At the time of filing of the immigrant visa at the US Consulate or an application to adjust status with the US Citizenship & Immigration Status (USCIS), every applicant must include Form I-693, Report of Medical Examination and Vaccination Record, signed by a Panel Physician/Civil Surgeon that documents that the applicant is up to date on all vaccinations designated as mandatory by the USCIS. Under US immigration law, all applicants are required to have received the vaccines against the following disease:
- Tetanus and Diphtheria Toxoids
- Influenza Type B
- Hepatitis B
- Meningococcal disease
- Pneumococcal disease
- any other diseases, preventable by vaccine, that are recommended by Advisory Committee for Immunization Practices (ACIP)
The vaccine requirement maybe waived if the panel physician/civil surgeon deems a specific vaccine medically inappropriate for the beneficiary or if the vaccine is not age-appropriate, the vaccine is contraindicated, lack of availability of a vaccine, there is insufficient time interval to complete the vaccination services, or similar other reason(s).
There is also a waiver available for individuals who can establish that compliance with the vaccine requirements would be contrary to their Religious Belief or Moral Conviction. This waiver is available only if the individual is opposed to all kinds of vaccination (not just a certain one).
Specifically, to meet the waiver on Religious Belief or Moral Conviction, the individual will need to meet the following requirements:
- The individual is opposed to all vaccinations in any form.
- The objection is based on religious belief or moral conviction.
- The religious belief or moral conviction is sincere.
As generally is the case with all waivers, a waiver of vaccination requirement requires an officer to exercise discretion on a case-by-case basis. A favorable exercise of discretion if generally warranted if the individual meets the requirements outlined above.
Additional information about waivers is available on the Department of State and USCIS websites. If you have specific questions about your case or waivers in general, please schedule a consultation with our office.
 ACIP comprises of medical and public health experts who develop recommendations on the use of vaccines in the civilian populations.
Last year in Fiscal Year (FY) 2018, the USCIS received enough petition towards H-1B visa lottery to satisfy the statutory cap of 65,000 as well as the advanced-degree exemption of 20,000 in less than five days. For petitioning employers that did not submit petitions before April 7th, 2017 or those who were unable to make it into the lottery, employers and beneficiaries must wait another year until they can petition for H-1B lottery in FY 2019 (starting April 2, 2018). However, for certain professionals, like physicians, USCIS offers exemptions to annual cap constraints.
General H-1B Cap Exemptions
If the petitioning employer is an institution of higher education, nonprofit entity related to or affiliated with institution of higher education, nonprofit research organization or a governmental research organization or if the beneficiary will be employed at a qualifying cap exempt institution, organization or entity, then the beneficiary is exempt from the H-1B cap. Although most hospitals are not considered to be education-based organizations, teaching hospitals qualify for the exemption. Therefore, the physician’s employer must qualify for the cap exemption either by itself or based on affiliation with a qualifying institution.
IGA Cap Exemption
For international medical graduates (IMG), the J-1 exchange visitor program assists many in obtaining graduate medical training in the United States. IMGs must pass the U.S. Medical Licensing Examination (USMLE), complete a medical residency, and get licensed in a state in order to practice medicine. However, IMGs who obtain a J-1 exchange visitor visa to do their residency and/or fellowships are subject to home-residence requirement (HRR) whereby they must return to their country of origin for at least two years after completion of the training. The rule serves to prevent “brain drain,” or the loss of intellectual talent to the U.S. Therefore, J-1 beneficiaries cannot be beneficiaries of an H-1B petition during the two-year home residence required stay. Similarly, they are also not eligible for permanent residency i.e., a green card. However, some J-1 physicians may be able to apply for waivers to overcome the requirement through an interested government agency waiver, or IGA which is done by generally utilizing a IGA waiver known as Conrad 30 waiver program or a Federal agency. Such waivers allow J-1 physicians to practice in a geographic region in the U.S. that is medically underserved. After working in the underserved area for a period of three years and subsequently obtaining a waiver, the physician receives permanent exemption from the H-1B cap. Additional method of obtaining a J-1 waiver is by documenting that the J-1 beneficiary would be persecuted if the individual had to return to his home country or by documenting that his/her U.S. citizen or lawful permanent resident spouse and/or children would suffer “exceptional hardship” if the physician had to return home.