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adminApril 26 2021
Ina 103a
Form I-130A
USCIS
OMB No. 1615-0012
To be completed by an attorney or accredited representative (if any).
Secretary of Homeland Security 1. The Secretary of Homeland Security shall be charged with the administration and enforcement of this chapter and all other laws relating to the immigration and naturalization of aliens, except insofar as this chapter or such laws relate to the powers, functions, and duties conferred upon the President, Attorney General, the Secretary of State. Edit, fill, sign, download Form I-130A online on Handypdf.com. Printable and fillable Form I-130A. Immigration and Naturalization Act, § 101(a)(27)(J) (codified at 8 U.S.C. § 1101(a)(27)(J).) (a) As used in this chapter— (1)–(26). (27) The term “special immigrant” means— (A)–(I). (J) an immigrant who is present in the United States— (i) who has been declared dependent on a juvenile court located in the United States or whom such a court has legally committed to,. Low Noise, Cascadable Silicon Bipolar MMIC Amplifier, INA-10386 datasheet, INA-10386 circuit, INA-10386 data sheet: HP, alldatasheet, datasheet, Datasheet search site for Electronic Components and Semiconductors, integrated circuits, diodes, triacs, and other semiconductors. If the appropriate entity under paragraph (1) (A) requests reimbursement from the sponsor or brings an action against the sponsor pursuant to the affidavit of support, the appropriate entity may appoint or hire an individual or other person to act on behalf of such entity acting under the authority of law for purposes of collecting any amounts owed.
Part 1. Information About You (Spouse
4.c.
4.h.
4.d.
4.b.
and Name
City or Town
Province
Postal Code
Address History
Provide your physical addresses for the last five years, whether
inside or outside the United States. Provide your current
address first. If you need extra space to complete this section,
use the space provided in Part 7. Additional Information.
6.f.
6.g.
6.a.
Street Number
Apt.Ste.Flr.
State6.e. ZIP Code
Country
Physical Address 2
Form G-28 is
Attorney State Bar Number
Attorney or Accredited Representative
Date From (mm/dd/yyyy)7.a.
Family Name
Given Name
Middle Name
3.c.
3.a.
►
A-
Date From (mm/dd/yyyy)5.a.
Postal Code
Province
Apt.Ste.Flr.
and Name
8.a.
8.f.
8.c.
Provide your last address outside the United States of more than
The purpose of this form is to collect additional information for a spouse beneficiary of Form I-130, Petition for Alien Relative. If
your spouse is a U.S. citizen, lawful permanent resident, or non-citizen U.S. national who is filing Form I-130 on your behalf, you
must complete and sign Form I-130A, Supplemental Information for Spouse Beneficiary, and submit it with the Form I-130 filed by
your spouse. If you reside overseas, you still must complete Form I-130A, but you do not need to sign the form.
(if any)
Supplemental Information for Spouse Beneficiary
U.S. Citizenship and Immigration Services
9.b.Date To (mm/dd/yyyy)
Part 1. Information About You (The Spouse
Full Name of Parent 1
Given Name
Middle Name
ofBirth
16.Country of Residence
Country of Birth
Family Name
Part 2. Information About Your Employment
Provide your employment history for the last five years,
whether inside or outside the United States. Provide your
current employment first. If you are currently unemployed,
type or print 'Unemployed' in Item Number 1. below. If you
need extra space to complete this section, use the space
Employment History
2.f.
Province
2.g.Postal Code
Street Number
2.a.
Employer 1
Date of Birth (mm/dd/yyyy)18.
22.City/Town/Village of Residence
21.
ofBirth
Middle Name
(First Name)
17.a.
Family Name
3.Your Occupation
Date To (mm/dd/yyyy)4.b.
6.f.
Province
6.g.Postal Code
Street Number
6.a.
Employer 2
10.a.
10.c.
17.c.
MaleFemale
MaleFemale
Part 2. Information About Your Employment
7.Your Occupation
Provide your last occupation outside the United States if not
shown above. If you never worked outside the United States,
provide this information in the space provided in Part 7.
Your Occupation
Date From (mm/dd/yyyy)8.a.
Date From (mm/dd/yyyy)4.a.
Part 3. Information About Your Employment
The interpreter named in Part 5. read to me every
question and instruction on this form and my answer
1.b.
a language in which I am fluent, and I understood
,
prepared this form for me based only upon
,
Spouse Beneficiary's Contact Information
Spouse Beneficiary's Mobile Telephone Number (if any)4.
Copies of any documents I have submitted are exact photocopies
of unaltered, original documents, and I understand that USCIS
may require that I submit original documents to USCIS at a later
date. Furthermore, I authorize the release of any information
from any of my records that USCIS may need to determine my
I further authorize release of information contained in this form,
in supporting documents, and in my USCIS records to other
entities and persons where necessary for the administration and
City or Town2.c.
2.h.
Country
ZIP Code2.e.State2.d.
and Name
2.b.Apt.Ste.Flr.
I can read and understand English, and I have read
and understand every question and instruction on this
1.a.
NOTE: Select the box for either Item Number 1.a. or 1.b. If
Part 4. Spouse Beneficiary's Statement, Contact
Spouse Beneficiary's Statement
NOTE: Read thePenalties section of the Form I-130 and
Form I-130A Instructions before completing this part.
I certify, under penalty of perjury, that I provided or authorized
all of the information in this form, I understand all of the
information contained in, and submitted with, my form, and that
all of this information is complete, true, and correct.
