Form I-864W at a glance
What it is: Form I-864W, Request for Exemption for Intending Immigrant's Affidavit of Support, is a form of the Department of Homeland Security, U.S. Citizenship and Immigration Services.
Who signs: The Requestor signs at 6.a. Requestor's Signature and enters 6.b. Date of Signature (mm/dd/yyyy).
You are EXEMPT from filing Form I-864, Affidavit of Support Under Section 213A of the INA, because:
1.a. You 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.
1.b. You are 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 your admission to the United States.
1.c. You are 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.
1.d. You are filing for an immigrant visa or adjustment of status as a battered spouse or child using Form I-360.
A filled-in Form I-864W example: a requestor fills in the identity boxes of Part 1
How to fill out Form I-864W, box by box
Name of Requestor
Under Name of Requestor, enter 1.a. Family Name (Last Name), 1.b. Given Name (First Name) and 1.c. Middle Name.
Mailing Address
Under Mailing Address, enter 2.a. In Care Of Name, 2.b. Street Number and Name, 2.c. Apt. Flr. Ste., 2.d. City or Town, 2.e. State, 2.f. ZIP Code, 2.g. Province, 2.h. Postal Code and 2.i. Country.
Physical Address
3. Is your current mailing address the same as your physical address? Answer No or Yes. If you answered "No" to Item Number 3., provide your physical address under Physical Address: 4.a. Street Number and Name, 4.b. Apt. Flr. Ste., 4.c. City or Town, 4.d. State, 4.e. ZIP Code, 4.f. Province, 4.g. Postal Code and 4.h. Country.
Other Information
Under Other Information, enter 5. Date of Birth (mm/dd/yyyy), 6. City or Town of Birth, 7. State or Province of Birth (if applicable) and 8. Country of Birth.
Enter 9. Alien Registration Number (A-Number), 10. USCIS Online Account Number (if any) and 11. U.S. Social Security Number (Required).
Requestor's Statement, contact information and signature
Under Requestor's Statement, select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.
1.a. I can read and understand English, and I have read and understand every question and instruction on this request and my answer to every question.
1.b. The interpreter named in Part 4. read to me every question and instruction on this request and my answer to every question in a language in which I am fluent, and I understood everything.
2. At my request, the preparer named in Part 5., prepared this request for me based only upon information I provided or authorized.
Under Requestor's Contact Information, enter the Requestor's Daytime Telephone Number 3., Requestor's Mobile Telephone Number (if any) 4. and Requestor's Email Address (if any) 5.
By signing you certify, under penalty of perjury, that all of the information in your request and any document submitted with it were provided or authorized by you, that you reviewed and understand all of the information contained in, and submitted with, your request, and that all of this information is complete, true, and correct.
The Requestor signs at 6.a. Requestor's Signature and enters 6.b. Date of Signature (mm/dd/yyyy).
More rules for Form I-864W
If you need extra space to provide any additional information within this request, use the space in Part 6. Additional Information. If you need more space than what is provided, you may make copies of Part 6. Additional Information to complete and file with this request 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.
If you do not completely fill out this request or fail to submit required documents listed in the Instructions, USCIS or DOS may deny your request.
Sources
[1] Form I-864W (Edition 12/08/21), Request for Exemption for Intending Immigrant's Affidavit of Support, U.S. Citizenship and Immigration Services (the Official source link on this page).