USCIS - 1-134, Affidavit of Support Page 1 of 1 US. Citizenship and Immigration “ae” Services 1-134, Affidavit of Support * Download (113KB PDF) + Download Instructions for Form J-I34 (53KB PDF) @ Purpose of Form : ‘To show that visa applicants have sponsorship and will not become public charges while in the United States. The sponsor must file a separate affidavit for each applicant, Number of Pages = Form 2; Instruetions 3. Edition Date : 05/21/2010. Previous editions accepted. Where to File : You must sign Form I-134 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 T- 134 before a notary, nor to have your signature notarize after you sign it 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. Filing Fee : $0 Special Instructions : (NA) Last updated:11/29/2010 Plug-ins http://www.uscis. gov/portal/site/uscis/template, PRINT/menuitem.Saf9bb95919135e66f614... 1/10/2011Affidavit of Support Page | of 1 Affidavit of Support Information about Affidavit of Support ‘The Affidavit of Support is a legal contract between you (the petitioner for an immigrant visa applicant) and the US Government. It ensures that the visa applicant has adequate means of financial support and is unlikely to become a public charge after entering the US. If you have received notification from the NVC to complete an Affidavit of Support for a family- member or an employee to become a legal immigrant to the US, please refer to the Affidavit of ‘Support Instructions. If you have not been requested by the NVC to complete an Affidavit of Support it may be because: * You have not paid the Affidavit of Support pracessing fee, or * Your petition is not ready to begin processing at the NVC. If You Have Visa Questions + Frequently Asked Questions * NVC Contact Information http:/travel state.gov/visa/immigrants/info/info_3730.html 1/10/2011Affidavit of Support Page | of I Affidavit of Support Information about Affidavit of Support ‘The Affidavit of Support Is a legal contract between you (the petitioner for an immigrant visa applicant) and the US Government. It ensures that the visa applicant has adequate means of financial support and is unlikely to become a public charge after entering the US. If you have received notification from the NVC to complete an Affidavit of Support for a family- member or an employee to become a legal immigrant to the US, please refer to the Affidavit of ‘Support Instructions. If you have not been requested by the NVC to complete an Affidavit of Support it may be because: + You have not paid the Affidavit of Support processing fee, or » Your patition is not ready to begin processing at the NVC. If You Have Visa Questions + Frequently Asked Questions * NVC Contact Information hitpy/travel state gov/visa/immigrants/info/info_3730.html 1/10/2011Department of Homeland Security US. Citizenship and Imai (OMB No. 1615-0014; Exp. 0512011 Instructions for Form 1-134, Affidavit of Support a Instructions Read the 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, atthe top of each sheet of paper and indicate the part and number of the item to which the answer refers What Is the Purpose of This Form? General Instructions 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. 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(aX4XC) 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 ease in which you are inadmissible on public charge grounds, but in which you are ‘ot required to have Form I-864 filed on his or her behalf. Section 213 of the Act (nof section 213A) permits the admission of an alien who is inadmissible on public charge grounds, in the discretion ofthe Seeretary of Homeland Security (or, for immigration judge cases, the discretion ofthe ‘Attomey General) upon the posting of a bond or other undertaking (method). Form 1-134, is the “undertaking” prescribed in section 213 of the Act. Do not use Form 1-134 ifthe alien whom you are sponsoring is required to have Form I-864 instead. Execution of Affidavit Ifyou 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 1-134 is under penalty of perjury under US. taw). For this reason, itis not necessary to sign Form I-134 before a notary, nor t@ have your signature notarized after you sign it. Fill Out Form 1-134 1. Type or print legibly in black ink 2, Lextra space is needed to complete any item, attach a continuation sheet, indicate the item number, and date and sign each sheet. Supporting Evidence {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 applies to your situation, Failure to provide evidence of sufficient income or financial resources may result in the denial ofthe alien's application for a visa or his or her removal from the United and resources, as appropriate: A. Statement from an officer of the bank or other financial institutions with deposits, identifying the following details regarding the account: 1. Date account opened: 2. Total amount deposited for the past year; and 3. Present balance, B. Statement(s) of your employer on business stationery showing 1, Date and neture of employment; 2. Salary paid and 3. Whether the position is temporary or permanent. ©. Ifselfemployed: 1. Copy of last income tax return filed; oF 2. Report of commercial rating concer, Form F154 raoions OSA YSS A D. List containing serial numbers and denominations of bonds and name of record owner(s). ‘Sponsor and Alien Liability Under section 213 of the Act, ifthe 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, {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 i eligible for Food Stamps, 7 U.S.C. 2014(i)(1), Supplemental Security Income (SSI), 42 U-S.C. 1382}, and Temporary Assistance for ‘Needy Families (TANF), 42 U:S.C, 608, ‘Documentation of Income and Resources ‘An alien applying for SSI must make available to the Social Security Administration documentation concerning his or het income and resources and those ofthe sponsor, including, information that was provided in the corresponding. application, An alien applying for TANF ot Food Stamps must make similar information available to the State public assistance agency. ‘The U.S, Secretary of Health and Human Services and the US. 