Information Collection

Contract Between Sponsor and Household Member

IC 204184 under ICR 202310-1615-014 · OMB 1615-0075.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0075 can be found here:

Documents and Forms

Document Name Document Type
Form I-864A Contract Between Sponsor and Household Member Form
Form I-864A Contract Between Sponsor and Household Member Form
I-864A Instructions.pdf www.uscis.gov/i-864a Instruction
I-864A Instructions.pdf www.uscis.gov/i-864a Instruction
I-864A Contract Between Sponsor and Household Member I-864A Form.pdf www.uscis.gov/i-864a Form
I-864A Contract Between Sponsor and Household Member I-864A Form.pdf www.uscis.gov/i-864a Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Contract Between Sponsor and Household Member	Agency IC Tracking Number:	I-864A

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 213A (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	I-864A	Contract Between Sponsor and Household Member	I-864A Form.pdf	https://www.uscis.gov/i-864a	Yes	No	Fillable Printable
Instruction			I-864A Instructions.pdf	https://www.uscis.gov/i-864a	Yes	No	Printable Only

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records
Title: USCIS Benefits Information System	FR Citation: 81 FR 72069

Number of Respondents: 215,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	215,800	215,800
Annual IC Time Burden (Hours)	377,650	377,650
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.