(Net
value means current assessed value minus mortgage debt.)
$
$
If your income, or the total income for you and your household,
from Part 6., Item Numbers 20
Or 24.a
24.c., exceeds the
Federal Poverty Guidelines for your household size, YOU ARE
NOT REQUIRED to complete this Part 7
Skip to Part 8
Your Assets (Optional)
Enter the balance of all savings and checking accounts
TOTAL:
$
$
Assets, Name of Relativeb.a
Assets of the principal sponsored immigrant (optional)
My Current Annual Household Income (Total all lines
from Part 6
Item Numbers 7., 10., 13., 16., and 19.; the
total will be compared to Federal Poverty Guidelines on
Form I-864P.) The people listed in Item Numbers 8., 11., 14., and have completed Form I-864A
I am filing along
with this affidavit all necessary Form I-864As
completed by these people
Enter the current cash value of the principal immigrant's
stocks, bonds, certificates of deposit, and other assets not
included in Item Number 6
Or Item Number 7
Part 6
Sponsor's Employment and Income
(continued)
Part 7
Use of Assets to Supplement Income
(Optional)
The principal sponsored immigrant is the person listed in Part, Item Numbers 1.a
1.c
Only include the assets if the
principal immigrant is being sponsored by this affidavit of
support
N/A
2021 34858.0000202200
N/A
N/A
N/A, A
Form I-864 Edition 12/08/21 E
For
USCIS
Use
Only
Page 6 of 10 Add together Item Numbers 4., 5.b., and 9
And enter the
number here
Total Value of Assets
Add together Item Numbers 6
8
And enter the number
here
TOTAL:
Household Size
4
Remarks, Poverty Guideline
$
5 6The total value of all assets, line 10, must equal 5 times (3 times for spouses and children of
USC's, or 1 time for orphans to be formally adopted in the U.S.) the difference between the
poverty guidelines and the sponsor's household income, line 10
Sponsor's Household Income
(Page 5, Line 10)
$
Please note that, by signing this Form I-864, you agree to
assume certain specific obligations under the Immigration and
Nationality Act (INA) and other Federal laws
The following
paragraphs describe those obligations
Please read the
following information carefully before you sign Form I-864
If
you do not understand the obligations, you may wish to consult
an attorney or accredited representative
The U.S
Government cannot make you sign Form 1-864 if you
do not want to do so
But if you do not sign Form I-864, the
intending immigrant may not become a lawful permanent
resident in the United States
What If I Choose Not to Sign Form I-864?
What Does Signing Form I-864 Require Me To Do?
If an intending immigrant becomes a lawful permanent resident
in the United States based on a Form I-864 that you have
signed, then, until your obligations under Form I-864 terminate,
you must:
NOTE: Read the Penalties section of the Form I-864
Instructions before completing this part
Sponsor's Contract
A
Provide the intending immigrant any support
necessary to maintain him or her at an income that is
at least 125 percent of the Federal Poverty Guidelines
for his or her household size (100 percent if you are
the petitioning sponsor and are on active duty in the
U.S
Armed Forces or U.S
Coast Guard, and the
person is your husband, wife, or unmarried child
under 21 years of age); and
Notify U.S
Citizenship and Immigration Services
(USCIS) of any change in your address, within 30
days of the change, by filing Form I-865
B
What is the Legal Effect of My Signing Form I-864?
If you sign Form I-864 on behalf of any person (called the
intending immigrant) who is applying for an immigrant visa or
for adjustment of status to a lawful permanent resident, and that
intending immigrant submits Form I-864 to the U.S
Government with his or her application for an immigrant visa or
adjustment of status, under INA section 213A, these actions
create a contract between you and the U.S
Government
The
intending immigrant becoming a lawful permanent resident is
the consideration for the contract
If an intending immigrant becomes a lawful permanent resident
in the United States based on a Form I-864 that you have
signed, then, until your obligations under Form I-864 terminate,
the U.S
Government may consider (deem) your income and
assets as available to that person, in determining whether he or
she is eligible for certain Federal means-tested public benefits
and also for state or local means-tested public benefits, if the
state or local government's rules provide for consideration
(deeming) of your income and assets as available to the person
What Other Consequences Are There?
Under this contract, you agree that, in deciding whether the
intending immigrant can establish that he or she is not
inadmissible to the United States as a person likely to become a
public charge, the U.S
Government can consider your income
and assets as available for the support of the intending
immigrant
If you do not provide sufficient support to the person who
becomes a lawful permanent resident based on a Form I-864
that you signed, that person may sue you for this support
What If I Do Not Fulfill My Obligations?
Part 7
Use of Assets to Supplement Income
(Optional) (continued)
Part 8
Sponsor's Contract, Statement, Contact
Information, Declaration, Certification, and
Signature
This provision does not apply to public benefits specified in
section 403(c) of the Welfare Reform Act such as emergency
Medicaid, short-term, non-cash emergency relief; services
provided under the National School Lunch and Child Nutrition
Acts; immunizations and testing and treatment for
communicable diseases; and means-tested programs under the