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 toa State public assistance agency. Joint and Several Liability Issues Sections 1621() 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 incorectly 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 ot where good cause existed. "Jointly and severally liable" means the alien and sponsors are each liable upto the full amount of ‘any repayment due. Incorrect payments that are not repaid will be withheld from any subsequent payments you or your sponsor are otherwise eligible under the Social Security Act or Food Stamp Act. ‘These provisions do not apply to SSI, TANF, oF Food Stamp eligibility of aliens admitted as refugees, granted asylum or Cuban/Haitian entrants as defined in section 501(¢) of PL. 96-422, and to dependent children of the sponsor or sponsor's spouse. Translations ‘Any document containing a foreign language submitted to USCIS shall be accompanied by a full English language translation which the transiator has certified as complete and ‘accurate, and by the translators certification that he or she is ‘competent to translate from the foreign language into English. Copies Unless specifically required that an original document be filed ‘with an application or petition, an ordinary legible photocopy (standard 8 1/2 11 letter size) may be submitted, Original documents submitted when not required will remain a part of the record Where To File? Where you submit the form depends on whether the alien you are sponsoring isin or outside the United States and what type ‘of application is being submited, See the instructions provided with the corresponding application for detailed information on where to submit this affidavit of support. What Is the Filing Fee? ‘There is no filing fee for Form 1-134, Address Changes Ifyou change your address and you have an application or petition pending with USCIS, you may change your address online al www.useis.gov, click on "Online Change of Address” with USCIS,” and follow the prompts, or you may complete and mail Form AR-11, Alien's Change of Address Card, to: US. Citizenship and Immigration Services Change of Address P.O, Box 7134 London, KY 40742-7134 For commercial overnight or fast freight services only, mail to US. Citizenship and Immigration Services Change of Address 1084-1 South Laurel Road London, KY 40744 orm 150 Tvonions (SIO Page>a a a Processing Information Privacy Act Notice Any Form [+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 1-134. Form 1-134 is not considered properly filed until accepted by USCIS. Initial processing Upon your Form 1-134 has been aceepted, it will be checked {for completeness, including submission of the required initial evidence. Failure to completely fill out Form I-134 or file it without required initial evidence, may result in the denial of -your application. Requests for more information or interview ‘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. USCIS Forms and Information ‘To order USCIS forms, call our toll-free number at 1-800-870-3676. You can also get USCIS forms and information on immigration laws, regulations, and procedures by telephoning our National Customer Service Center at 1-800-375-5283 or visiting our Internet Web site at www. seis. gov. Asan altenative 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 prompis to set up your appointment. InfoPass generates an electronic appoiniment notice that appears on the sereen, [Penalties Ifyou knowingly and willfully make any false statement on| Form 1-134, or conceal any material fact, or submit a false ith Form 1-134, we will deny the application for ‘immigration benefits thatthe alien for whom you are submitting Form 1-134 has filed, and may deny any other immigration benefits document In addition, you will face severe penalties provided by law and may be subject to criminal prosecution. ‘We ask for the information on this form, and associated evidence, to determine if you have established eligibility for the immigration benefit for which you ere seeking. Our legal right to ask for this information can be found in the Immigration and Nationality Act, as amended. We may provide this information to other government agencies, Failure to provide this information, and any requested evidence, may delay a final decision or result in denial of your request. Authority for the collection of the information requested on this form is contained in 8 U.S.C. 1182(a}(4), 1183, 1184(@), and 1258, ‘The information will be used principally by USCIS, or by any consular officer to whom it may be furnished, to support an alien's application for benefits under the Act and specifically the assertion that you have adequate means of financial support and will not become a public charge. Submission of ‘the information is voluntary ‘The information may also be disclosed to other Federal, State, local, and foreign law enforcement and regulatory agencies, including the U.S, Departments of Health and Human Services, Agriculture, State, Defense and any component (if the applicant has served or is serving in the U.S. Armed Forces), Central Intelligence Agency, and individuals and ‘organizations during the course of any investigation to obtain, further information required to carry out USCIS functions. Paperwork Reduction Act ‘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 @ currently val 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 Products Division, 111 Massachusetts Avenue, 'N.W., 3rd Floor, Suite 3008, Washington, DC 20529. OMB. ‘No. 1615-0014, Do not mail your application to this address. Tora 157 Toons OSETTOVY FassDepartment of Homeland Security (M8 No, 1615-0014 Bp. 0812011 US. Chizenhi nd Immigration Sorvces Form I-134, Affidavit of Support eae (Answer all items. Type or print in black ink.) 1 residing at oo) (Gireet Number and Name) (Cin) ‘Siatey ip Code fin US) (County under penalty of perjury under U.S. law, that 1. 