I-864a

Contract Between Sponsor and Household Member

Purpose of Form:

This contract is intended to benefit the sponsored immigrant(s) and any agency of the Federal Government, any agency of a State or local government, or any private entity to which the sponsor has an obligation under the affidavit of support to reimburse for benefits granted to the sponsored immigrant. This contract may be enforced in any court with appropriate jurisdiction. By signing this form, a household member who is not a sponsored immigrant, agrees to make his or her income and/or assets available to the sponsor to help support the immigrant for whom the sponsor has filed an affidavit of support.

Number of Pages: 7

Edition Date:

1/15/06. Versions other than the 1/15/06 edition are not acceptable.

Where to File:

Should be filed with Form I-864, Affidavit of Support Under Section 213A of the Act.

The signatures on the I-864A must be notarized by a notary public or signed before an immigration or consular officer.

Filing Fee: $0.00

Special Instructions: 

In terms of tax returns, you are only required to submit a photocopy or an Internal Revenue Service-issued transcript of a photocopy or an Internal Revenue Service-issued transcript of your complete Federal income tax return for your most recent tax year, or an explanation if it is not submitted. You may also, at your option, submit a photocopy or an Internal Revenue Service-issued transcript of your complete Federal income tax returns for your second and third most recent tax years if you believe these additional tax returns may help you establish the ability to maintain your household income at the governing threshold set forth in Form I-864P, Poverty Guidelines.