Form I-912 Instructions 04/01/24 Page 8 of 12
Item Number 7. Annual Adjusted Income of All Household Members. Provide the annual income from all family
members counted as part of your household.
1. If a person lives with you, but does not contribute nancial support to your household, then you should not include
this person’s income when calculating your household income.
2. If you are separated or still married, but do not live with your spouse, do not include your spouse’s income. However,
you must include any nancial support your spouse provides to your household.
3. You must include any ongoing additional income or additional nancial assistance that you or your household
members receive and provide documentation that is not otherwise listed in your taxes. If you do not have
documentation of your additional income or additional nancial assistance then you must provide an explanation in
Part 10. Additional Information.
4. If you are applying for any immigration benets (such as for adjustment of status) based on the Violence Against
Women Act (VAWA), or T or U nonimmigrant status under the Victims of Violence and Tracking Protection
Reauthorization Act, do not provide your spouse’s income. You do not need to include as a household member or
provide income for:
• Any person in the household who is or was the requestor’s abuser, human tracker, or perpetrator; or
• A person who is or was a member of the abuser, human tracker, or perpetrator’s household.
5. If you are a full-time student, over 21 years of age but under 24 years of age, are unmarried, and are living with your
parents, or you are claimed as a dependent on your parents’ Federal tax return, include your parents’ income. You
must provide a copy of both parents’ Federal tax returns and your own Federal tax return, or provide proof of income
as supporting documentation.
6. If members of your household are recently unemployed, and your annual household income on your Federal tax return
or other proof of income is above 150 percent of the Federal Poverty Guidelines, describe your particular situation
that you believe qualies you for a fee waiver in Part 5., Item Number 9.
Documentation. To document your household members’ incomes, provide the following:
1. A copy of each household member’s most recent Federal tax return, if available;
2. If the household member did not le a Federal tax return, or if the tax return does not properly reect their current
income, submit copies of consecutive pay statements (stubs) for a minimum of the past month, a recent Form W-2,
Form SSA-1099, or employer statements on business stationery showing salary or wages paid; or
3. If you do not have any income or cannot provide evidence of income for your household, describe your particular
situation in Part 5., Item Number 9. If applicable, you may submit adavits from religious institutions, non-prots,
or community-based organizations verifying that you are currently receiving some benet or support from them.
In addition, if no unemployment compensation is being received, you may submit a letter of termination from the
employer.
You must document additional nancial assistance as income. Include the following information:
1. Documentation such as parental support; alimony; child support; educational stipends; pensions; Social Security;
royalties, pensions, veterans benets; unemployment benets; and consistent or regular nancial support from adult
children, parents, dependents, or other people living in your household.
2. A court order of any child support or documentation that indicates the actual amount of child support amount being
received (for example, bank statements or IRS Form W-2), or documentation from an agency providing the other
income or nancial assistance.
3. A copy of your most recent Federal tax return, if available. If you are receiving unemployment benets, the tax
document, IRS Form 1099-MISC, is not enough to establish total income. Provide information regarding any
unemployment benets you are currently receiving in Part 5., Item Number 9.