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Instructions for Sponsor’s Notice of Change of AddressDepartment of Homeland SecurityU.S. Citizenship and Immigration ServicesUSCISForm I-865What Is The Purpose of Form I-865?The purpose of Form I-865, Sponsor’s Notice of Change of Address, is to report a sponsor’s new address. If you, as asponsor, change your address, you must submit a completed and signed Form I-865 to U.S. Citizenship and ImmigrationServices (USCIS).When Should I Use Form I-865?If at any time in the past you completed Form I-864, Affidavit of Support, to sponsor an immigrant, you are required toreport your change of address within 30 days of the change if the sponsorship agreement is still in force.The sponsorship agreement remains in force until the sponsored immigrant:1. Becomes a U.S. citizen;2. Receives credit for 40 quarters of work;3. Departs the United States permanently and either formally abandons lawful permanent resident status (by filing FormI-407, Record of Abandonment of Lawful Permanent Resident Status) or is formally held in a removal proceeding tohave abandoned that status;4. In a removal proceeding, loses the lawful permanent resident status that the sponsored immigrant obtained based onyour Form I-864; or5. Dies.NOTE: Each sponsor must submit a separate Form I-865 to report an address change, even if sponsors share the sameaddress.General InstructionsUSCIS provides forms free of charge through the USCIS Web site. In order to view, print, or fill out our forms, youshould use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If youdo not have Internet access, you may call the USCIS National Customer Service Center at 1-800-375-5283 and ask thatwe mail a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.Signature. Each notice must be properly signed and filed. For all signatures on this notice, USCIS will not accept astamped or typewritten name in place of a signature. If you are under guardianship, your legal guardian may print yourname and sign Form I-865 for you. “Legal guardian” includes any person who is appointed and authorized by law toprotect your estate as a result of your incapacity. The legal guardian must present proof of the appointment as legalguardian of your estate and a copy of an order from the appointing court or agency specifically permitting the guardian tomake your income and assets available for the support of the sponsored immigrant .Filing Fee. There is no filing fee for this notice.Copies. You may submit legible photocopies of documents requested, unless the Instructions specifically state that youmust submit an original document. USCIS may request an original document at the time of filing or at any time duringprocessing of an application, petition, or request. If you submit original documents when not required, the documentsmay remain a part of the record, and USCIS will not automatically return them to you.Form I-865 Instructions 07/17/15 NPage 1 of 5

Translations. If you submit a document with information in a foreign language, you must also submit a full Englishtranslation. The translator must sign a certification that the English language translation is complete and accurate, and thathe or she is competent to translate from the foreign language into English.How To Fill Out Form I-8651. Type or print legibly in black ink.2. If you need extra space to complete any item within this notice, use the space provided in Part 6. AdditionalInformation or attach a separate sheet of paper; type or print your name at the top of each sheet; indicate the PageNumber, Part Number, and Item Number to which your answer refers; and sign and date each sheet.3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never beenmarried and the question asks “Provide the name of your current spouse”), type or print “N/A,” unless otherwisedirected. If your answer to a question which requires a numeric response is zero or none (for example, “How manychildren do you have” or “How many times have you departed the United States”), type or print “None,” unlessotherwise directed.Specific InstructionsForm I-865 is divided into Parts 1. through 6. The following information should help you fill out the notice.Part 1. Information About You (Sponsor)Item Number 1.a. - 1.c. Your Full Name. Provide your Family Name (Last Name), Given Name (First Name), andMiddle Name.Item Number 2. Date of Birth. Provide your date of birth in the mm/dd/yyyy format.Item Numbers 3.a. - 5. Your New Physical Address. Provide your new physical address in the spaces provided. Donot provide a post office box (PO Box) number in the spaces. Also, include the date that your physical address changebecame effective in the mm/dd/yyyy format and indicate if your physical address is the same as your mailing address.Item Numbers 6.a. - 7. Your New Mailing Address. Provide your new mailing address, including “In Care Of Name,”if applicable. Also, include the date that your mailing address change became effective in the mm/dd/yyyy format.NOTE: You do not need to complete these Item Numbers if your new mailing address is the same as your new physicaladdress.Part 2. Information on the Sponsored ImmigrantsItem Numbers 1.a. - 8. Provide the names and Alien Registration Numbers (A-Number) (if any) of the immigrants youare sponsoring. If you are sponsoring more than four immigrants, provide the requested information for each additionalimmigrant in the space provided in Part 6. Additional Information.Part 3. Sponsor’s Statement, Contact Information, Certification and Signature.Item Numbers 1.a. - 6.b. Select the appropriate box to indicate that you either read this notice yourself or someoneinterpreted this notice for you from English to a language in which you are fluent. If applicable, select the box to indicateif someone prepared this notice for you. Further, you must sign and date your notice and provide your daytime telephonenumber, mobile telephone number (if any), and email address (if any). Every notice MUST contain the signature of thesponsor (or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.Form I-865 Instructions 07/17/15 NPage 2 of 5