Date of Signature (mm/dd/yyyy)6.b.
NOTE TO ALL SPOUSE BENEFICIARIES:If you do not
completely fill out this form or fail to submit required documents
listed in the Instructions, USCIS may deny the Form I-130 filed
Interpreter's Business or Organization Name (if any)2.
Interpreter's Family Name (Last Name)1.a.
Part 5. Interpreter's Contact Information,
Provide the following information about the interpreter you used
to complete Form I-130A if he or she is different from the
interpreter used to complete the Form I-130 filed on your behalf.
3.c.City or Town
3.f.
Street Number
3.a.
3.g.
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Province
I am fluent in English and
which is the same language provided in Part 4., Item Number
1.b., and I have read to this spouse beneficiary in the identified
language every question and instruction on this form and his or
her answer to every question. The spouse beneficiary informed
me that he or she understands every instruction, question, and
answer on the form, including the Spouse Beneficiary's
Certification, and has verified the accuracy of every answer.
,
Date of Signature (mm/dd/yyyy)7.b.
Part 6. Contact Information, Declaration, and
Other Than the Spouse Beneficiary
Provide the following information about the preparer you used
to complete Form I-130A if he or she is different from the
preparer used to complete the Form I-130 filed on your behalf.
2.Preparer's Business or Organization Name (if any)
1.a.Preparer's Family Name (Last Name)
Interpreter's Daytime Telephone Number4.
Interpreter's Mobile Telephone Number (if any)5.
3.c.City or Town
3.f.
Street Number
3.a.
3.g.
Province
Part 6. Contact Information, Declaration, and
Other Than the Spouse Beneficiary(continued)
Preparer's Mobile Telephone Number (if any)5.
Preparer's Email Address (if any)6.
I am not an attorney or accredited representative but
beneficiary and with the spouse beneficiary's consent.
NOTE: If you are an attorney or accredited
representative whose representation extends beyond
preparation of this form, you may be obliged to submit
Appearance as Attorney or Accredited Representative,
I am an attorney or accredited representative and my
representation of the spouse beneficiary in this case
7.b.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this form at the request of the spouse beneficiary. The
spouse beneficiary then reviewed this completed form and
informed me that he or she understands all of the information
contained in, and submitted with, his or her form, including the
Spouse Beneficiary's Certification, and that all of this
information is complete, true, and correct. I completed this
form based only on information that the spouse beneficiary
Preparer's Signature
8.b.Date of Signature (mm/dd/yyyy)
Part 7. Additional Information
If you need extra space to provide any additional information
within this form, 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 form 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
A-Number (if any) ►
3.a.
Page Number3.b.Part Number3.c.Item Number
Page Number
Page NumberPart NumberItem Number5.a.
5.b.
5.c.
5.d.
1.c.
(Last Name)
(First Name)
4.c.4.b.
4.a.
6.c.6.b.6.a.
7.d.
Enforceability
Terms of affidavit
No affidavit of support may be accepted by the Attorney General or by any consular officer to establish that an alien is not excludable as a public charge under section 212(a)(4) of this Act [8 U.S.C 1182(a)(4)] unless such affidavit is executed by a sponsor of the alien as a contract—
in which the sponsor agrees to provide support to maintain the sponsored alien at an annual income that is not less than 125 percent of the Federal poverty line during the period in which the affidavit is enforceable;
that is legally enforceable against the sponsor by the sponsored alien, the Federal Government, any State (or any political subdivision of such State), or by any other entity that provides any means-tested public benefit (as defined in subsection (e) of this section ), consistent with the provisions of this section ; and
in which the sponsor agrees to submit to the jurisdiction of any Federal or State court for the purpose of actions brought under subsection (b)(2) of this section .
Period of enforceability
An affidavit of support shall be enforceable with respect to benefits provided for an alien before the date the alien is naturalized as a citizen of the United States, or, if earlier, the termination date provided under paragraph (3).
Termination of period of enforceability upon completion of required period of employment, etc.
In general
An affidavit of support is not enforceable after such time as the alien
has worked 40 qualifying quarters of coverage as defined under title II of the Social Security Act [42 U.S.C. 401 et seq.] or can be credited with such qualifying quarters as provided under subparagraph (B), and
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in the case of any such qualifying quarter creditable for any period beginning after December 31, 1996, did not receive any Federal means-tested public benefit (as provided under section 1613 of this title [8.U.S.C 1613]) during any such period.
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Qualifying quarters
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For purposes of this section , in determining the number of qualifying quarters of coverage under title II of the Social Security Act [42 U.S.C. 401 et seq.] an alien shall be credited with—
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all of the qualifying quarters of coverage as defined under title II of the Social Security Act worked by a parent of such alien while the alien was under age 18, and
all of the qualifying quarters worked by a spouse of such alien during their marriage and the alien remains married to such spouse or such spouse is deceased.
No such qualifying quarter of coverage that is creditable under title II of the Social Security Act for any period beginning after December 31, 1996, may be credited to an alien under clause (i) or (ii) if the parent or spouse (as the case may be) of such alien received any Federal means-tested public benefit (as provided under section 1613 of this title [8.U.S.C 1613]) during the period for which such qualifying quarter of coverage is so credited.
Provision of information to save system
The Attorney General shall ensure that appropriate information regarding the application of this paragraph is provided to the system for alien verification of eligibility (SAVE) described in section 1137(d)(3) of the Social Security Act [42 U.S.C. 1320b–7(d)(3)].
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