What Other Consequences Are There?
If an intending immigrant becomes a lawful permanent resident
in the United States based on a Form I-864EZ that you have
signed, then, until your obligations under Form I-864EZ
terminate, your income and assets may be considered 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 of your income
and assets as available to the person.
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
Elementary and Secondary Education Act.
Part 6. Sponsor's Contract, Statement, Contact
Information, Declaration, Certification, and
If a Federal, state, local, or a private agency provides any
covered means-tested public benefit to the person who becomes
a lawful permanent resident based on the Form I-864EZ that you
signed, the agency may ask you to reimburse them for the
amount of the benefits they provided. If you do not make the
reimbursement, the agency may sue you for the amount that the
agency believes you owe.
If you do not provide sufficient support to the person who
becomes a lawful permanent resident based on the Form
I-864EZ that you signed, that person may sue you for this
What If I Do Not Fulfill My Obligations?
If you do not file a properly completed Form I-865 within 30
days of any change of address, USCIS may impose a civil fine
for your failing to do so. Please see the USCIS website at
www.uscis.gov/I-865 for more information on filing a change
of address as a sponsor.
If you are sued, and the court enters a judgment against you, the
person or agency that sued you may use any legally permitted
procedures for enforcing or collecting the judgment. You may
also be required to pay the costs of collection, including
No longer has lawful permanent resident status and
has departed the United States;
Becomes subject to removal, but applies for and
obtains in removal proceedings a new grant of
adjustment of status, based on a new affidavit of
support, if one is required; or
Becomes a U.S. citizen;A.
Has worked, or can receive credit for 40 quarters of
coverage under the Social Security Act (SSA);
Your obligations under Form I-864EZ also end if you die.
Therefore, if you die, your estate will not be required to take
responsibility for the person's support after your death. Your
estate may, however, be responsible for any support that you
owed before you died.
NOTE: Divorce does not terminate your obligations
under this Form I-864EZ.
The interpreter named in Part 7. read to me every
question and instruction on this affidavit and my
answer to every question in
a language in which I am fluent, and I understood
I can read and understand English, and I have read
and understand every question and instruction on this
affidavit and my answer to every question.
NOTE: Select the box for either Item Number 1.a. or 1.b.
If applicable, select the box for Item Number 2.
At my request, the preparer named in Part 8.,
prepared this affidavit for me based only upon
information I provided or authorized.
Your obligations under Form I-864EZ will end if the person
who becomes a lawful permanent resident based on a Form
I-864EZ that you signed:
When Will These Obligations End?
Sponsor's Contact Information
Sponsor's Daytime Telephone Number
Sponsor's Mobile Telephone Number (if any)
Sponsor's Email Address (if any)
Sponsor's Declaration and Certification
Copies of any documents I have submitted are exact
photocopies of unaltered, original documents, and I understand
that USCIS or the U.S. Department of State (DOS) may require
that I submit original documents to USCIS or DOS at a later
date. Furthermore, I authorize the release of any information
from any of my records that USCIS or DOS may need to
determine my eligibility for the immigration benefit I seek.
Form I-864EZ 10/15/19 Page 4 of 7