Affidavit of Support Form - North Carolina

The information may also as a matter of routine use be
disclosed to other federal, state, local and foreign law
enforcement and regulatory agencies, including the
Department of Health and Human Services, Department of
Agriculture, Department of State, Department of Defense and
any component thereof ( if the deponent has served or is
serving in the armed forces of the United States), Central
Intelligence Agency, and individuals and organizations during
the course of any investigation to elicit further information
required to carry out USCIS functions.
However, failure to provide the information may result in the
denial of the alien's application.
Form I-134 (Rev. 02/28/07)Y Page 2
IV. Information and USCIS Forms.
For information on immigration laws, regulations and
procedures or to order USCIS forms, call our National
Customer Service Center at 1-800-375-5283 or visit our
website at
VII. Paperwork Reduction Act Notice.
The information will be used principally by USCIS, or by any
consular officer to whom it may be furnished, to support an
alien's application for benefits under the Immigration and
Nationality Act and specifically the assertion that he or she
has adequate means of financial support and will not become a
public charge. Submission of the information is voluntary.
These provisions do not apply to SSI, TANF or Food
Stamp eligibility of aliens admitted as refugees, granted
asylum or Cuban/ Haitian entrants as defined in section
501(e) of P.L. 96-422, and to dependent children of the
sponsor or sponsor's spouse.
As an alternative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
our internet-based system, InfoPass. To access the system,
visit our website at Use the InfoPass
appointment scheduler and follow the screen prompts to set up
your appointment. InfoPass generates an electronic
appointment notice that appears on the screen. Print the notice
and take it with you to your appointment. The notice gives the
time and date of your appointment, along with the address of
the USCIS office.
V. Use InfoPass for Appointments.
You are not required to respond to this form unless it displays
a currently valid OMB control number.
Joint and Several Liability Issues.
Sections 1621(e) 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 mis-information provided by a
sponsor or because of a sponsor's failure to provide
information, except where the sponsor was without fault or
where good cause existed.
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.
The Secretary of Health and Human Services and the
Secretary of Agriculture are authorized to obtain copies of
any such documentation submitted to USCIS or the U.S.
Department of State and to release such documentation to a
State public assistance agency.
An alien applying for TANF or Food Stamps must make
similar information available to the State public assistance
Authority for the collection of the information requested on
this form is contained in 8 U.S.C. 1182(a)(4),1183(a),1184(a)
and 1258.
We ask for the information on this form and associated
evidence to determine if you have established eligibility for
the immigration benefit you are seeking. We may provide this
information to other government agencies. Failure to provide
this information and any requested evidence may delay a final
decision or result in denial of your request.
VI. Privacy Act Notice.
We try to create forms and instructions that are accurate, can
be easily understood and impose the least possible burden on
you to provide us with information. Often this is difficult
because some immigration laws are very complex.
The estimated average time to complete and file this notice is
15 minutes.
If you have comments regarding the accuracy of this estimate,
or suggestions for making this form simpler, you may write to:
U.S. Citizenship and Immigration Services, Regulatory
Management Division, 111 Massachusetts Avenue, N.W., 3rd
Floor, Suite 3008, Washington, DC 20529. Do not mail your
completed affidavit of support to this address.
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