I-134, Affidavit of Support
Instructions
An alien applying for SSI must make available to the Social
Security Administration documentation concerning his or
her income and resources and those of the sponsor,
including information that was provided in support of the
application for an immigrant visa or adjustment of status.
An alien applying for TANF or Food Stamps must make
similar information available to the State public assistance
agency.
The Secretary of Health and Human Services and the
Secretary of Agriculture are authorized to obtain copies of
any such documentation submitted to the CIS or the U.S.
Department of State and to release such documentation to a
State public assistance agency.
A separate affidavit must be submitted for each person. As
the sponsor, you must sign the affidavit in your full, true
and correct name and affirm or make it under oath.
As the sponsor, you must show you have sufficient income
and/or financial resources to assure that the alien you are
sponsoring will not become a public charge while in the
United States.
Evidence should consist of copies of any or all of the
following documentation listed below that are applicable to
your situation.
Failure to provide evidence of sufficient income and/or
financial resources may result in the denial of the alien's
application for a visa or his or her removal from the United
States.
The sponsor must submit in duplicate evidence of income
and resources, as appropriate:
Sections 1621(e) and 415(d) of the Social Security Act and
subsection 5(i) of the Food Stamp Act also provide that an
alien and his or her sponsor shall be jointly and severally
liable to repay any SSI, TANF or Food Stamp benefits that
are incorrectly paid because of misinformation provided by
a sponsor or because of a sponsor's failure to provide
information.
Incorrect payments that are not repaid will be withheld from
any subsequent payments for which the alien or sponsor
are otherwise eligible under the Social Security Act or Food
Stamp Act, except that the sponsor was without fault or
where good cause existed.
A. Statement from an officer of the bank or other financial
institution where you have deposits, giving the
following details regarding your account:
1. Date account opened;
2. Total amount deposited for the past year;
3. Present balance.
B. Statement of your employer on business stationery,
showing:
1. Date and nature of employment;
2. Salary paid;
3. Whether the position is temporary or permanent.
C. If self-employed:
1. Copy of last income tax return filed; or
2. Report of commercial rating concern.
D. List containing serial numbers and denominations of
on
s an
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eco
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.
U.S. Department of Homeland Security
Bureau of Citizenship and Immigration Services
I. Execution of Affidavit.
II. Supporting Evidence.
Effective October 1, 1981, amendments to section 415 of the
Social Security Act establish similar requirements for
determining the eligibility of aliens who apply for the first
time for Aid to Families with Dependent Children (AFDC),
currently administered under Temporary Assistance for
eedy Families (TANF). Effective December 22, 1981,
amendments to the Food Stamp Act of 1977 affect the
eligibility of alien participation in the Food Stamp Program.
These amendments require that the income and resources of
any person, who as the sponsor of an alien's entry into the
United States, executes an affidavit of support or similar
agreement on behalf of the alien, and the income and
resources of the sponsor's spouse (if living with the
sponsor) shall be deemed to be the income and resources of
the alien under formulas for determining eligibility for SSI,
TANF and Food Stamp benefits during the three years
following the alien's entry into the United States.
Form I-134 (Rev. 06/17/04)N (Prior versions may be used until 09/30/04)
OMB No. 1615-0014; Exp. 04-30-07
Effective October 1, 1980, amendments to section 1614(f) of
the Social Security Act and Part A of Title XVI of the Social
Security Act establish certain requirements for determining
the eligibility of aliens who apply for the first time for
Supplemental Security Income (SSI) benefits.
III. Sponsor and Alien Liability.
If you are in the United States, the affidavit may be
sworn to or affirmed before an officer of the
Bureau of Citizenship and Immigration Services
(CIS) without the payment of fee, or before a
notary public or other officers authorized to
administer oaths for general purposes, in which
case the official seal or certificate of authority to
administer oaths must be affixed.
If you are outside the United States, the affidavit
must be sworn to or affirmed before a U.S.
consular or immigration officer.
Joint and Several Liability Issues.
Documentation on Income and Resources.