Part 4. Interpreter’s Contact Information, Certification, and Signature.Item Numbers 1.a. - 6.b. If you used anyone as an interpreter to read the Instructions and questions on this notice toyou in a language in which you are fluent, the interpreter must fill out this section, provide his or her name, the name andaddress of his or her business or organization (if any), his or her daytime telephone number, and his or her email address(if any). The interpreter must sign and date the notice.Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this Notice, If OtherThan the Sponsor.Item Numbers 1.a. - 8.b. This section must contain the signature of the person who completed your notice, if other thanyou, the sponsor. If the same individual acted as your interpreter and your preparer, that person should complete bothPart 4. and Part 5. If the person who completed this notice is associated with a business or organization, that personshould complete the business or organization name and address information. Anyone who helped you prepare this noticeMUST sign and date the notice. A stamped or typewritten name in place of a signature is not acceptable. If the personwho helped you prepare your notice is an attorney or accredited representative, he or she must also submit a completedForm G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with your notice.Part 6. Additional InformationItem Numbers 1.a. - 6.d. If you need extra space to provide any additional information within this notice, use the spaceprovided in Part 6. Additional Information. If you need more space than what is provided in Part 6., you may makecopies of Part 6. to complete and file with your notice, or attach a separate sheet of paper. Include your name at the top ofeach sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and dateeach sheet.We recommend that you print or save a copy of your completed notice to review in the future and for yourrecords.You should retain in your records:1. A copy of the completed Form I-865; and2. Evidence that you sent the original Form I-865 to the correct USCIS office and USCIS received that Form I-865.USCIS will accept this documentation as proof that you complied with the requirement to file Form I-865. Forexample, if you send Form I-865 using the U.S. Postal Service (USPS), you should keep with your file copy ofForm I-865, the USPS certified mail receipt or Express Mail shipping label along with a return receipt, both bearingpostmarks and the address where you mailed Form I-865. If you send Form I-865 by a commercial delivery service,you should keep a photocopy of the shipping label and signature proof of delivery.What Is the Filing Fee?There is no fee to file Form I-865.How To Check If the Fees Are CorrectForm I-865 filing fee is current as of the edition date in the lower left corner of this page. However, because USCIS feeschange periodically, you can verify that the fees are correct by following one of the steps below.1. Visit the USCIS Web site at www.uscis.gov, select “FORMS,” and check the appropriate fee; or2. Call the USCIS National Customer Service Center at 1-800-375-5283 and ask for fee information. For TTY (deaf orhard of hearing) call: 1-800-767-1833.Form I-865 Instructions 07/17/15 NPage 3 of 5

Where To File?Please see our Web site at www.uscis.gov/I-865 or call our National Customer Service Center at 1-800-375-5283 for themost current information about where to file this notice. For TTY (deaf or hard of hearing) call: 1-800-767-1833.Address Change (For Lawful Permanent Resident Sponsors)If the sponsor is a lawful permanent resident, he or she must file Form I-865 AND comply with the change of addressrequirement in 8 CFR 265.1 He or she must notify USCIS of his or her new address within 10 days of moving from his orher previous residence. For information on filing a change of address go to the USCIS Web site atwww.uscis.gov/addresschange or contact the USCIS National Customer Service Center at 1-800-375-5283. For TTY(deaf or hard of hearing) call: 1-800-767-1833.Processing InformationInitial Processing. Once USCIS accepts your notice, we will check it for completeness. If you do not completely fill outthis notice, USCIS may reject your notice.Requests for More Information. We may request that you provide more information or evidence to support your notice.We may also request that you provide the originals of any copies you submit. USCIS will return any requested originalswhen they are no longer needed.Decision. The decision on Form I-865 involves a determination of whether you have provided the required information toupdate your address in USCIS records. USCIS will notify you in writing if your notice is rejected.USCIS Forms and InformationTo ensure you are using the latest version of this notice, visit the USCIS Web site at www.uscis.gov where you can obtainthe latest USCIS forms and immigration-related information. If you do not have Internet access, you may order USCISforms by calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by calling theUSCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.Instead of waiting in line for assistance at your local USCIS office, you can now schedule an appointment through theUSCIS Internet-based system, InfoPass, at https://my.uscis.gov/en/appointment/v2. Use the InfoPass appointmentscheduler and follow the screen prompts to set up your appointment. InfoPass generates an electronic appointment noticethat appears on the screen.PenaltiesIf you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form I-865, we willreject your Form I-865, and may deny any other immigration benefit. In addition, you will face severe penalties providedby law and may be subject to criminal prosecution.Form I-865 Instructions 07/17/15 NPage 4 of 5

If you fail to give notice of your change of address, as required by 8 U.S.C. 1183a(d) and 8 CFR 213a.3, you may be liablefor the civil penalty established by 8 U.S.C. 1183a(d)(2). The amount of the civil penalty will depend on whether youfailed to give this notice because you were aware that the immigrants you sponsored had received Federal, state, or localmeans-tested public benefits. If the failure to report your change of address occurs with knowledge that the sponsoredimmigrant received means-tested public benefits (other than benefits described in section 401(b), 403(c)(2), or 4ll(b) ofthe Personal Responsibility and Work Opportunity Reconciliation Act of 1996, such failure may result in a fine of not lessthan 2,000 or more than 5,000. Otherwise, the failure to report your change of address may result in a fine not less than 250 or more than 2,000.USCIS Privacy Act StatementAUTHORITIES: The information requested on this notice of change of address, and the associated evidence, iscollected under Section 213A(d) the Immigration and Nationality Act (INA).PURPOSE: The primary purpose for providing the requested information on this notice is to document your addresschange with USCIS within 30 days of the change during the period in which an affidavit of support is enforceable.DISCLOSURE: Failure to report a change of address may result in a civil penalty pursuant to INA Section 213A(d)(2).ROUTINE USES: DHS may share the information you provide on this benefit application with other Federal, state,local, and foreign government agencies and authorized organizations. DHS follows approved routine uses as described inthe associated published s