I-134
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| START HERE - Type or print in black ink. |
| Part 1. Basis for Filing |
| 1. | I am filing this form on behalf of: |
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| Part 2. Information about the Beneficiary |
| Complete Part 2. regardless of whether you are filing this form on behalf of yourself as the beneficiary or on behalf of another individual who is the beneficiary. |
| 1. |
Beneficiary's Current Legal Name (Do not provide a nickname.)
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| 2. |
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| 3. |
Date of Birth (mm/dd/yyyy)
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4. |
Gender
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5. |
Alien Registration Number (A-Number)(if any)
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| 6. |
Place of Birth
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| 7. |
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| 8. |
Marital Status
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| Form I-134 Edition 11/09/23 | Page 1 of 13 |
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| Part 2. Information about the Beneficiary (continued) |
| 9. |
Beneficiary's Mailing Address
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| 10. | Are the beneficiary's mailing address and physical address the same? |
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| If you answered “No” to Item Number 10., provide your physical address in Item Number 11. |
| 11. |
Beneficiary's Physical Address
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| Beneficiary's Anticipated Length of Stay |
| 12. |
Beneficiary's Anticipated Period of Stay in the United States
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| To (select one): |
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| Form I-134 Edition 11/09/23 | Page 2 of 13 |
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| Part 2. Information about the Beneficiary (continued) |
| Beneficiary's Financial Information |
| Provide information about the beneficiary's income and assets. If you need additional space to complete any Item Number in this section, use the space provided in Part 8. Additional Information. |
| Beneficiary's Income |
| 13. |
Provide all of the information requested in the table below about the beneficiary, all of the beneficiary's dependents, and any other individuals the beneficiary financially supports (do not include any individuals named in Part 3.). Information about assets that are not based on employment should be added in Item Number 16. and not in Item Number 13.
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| 14. |
Is any part of the beneficiary's overall income, which encompasses earnings from dependents and others contributing to the beneficiary's financial resources (except for those individuals mentioned in Part 3), derived from an unlawful activity or source, like profits from illegal gambling or illicit drug sales? |
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| 15. | If your answer was "Yes," what portion of the beneficiary's overall income is derived from an unlawful activity or source? |
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| Form I-134 Edition 11/09/23 | Page 3 of 13 |
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| Part 2. Information about the Beneficiary (continued) |
| Beneficiary's Assets |
| 16. |
In the table below, provide the amounts of assets available to the beneficiary for the expected period of his or her stay (excluding assets from any individuals named in Part 3.). Attach evidence showing that the beneficiary has these assets.
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| Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in Part 2. |
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If you are not the beneficiary named in Part 2., complete Part 3. |
| 1. |
Current Legal Name ( Do not provide a nickname.)
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| 2. |
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| 3. |
Current Mailing Address
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| Form I-134 Edition 11/09/23 | Page 4 of 13 |
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| Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in Part 2. (continued) |
| 4. | Is your current mailing address the same as your current physical address? |
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| If you answered “No” to Item Number 4., provide your current physical address in Item Numbers 5. |
| 5. |
Physical Address
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| Other Information |
| 6. |
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| 7. |
Place of Birth
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Country
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| 8. |
Alien Registration Number (A-Number)(if any)
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9. |
USCIS Online Account Number(if any)
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| Immigration Status |
| 10. |
What is your current immigration status? Provide documentation as provided in the instructions.
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| Lawful Permanent Resident A-Number |
| A- |
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| Nonimmigrant Form I-94 Arrival-Departure Record Number |
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Other (Explain):
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| Form I-134 Edition 11/09/23 | Page 5 of 13 |
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| Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in Part 2. (continued) |
| Employment Information |
| 11. |
Employment Status
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| If you indicated that you are employed in Item Number 11., provide the information requested in Item Numbers 12. - 13. |
| 12. | A. |
I am currently employed as a/an
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Name of Employer
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| B. |
I am currently self-employed as a/an
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| 13. |
Current Employer's Address
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| Financial Information |
| Provide information about your income and assets. If you need additional space to complete any Item Number in this section, use the space provided in Part 8. Additional Information. |
| Income |
| 14. |
Provide all of the information requested in the table below about yourself, all of your dependents, and any other individuals you
financially support (do not include any individuals named in Part 2.). Information about assets that are not based on employment should be added in Item Number 17. and not in Item Number 14.
