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US Naturalization Process In a Nutshell

1. Complete Your Application and Get Photographed

Complete your application.

Get two passport-style photographs taken.

Collect the necessary documents.

Send your application, passport-style photographs, documents, and fee (DO NOT SEND CASH) to the appropriate Lockbox Facility or Service Center.

Keep a copy of everything you send to USCIS.

2. Get Fingerprinted

Receive an appointment letter from USCIS.

Go to the fingerprinting location.

Get your fingerprints taken.

Mail additional documents if USCIS requests them.

Wait for USCIS to schedule your interview.

3. Get Interviewed

Receive an appointment for your interview.

Go to your local USCIS office at the specified time.

Bring state-issued identification, Permanent Resident Card, and any additional documents specific to your case.

Answer questions about your application and background.

Take the English and civics tests.

Receive case status.

4. Take the Oath

Receive a ceremony date.
Check in at the ceremony.
Return your Permanent Resident Card.
Answer questions about what you have done since your interview.
Take the Oath of Allegiance.
Receive your Certificate of Naturalization.

US Naturalization (N-400) Requirements

For certain family members, the typical five year waiting period may be reduced to three years.

Generally, certain lawful permanent residents married to a U.S. citizen may file for naturalization after residing continuously in the United States for three years if immediately preceding the filing of the application the applicant has:

  · been married to and living in a valid marital union with the same U.S. citizen spouse for all three years
  · the U.S. spouse has been a citizen for all three years and meets all physical presence and residence requirements
  · the applicant meets all other naturalization requirements

Age

Applicants must be at least 18 years old.

Refer to the section, Naturalized Citizen's Children under Waivers, Exceptions, and Special Cases for information on applicants who are less than 18 years old.

Residency

An applicant must have been lawfully admitted to the United States for permanent residence. Lawfully admitted for permanent residence means having been legally accorded the privilege of residing permanently in the United States as an immigrant in accordance with the immigration laws. Individuals who have been lawfully admitted as permanent residents will be asked to produce an I-551, Alien Registration Receipt Card, as proof of their status.

Residence and Physical Presence

An applicant is eligible to file if, immediately preceding the filing of the application, he or she:

has been lawfully admitted for permanent residence (see preceding section);

has resided continuously as a lawful permanent resident in the U.S. for at least 5 years prior to filing with no single absence from the United States of more than one year;

has been physically present in the United States for at least 30 months out of the previous five years (absences of more than six months but less than one year shall disrupt the applicant's continuity of residence unless the applicant can establish that he or she did not abandon his or her residence during such period) and has resided within a state or district for at least three months.

Good Moral Character

Generally, an applicant must show that he or she has been a person of good moral character for the statutory period (typically five years or three years if married to a U.S. citizen or one year for Armed Forces expedite) prior to filing for naturalization. The Service is not limited to the statutory period in determining whether an applicant has established good moral character. An applicant is permanently barred from naturalization if he or she has ever been convicted of murder. An applicant is also permanently barred from naturalization if he or she has been convicted of an aggravated felony as defined in section 101(a)(43) of the Act on or after November 29, 1990. A person also cannot be found to be a person of good moral character if during the last five years he or she:

has committed and been convicted of one or more crimes involving moral turpitude

has committed and been convicted of 2 or more offenses for which the total sentence imposed was 5 years or more

has committed and been convicted of any controlled substance law, except for a single offense of simple possession of 30 grams or less of marijuana

has been confined to a penal institution during the statutory period, as a result of a conviction, for an aggregate period of 180 days or more

has committed and been convicted of two or more gambling offenses

is or has earned his or her principal income from illegal gambling

is or has been involved in prostitution or commercialized vice

is or has been involved in smuggling illegal aliens into the United States

is or has been a habitual drunkard

is practicing or has practiced polygamy

has willfully failed or refused to support dependents

has given false testimony, under oath, in order to receive a benefit under the Immigration and Nationality Act.

An applicant must disclose all relevant facts to the Service, including his or her entire criminal history, regardless of whether the criminal history disqualifies the applicant under the enumerated provisions.

Attachment to the Constitution

An applicant must show that he or she is attached to the principles of the Constitution of the United States.

Language

Applicants for naturalization must be able to read, write, speak, and understand words in ordinary usage in the English language. Applicants exempt from this requirement are those who on the date of filing:

have been residing in the United States subsequent to a lawful admission for permanent residence for periods totaling 15 years or more and are over 55 years of age;

have been residing in the United States subsequent to a lawful admission for permanent residence for periods totaling 20 years or more and are over 50 years of age; or

have a medically determinable physical or mental impairment, where the impairment affects the applicant's ability to learn English.

