Wednesday, September 5, 2007

USCIS Civil Surgeons Locator, Adjustment of status, Permanent Resident, Green Card, Civil Surgeons Illinois, Medical Exam Form I-693

All 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 U.S. Citizenship and Immigration Service (USCIS). The designated civil surgeon is responsible for the entire medical examination, and will record the results on Form I-693. The required medical exam consists of a physical examination, a tuberculin (TB) skin test and a serologic (blood) test. The designated civil surgeon must perform these tests in accordance with the Technical Instruction for the Medical Examination of Aliens in the United States, published by the Centers for Disease Control and Prevention (CDC). The Form I-693 will be given to you in a sealed envelope to present to the USCIS. You should not open the sealed envelope. The requirements of the medical examination are as follows:

PHYSICAL EXAMINATION: Required of ALL applicants.

TUBERCULIN (TB) SKIN TEST: Required of ALL APPLICANTS TWO YEARS OF AGE AND OLDER. Applicants under the age of two may be required to have a tuberculin skin test if tuberculosis is suspected, if the applicant has a history of contact with a known TB case, and/or if there is any other reason to suspect TB. A chest x-ray is required only if the reaction to the TB skin test is 5mm or greater.

SEROLOGIC (BLOOD) TEST: Required of ALL APPLICANTS 15 YEARS OF AGE AND OLDER. The serologic test will include tests for the virus that causes the acquired immune deficiency syndrome (AIDS). Applicants under the age of 15 must be tested if there is reason to suspect HIV infection.

USCIS Civil Surgeons Locator
https://egov.uscis.gov/crisgwi/go?action=offices.type&OfficeLocator. office_type=CIV
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From: Michael Aytes /s/ Associate Director, Domestic Operations
Date: January 3, 2007

Re: Extension of Validity of Medical Certifications on Form I-693

This memorandum temporarily extends the validity of civil surgeon endorsements on Form I-693 for certain adjustment of status applicants.

For adjustment of status applicants, the endorsement of a civil surgeon on Form I-693, Medical Examination of Aliens Seeking Adjustment of Status, is generally valid for one year. Some adjustment of status applications are concurrently filed with an immigrant visa petition as provided for at 8 CFR 245.2(a) (2).

These applications are filed with a Form I-693 as required by 8 CFR 245.5. Some of these applications remain pending for more than the one-year validity period.

In a policy memorandum dated January 11, 2006, U.S. Citizenship and Immigration Services (CIS) extended the validity of the civil surgeon endorsement on Form I-693 until the adjustment of status application could be adjudicated. This policy was issued in consultation with the Centers for Disease Control and Prevention (CDC) and is limited to those applications where no Class A or Class B medical condition was certified. The policy is in effect until January 1, 2007.

Due to the continuing backlog of some concurrently filed adjustment of status applications, the validity of the civil surgeon’s endorsement on Form I-693, when submitted in support of a concurrently filed adjustment of status application as provided for at 8 CFR 245.2(a) (2), is extended until the time of adjudication if no Class A or Class B medical condition is certified by the civil surgeon. This policy will be in effect until January 1, 2008.

Download Memo: http://www.uscis.gov/files/pressrelease/I693MedExt010307.pdf

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Medical Examinations.

(a) Medical Grounds of Inadmissibility Defined . Section 212(a)(1)(A) of the Act designates four categories that render an applicant for a visa, admission, or adjustment of status inadmissible on medical grounds. The medical grounds are determined according to the regulations published by the Department of Health and Human Services (HHS) at 42 CFR part 34. The required medical exam, discussed in Chapter 23.3(b), below, must be performed according to the specific guidelines published by the Centers for Disease Control and Prevention (CDC). These are the Technical Instructions for the Medical Examination of Aliens in the United States , used by civil surgeons in the United States, and the Technical Instructions for the Medical Examination of Aliens , used by panel physicians abroad. ( Technical Instructions) . The Technical Instructions have the force of a regulation. See 42 CFR 34.3(f). They can be accessed online at: www.cdc.gov/ncidod/dq/technica.htm . If the medical condition found by the panel physician or civil surgeon falls under any of the four categories described below, the civil surgeon or panel physician must certify it as Class A in order for the applicant to be inadmissible on medical grounds. Class B medical conditions are defined at 42 CFR § 34.2(e) as physical or mental abnormalities, diseases, or disabilities serious in degree or permanent in nature amounting to a substantial departure from normal well-being; however, they do not render the applicant inadmissible on medical grounds. Waivers are discussed in Chapter 41.3.