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| Form I-134 Edition 11/09/23 | Page 6 of 13 |
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| Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in Part 2. (continued) |
| 15. | Does any of the income listed above come from an illegal activity or source (such as proceeds from illegal gambling or illegal drug sales)? |
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| 16. | If you answered “Yes” to Item Number 15., what amount of income comes from an illegal activity? |
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| Assets |
| 17. | Fill out the table below regarding the assets available to you(do not include any assets from any individuals named in Part 2.). Attach evidence showing you have these assets.
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| Financial Responsibility for Other Beneficiaries |
| 18. | Have you previously submitted a Form I-134 on behalf of a person other than the beneficiary listed on this Form I-134? |
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| If you answered “Yes” to Item Number 18., provide the information requested in Item Numbers 19. - 20. If you need additional space to complete this section, use the space provided in Part 8. Additional Information. |
| 19. | Person 1
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A-Number
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| 20. | Person 2
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A-Number
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| Form I-134 Edition 11/09/23 | Page 7 of 13 |
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| Part 3. Information About the Individual Agreeing to Financially Support the Beneficiary Named in Part 2. (continued) |
| Intent to Provide Specific Contributions to the Beneficiary |
| 21. | I |
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Explain the contribution. For example, if you intend to furnish room and board, state for how long. If you intend to provide money, state the amount in U.S. dollars and whether it is to be given in a lump sum, weekly, or monthly, and for how long. If you need additional space, use Part 8. Additional Information. |
| Part 4. Statement, Contact Information, Certification, and Signature of the Beneficiary (if filing Form I-134 on his or her own behalf) |
| If you are the beneficiary and are filing Form I-134 on your own behalf, complete and sign Part 4. |
| NOTE: Read the Penalties section of the Form I-134 Instructions before completing this section. |
| Beneficiary's Statement |
| NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. |
| 1. | I, as the beneficiary, certify the following: |
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| 2. | At my request, the preparer named in Part 7., , prepared this declaration for me based only upon information I provided or authorized. |
| Beneficiary's Contact Information |
| 3. |
Beneficiary's Daytime Telephone Number
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4. |
Beneficiary's Mobile Telephone Number (if any)
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| 5. | Beneficiary's Email Address (if any) |
| Beneficiary's Certification |
| Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS or the Department of State may require that I submit original documents to USCIS or the Department of State at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS or the Department of State may need to determine my eligibility for the immigration benefit I seek. |
| I further authorize release of information contained in this declaration, in supporting documents, and in my USCIS or the Department of State records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws. |
| Form I-134 Edition 11/09/23 | Page 8 of 13 |
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| Part 4. Statement, Contact Information, Certification, and Signature of the Beneficiary (if filing Form I-134 on his or her own behalf) (continued) |
| I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that: |
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| 2) |
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| 3) |
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| I certify, under penalty of perjury, that I provided or authorized all of the information in my declaration, I understand all of the information contained in, and submitted with, my declaration, and that all of this information is complete, true, and correct. |
| That this declaration is made by me to assure the U.S. Government that I will be able to financially support myself while in the United States. |
| That I am willing and able to pay for necessary expenses for the duration of my temporary stay in the United States. |
| Beneficiary's Signature |
6.
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| Part 5. Statement, Contact Information, Certification, and Signature of the Individual Agreeing to Financially Support the Beneficiary |
| If you are filing Form I-134 on behalf of someone else (the beneficiary listed in Part 2.), complete and sign Part 5 |
| NOTE: Read the Penalties section of the Form I-134 Instructions before completing this section. |
| Statement of Individual Agreeing to Financially Support the Beneficiary |
| NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. |
| 1. | I, as the individual agreeing to financially support the beneficiary, certify the following: |
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| 2. | At my request, the preparer named in Part 7., , prepared this declaration for me based only upon information I provided or authorized. |
| Contact Information of Individual Agreeing to Financially Support the Beneficiary |
| 3. |
Daytime Telephone Number
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4. |
Mobile Telephone Number (if any)
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| 5. | Email Address (if any) |
| Form I-134 Edition 11/09/23 | Page 9 of 13 |
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| Part 5. Statement, Contact Information, Certification, and Signature of the Individual Agreeing to Financially Support the Beneficiary (continued) |
| Certification of Individual Agreeing to Financially Support the Beneficiary |
| Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS or the Department of State may require that I submit original documents to USCIS or the Department of State at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS or the Department of State may need to determine my eligibility for the immigration benefit I seek. |
| I further authorize release of information contained in this declaration, in supporting documents, and in my USCIS or the Department of State records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law. |
| I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that: |
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| 2) |
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| I certify, under penalty of perjury, that I provided or authorized all of the information in my declaration, I understand all of the information contained in, and submitted with, my declaration, and that all of this information is complete, true, and correct. |
| That this declaration is made by me to assure the U.S. Government that the person named in Part 2. will be financially supported while in the United States. |
| That I am willing and able to receive, maintain, and support the person named in Part 2. to better ensure that such persons will have sufficient financial resources or financial support to pay for necessary expenses for the period of his or her temporary stay in the United States. |
| I acknowledge that I have read this section, and I am aware of my responsibilities as an individual agreeing to financially support the beneficiary |
| Signature of Individual Agreeing to Financially Support the Beneficiary |
6.