United States Government and History Knowledge

An applicant for naturalization must demonstrate a knowledge and understanding of the fundamentals of the history and of the principles and form of government of the United States. Applicants exempt from this requirement are those who, on the date of filing, have a medically determinable physical or mental impairment, where the impairment affects the applicant's ability to learn U.S. History and Government

Applicants who have been residing in the U.S. subsequent to a lawful admission for permanent residence for at least 20 years and are over the age of 65 will be afforded special consideration in satisfying this requirement.

Naturalization Test Questions for Applicants Meeting 65/20 Exception

Test Yourself on U.S. History

Sample U.S. History Questions with Answers

Oath of Allegiance

To become a citizen, one must take the oath of allegiance. By doing so, an applicant swears to:

support the Constitution and obey the laws of the U.S.;

renounce any foreign allegiance and/or foreign title; and

bear arms for the Armed Forces of the U.S. or perform services for the government of the U.S. when required.

In certain instances, where the applicant establishes that he or she is opposed to any type of service in armed forces based on religious teaching or belief, USCIS will permit these applicants to take a modified oath.

Read the Oath of Allegiance

"I hereby declare, on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince, potentate, state or sovereignty, of whom or which I have heretofore been a subject or citizen; that I will support and defend the Constitution and laws of the United States of America against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I will bear arms on behalf of the United States when required by the law; that I will perform noncombatant service in the armed forces of the United States when required by the law; that I will perform work of national importance under civilian direction when required by the law; and that I take this obligation freely without any mental reservation or purpose of evasion; so help me God."

Family Members of U.S. Citizens

Spouses of U.S. Citizens

Children

Veterans of U.S. Armed Forces

Lawful Permanent Residents with Three Years U.S. Military Service

Naturalization Applicants Who Have Served Honorably in Any Specified Period of Armed Conflict with Hostile Foreign Forces

US Naturalization (N-400) Step-by-Step Guide

Download and save the N-400 Naturalization Form

http://www.uscis.gov/files/form/n-400.pdf

Assemble the US Naturalization (N-400) package using the following checklist:

US Naturalization (N-400) Package Checklist
Follow these assembly instructions. All supporting documents must be in English or be translated.

Include Required Payment:

Use a personal check or money order for both the application and biometrics fee (if required).
Make sure the check or money order is made out to: U.S. Department of Homeland Security

Completed, signed and dated N-400 Form:

Be sure that the form is completed and correct to the best of your knowledge. Print, sign and date as required.

All applicants must send the following three items with their N-400 application:

		1.	A photocopy of both sides of your Permanent Resident Card (formerly known as the Alien Registration Card or 'Green Card'). If you have lost the card, submit a photocopy of the receipt of your Form I-90, 'Application to Replace Permanent Resident Card'; and
		2.	Two identical color photographs, with your name and A-number written lightly in pencil on the back of each photo. For details about the photo requirements, see this specification. Do not wear eyeglasses or earrings for the photo. If your religion requires you to wear a head covering, your facial features must still be exposed in the photo for purposes of identification; and
		3.	A check or money order for the correct application fee and the biometric services fee for fingerprinting. (Applicants 75 years of age or older are exempted from fingerprinting and the biometrics services fee). Write your 'A-number' on the back of the check or money order.

Only if required, send copies of the following documents (the USCIS will request originals if needed):

If an attorney or accredited representative is acting on your behalf, send:
A completed original Form G-28, 'Notice of Entry of Appearance as Attorney or Representative.'

If your current legal name is different from the name on your Permanent Resident Card, send:
The document(s) that legally changed your name (marriage certificate, divorce decree, or court document).

If you are applying for naturalization on the basis of marriage to a U.S. citizen, send the following four items:

1. Evidence that your spouse has been a U.S. citizen for the last three years:

	Birth certificate (if your spouse never lost citizenship since birth), or
	Naturalization certificate, or
	Certificate of Citizenship, or
	The inside of the front cover and signature page of your spouse's current U.S. passport, or
	Form FS-240, 'Report of Birth Abroad of a Citizen of the United States of America', and

2. Your current marriage certificate; and

3. Proof of termination of all prior marriages of your spouse-divorce decree(s), annulment(s), or death certificate(s); and

4. Documents referring to you and your spouse:

	Tax returns, bank accounts, leases, mortgages, or birth certificates of children, or
	Internal Revenue Service (IRS)-certified copies of the income tax forms that you both filed for the past three years, or
	An IRS tax return transcript for the last three years.

If you were married before, send:
Proof that all earlier marriages ended-divorce decree(s), annulments, or death certificates(s);

If you were previously in the U.S. military service, send:
A completed original Form G-325B, 'Biographic Information.'