(1) Section 212(a)(1)(A)(i) of the Act . This ground of inadmissibility covers individuals who are found to have a communicable disease of public health significance, including, “. . . infection with the etiologic agent for acquired immune deficiency syndrome.” The HHS regulations that define a communicable disease of public health significance are found at 42 CFR § 34.2(b). The following eight conditions are listed: chancroid; gonorrhea; granuloma inguinale; acquired immune deficiency syndrome (HIV/AIDS); Hansen’s disease (infectious leprosy); lymphogranuloma venereum; infectious state syphilis; and infectious tuberculosis (TB). Note that, for TB, only Class A TB renders the applicant inadmissible under section 212(a)(1)(A)(i) of the Act. Under current CDC guidelines, Class A TB means tuberculosis that is clinically active and infectious (communicable).

(2) Section 212(a)(1)(A)(ii) of the Act . This ground covers only immigrant visa and adjustment of applicants who have not received all of the required vaccinations. See Chapter 23.3(g) further below.

(3) Section 212(a)(1)(A)(iii) of the Act . This ground covers individuals who have a physical or mental disorder or harmful behavior associated with that disorder. It is further divided into two subcategories:

(I) Current physical or mental disorders, with harmful behavior associated with that disorder; and

(II) Past physical or mental disorders, with associated harmful behavior that is likely to recur or lead to other harmful behavior.

Note 1: Harmful behavior is defined under section 212(a)(1)(A)(iii) of the Act as behavior that “. . . may pose, or has posed, a threat to the property, safety, or welfare of the alien or others . . . .”

Note 2: Mental retardation no longer renders an applicant inadmissible on medical grounds, unless the civil surgeon or panel physician determines that the applicant is also exhibiting or has exhibited in the past, associated harmful behavior, as described in Note 1.

(4) Section 212(a)(1)(A)(iv) of the Act . This ground of inadmissibility covers individuals who are found to be drug abusers or drug addicts. The Technical Instructions published by the CDC refer to the nonmedical use of a psychoactive substance, and make an exception for experimentation. The CDC has instructed civil surgeons and panel physicians to use their clinical judgement and/or seek a consultation when facing a situation where the applicant’s medical history indicates past nonmedical use of a psychoactive substance or when there is a clinical question as to whether the use was experimental or part of a pattern of abuse. If you have valid reasons to question the com pleteness or accuracy of the medical exam report, you may direct the applicant to return to the civil surgeon or panel physician for a reexamination or ask the CDC to review the medical report.

(b) Aliens Required to Have a Medical Examination . Because section 212(a)(1)(A) of the Act states that all medical-related grounds of inadmissibility are determined “. . . in accordance with regulations prescribed by the Secretary of Health and Human Services,” the applicant’s own admission is not sufficient to uphold a finding of inadmissibility on medical grounds. A medical examination performed by panel physician designated by the Department of State or a civil surgeon designated by the district director is required. Hill v. INS, 714 F 2d. 1470 (9 th Cir. 1983). The following requirements apply with respect to medical examinations.

(1) Immigrant Visa Applicants . Per section 221(d) of the Act, all individuals applying for an immigrant visa must submit to a medical examination before the visa is issued.

(2) Refugees Applying for Admission under Section 207 of the Act . Per section 207(c)(1) of the Act, all individuals applying for admission as refugees must, among other requirements, establish that they are admissible to the United States, or establish eligibility for a waiver as provided under section 207(c)(3) of the Act. Because the medical grounds of inadmissibility under section 212(a)(1)(A) of the Act apply, a medical exam is required. For a discussion of the vaccination requirements specifically as they apply to refugees, refer to Chapter 23.3(g)(4)(C).

