USCIS · Official form

Form I-864A: Contract Between Sponsor and Household Member

Form I-864A is a contract a sponsor’s household member signs to add their income or assets to the sponsor’s Form I-864 Affidavit of Support when the sponsor cannot meet the income requirement alone.

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What is I-864A?

When a sponsor’s own income does not reach the required level of the Federal Poverty Guidelines, a qualifying household member can agree to make their income or assets available by signing Form I-864A. The form is filed together with the sponsor’s Form I-864, never on its own.

By signing, the household member accepts joint and several liability with the sponsor: both become legally responsible for supporting the sponsored immigrant and can be required to repay certain means-tested public benefits the immigrant receives. The obligation lasts until it ends under the rules in the form, such as the immigrant becoming a US citizen or being credited with 40 quarters of work.

Who files I-864A?

Household members (such as a spouse, parent, adult child, or sibling living with the sponsor) whose income is needed to meet the support requirement
Relatives listed as dependents on the sponsor’s federal tax return, even if living elsewhere
The sponsored immigrant in limited cases where their own income can be counted and the instructions permit it
Each household member contributing income signs a separate I-864A

How to fill out I-864A

Confirm the sponsor actually needs additional income by comparing household income to the current Federal Poverty Guidelines (Form I-864P).
Complete the household member’s biographic information and relationship to the sponsor.
State the income and any assets being made available, matching the household member’s federal tax return and pay records.
Both the sponsor and the household member sign the contract.
Submit it as an attachment to the sponsor’s Form I-864 in the immigrant’s adjustment of status or consular processing package; it is not filed separately.

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These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to USCIS.

Page 1 20 fields

To be completed by an attorney or accredited representative (if any). Enter Attorney or State Bar Number (if applicable).

To be completed by an attorney or accredited representative (if any). Enter Attorney or Accredited Representative Number U S C I S Online

To be completed by an attorney or accredited representative (if any). Select this box if Form G- 28 or Form G- 28 I is attached.

Part 1. Information About You. 1. Your Full Legal Name. Enter Family Name, Last Name.

Part 1. Information About You. 1. Your Full Legal Name. Enter Given Name, First Name.

Part 1. Information About You. 1. Your Full Legal Name. Enter Middle Name, if applicable.

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. Enter In Care of Name if any.

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. Enter Street Number and Name.

Part 1. Information About You (the Household Member). Mailing Address. 2. Physical Address. Select Floor.

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. Select Suite.

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. Select Apartment.

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. Enter Apartment, Suite or Floor Number.

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. Enter City or Town.

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. This is a drop down menu. Select State

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. Enter ZIP Code.

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. Enter Province.

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. Enter Postal Code.

Part 1. Information About You (the Household Member). Mailing Address. 2. Current Physical Address. Enter Country.

Part 1. Information About You (the Household Member). Mailing Address. 3. Is your current mailing address the same as your physical

Page 2 13 fields

Part 1. Information About You (the Household Member). Other Information. 5. Enter Date of Birth. Enter as 2 digit month, 2 digit day and 4

Part 1. Information About You (the Household Member). Other Information. 6. Enter Country of Birth.

Part 1. Information About You (the Household Member). Other Information. 7. Enter U.S. Social Security Number, if any. 9 digits.

Part 1. Information About You (the Household Member). Other Information. 8. Enter Alien Registration Number (A. Number), if any.

Part 1. Information About You (the Household Member). Other Information. 9. Enter U S C I S Online Account Number, if any.

Part 2. Your (the Household Member's) Relationship to the Sponsor. Select Item Number 1., 2., or 3. 1. Select I am the intending immigrant

Part 2. Your (the Household Member's) Relationship to the Sponsor. Select Item Number 1., 2., or 3. 2. Select I am the intending immigrant

Part 2. Your (the Household Member's) Relationship to the Sponsor. Select Item Number 1., 2., or 3. 3. Select I am not the intending

Part 3. Your (the Household Member's) Employment and Income. I am currently. 1. Select Employed.

Part 3. Your (the Household Member's) Employment and Income. I am currently. 4. Select Self employed.

Part 3. Your (the Household Member's) Employment and Income. I am currently. 5. Select Retired.

Part 3. Your (the Household Member's) Employment and Income. I am currently. 6. Select Unemployed.

Part 3. Your (the Household Member's) Employment and Income. 7. Enter current individual annual income.

Page 3 31 fields

Part 4. Your (the Household Member's) Federal Income Tax Information and Assets. 1. A. Have you filed a Federal income tax return for each

Part 4. Your (the Household Member's) Federal Income Tax Information and Assets. My total income (adjusted gross income on I R S Form 10 40

Part 4. Your (the Household Member's) Federal Income Tax Information and Assets. 2. A. Enter Most Recent Total Income.