If you are currently in the U.S. military service and are seeking citizenship based on that service, send:
A completed original Form N-426, 'Request for Certification of Military or Naval Service'; and A completed original Form G-325B, 'Biographic Information.'

If you have taken any trip outside the United States that lasted six months or more since becoming a Permanent Resident, send evidence that you (and your family) continued to live, work and/or keep ties to the United States, such as:

	An IRS tax return 'transcript' or an IRS-certified tax return listing tax information for the last five years (or for the last three years if you are applying on the basis of marriage to a U.S. citizen).
	Rent or mortgage payments and pay stubs.

If you have a dependent spouse or children who do not live with you, send:
Any court or government order to provide financial support; and Evidence of your financial support (including evidence that you have complied with any court or government order), such as:

	Cancelled checks,
	Money and receipts,
	A court or agency printout of child support payments,
	Evidence of wage garnishments,
	A letter from the parent or guardian who cares for your children.

If you answer 'Yes' to any of Questions 1 through 15 in Part 7 of form N-400, send:
A written explanation on a separate sheet of paper.

If you answer 'No' to any of Questions 1 through 5 in Part 8 of form N-400, send:
A written explanation on a separate sheet of paper.

If you have ever been arrested or detained by any law enforcement officer for any reason, and no charges were filed, send:
An original official statement by the arresting agency or applicant court confirming that no charges were filed.

If you have ever been arrested or detained by any law enforcement officer for any reason, and charges were filed, send:
An original or court-certified copy of the complete arrest record and disposition for each incident (dismissal order, conviction record or acquittal order).

If you have ever been convicted or placed in an alternative sentencing program or rehabilitative program (such as a drug treatment or community service program), send:

1. An original or court-certified copy of the sentencing record for each incident; and
2. Evidence that you completed your sentence:

	An original or certified copy of your probation or parole record; or
	Evidence that you completed an alternative sentencing program or rehabilitative program.

If you have ever had any arrest or conviction vacated, set aside, sealed, expunged or otherwise removed from your record, send:
An original or court-certified copy of the court order vacating, setting aside, sealing, expunging or otherwise removing the arrest or conviction, or an original statement from the court that no record exists of your arrest or conviction.

NOTE: If you have been arrested or convicted of a crime, you may send any countervailing evidence or evidence in your favor concerning the circumstances of your arrest and/or conviction that you would like USCIS to consider.

If you have ever failed to file an income tax return since you became a Permanent Resident, send:
All correspondence with the IRS regarding your failure to file.

If you have any federal, state or local taxes that are overdue, send:

1. A signed agreement from the IRS or state or local tax office showing that you have filed a tax return and arranged to pay the taxes you owe; and
2. Documentation from the IRS or state or local tax office showing the current status of your repayment program. NOTE: You may obtain copies of tax documents and tax information by contacting your local IRS offices, using the Blue Pages of your telephone directory, or through its website at www.irs.gov.

If you are applying for a disability exception to the testing requirement, send:
An original Form N-648, 'Medical Certification for Disability Exceptions,' completed less than six months ago by a licensed medical or osteopathic doctor or licensed clinical psychologist.

If you did not register with the Selective Service and you (1) are male, (2) are 26 years old or older, and (3) lived in the United States in a status other than as a lawful nonimmigrant between the ages of 18 and 26, send:
A 'Status Information Letter' from the Selective Service (Call 1-847-688-8888 for more information).

Determine your filing location based on where you live:

Check the USCIS N-400 Information Page for the current filing location based on where you live.

Attach "E-Notification" Form (Optional):

Clip a completed G-1145 (E-Notification of Application/Petition Acceptance), to the first page of your application (on top of the cover page). By completing this form and attaching it, USCIS will send you an email and/or text message to alert you when your application was received.

Mail the package with return receipt requested / delivery confirmation. Send via USPS:

IMPORTANT!
Make TWO copies of the entire package before you send it in. This includes money orders or checks too. You want to have a perfect replica of the package you are sending in. All Forms that you submit must be originals with original signatures. Supporting Evidence that you submit may be photocopies. Retain ALLoriginal supporting Evidence since the USCIS has the right to check them by issuing an RFE (Request For Evidence). If you receive an RFE, follow the direction exactly, and make two copies of what you sent back. During any future interviews the USCIS may also want to examine the original supporting evidence.

General Tips on Assembling USCIS Immigration Applications for Mailing

Note 1: Mark both the envelope and the cover letter as to the nature of the submission. Example: ORIGINAL SUBMISSION - BRIEF FOR AN APPEAL - RESPONSE TO REQUEST FOR ADDITIONAL INFORMATION - etc.

