FORM I-864A HOUSEHOLD MEMBER CONTRACT
COVER LETTER AND EVIDENCE CHECKLIST
Filing Overview
- Sponsor: [NAME], A#: [A-NUMBER]
- Household member contributing income/assets: [NAME], Relationship: [RELATION]
- Principal applicant/beneficiary: [NAME], A#: [A-NUMBER]
- Filing context: [I-485 concurrent / Consular IV at NVC/Post]
Packet Order (suggested)
1) Cover letter (this document).
2) Form I-864A (signed by household member and sponsor).
3) Sponsor’s I-864 (signed) for cross-reference.
4) Proof of household member status (USC/LPR/other if permitted) and residence at same address (lease/utility bill/joint mail).
5) Income evidence for household member: pay stubs (last 2-3 months), employment letter, IRS tax transcript (most recent year), W-2/1099.
6) Asset evidence for household member (if used): bank/brokerage statements, property title + valuation.
7) Calculation sheet showing combined income meeting 125% (or 100% if applicable) of HHS poverty guideline.
8) Translations as needed; G-28/G-1145 if used.
Cover Letter Body (sample)
text
Date: [DATE]
USCIS/NVC [ADDRESS]
RE: Form I-864A Household Member Contract - Household Member: [NAME]; Sponsor: [SPONSOR NAME]; Beneficiary: [NAME]
Dear Officer:
Enclosed is Form I-864A to combine the income/assets of the household member listed above with the sponsor’s Form I-864. Evidence of co-residence, status, and income/assets is included. The combined income meets the applicable poverty guideline for a household of [SIZE].
Sincerely,
[ATTORNEY/SPONSOR NAME]
[ADDRESS]
[PHONE] | [EMAIL]
Practice Notes
- Ensure household member resides at the same principal residence as sponsor.
- Include IRS transcript over return when possible; explain any non-filing with IRS verification.
- If assets are used, apply correct multipliers (5x/3x/1x) based on category.
- Keep calculations consistent across I-864 and I-864A.