Form I-485 – Part 9d: General Eligibility (Public Charge)

I-485 Form
Part 9d: General Eligibility (Public Charge)

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Part 9d: General Eligibility (Public Charge)

56. I am exempt from the public charge ground of inadmissibility because I am a/an (select only one box):

VAWA Self-Petitioner (Form I-360)

Special Immigrant Juvenile (Form I-360)

Certain Afghan or Iraqi National

Asylee

Refugee

Victim of Qualifying Criminal Activity

Other INA section 245(m) exemption

Human Trafficking Victim

Any category other than INA section 245(l)

Cuban Adjustment Act

Cuban Adjustment Act for Battered Spouses and Children

Dependent Status under the Haitian Refugee Immigrant Fairness Act

Dependent Status under the Haitian Refugee Immigrant Fairness Act for Battered Spouses and Children

Cuban and Haitian Entrants Applying for Adjustment of Status

A Lautenberg Parolee

National of Vietnam, Cambodia, or Laos

Continuous Residence in the U.S. Since Before January 1, 1972

Amerasian Homecoming Act

Polish or Hungarian Parolee

Nicaraguans and Other Central Americans

American Indian Born in Canada / Texas Band of Kickapoo Indians

Section 7611 of the National Defense Authorization Act for Fiscal Year 2020

Syrian National Adjusting Status under Public Law 106-378

Spouse, Child, or Parent of a U.S. Active-Duty Service Member in the Armed Forces

I do not fall under any of the exempt categories listed above and will complete Items Number 57. - 66.

Please select one option.

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57. What is the size of your household?

Please enter your household size.

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58. Indicate your annual household income.

$0-27,000

$27,001-52,000

$52,001-85,000

$85,001-141,000

Over $141,000

Please select one option.

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59. Identify the total value of your household assets.

$0-18,400

$18,401-136,000

$136,001-321,400

$321,401-707,100

Over $707,100

Please select one option.

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60. Identify the total value of your household liabilities.

$1-10,100

$10,101-57,700

$57,701-186,800

Over $186,800

Please select one option.

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61. What is the highest degree or grade of school you have completed?

Less than a high school diploma

Indicate the highest grade of school you have completed

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High school diploma, GED, or alternative credential

Associate's degree

Bachelor's degree

Master's degree

Professional degree

Doctorate degree

Please select one option.

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62. List your certifications, licenses, skills obtained through work experience, and educational certificates.

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63. Have you ever received any means-tested public benefit?

Yes

Please select Yes or No.

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64. Benefits Received

If your answer to Item Number 63. is “Yes,” list the specific means-tested public benefit(s) you received, the start and end dates of each period of receipt, the dollar amount of benefits received (if applicable), and the reason you received the benefit.

Benefit Record 1

Means-Tested Public Benefit Received

Start Date

End Date

Dollar Amount (if applicable)

Reason

Benefit Record 2

Means-Tested Public Benefit Received

Start Date

End Date

Dollar Amount (if applicable)

Reason

Benefit Record 3

Means-Tested Public Benefit Received

Start Date

End Date

Dollar Amount (if applicable)

Reason

Benefit Record 4

Means-Tested Public Benefit Received

Start Date

End Date

Dollar Amount (if applicable)

Reason

Next: Part 9e: General Eligibility (Illegal Entries)

Part 9d: General Eligibility (Public Charge)

56. I am exempt from the public charge ground of inadmissibility because I am a/an (select only one box):

64. Benefits Received

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Part 9d: General Eligibility (Public Charge)

56. I am exempt from the public charge ground of inadmissibility because I am a/an (select only one box):

64. Benefits Received