Form I-864W, Request for Exemption for Intending Immigrant’s Affidavit of Support

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Last updated: April 8, 2024.

Form I-864W, officially known as the “Request for Exemption for Intending Immigrant’s Affidavit of Support,” is a form used in specific situations to request an exemption from the affidavit of support requirement when applying for certain immigration categories.

Form I-864W may be filed by intending immigrants who are applying for an immigrant visa abroad or permanent residence in the U.S. and believe they qualify for an exemption from the Form I-864 affidavit of support requirement.

If you are allowed to file Form I-864W, then filing of Form I-864 (Affidavit of Support) is not required.

The foreign national applying for permanent residence is called an “Intending immigrant”.

Who can file Form I-864W?

The following individuals can file Form I-864W:

  1. Intending immigrants who have earned or can receive credit for 40 quarters of coverage under the Social Security Act (SSA).
  2. The intending immigrant is a child who will become a U.S. citizen upon entry to the U.S. or Adjustment of Status.
  3. Widow and widowers of U.S. citizens.
  4. Battered spouses or children (Violence Against Women Act, VAWA)

Where can I find Form I-864W?

Make sure you are using the most recent version of the Form I-864W which is available on the official USCIS website: Form I-864W

Form I-864W is a pdf form that the intending immigrant can fill out on a computer, print the completed form, sign and date it.

USCIS will reject any outdated, unsigned or undated forms.

When Form I-864W must be filed?

Form I-864W must be filed either with Form DS-260 when applying for immigrant visa abroad (Consular Processing) or when submitting Form I-485 in the U.S. (Adjustment of Status).

Form I-864W checklist of documents

  • All Social Security Act (SSA) forms necessary to establish that you have or can receive credit for 40 quarters of work under the SSA (ONLY if applicable).

How to fill out Form I-864W

Form I-864W consists of 6 parts.

For Government Use Only – leave this section blank.

To be completed by an attorney or accredited representative (if any) – this section must be filled out by your attorney or accredited representative. If you are preparing this form yourself or your preparer is not an attorney or accredited representative, leave this section blank.

Part 1. Information About You or Your Adopted Child (Intending Immigrant)

This part must be filled out by the intending immigrant, a foreign national applying for an immigrant visa (outside the U.S.) or green card (in the U.S.)

The intending immigrant is called a “Requestor” on this form, since the intending immigrant is requesting the U.S. government for Affidavit of Support (Form I-864) exemption.

Name of requestor

1.a. Family Name (Last Name) enter the intending immigrant’s last name

1.b. Given Name (First Name) enter the intending immigrant’s first name

1.c. Middle Name enter the intending immigrant’s middle name (if any). If the intending immigrant does not have a middle name, leave this field blank

Mailing address

2.a. – 2.i. – provide the intending immigrant’s mailing address (in the U.S. or abroad). If the intending immigrant wants to receive the correspondence herself/himself, leave “In Care of Name” field blank. If the intending immigrant wants someone to receive the correspondence on their behalf, enter that person’s first and last name in the “In Care of Name” field.

  1. Is your current mailing address the same as your physical address? – Answer “Yes” if your mailing address matches the physical address. Answer “No” if you do not reside at your mailing address.

Physical address

This section must be completed only by the intending immigrant who does not reside at the mailing address provided on this form.

4.a. – 4.h. – provide the intending immigrant’s physical address (in the U.S. or abroad).

Other Information – this section collects the intending immigrant’s information

  1. Date of birth – enter the intending immigrant’s date of birth in the mm/dd/yyyy format.
  1. City or Town of Birth – enter the intending immigrant’s city or town of birth.
  1. State or Province of Birth (if applicable) – enter the intending immigrant’s state or province of birth. If this question does not apply to the intending immigrant, enter “Not applicable”.
  1. Country of birth – enter the intending immigrant’s country of birth.
  1. Alien Registration Number (A-number) (if any)enter the intending immigrant’s A number. Learn where to find the A number. If the intending immigrant doesn’t have an A number, enter “None”.
  1. USCIS Online Account Number (if any) – if the intending immigrant has ever created an USCIS Online Account Number (12-digit number), enter it in this field. If you never created an online USCIS account or do not have access to it, leave this field blank. Keep in mind that USCIS Online Account Number is not the same as an A-Number (Alien Registration Number). If you have access to your online USCIS account, you can find your online account number in “My Account” – “Profile” – Online Account Number.

Form I-864W, Request for Exemption for Intending Immigrant’s Affidavit of Support 1

USCIS online account number will be listed under “Online Account Number”:

Form I-864W, Request for Exemption for Intending Immigrant’s Affidavit of Support 2

  1. U.S. Social Security Number (Required) – enter the intending immigrant’s SSN. If the intending immigrant does not have a SSN, enter “None”.

 

Part 2. Reason for Exemption

I am EXEMPT from filing Form I-864, Affidavit of Support Under Section 213A of the INA, because:

1.a. I have earned (or can be credited with) 40 quarters (credits) of coverage under the Social Security Act (SSA). (Attach SSA earnings statements. Do not count any quarters during which you received a means-tested public benefit). – Choose this option if the intending immigrant has earned or can be credited with 40 quarters (credits) of coverage under the Social Security Act (SSA).

