Fillable Form I-865 - Sponsor'S Notice Of Change Of Address printable pdf download

OMB No. 1615-0076; Expires 10/31/2012

I-865, Sponsor's Notice

Department of Homeland Security

of Change of Address

U.S. Citizenship and Immigration Services

Instructions

Read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a separate sheet of

paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet and indicate the number of the item

that refers to your answer. Include the part and letter or number of the item on the form relating to the additional information you are

providing (example: Part 2, Z).

What Is the Purpose of Form I-865?

Date of Birth - Use eight numbers to show your date of birth

(example: May 1, 1979, should be written 05/01/1979).

Place of Birth - Give the name of the country where you were

The purpose of Form I-865, Sponsor's Notice of Change of

born. Include also the city and State or province.

Address is to report a sponsor's new address. You will need to

supply USCIS a completed and signed Form I-865.

A Number - This is your USCIS file number. If you do

not have an Alien Registration Number (A-Number) or

When Should I Use Form I-865?

do not know it, leave this blank or write "None."

U.S. Social Security Number - This is your U.S. Social

If at any time in the past you completed Form I-864,

Security Number. If you do not have a U.S. Social Security

Affidavit of Support, to sponsor an immigrant, you are

Number, leave this blank.

required to report your change of address within 30 days

U.S. Citizen - Check the appropriate box if you are a U.S.

of the change if the sponsorship agreement is still in force.

citizen and provide proof of your citizenship if you became a

U.S. citizen following the filing of your Form I-864, Affidavit

The sponsorship agreement remains in force until the

of Support, or submission of a prior Form I-865 address change.

sponsored immigrant:

Lawful Permanent Resident - Check the appropriate

Becomes a U.S. citizen;

box if you are a permanent resident.

Can be credited with 40 quarters of work;

New Home Address - Provide your new physical street

Departs the United States permanently and either formally

address. This must include a street number and name or a rural

abandons lawful permanent resident status (by filing Form

route number. Do not put a post office box (P.O. Box) number

I-407) or is formally held in a removal proceeding to have

here.

abandoned that status;

New Mailing Address - Provide your mailing address, if

In a removal proceeding, loses the lawful permanent

different from your home address.

resident status that the sponsored immigrant obtained based

Telephone Number - Provide a telephone number with area

on your Form I-864; or

10.

code where you can be reached during the day.

Dies.

Part 2 - Information on Sponsored Immigrant(s)

How Do I File Form I-865?

Give the requested information about the sponsored

A separate Form I-865 must be submitted for each person

immigrant(s). If there is more than one immigrant, use a

who is filing a notice of address change. Follow the steps

separate sheet(s) of paper to provide complete information.

below to complete the form:

Part 3 - Signature

Step 1 - Fill Out Form I-865.

Step 2 - Submit Your Form I-865.

You, the sponsor, must sign and date the notice. If you do not

sign the form, the notice will be returned as incomplete.

Step 1. Fill Out Form I-865

Part 4 - Signature of Person Preparing Form,

Use black ink. Type or print clearly using capital letters. If an

If Other Than the Sponsor

item does not apply to you, write "N/A." If the answer is none,

write "None."

If you, the sponsor, did not fill out Form I-865, the preparer

must also sign, date, and give his or her address.

This form is divided into Parts 1 through 4. The following

information should help you fill out the form.

Step 2. Submit Your Form I-865

Part 1 - Information About You, the Sponsor

You must include the following items:

Family Name (Last name) - Give your legal name. If you

have two last names, include both and use a hyphen (-)

Your signed and completed Form I-865;

between the names, if appropriate.

Instructions I-865 (Rev. 10/26/10) Y

Form I-865 - Sponsor'S Notice Of Change Of Address

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