(3) Adjustment of Status Applicants . Per section 245(a)(2) of the Act, an individual applying for adjustment of status to that of a permanent resident must be “eligible to receive an immigrant visa and [be] admissible to the United States for permanent residence. . . .” Thus, to comply with the visa issuance requirements of sections 221(d) and 245(a)(2) of the Act, and the medical grounds of inadmissibility under section 212(a)(1)(A) of the Act, all individuals applying for adjustment of status under section 245 of the Act are required to ha ve as part of their applications for adjustment of status:

• A valid medical examination (Form I-693, Medical Examination of Aliens Seeking Adjustment of Status ), properly endorsed by a physician authorized to conduct medical examinations for this purpose; and

• A certificate establishing compliance with the vaccination requirements described in section 212(a)(1)(A)(ii) of the Act, unless otherwise exempt. For ease of reading, the vaccination supplement to Form I-693 is referred to in this guidance as the “vaccination sign-off.”

(4) Presumption of Lawful Admission Cases, Section 249 Registry Cases, and Section 289 Indian Cases . A medical examination is not required.

(5) Nonimmigrants .

(A) General . Per section 221(d) of the Act, a consular officer may, prior to the issuance of a nonimmigrant visa, require the applicant to submit to a physical or mental examination or both, if considered necessary to determine whether the applicant is eligible to receive the visa. Similarly, CBP officers at ports-of-entry may require a nonimmigrant (arriving with or without a visa) to submit to a medical examination if necessary to determine whether a medical ground of inadmissibility under section 212(a)(1)(A) of th e Act applies.

(B) Nonimmigrants under Section 101(a)(15)(K) or (V) of the Act . Individuals outside the United States applying for nonimmigrant visas under any provision of section 101(a)(15)(K) or (V) of the Act must undergo a medical exam by a panel physician as part of the visa application process. Individuals in the United States applying for change of status to that of a “V” nonimmigrant pursuant to section 214(o) of the Act must submit with their application a medical exam report (Form I-693) completed by a designated civil surgeon. The vaccination requirements of section 212(a )(1)(A)(ii) of the Act do not apply at this stage of the process. See also Chapter 23.3(g)(4)(J).

(c) Authorized Civil Surgeons . If Form I-693 and the accompanying vaccination supplement have been endorsed by anyone other than a designated civil surgeon, they must be returned to the applicant for corrective action. To verify whether the physician that performed the medical exam is a civil surgeon, go to the USCIS website. The list of designated civil surgeons is found at the end of each individual office profile. Select the office and check the civil surgeon list maintained in the local office profile for the USCIS district where the medical exam was performed. If you cannot access this information from the USCIS intranet, refer to Appendix 23-1 of this field manual from the latest version of I-LINK. The civil surgeon listing found in Appendix 23-1 is divided into three parts (23-1A, 23-1B, and 23-1C) representing the Eastern, Central, and Western regions, respectively. Note, however, that the civil surgeon list maintained on the website is updated daily. Therefore, try to clarify any discrepancies through your district/sub-office and/or your regional point of contact (POC), before you return the case for evidence (RFE the case). If you have reaso n to doubt the authenticity of the endorsement by a civil surgeon within your district, refer to the file maintained in your district office. If you have doubts about the authenticity of an endorsement by a civil surgeon located in another district, consult informally (i.e., by telephone and fax machine) with the Adjudications section of that district office. If informal consultation does not clear up all doubts, refer the matter formally through a request for an auxiliary investigation (see AFM Chapter 10.14 ). See AFM Chapter 83 for the procedures to be followed for certifying, reviewing, and decertifying civil surgeons.

(d) Submission of the Medical Examination Report . According to Form I-485, Application to Register Permanent Residence or Adjust Status , which was last revised on February 27, 2000, the following instructions apply:

• Applications Filed at a Service Center : Individuals applying through a USCIS Service Center (including asylees adjusting under section 209 of the Act), must submit the medical examination report with the adjustment of status application. Note that refugees need only submit the vaccination supplement to Form I-693 (not the entire Form I-693) if there were no medical grounds of inadmissibility that arose during the initial medical exam performed overseas. See 8 CFR § 209.1(c).

• Applications Filed at a District Office : Individuals applying for adjustment of status through a district or sub-office do not submit Form I-693 with the initial filing. Rather, they should be provided instructions about the medical examination in conjunction with the notice of their in-person interview. See Chapter 23.3(g) for information about the specific situations applicable to K and V nonimmigrants.

(e) Validity of Medical Certifications.

