call: 1-800-767-1833.
These provisions do not apply to SSI, TANF, or Food
Stamp eligibility of aliens admitted as refugees, granted
asylum or Cuban/Haitian entrants as defined in section
501(e) of P.L. 96-422, and to dependent children of the
sponsor or sponsor's spouse.
Translations
Copies
NOTE: Do not submit a change of address request to the
USCIS Lockbox facilities because the USCIS Lockbox
facilities do not process change of address requests.
Form I-134 Instructions 02/19/14 Y Page 3
We may request more information or evidence, or we may
request that you appear at a USCIS office for an interview.
We may also request that you submit the originals of any
copy. We will return these originals when they are no longer
required.
As an alternative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
our Internet-based system, InfoPass. To access the system,
visit our Web site. Use the InfoPass appointment scheduler
and follow the screen prompts to set up your appointment.
InfoPass generates an electronic appointment notice that
appears on the screen.
USCIS Forms and Information
To ensure you are using the latest version of this form, visit
the USCIS Web site at www.uscis.gov where you can obtain
the latest USCIS forms and immigration-related information.
If you do not have internet access, you may order USCIS
forms by calling our toll-free number at 1-800-870-3676.
You may also obtain forms and information by calling our
USCIS National Customer Service Center at
1-800-375-5283. For TDD (hearing impaired) call:
1-800-767-1833.
ROUTINE USES: The information you provide on this
benefit application may be shared with other federal, state,
local, and foreign government agencies and authorized
organizations in accordance with approved routine uses, as
described in the associated published system of records
notices [DHS-USCIS-007 - Benefits Information System
and DHS-USCIS-001 - Alien File (A-File) and Central
Index System (CIS), which can be found at www.dhs.gov/
privacy]. The information may also be made available, as
appropriate for law enforcement purposes or in
the interest of national security.
DISCLOSURE: The information you provide is voluntary.
However, failure to provide the requested information, and
any requested evidence, may delay a final decision or result in
denial of your benefit request.
USCIS Privacy Act Statement
AUTHORITIES: The information requested on this benefit
application, and the associated evidence, is collected pursuant
to Sections 1182(a)(4), 1183, 1184(a), and 1258 of the
Immigration and Nationality Act (INA), as amended INA §
101, et seq.
PURPOSE: The information you provide will be used
principally by USCIS, or by any consular officer to whom it
may be furnished, in the processing of Form I-131,
Application for Travel Document, to determine whether you
have adequate financial means to support the individual for
whom parole is requested on form I-131 and that this
individual will not become a public charge.
Any Form I-134 that is not signed will be rejected with a
notice that your Form I-134 is deficient. You may correct
the deficiency and resubmit Form I-134. Form I-134 is not
considered properly filed until accepted by USCIS.
Once your Form I-134 has been accepted, it will be checked
for completeness, including submission of the required initial
evidence.
Processing Information
Requests for more information or interview
If you knowingly and willfully make any false statement on
Form I-134, or conceal any material fact, or submit a false
document with Form I-134, we will deny the application for
immigration benefits that the alien for whom you are
submitting Form I-134 has filed, and may deny any other
immigration benefits.
Penalties
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a currently valid
OMB control number. The public reporting burden for this
collection of information is estimated at 90 minutes per
response, including the time for reviewing instructions, and
completing and submitting the form. Send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
this burden, to: U.S. Citizenship and Immigration Services,
Regulatory Coordination Division, Office of Policy and
Strategy, 20 Massachusetts Ave NW, Washington, DC
20529-2140; OMB No. 1615-0014. Do not mail your
completed Form I-134 to this address.
Paperwork Reduction Act
Initial processing
In addition, you will face severe penalties provided by law and
may be subject to criminal prosecution.