Note 2: Use the appropriate mailing address and mark both the envelope and the cover letter as to the form type. Example: I-129; I-130; I-690; I-698, etc.

Note 3: Provide both the receipt notice number and the A-Number as an identifier, if they are available.

Note 4: If the packet is being resubmitted in response to a REQUEST FOR ADDITIONAL EVIDENCE, please place the notice requesting the additional evidence/information on the top of the packet. Also, please use the special mailing envelope provided.

Note 5: If evidence is being submitted in support of a previously filed appeal or motion, a cover letter stating "BRIEF FOR APPEAL", etc., should be placed on top of the packet.

Note 6: In preparing your packet, please take note of the following:

  a. Do not use binders or folders that cannot be easily disassembled.
  b. Use ACCO fasteners to hold together thick or bulky applications or petitions. Two-hole punching the top of the material for easy placement in the file is appreciated. Exception: Petitions filed at the Chicago lockbox should use paperclips when attaching supporting personal documents to forms instead of “ACCO” fasteners; staples are acceptable when attaching fees.
  c. The use of tabs assist in locating items listed as attachments. The tabs should be placed on the bottom and not the side for ease in filing.
  d. Avoid using heavy-duty staples; instead use ACCO fasteners or heavy clips.
  e. Avoid submitting originals unless specifically required (Forms I-94, Labor certifications, etc). Avoid submitting oversized documentation when possible.

Note 7: If you are sending more than one case in an envelope, clearly separate the cases by rubber band or clip fasteners.

Note 8: A form G-28 is not acceptable unless signed by the authorized representative and the petitioner (re: petitions) or the applicant (re: applications). Facsimile signature stamps are acceptable for the signature of the representatives. However, applicants/petitioners must live sign the initial Form G-28 submitted with the application/petition. Any subsequent Form G-28 relating to the same case may be a photocopy of the original, which should be already attached to the relating case.

Note 9: Send copies of any prior approval notices with any new requests for extensions of stay, change of status or amended petitions.

Note 10: Keep copies of all submissions. Don't assume the officer will have access to a prior file or record. Submit as complete a packet as possible so the case can be adjudicated from what you submit. Submit a complete packet of information for each petition or application. If officers have to review prior files or records, the adjudication of the case can be delayed substantially.

Note 11: Be sure to complete all pertinent items on the petition or application. Ensure all entries on the forms are legible. Note the appropriate consulate, embassy, or a request to adjust status on the petition. Do not enter "N/A" when "None" is appropriate.

Note 12: If you believe your situation to be unique, explain it fully in an attachment to the packet, not as a cover letter.

Note 13: Please submit certified translations for all foreign language documents. The translator must certify that s/he is competent to translate and that the translation is accurate. The certification format should include the certifier's name, signature, address, and date of certification. The formated required by the USCIS can be found here.

Note 14: USCIS no longer routinely requires submission of original documents or "certified copies." Instead, ordinary legible photocopies of such documents (including naturalization certificates and alien registration cards) will be acceptable for initial filing and approval of petitions and applications.

At the discretion of the officer, original documents may still be required in individual cases. Please be advised that USCIS no longer returns original documents submitted with the exception of Certificates of Naturalization, Forms I-551, Permanent Resident Card, Forms I-94, Arrival/Departure Document, valid passports, or those specifically requested by the officer. Such documents will be returned when they are no longer needed.

Note 15: Reminder: The best way to locate records is through the receipt number and/or the A-Number. Always provide this information whenever possible. If you don't know the A-Number, provide a COMPLETE name and date of birth. ALSO: Provide ANY AND ALL names used by the individual, including aliases, maiden names, names used when originally admitted to the United States, etc. Providing this information is extremely helpful and speeds up processing time.

Note 16: DUPLICATE FILINGS (without fee): Cases will be accepted as a duplicate filing only when USCIS has specifically requested that a duplicate be filed. In such a case, be sure to submit the receipt number of original filing or any copies of notices received from USCIS on the first filing when submitting a duplicate petition or application.

Note 17: The address block on the forms is the data field captured for all of our mailings. Consistent with the limitations on the number of characters per line (a maximum of 32) and the total numbers of lines (4) in that field, whatever is in the block will become the mailing address used by the system. The data in these fields is entered exactly as indicated on the forms. Please include internal routing symbols in the address block, especially for large organizations. It is better to abbreviate the name of the organization and have space for the routing codes than to fully spell out the name and have notices sit in the organization's mailroom.

Note 18: Recognized authorities: Many I-129 petitions filed with evidence of the beneficiary's education or accomplishments include documentation submitted by various authorities. For example, petitions for artists and entertainers may include evidence the beneficiary has received an award or other recognition of achievement. Petitions for individuals employed in a specialty occupation may include evidence the beneficiary belongs to a professional organization. When an individual's awards or membership is used to support a petition, evidence establishing the reputation of that organization must also be submitted. Examples of the type of evidence needed includes the following: the size and standing of the organization or the organization's requirements for membership and any other documentation which would establish the reputation of that organization.

