Affidavit of Support Form - North Carolina
I-134, Affidavit of Support
An alien applying for SSI must make available to the Social
Security Administration documentation concerning his / her
income and resources and those of the sponsor, including
information that was provided in support of the corresponding
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
Evidence should consist of copies of any or all of the
following documentation listed below that are applicable to
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
The sponsor must submit in duplicate evidence of income
and resources, as appropriate:
A. Statement from an officer of the bank or other financial
institutions where you have deposits, identifying the
following details regarding your account:
1. Date account opened;
B. Statement of your employer on business stationery,
1. Date and nature of employment;
C. If self-employed:
2. Report of commercial rating concern.
D. List containing serial numbers and denominations of
bonds and name of record owner(s).
I. Execution of Affidavit.
II. Supporting Evidence.
Effective October 1, 1981, amendments to section 415 of the
Social Security Act established 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 Needy
Families (TANF). Effective December 22, 1981, amendents 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. 02/28/07)Y
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 U.S. Citizenship
and Immigration Services (USCIS) 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 notice affirmed before a U.S.
consular or immigration officer.
Documentation on Income and Resources.
Department of Homeland Security
U.S. Citizenship and Immigration Services
How you submit the form depends on whether the alien you
are sponsoring is in or outside the United States and what type
of application is being submitted. See the instructions
provided with the corresponding application for detailed
information on how to submit this affidavit of support form.
2. Total amount deposited for the past year;
3. Present balance.
2. Salary paid;
3. Whether the position is temporary or permanent.
1. Copy of last income tax return filed; or
Affidavit of Support Form - North Carolina PDF
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