Part 5: Income at or Below 150 Percent of the Federal Poverty Guidelines

Provide information about your adjusted gross income. See Instructions for more details.

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

Your Employment Status

1. Employment Status

Your Annual Household Income

Provide information about your adjusted gross income and the adjusted gross income of all family members counted as part of your household. List all amounts in U.S. dollars.

For Item 7, include all family members counted as part of your household. Do not include the amount provided in Item 6.

Calculated by adding Items 6 and 7. Enter 0 for an income amount of zero.

9. Has anything changed since the date you filed your Federal tax returns or is there any difference in your circumstances from the information on your petition?

For example, your marital status, income, or number of dependents as related to documents provided.

If you answered Yes to Item 9, provide an explanation below and documentation if available. You may also use this space for any additional information about your circumstances you would like USCIS to consider.

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