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| NOTE TO ALL INDIVIDUALS AGREEING TO FINANCIALLY SUPPORT THE BENEFICIARY: If you do not completely fill out this declaration or if you fail to submit required documents listed in the Instructions, USCIS or the Department of State may deny or not consider your declaration. |
| Part 6. Interpreter's Contact Information, Certification, and Signature |
| Provide the following information about the interpreter. |
| Interpreter's Full Name |
| 1. |
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| 2. |
Interpreter's Business or Organization Name (if any)
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| Form I-134 Edition 11/09/23 | Page 10 of 13 |
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| Part 6. Interpreter's Contact Information, Certification, and Signature (continued) |
| Interpreter's Mailing Address |
| 3. |
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| Interpreter's Contact Information |
| 4. | Interpreter's Daytime Telephone Number
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5. | Interpreter's Mobile Telephone Number (if any)
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| 6. | Interpreter's Email Address (if any) |
| Interpreter's Certification |
| I certify, under penalty of perjury, that: |
| I am fluent in English and which is the same language specified in Part 4. or in Part 5., Item B. in Item Number 1., and I have read to this individual agreeing to financially support the beneficiary in the identified language every question and instruction on this declaration and his or her answer to every question. The individual agreeing to financially support the beneficiary informed me that he or she understands every instruction, question, and answer on the declaration, including the Certification of the Individual Agreeing to Financially Support the Beneficiary, and has verified the accuracy of every answer. |
| Interpreter's Signature |
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7.
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Declaration, if Other Than the Individual Agreeing to Financially Support the Beneficiary |
| Provide the following information about the preparer. |
| Preparer's Full Name |
| 1. | Preparer's Family Name (Last Name)
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Preparer's Given Name (First Name)
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| 2. | Preparer's Business or Organization Name (if any) |
| Form I-134 Edition 11/09/23 | Page 11 of 13 |
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| Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Declaration, if Other Than the Individual Agreeing to Financially Support the Beneficiary (continued) |
| Preparer's Mailing Address |
| 3. |
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| Preparer's Contact Information |
| 4. |
Preparer's Daytime Telephone Number
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5. |
Preparer's Mobile Telephone Number
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| 6. |
Preparer's Email Address (if any)
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| Preparer's Statement |
| 7. | A. |
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| B. |
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| NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application. |
| Preparer's Certification |
| By my signature, I certify, under penalty of perjury, that I prepared this declaration at the request of the individual agreeing to financially support the beneficiary (which is the beneficiary if filing on behalf of him or herself). The individual agreeing to financially support the beneficiary (which is the beneficiary if filing on behalf of him or herself) then reviewed this completed declaration and informed me that he or she understands all of the information contained in, and submitted with, his or her declaration, including the Certification of the Individual Agreeing to Financially Support the Beneficiary, and that all of this information is complete, true, and correct. I completed this declaration based only on information that the individual agreeing to financially support the beneficiary provided to me or authorized me to obtain or use. |
| Preparer's Signature |
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8.
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| Form I-134 Edition 11/09/23 | Page 12 of 13 |
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| Part 8. Additional Information |
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If you need extra space to provide any additional information within this application, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. |
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| 2. | A-Number (if any) | A- |
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| Form I-134 Edition 11/09/23 | Page 13 of 13 |
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