When an opinion from a recognized authority is submitted, the opinion should state: the writer's qualifications as an expert; the writer's experience giving such opinions, citing specific instances where past opinions have been accepted as authoritative and by whom; how the conclusions were reached; and the basis for the conclusions, including copies or citations of any research material used.

Note 19: Any application or petition for an individual currently in F-1 status needs to include evidence the student has been maintaining status and has been authorized employment if applicable. Such evidence usually can be satisfied by submitting the latest Form I-20AB/I-20ID and a copy of the employment authorization card.

USCIS Designated Civil Surgeons

Most applicants for adjustment of status are required to have a medical examination. The medical examination must be conducted by a civil surgeon who has been designated by the United States Citizenship and Immigration Services.

Civil Surgeon Locator

For information about a specific office, use the map below or enter your zip code in the box provided.

Find your civil surgeons by state:

Click on your state in the map or select it from the dropdown below.

USCIS Immigration Vaccination Requirements

Introduction

These Questions and Answers provide basic information about the general vaccination requirements for immigrants (including individuals seeking adjustment of status), and specifically about the assessment made by the civil surgeon to determine whether an applicant meets the vaccination requirements. These Questions and Answers do not address the vaccination assessments conducted by panel physicians overseas. For refugees only, health departments may be considered a civil surgeon for purposes of completing the vaccination record.

Related Forms

USCIS Form I-693, Report of Medical Examination and Vaccination Record http://www.uscis.gov/files/form/i-693.pdf

Background

Under the immigration laws of the United States, a foreign national who applies for an immigrant visa abroad, or who seeks to adjust status to a permanent resident while in the United States, is required to receive vaccinations to prevent the following diseases:

--o Mumps
--o Measles
--o Rubella
--o Polio
--o Tetanus and Diphtheria Toxoids
--o Pertussis
--o Haemophilus influenzae type B
--o Hepatitis B
--o Any other vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices

The Advisory Committee for Immunization Practices (ACIP) is an advisory committee to the Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) that recommends immunizations for the general U.S. population. Starting Dec.14, 2009, when the ACIP recommends new vaccines for the general U.S. population, CDC will assess whether these vaccines should be required for immigration purposes on a regular and on an as-needed basis according to specific criteria set by CDC.

CDC is responsible for publishing the Technical Instructions for the Medical Examination of Aliens in the United States. These documents set the requirements for the immigrant medical examination and are binding on civil surgeons. The Technical Instructions include a vaccination component, specifying how the civil surgeon has to conduct the vaccination assessment. The civil surgeon records the results of the medical examination, including the results of the vaccination assessment, on USCIS Form I-693, Report of Medical Examination and Vaccination Record.

If a foreign national applies for an immigrant visa abroad, that individual has to receive the medical examination by a panel physician designated by the U.S. Department of State (DOS). CDC issues separate instructions to panel physicians designated by DOS to conduct medical examinations abroad. For more information about panel physicians, please consult DOS' website at http://travel.state.gov/visa/immigrants/info/info_3739.html.

Questions and Answers

Q. Where can I find information about vaccinations in general?
A. CDC publishes information about vaccinations in general and information about the vaccine requirements for immigration purposes at http://www.cdc.gov/vaccines/.

Q. Why do immigrants and adjustment of status applicants have to show proof they have received certain vaccinations?
A. In 1996, Congress provided in legislation that every immigrant entering the United States, or every individual seeking adjustment of status to that of a legal permanent resident, show proof that he or she was vaccinated against vaccine-preventable diseases. The text for this requirement is in the Immigration and Nationality Act (INA), section 212(a)(1)(A)(ii).

Q. How does the CDC decide which vaccines are required for immigration purposes?
A. Some of the vaccines that are required are specifically listed in the INA. In addition to these, the statute also requires that an individual receive any other vaccinations recommended by the ACIP. CDC uses the following criteria in determining which of these recommended vaccines should be required for immigration purposes:

--o The vaccine must be an age-appropriate vaccine as recommended by the ACIP for the general U.S. population, and
--o At least one of the following:
- --o The vaccine must protect against a disease that has the potential to cause an outbreak; or
- --o The vaccine must protect against a disease eliminated in the United States, or is in the process of being eliminated in the United States.

Q. I am seeking immigrant status in the United States but had a medical examination abroad by a panel physician; I also received some vaccines. Do I have to repeat the medical examination and get the vaccines again?
A. Please read the instructions to Form I-693 to determine if you must repeat the medical examination, including the vaccination assessment, based on your current status in the United States.