(1) General . [Revised as of January 3, 2008; AD 07-22.] Form I-693 is normally valid for a period of 1 year from the date it was endorsed by the civil surgeon. In accordance with the agreements reached between USCIS and the CDC, if the adjustment of status application has been pending for over 1 year and Form I-693 was included with the initial filing, the adjudicating officer may accept a medical exam report that is more than 1 year old because of the pending adjustment of status application, IF there was no Class A or B medical condition noted. This agreement is in effect until January 1, 2008. See January 3, 2007, Extension of Validity of Medical Certifications on Form I-693. http://www.uscis.gov/files/pressrelease/I693MedExt010307.pdf

(2) K and V nonimmigrants . A new medical exam is not required in order to apply for adjustment of status to that of a lawful permanent resident, if one of the following scenarios exists:

• The applicant is a K or V nonimmigrant and the medical exam did not reveal any Class A or B medical condition, and the application for adjustment of status was filed within 1 year of the date of the original medical exam. If these requirements are met, the medical exam remains valid until the date USCIS adjudicates the adjustment of status application; or

• The applicant is a K or V nonimmigrant who received a conditional waiver under section 212(g) of the Act in conjunction with the K or V nonimmigrant visa or the change of status to V. The section 245 adjustment of status application must be filed with USCIS within 1 year of the date of the original medical exam, and the applicant must submit evidence of compliance with the specific terms and conditions imposed on the waiver. The medical exam remains valid until the date USCIS adjudicates the adjustment of status application. If these requirements have not been met, a new medical examination is required. And, if that new medical examination reveals a Class A medical condition, a new waiver application will also be required. In such cases, determine whether the applicant complied with the terms and conditions of the first waiver. That determination should be given considerable weight in the adjudication of a subsequent waiver application.

Note: Although there may be cases where a new medical exam is not required, compliance with the vaccination requirements is still required, as the vaccination sign-off was not included as part of the original medical exam report. See Chapter 23.3(g)(4)(J).

(f) Review of Form I-693 . For those applicants required to undergo a complete medical exam, review Form I-693 to ensure compliance with the following requirements:

(1) Form I-693 Must Be Signed by a Designated Civil Surgeon . To verify whether the physician who performed the medical exam is a designated civil surgeon, refer to the instructions in Chapter 23.3(b).

(2) Form I-693 Must Be Completed Legibly in English and Must Be in a Sealed Envelope . The results must be typed or printed legibly and placed in an envelope sealed by the civil surgeon. If Form I-693 has not been dated and signed by the civil surgeon, has not been completed legibly in English, or if the envelope was not sealed by the civil surgeon or there is evidence of tampering with the sealed envelope, return a copy of the I-693 to the applicant for corrective action.

(3) Form I-693 Must Clearly Indicate That All Required Tests Were Performed and the Results . The medical examination must include all evaluations/assessments/tests necessary to determine whether the applicant is inadmissible on medical grounds under section 212(a)(1)(A) of the Act. Findings of physical and mental disorders and drug abuse must be indicated in the "Remarks" section of Form I-693. If an applicant has been referred for further evaluation for a communicable disease of public health significance, physical or mental disorders with associated harmful behavior, psychoactive substance abus e or other physical or mental abnormalities, diseases or disabilities, the medical report must be accompanied by a definitive diagnosis (or a short list of likely diagnoses) and a statement as to whether the presence or absence of a Class A or Class B medical condition has been established. If the findings have not been clearly stated, return a copy of Form I-693 to the applicant for corrective action.

(4) Form I-693 Must Be Accompanied by a Properly Completed Vaccination Supplement, Unless the Applicant Is Applying for “Adjustment” of Status to V . For a complete discussion of the vaccination requirements and review of the vaccination supplement, refer to Chapter 23.3(g). For a discussion of waiver issues related to the vaccination requirements, see Chapter 41.3(b).

(5) Required Testing . All applicants must undergo a general physical examination and a mental status evaluation. In addition, other tests may be required depending on the applicant’s age and/or possible exposure to a particular disease. If all required tests/evaluations have not been performed, return a copy Form I-693 to the applicant for corrective action.

