Form I-942 02/13/19 Page 3 of 9
8.
Has anything changed since the date you filed your Federal tax returns? (For example, your marital status,
income, or number of dependents.)
Yes No
If you answered "Yes" to Item Number 8., provide an explanation below. Provide documentation if available.
At my request, the preparer named in Part 7.,
Requestor's Statement Regarding the Preparer2.
I can read and understand English, and I have read and understand every question and instruction on this request, and my
answer to every question.
Part 4. Requestor's Statement, Contact Information, Certification, and Signature
A.
Requestor's Statement Regarding the Interpreter1.
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
The interpreter named in Part 6. read to me every question and instruction on this request, and my answer to every
B.
, a language in which I am fluent,
and I understood everything.
NOTE: Read the Penalties section of the Form I-942 Instructions before completing this part.
Requestor's Daytime Telephone Number 3. 4. Requestor's Mobile Telephone Number (if any)
Requestor's Contact Information
Requestor's Email Address (if any)5.
Requestor's Statement
question in
Part 3. Household Income (continued)
,
prepared this request for me based only upon information I provided or authorized.
Requestor's Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of
my records that USCIS may need to determine my eligibility for the immigration benefit I seek.
I further authorize release of information contained in this request, in supporting documents, and in my USCIS records to other entities
and persons where necessary for the administration and enforcement of U.S. immigration laws.
Each person applying for a reduced fee must complete, sign, and date Form I-942 and provide the required documentation. This
includes family members identified in Part 2., Item Number 1. Signature fields for family members are at the end of this part. A
legal guardian may sign the request on behalf of the applicant. USCIS rejects any Form I-942 that is not signed by all individuals
requesting a reduced fee and may deny a request that does not provide the required documentation. If the information provided by the
requestor in Part 4. is not applicable to a family member identified in Part 2., that individual should complete Part 5.