Q. How do I know which vaccines are required for immigration purposes?
A. A civil surgeon is required to follow the Technical Instructions for the Examination of Aliens in the United States, including the 2009 Technical Instructions to Civil Surgeons for Vaccinations, and any updates published online. CDC publishes the vaccination requirements and medical examination instructions (including a detailed table listing all required vaccines) at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/vaccination-civil-technical-instructions.html

Q. Do I have to receive all the required vaccines, even though I have been vaccinated before?
A. No. The civil surgeon will review your vaccination records at the time of your medical examination to see whether you have proof of earlier vaccinations against vaccine-preventable diseases that are appropriate for your age category. It is important that you take any written vaccination documentation you may have to the civil surgeon when you have your immigration medical examination.

If you lack any vaccinations required for your age category, the civil surgeon will administer the vaccines as needed. In the alternative, you can also choose to obtain the required vaccines from your private healthcare provider. However, because only a civil surgeon is authorized to complete the vaccination assessment on the Form I-693, you must return to the civil surgeon with the proof that you have received the missing vaccines.

In addition, some individuals are immune to vaccine-preventable diseases, and they know of the immunity because their private healthcare provider has tested them. If you have any written evidence of immunity, you should take this documentation to your civil surgeon. This will enable the civil surgeon to determine which vaccines you need to receive.

Q. Do I have to receive all the vaccines on CDC's vaccination list for the immigrant population, or only the ones that are age appropriate?A. You are required to document receipt of vaccines that are age appropriate for you. The civil surgeon will annotate Form I-693 to indicate that you were not required to receive a particular vaccine because it was not age appropriate at the time of the medical examination.

Q. Do I have to receive all the vaccines that are on CDC's list and that are age appropriate, although I may have a medical condition that prevents me from receiving the required vaccines?
A. If you have a medical condition that prevents you from receiving a vaccine that is appropriate for your age, the civil surgeon will annotate the Form I-693 accordingly and mark the vaccine as contraindicated. A contraindication is a condition that prevents you from receiving a particular vaccine. CDC lists in its Technical Instructions what is considered a contraindication. It is up to the civil surgeon to determine whether you have such a condition that prevents you from receiving a particular vaccine at the time of the immigration medical examination.

Q. Certain vaccine series can only be completed with multiple visits to the civil surgeon. Am I required to complete the entire series before the civil surgeon can sign the Form I-693?A. You are only required to receive a single dose of each vaccine when you visit the civil surgeon. You are encouraged to follow up with your private health care provider to complete the series. Once you have received the single dose appropriate at the time, the civil surgeon can sign and certify the Form I-693.

Q. I am pregnant and do not wish to receive any vaccinations. Do I still have to get them to be able to obtain permanent resident status in the United States?
A. If you are pregnant, the CDC's Technical Instructions direct the civil surgeon how to evaluate the vaccines you are able to receive during pregnancy. If the civil surgeon cannot safely administer a required vaccine, he/she will annotate the Form I-693 by marking the vaccine as contraindicated. See link to the right for information on pregnancy and vaccinations in general.

Q. Can the civil surgeon safely administer all vaccines that are required all at once?
A. The civil surgeon will let you know if you can receive all the vaccines at once, or if there is a concern based on your particular medical condition that will not allow you to receive all required vaccines at once.

Q. When does the flu season start for purposes of the seasonal flu vaccine requirement? Since the seasonal flu vaccine is required, do I have to get the seasonal flu vaccine if it is not the flu season?
A. For purposes of the immigration medical examination, the flu season starts on October 1 and ends on March 31 each year. If your immigration medical examination is during this period, you are required to have the seasonal flu vaccine. If you have an immigration medical examination completed between April 1 and September 30, when it is not the flu season for immigration purposes, you are not required to document that you have received the seasonal flu vaccine.

Q. I heard that the vaccine against herpes zoster (zoster) and the Human Papillomavirus (HPV) are required vaccines. Is this true?A. From Aug. 1, 2008, until Dec. 13, 2009, the zoster and the HPV were required vaccines for immigration purposes. However, the zoster vaccine was not available from Aug. 1, 2008, through Dec. 13, 2009, and USCIS posted a message on the Web to inform civil surgeons they could annotate the vaccination record with "not available" if they were not able to obtain the vaccine. In 2009, CDC changed the vaccination requirements based on ACIP's recommendations. As of Dec. 14, 2009, the zoster and the HPV vaccine were no longer required.