• Tuberculin (TB) Skin Test : All applicants 2 years of age and older must have a tuberculin skin test (TST). Civil surgeons may require an applicant who is less than 2 years of age to have a TST if he or she has a history of contact with a known TB case, or if there is any other reason to suspect TB disease. If the applicant’s reaction to the TST is 4 millimeters or less, no further testing is required. A chest X-ray is required only when the reaction to the TST is 5 millimeters or more. If the civil surgeon has performed a chest x-r ay for TB, but not a TST, the USCIS office that granted the civil surgeon designation should advise the civil surgeon in writing of the deficiency and of the need to comply with CDC’s Technical Instructions . Forward a copy of the letter and Form I-693 to CDC at the following address:

Chief, Migration Health Assessment Section

Division of Global Migration and Quarantine (E03)

Centers for Disease Control and Prevention (CDC)

Atlanta, Georgia 30333.

If the same civil surgeon receives two such letters of corrective action, the District Director may take appropriate steps to revoke the civil surgeon designation. See Chapter 83.4(c).

• Serologic (blood) tests . All applicants 15 years of age and older must undergo serologic (blood) testing for syphilis and human immunodeficiency virus (HIV) infection. Applicants under the age of 15 must undergo serologic testing if there is reason for the civil surgeon or for DHS to suspect infection.
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Vaccinations.

Section 212(a)(1)(A)(ii) of the Act requires all immigrant visa and adjustment of status applicants to establish that they have been vaccinated against certain vaccine-preventable diseases. Section 212(g)(2) of the Act authorizes waivers in certain instances. To implement the vaccination requirements and the corresponding waiver provisions, USCIS developed streamlined procedures whereby certain individuals may be granted a waiver without the need to file a form or pay a fee. Furthermore, those applicants who are not covered under the streamlined procedures may apply for a waiver on an individual basis. Refer to Chapter 41.3(b) for additional information about these procedures.

(1) Vaccination Requirements Defined . Section 341 of the Illegal Immigration and Immigrant Responsibility Act (IIRIRA) created an additional medical ground of inadmissibility under section 212(a)(1)(A)(ii) of the Act relating to vaccinations. Individuals who are subject to the vaccination requirements who have not complied (or who are unable to submit acceptable proof of compliance) are inadmissible under section 212(a)(1)(A)(ii) of the Act, unless they are fully vaccinated or receive a waiver.

(2) Effective Date . The vaccination requirements became effective on the IIRIRA enactment date, September 30, 1996, and apply with respect to all immigrant visa and adjustment of status applications filed on or after that date.

(3) Required Vaccinations . Section 212(a)(1)(A)(ii) of the Act specifies the following vaccinations: mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, Haemophilus influenzae type b, and hepatitis B. Section 212(a)(1)(A)(ii) of the Act states that the applicant is also required to have any other vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP). The ACIP provides guidelines on appropriate doses of vaccines at specific intervals for specific age groups. The varicella, influenza, and pneumococcal vaccines are also required, because they are currently recommended by the ACIP.

(4) Applicability . Section 212(a)(1)(A)(ii) of the Act states that the vaccination requirements apply with respect to anyone who “. . . seeks admission as an immigrant, or who seeks adjustment of status to the status of an alien lawfully admitted for permanent residence . . . .” Thus, the applicability of the vaccination requirements depends on the specific immigration benefit the applicant is seeking. The following list clarifies these distinctions for purposes of section 212(a)(1)(A)(ii) of the Act:

(A) Adjustment of Status and Immigrant Visa Applicants . All adjustment of status and immigrant visa applications filed on or after September 30, 1996, must be sufficient to establish compliance with the vaccination requirements under section 212(a)(1)(A)(ii) of the Act or eligibility for a waiver. The waiver provisions and application procedures are addressed in Chapter 41.3 of this field manual.

(B) Refugees Making an Initial Application for Admission under Section 207 of the Act . USCIS has determined that the vaccination requirements do not apply to individuals seeking admission to the United States as refugees under section 207 of the Act, because there is no application for an immigrant visa or for adjustment of status at this stage of the process. Therefore, the results of a medical examination performed abroad for a refugee seeking admission to the United States under section 207 of the Act need not include the results of a vaccination assessment. DHS officers at ports-of-entry shoul d not refuse admission to refugees solely because they have not yet complied with the vaccination requirements.