Part 4. Your (the Household Member's) Federal Income Tax Information and Assets. 2. B. Enter Second Most Recent Tax Year.

Part 4. Your (the Household Member's) Federal Income Tax Information and Assets. 2. B. Enter Second Most Recent Total Income.

Part 4. Your (the Household Member's) Federal Income Tax Information and Assets. 2. C. Enter Third Most Recent Tax Year.

Part 4. Your (the Household Member's) Federal Income Tax Information and Assets. 2. C. Enter Third Most Recent Total Income.

Part 4. Your (the Household Member's) Federal Income Tax Information and Assets. My assets (complete only if necessary). 3. Enter the

Part 4. Your (the Household Member's) Federal Income Tax Information and Assets. My assets (complete only if necessary). 4. Enter the net

Part 4. Your (the Household Member's) Federal Income Tax Information and Assets. My assets (complete only if necessary). 5. Enter the cash

Part 4. Interpreter's Contact Information, Certification, and Signature. Interpreter's Certification. I certify, under penalty of perjury,

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. 1. Intending Immigrant Number 1.

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. 2. Intending Immigrant Number 2.

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. 3. Intending Immigrant Number 3.

Page 4 13 fields

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Statement. 5. b. Select:

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Statement. NOTE: Select the

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Statement. 5. c. Select: At

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Contact Information. 8.

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Contact Information. 9.

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Contact Information. 7.

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. Sponsor's Declaration and

Part 5. Sponsor's Promise, Statement, Contact Information, Declaration, Certification, and Signature. 1. Intending Immigrant Number 4.

Page 5 8 fields

Part 6. Your (the Household Member's) Promise, Statement, Contact Information, Declaration, Certification, and Signature. NOTE: Read the

Part 6. Your (the Household Member's) Promise, Statement, Contact Information, Declaration, Certification, and Signature. Enter the number

Part 6. Your (the Household Member's) Promise, Statement, Contact Information, Declaration, Certification, and Signature. Your (the

Page 6 8 fields

Part 6. Your (the Household Member's) Promise, Statement, Contact Information, Declaration, Certification, and Signature. Your (the

Part 7. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 1. Enter the Interpreter's Given Name

Part 7. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 1. Enter the Interpreter's Family Name

Part 7. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 2. Interpreter's Business or Organization

Part 6. Your (the Household Member's) Promise, Statement, Contact Information, Declaration, Certification, and Signature. Your (the

Part 7. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 5. Interpreter's Email Address

Part 7. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 3. Interpreter's Daytime

Part 7. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 4. Interpreter's Mobile

Page 7 9 fields

Part 7. Interpreter's Contact Information, Certification, and Signature. Interpreter's Certification. I certify, under penalty of perjury,

Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Contract, if Other Than the Sponsor or Household

Part 7. Interpreter's Contact Information, Certification, and Signature. Interpreter's Signature. 6. Enter the Date of the Interpreter's

Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Contract, if Other Than the Sponsor or Household

Page 8 16 fields

Part 9. Additional Information. 5. Enter Additional Information.

Part 9. Additional Information. 3. Enter Page Number.

Part 9. Additional Information. 3. Enter Part Number.

Part 9. Additional Information. 3. Enter Item Number.

Part 9. Additional Information. 6. Enter Page Number.

Part 9. Additional Information. 6. Enter Part Number.

Part 9. Additional Information. 6. Enter Item Number.

Part 9. Additional Information. 6. Enter Additional Information.

Part 9. Additional Information. 5. Enter Item Number.

Part 9. Additional Information. 5. Enter Part Number.

Part 9. Additional Information. 5. Enter Page Number.

Part 9. Additional Information. 4. Enter Page Number.

Part 9. Additional Information. 4. Enter Part Number.

Part 9. Additional Information. 4. Enter Item Number.

Part 9. Additional Information. 4. Enter Additional Information.

Part 9. Additional Information. 3. Enter Additional Information.

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Frequently asked questions

Who counts as a household member for Form I-864A?

Generally a relative who lives at the sponsor’s residence (spouse, adult child, parent, or sibling) or a relative claimed as a dependent on the sponsor’s most recent tax return regardless of where they live. The form instructions list the qualifying relationships.

What am I agreeing to by signing Form I-864A?

You accept legal responsibility, together with the sponsor, to maintain the sponsored immigrant at the required income level, and you can be sued or asked to repay certain means-tested benefits. The obligation can last for years, so read the contract terms before signing.

Form I-864A: Contract Between Sponsor and Household Member

What is I-864A?

Who files I-864A?

How to fill out I-864A

Quick fill I-864A on this page

Frequently asked questions

Related forms

Form I-864, Affidavit of Support Under Section 213A

Form I-864EZ: Affidavit of Support Under Section 213A of the INA

Form I-865: Sponsor’s Notice of Change of Address