Q. I had my immigration medical examination before Dec. 14, 2009, before the zoster and HPV vaccines were eliminated. I was required to have one of them, but did not receive it. My Form I-693 says that I refused to have the HPV or zoster vaccine. Will my I-693 be returned or my application denied?A. On Dec. 14, 2009, vaccines against herpes zoster (zoster) and HPV are no longer required. It is irrelevant that you did not receive either the zoster or the HPV because beginning on Dec. 14, 2009; you are no longer inadmissible solely because you did not have the vaccine. USCIS will not return your Form I-693, nor will it deny your application because you did not receive the vaccine.

Q. Who pays for the vaccinations?
A. The applicant is responsible for paying the appropriate fee for all vaccinations directly to the civil surgeon, as agreed upon with the civil surgeon. You should ask about the price of the vaccinations before the medical examination or the administration of the vaccinations.

Q. Can I be forced to be vaccinated for immigration purposes?
A. If you refuse to receive the vaccines required for immigration purposes, as mandated by the immigration laws of the United States, your application for legal permanent resident status may be denied.

Q. What will happen if I refuse to receive one or all of the required vaccines?
A. Tell the civil surgeon if you do not wish to receive the required vaccines or a particular vaccine. You should also tell the civil surgeon the reason you do not wish to receive the vaccine(s). In this case, a waiver may be available to you, but only under the following circumstances:

--o You are opposed to vaccinations in any form– that is, you cannot obtain a waiver based on an objection only as to one vaccination
--o Your objection must be based on religious beliefs or moral convictions; and
--o The religious or moral beliefs must be sincere.

The form used to apply for a waiver depends on the adjustment category under which you are seeking legal permanent residence status. For example, refugees and asylees seeking adjustment of status should file Form I-602, Application by Refugee for Waiver of Grounds of Excludability. Individuals seeking adjustment of status as a result of an approved Form I-130, Petition for Alien Relative, or Form I-140, Immigrant Petition for Alien Worker, would file Form I-601, Application for Waiver of Grounds of Inadmissibility.

Q. My civil surgeon says that a vaccine is currently not available. What should I do?
A. Ask the civil surgeon whether another health care provider may have the vaccine. If another physician or department or pharmacy carries the vaccine and can administer the vaccine, you should get the vaccine and request documentation that you have received the vaccine. Bring the written record back to the civil surgeon so that s/he can complete the Form I-693.
HHS/CDC monitors which vaccines are not available in the United States, or which vaccines may experience a shortage. If CDC determines there is a nation-wide shortage of a vaccine, it will recommend to USCIS to post a message on www.uscis.gov to explain to applicants and civil surgeons whether the vaccine is required and under what circumstances. The information is available on USCIS’ Form I-693 page, the Immigration Medical Examination page, or the Designated Civil Surgeon page.

Q. Will USCIS accept a Form I-693 if the vaccination chart is incomplete?
A. No. The vaccination chart should have at least one entry in each row for each vaccine. If the vaccination chart is not properly completed at the time of the medical examination, USCIS may return the Form I-693 to you with instructions on how to correct it.

If you refuse a vaccine because of religious or moral reasons, the civil surgeon will mark this on the Form I-693. In this case, you will have to apply for a waiver.

Q: Where can I find more information about the vaccination requirements for immigration purposes and how these requirements affect the completion of Form I-693?
A. CDC publishes the Technical Instructions including the vaccination component http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html
For more information about the civil surgeon program, the completion of Form I-693, or the adjustment of status application, please visit www.uscis.gov, or call USCIS’ National Customer Service Center at 1-800-375-5283 (TTY 1-800-767-1833).

Medical Exam's by the USCIS: Everything you wanted to know

Note: Canadian USCIS civil surgeons are now requiring pictures in order to have the medical exam, and
others may also require these. It would be wise to have pictures ready when you go to your medical
exam. Canadian doctors are requiring passport-style pictures, however this may not be a uniform
requirement for all consulates. Check with the facility/doctor where you will have your medical exam
to confirm whether they will require pictures and if so, what type (adit or passport).

Here is a helpful URL regarding the medical exam.

One vital thing that you need to understand is this: IF there are any irregularities regarding your

medical exam, it is the CONSULATE (or the USCIS if you are filing adjustment while inside the U.S.) who

has the final say on whether this allows you to get the visa. The consulate or USCIS may consult the

doctor for answers to questions they may have, and while the doctor can make recommendations, the

USCIS or consulate makes the final decision.

You can also read the 9FAM consular directives regarding medical examinations.

I have seen many questions from anxious foreign fiances and spouses about the medical exam that they must

take prior to the interview. Frankly, it is rare to have someone flunk this exam. The primary problem that the

doctor is checking for would be infectious diseases that are a public health threat, the most notable of

these being HIV/AIDS and active TB, however there are other factors involved that you need to read about.