(C) Refugees Applying for Adjustment of Status under Section 209 of the Act . Refugees must satisfy the vaccination requirements under section 212(a)(1)(A)(ii) of the Act when they apply for adjustment of status under section 209 of the Act, 1 year following their admission under section 207 of the Act.

The regulations at 8 CFR § 209.1(c) state that "[u]nless there were medical grounds for exclusion at the time of arrival, a United States Public Health Service medical examination is not required." The term “medical ground for exclusion” means only Class A medical conditions. Therefore, a refugee who received a medical exam in conjunction with the initial application for admission under section 207 of the Act generally does not need to repeat the entire medical exam. He or she does, however, need the vaccin ation sign-off from the civil surgeon when adjusting under section 209 of the Act 1 year later. Consequently, USCIS officers should not require refugees to repeat the entire medical exam if it did not reveal a Class A medical condition. A refugee who was found to have any Class B medical condition that would result in any medical ineligibility under section 212(a)(1)(A) of the Act, without proper medical care or follow up, must submit evidence establishing compliance with any follow up examinations or treatment, as may have been required as a condition of the original admission.

Although a new medical examination may not be required, the refugee must nevertheless establish compliance with the vaccination requirements of section 212(a)(1)(A)(ii) of the Act at the time of adjustment under section 209 of the Act, by submitting a vaccination supplement completed by a designated civil surgeon or in certain cases, by a state or local health department official. For information about the designation of state and local health departments as civil surgeons for refugees adjusting under secti on 209 of the Act who need only the vaccination sign-off, refer to Chapter 83.4(b) of this field manual.

(D) Asylees Making an Initial Application for Asylum under Section 208 of the Act . Individuals applying for asylum under section 208 of the Act are not subject to the vaccination requirements under section 212(a)(1)(A)(ii) of the Act. They are not required to undergo a medical exam.

(E) Asylees Applying for Adjustment under Section 209 of the Act . If the asylum application is approved and the individual applies for adjustment of status under section 209 of the Act and 8 CFR § 209.2 at least 1 year later, a complete medical exam is required, including a vaccination assessment, as required under section 212(a)(1)(A)(ii) of the Act. See 8 CFR § 209.2(d).

Note : Regarding Kurdish asylees paroled under Operation Pacific Haven, the INS determined, in consultation with the Centers for Disease Control and Prevention (CDC), that medical examinations performed under Operation Pacific Haven for Kurdish asylees either before arrival or while on Guam are acceptable for purposes of adjustment of status under section 209 of the Act and 8 CFR § 209.2. Kurdish asylees were given copies of these medical reports and should include them with the adjustment application. If the Ku rdish asylee no longer has a copy of the medical report, a new medical exam must be performed by a designated civil surgeon, including the vaccination assessment. In all cases, the adjustment application under 8 CFR § 209.2 submitted by a Kurdish asylee must also include the vaccination sign-off.

(F) Registry Applicants under Section 249 of the Act . Aliens applying for the creation of a record of admission for permanent residence are not required to undergo a medical examination or comply with the vaccination requirements. This is because section 212(a)(1) of the Act is not among the grounds of inadmissibility or ineligibility specified in section 249 of the Act.

(G) North American Indians . American Indians born in Canada who meet the requirements described in the regulations at 8 CFR §§ 289.1 and 289.2 may be regarded as having been lawfully admitted for lawful permanent residence. Because such lawful admission is recorded on Form I-181, and neither an immigrant visa nor an adjustment of status application is required, the applicant is not required to establish compliance with the vaccination requirements. Therefore, officers at ports-of-entry should not consider the vaccination requirement s in determining the eligibility of North American Indians seeking benefits under section 289 of the Act and 8 CFR part 289.

(H) Children of Returning Residents (XA and NA Babies) . This group covers children born abroad either subsequent to the issuance of an immigrant visa to a parent applying for admission while the visa remains valid, or during the temporary visit abroad of a mother who is a national or permanent resident of the United States. Until further notice, continue admitting these two groups of children under the procedures in effect prior to the implementation of IIRIRA (i.e., with no medical or vaccination requirement).

(I) Nonimmigrants . Except as provided in paragraphs (J) and (K), individuals applying for a nonimmigrant visa under any provision of section 101(a)(15) of the Act or for admission to the United States as a nonimmigrant, are not required to comply with section 212(a)(1)(A)(ii) of the Act relating to vaccinations.

