Part 6: Financial Hardship

If you selected Item Number 1.C. in Part 1, complete this section.

1. Describe any situation affecting you or your family members that has caused expenses, debts, or loss of income. Specify the amounts in as much detail as possible. This may include homelessness, major medical debt for yourself or a family member, and natural disasters. You may also provide other information about your circumstances you would like USCIS to consider.

2. Assets

List cash or assets you can quickly convert to cash, such as bank accounts, stocks, or bonds. Do not include retirement accounts. Leave unused rows blank.

List each additional asset and its value. These entries will go in Part 10 of the PDF.

Calculated from the three asset rows plus the combined value of additional assets.

3. Total Monthly Expenses and Liabilities

Add all monthly expense and liability amounts and enter the total. Enter 0 if there are none. Select the types you have each month and provide evidence of monthly payments where possible.

Responses save in this browser as you type.