One other factor to consider is whether the fiance or spouse or child of the alien relative has a disease or

disorder which could lead to debilitation and inability to wok. Another factor would be whether the

immigrant was a danger to himself or others (such as mental illness in which psychosis was involved and

was not controlled).

Many people want to know whether they will have any trouble passing this exam if they have a chronic

medical problem of asthma, depression, diabetes, heart trouble, high blood pressure and other similar

problems. Generally the answer is that you will have no problems. As an example, one fiance had high blood

pressure...on the day of his exam, his blood pressure was around 160/120, and he passed the exam. The only

word he received from the doctor was "in the US you will get better treatment because they have better

medicines there." However the examining doctor did require the fiance to have a letter from his doctor attesting

to the fact that his hypertension was under treatment and was causing him no problems--it is a good idea to go

ahead and get a letter of this type prior to your medical exam, just to be on the safe side, if you have a

questionable health condition that may need clarification.)

Concerning depression: having depression does not mean that you flunk this test...there are many people who

have this medical problem who have passed the medical exam. A primary concern would be whether the

disease was being treated successfully and the person was FUNCTIONAL...that is, stable and able to work.

Another consideration regarding mental disorders would be whether the person was having problems currently

with psychoses, as these would be disabling and possibly require institutionalization, or might be a threat to

himself or others. If there was no psychosis, then you would have a good chance of passing the exam. Mental

and mood disorders do not automatically mean you flunk the exam. Again, physician documentation regarding

the problem, it's treatment, and the success of that treatment could be very important.

If you have a chronic medical problem which causes you concern regarding your ability to pass the exam,

you should obtain copies of your medical records and bring these to your exam. Also, obtain a letter signed by

your doctor, attesting to the stability of your problem, and that you were being successfully treated. If you have

a history of drug abuse, you need to obtain a letter which states for what period of time you have been

drug-free, and you *might* want to even obtain a drug test and bring the results with you to the exam. These

are just suggestions you may want to consider in building your case for having a medical problem which will not

cause you problems when you immigrate.

When you read the documents below, you will note that another one of the primary considerations the

doctor must make is whether the person has a problem that might cause him/her to be debilitated and

institutionalized, unable to work, a threat to others, and being so debilitated that someone would have

to provide care for the immigrant fiance. Thus even chronic diseases would not automatically fall into this

category. One thing that might be a deciding factor would be the stability of a disorder, if it fell into a

questionable type of disease....read on below...

Let's consider some of the more serious diseases such as multiple sclerosis, for an example. Some types of

multiple sclerosis cause rapid deterioration, and fall into the category of a rapidly deteriorating problem where

the person will not be able to function independently for very long. A person in this category might be rejected

on the medical examination. But consider another person with this disease who is doing well and has been

stable for, say, five years. This person would very possibly pass the exam, based on the stability of the disease.

It would all fall back to the documentation provided by the treating physician, I think...

On the other hand, someone with amyotropic lateral sclerosis (known as ALS or Lou Gehrig's disease) would

most definitely flunk the medical exam, simply because this disease is characteristically always a deteriorating

disease with a debilitating and finally fatal outcome. Multiple sclerosis, on the other hand, is not always fatal,

and can even go into total remission. So there are times when there may be a fine line regarding who passes

and does not pass the medical in these types of situations. Arming yourself with as much medical information

as you can from your past medical file, and a letter from your doctor, even blood testing if appropriate, may be

the factors which enable you to pass the medical exam instead of failing it....I cannot overemphasize this point!

Here is another example: a fiance was denied recently due to his having a cancerous mole. The consulate

would not issue the visa until the mole was removed and he had a clean bill of health. One plausible reason is

that cancerous moles can be associated with melanoma, which is a disease that can cause debilitation.

However, for you worry-warts who need "mental satisfaction" about the exact criteria used by the examining

doctor for the medical exam, I am giving you links here to the CDC recommendations to doctors who perform

the medical exam on aliens outside the United States.

One thing I would note: if you read these instructions carefully, you will see that it does give the

examining physician some leeway regarding exactly what he tests for...for instance, IF he so chooses,

he can test for drugs in the blood test, especially if the person has a history of drug abuse recently.

These are the Technical Instructions for Medical Examination of Aliens (June 1991, with changes of July

1992 and addendum of April 1997 for Vaccination Requirements for Immigrant Visa applicants with

changes of March 1998) used by the Panel Physicians in the medical examinations conducted outside

the United States. (Files are in Adobe Acrobat format. )

Read the actual I-693 medical form that USCIS civil surgeon uses for recording data about the medical exam, this is a PDF document.

If you have HIV/AIDS, see this URL