(J) Special Considerations for K and V Nonimmigrants . The plain language in section 212(a)(1)(A)(ii) of the Act regarding the vaccination requirements refers to applicants for immigrant visas and for adjustment of status. Applicants for visas under section 101(a)(15)(K) or (V) of the Act are not applicants for immigrant visas at this stage of the process. DOS and USCIS have agreed that the required medical examination for K and V nonimmigrants outside of the United States will include the vaccination assessment described in section 212(a)(1)(A)(ii) of the Ac t. The vaccination assessment will be performed in anticipation of the adjustment of status application, to give the applicants the opportunity to retrieve the records for those vaccinations they have already received, while they are still abroad. Individuals in the United States applying for change of status to V will not be required to undergo a vaccination assessment in conjunction with their medical exam, but civil surgeons are not precluded from advising them about the vaccination requirements in antic ipation of their adjustment of status application.

While some panel physicians may elect to indicate the vaccinations already received on the vaccination supplement, consular officers will not refuse the K or V visa and CBP officers will not refuse admission to a K or V nonimmigrant, solely because all of the vaccination requirements have not been met. When the panel physician's report indicates that the applicant lacks certain required vaccines, consular officers will attach a single-page addendum to Form DS-2053 (Formerly Form OF-157), Medical Examination for Immigrant or Refugee Applicant , and the accompanying worksheets, advising the applicant of the need to comply with the vaccination requirements upon the application for adjustment of status in the United States.

(K) Vaccination Requirements for K and V Nonimmigrants Adjusting Status to That of Lawful Permanent Resident under Section 245 of the Act . In certain instances, K and V nonimmigrants are not required to repeat the original medical examination that was performed to obtain that nonimmigrant classification. See Chapter 23.3(d)(2). When this is the case, only the vaccination sign-off is required. The vaccination sign-off must have been done by a designated civil surgeon. If the applicant obtained a K or V nonimmigrant visa overseas, the medical exam report completed by the panel physician overseas, Form DS-2053 and accompanying worksheets, should already be in the alien’s A-File, if it was surrendered at the port-of-entry with the visa packet. Note that, in completing the vaccination sign-off, the designated civil surgeon may accept the vaccination supplement to Form DS-2053 completed by the panel physician overseas and proof of additional vaccines received following the applicant's admission to the United States. If the applicant was granted a change of status to V in the United States under section 214(o) of the Act, the medical exam report completed by the civil surgeon should be in the A-file created at the time that the change of status was initially granted. The applicant will need to return to the civil surge on for the vaccination sign-off. If, however, the requirements of Chapter 23.3(d)(2) have not been met, a new medical examination is required, including the vaccination assessment specified under section 212(a)(1)(A)(ii) of the Act.

(L) Exceptions for Orphans . On November 12, 1997, the President signed into law Pub. L. 105-73. This bill amended section 212(a)(1)(A)(ii) of the Act by creating section 212(a)(1)(A)(ii)(C) to provide exceptions to the vaccination requirements for internationally adopted children 10 years of age or younger. This exception covers children 10 years of age or younger classified as orphans under section 101(b)(1)(F) who are applying for immigrant visas as immediate relatives under section 201(b) of the Act (IR-3 and-4 visas). In order f or the child to benefit from the exception, the adopting parent(s) must sign an affidavit prior to visa issuance. The adopting parent(s) must affirm that the child will receive the required vaccination within 30 days of admission to the United States or at the earliest time that it is medically appropriate. However, noncompliance with the vaccination requirements following the child's admission to the United States is not a ground for removal under section 237 of the Act.

DOS has developed a standard affidavit form to ensure that adopting parents are aware of the possibility of an exception from the vaccination requirements provided under section 212(a)(1)(A)(ii)(C) of the Act, and of their obligation to ensure that the child is vaccinated following admission. The affidavit must be made under oath or affirmation in the presence of either the consular officer or a notary public, and the completed form must be included with Form OF 157.

When the adoptive or prospective adoptive parent cannot sign the affidavit in good faith because of religious or moral objections to vaccinations, the child will require a waiver under section 212(g)(2)(C) of the Act. The requirements for this waiver are described in Chapter 41.3(b) of this field manual.

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