1.b. I am under 18 years of age, unmarried, immigrating as the child of a U.S. citizen, and will automatically become a U.S. citizen under the Child Citizenship Act of 2000 upon my admission to the United States – choose this box if the intending immigrant is a biological or adopted child who has at least 1 U.S. citizen parent, the child is under 18 years of age, the child is residing in the U.S. in the legal and physical custody of the U.S. citizen parent after having been lawfully admitted for permanent residency.

1.c. – I am filing for an immigrant visa or adjustment of status as a self-petitioning widow(er) using Form I-360, Petition for Amerasian, Widow(er), or Special Immigrant – choose this box if the intending immigrant is a widow/widower of a deceased U.S. citizen or special immigrant in the EB-4 category who filed Form I-360.

1.d. – I am filing for an immigrant visa or adjustment of status as a battered spouse or child using Form I-360 – choose this box if the intending immigrant is applying for permanent residence under the Violence Against Women Act (VAWA).

Part 3. Requestor’s (Intending Immigrant’s) Contract, Statement, Contact Information, Declaration, Certification, and Signature

This part must be completed, signed and dated by the intending immigrant.

Requestor’s Statement

1.a. I can read and understand English, and I have read and understand every question and instruction on this contract and my answer to every question – choose this box if the intending immigrant is fluent in English and did not use an interpreter’s services to prepare this form.

1.b. The interpreter named in Part 4. read to me every question and instruction on this contract and my answer to every question in ______________ (enter your native language, for example Spanish), a language in which I am fluent, and I understood everything – choose this box if the intending immigrant used an interpreter’s services to understand the questions on this form. Anyone can serve as an interpreter – a family member, friend, or professional interpreter. Indicate into which language the interpreter translated questions on this form.

  1. At my request, the preparer named in Part 5., _______________(enter the preparer’s first and last name), prepared this request for me based only upon information I provided or authorized – choose this box if anyone helped the intending immigrant to prepare this form (it can be a family member, a friend, interpreter or immigration attorney). Enter the preparer’s first and last name. If the intending immigrant prepared the form herself/himself, leave this box unchecked.

Requestor’s Contact Information

In this section provide the phone number and email address of the intending immigrant.

  1. Requestor’s Daytime Telephone Number – enter intending immigrant’s cell phone or work phone number in this field where the intending immigrant will be available at daytime hours
  1. Requestor’s Mobile Telephone Number (if any) – enter intending immigrant’s cell phone number
  1. Requestor’s Email Address (if any) – enter intending immigrant’s email address.

Requestor’s Signature

This section must be signed by the intending immigrant. If the intending immigrant is a child under 14 years of age, the form can be signed by the parent.

6.a. Requestor’s Signature – petitioner must sign in black ink. Do not type or stamp the intending immigrant’s name. It must be a handwritten signature.

6.b. Date of Signature (mm/dd/yyyy) – date the form in the mm/dd/yyyy format.

Unsigned or undated forms will be rejected by USCIS.

Part 4. Interpreter’s Contact Information, Certification, and Signature 

Part 4 must be completed by an interpreter who helped to translate the questions on this form. 

If you did not use a translator to complete this form, leave Part 4 blank.

If an interpreter was used to read the questions on this form, Part 4 must be completed with the information of the interpreter and the interpreter must sign and date certifying that they are:

  • Fluent in English and the language used by the applicant; 
  • They have completely read the application to the applicant in that language; and 
  • The applicant confirmed they understood what was in the application and they verified the accuracy of the application.

Part 4 is filled out by entering the following details:

  • Full legal name of the interpreter
  • The name of the interpreter’s business or organization (if applicable). If the interpreter does not belong to any company or organization, enter “Not applicable”.
  • Interpreter’s mailing address, daytime phone number, and email address. 

Interpreter’s Certification – The language used by the interpreter to translate the form to the petitioner is entered in the appropriate box in the certification. It should be the same language listed in Part 3.

The interpreter must sign and date the Interpreter’s Certification where indicated at Questions 7.a. and 7.b. that can be found in Part 4 of this form.

Part 5. Contact Information, Declaration, and Signature of the Person Preparing this Contract, If Other than the Requestor

Part 5 must be completed only if any person has assisted you to prepare this form (a family member, a friend, immigration attorney, any other person).

If you did not use a preparer to complete this form, leave the whole Part 5 blank.

This part is completed and signed by the preparer. 

Part 5 is completed by the preparer answering Questions 1–7:  full name, preparer’s company or organization (can enter “Not applicable” if preparer is not a part of a company or organization), mailing address, daytime telephone number, cell phone (if any), and email address (if any). 

Preparer must sign the Preparer’s Statement, declaring that they prepared the Form I-864W based on the information provided by the intending immigrant, and it is based on all the information of which the preparer has knowledge. The preparer must sign and date the Preparer’s Signature where indicated as Questions 8.a. and 8.b.

Part 6. Additional Information

You can use this if there is not enough space in any other parts of the form to provide all requested information. 

Note: Even if no information is provided in Part 6, this page should still be included with the application when submitted to USCIS or U.S. Department of State.

If additional space is required, make additional copies of this page to provide all the details requested. 

If Part 6 is being used to provide additional information, enter the intending immigrant’s name and Alien Registration Number (A-Number) (if intending immigrant has one), where indicated on each page being used. 

For each additional item of information provided, indicate the Page Number, Part Number, and Item Number to which your answer refers.

Related Links:

Form I-864W Instructions