1 was born on. in (Damnit) Giny Gate) ‘(County {fyou ae not aU. etzen based on your birt inthe United States, or a non-citizen U.S, national based on your bith in American Samoa (including Swans Island), answer the following as appropiate a Ifa US citizen through naturalization, give Cerificate of Naturalization number '. Ifa USS. citizen through pareni{s) or mariage, give Crticae of Citizenship umber «©. IFUSS. citizenship was derived by some otber method, stach statement of explanation. 4. Ife Lawful Permanent Residert ofthe United States, give A-Number «If lawfully admittee nonimmigrant, give Form 1-94, ArivalDepariure Record, number 21am years of age and have esied inthe United States since 3. This affidavit is executed on behalf ofthe following person ‘Name (Family Name) (First Name) ‘(idle Name) Gender] Age Citizen of (Country) “Marital Status ‘Relationship to Sponsor Tisseally SRE a Sioa NUMERT ORT NGA) aT Ta) TAIT ‘Name of spouse and chilren accompanying or following wo join person POU Gender | Age [OM [Gents] Age Caild (Gender |_Age [Chia Gender | Aes Cnild Gonder | Age | Chile (Gender | Age 44. This afidavits made by me forthe purpose of assuring the U.S. Government thatthe person(s) named in item (3) will not become « public charge in the United States, ‘5. 1am willing and able to receive, maintain, and suppor the person(s) named in item 3. 1am ready and willing ta deposit a bond, if necessary, 0 ‘guarantee that such person(s) vill not become a public charge during his or her stayin the United States, orto guarantee that the above named person(s) will maintain is or her nonimmigrant status, ifadmitted temporarily, and wil depart prior the expiration oF his or her authorized stay Inthe United States. 6. understand that: 1, Form Ie134 isan “undertaking” under section 213 ofthe [migration and Natonslity Act, and I may be sued ifthe person(s) named in item 3 becomes a public charge attr admission to the United States; ». Form 1-134 may be made available to any Federal, State, of local agency that may receive an application from the person(s) named in tem 3 for Food Stamps, Supplemental Security Income, or Temporary Assistenee to Needy’ Families; and «Ifthe person() named in item 3 does apply for Food Stamps, Supplemental Security Income, ot Temporary Assistance for Needy Families, ‘my ovim income and esses may be considered in deciding th person's application, How long my’ income and assets may be attributed to the eon(s) named in item 3 is determined under the statutes and rules governing each specifi program.7. Tam employed as or engaged in the business of with Tipe of Bay ‘Wane oF Concery ‘Gires Nant and Name cy Tay peak {derive an annual income of (fseiPemployed. 1 have ataced a copy of my last income tax return oF ‘report of commercial rating concern which I eer to be true and correct tothe best of my hrowledge and belief See msiructions fr nature ofexience of net worth tobe submited) s "have on deposit in savings banks inthe United States: | have other personal property, the reasonable value of which is s {have stocks and bonds with the following market valu, as indicated on the atached list, which I certify to be te and correct to she best of my knowledge and bli s [have lif insurance in the sum of: s With cash surender value of 8 5 [own eal esate valued at: ‘With morigage(s) or other encumbranee(s) thereon amounting to: $ Which is located at: (Sues Namer and Name) cis) Baas) 8, The following persons are dependent upon me for support (Cheok the bor inthe appropriate columa to indicate whether dhe person named i wholly oF partially dependent upon you for suppor) ame of Pon ‘Wholly Dependent | Pavially Dependent | Age | Relationship to Me oO oO O O Oo Oo 9. Lave previously submitted affdavi() of suppor for de following person(s). IF none, state "None" Name of Person aie submined 10, Thave submited a visa pettion(s) 0 U.S, Citizenship and Immigration Services on behalf of the folowing person(s). Mfmone, state "None Name of Person Relationship Date submited 11.1 CJimend [F] donot invend ro make specific contributions to the support ofthe person(s) named in item 3 (Afyou chock "intend," indicate the exact nature and duration ofthe contributions. For example, i'you intend ta furnish roam and Boar, sate Jor how tong and, ifmanes, site the amet in US. dollars and whether i isto be given ina lump sum, weekly or monthly, and fr how long Oath oF Affirmation of Sponsor acknowledge that Ihave read "Sponsor and Allen Liability on Page 2 of the instructions fortis form, and am aware of my responsibilities a a sponsor under the Socal Security Act, as amended, andthe Pood Stamp Act, as amended, === 1 certify under penalty of perjury under United States law that | know the contents of this affidavit signed by me and thatthe statements are true and correct TN Form F134 (Rey. 0520/10) ¥ Page? Signature of Sponsor