Application for Authorization to Issue Certification for Health Care Workers and Related Requirements

OMB No. 1615-0086; Expires 06/30/09

Instructions for I-905, Application
for Authorization to Issue
Certification for Health Care Workers

Department of Homeland Security
U.S. Citizenship and Immigration Services

Instructions
Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper
and indicate the section and number of the item to which the answer refers.

What Is the Purpose of This Application?
For an organization to apply for authorization to issue
certificates to health care workers.

Who Must File This Application?
An organization wishing to obtain authorization to issue
certificates to health workers under section 212(a)(5)(C) or
section 212(r) of the Immigration and Nationality Act must
file this application.

Which Occupations Require Certification?
The occupations requiring health care worker certification
are:
1. Licensed practical nurses, licensed vocational nurses and
registered nurses;
2. Occupational therapists;
3. Physical therapists;
4. Speech language pathologists and audiologists;
5. Medical technologists (clinical laboratory scientists);
6. Physician assistants; and
7. Medical technicians (clinical laboratory technicians).

What Documents Do You Need
to File With This Application?
You must submit a statement addressing how your
organization meets the standards provided in Item 8 of these
instructions. In addition, by filing this application you agree
to submit any information that U.S. Citizenship and
Immigration Services (USCIS) may request in order to
determine your eligibility to issue certificates. USCIS is
comprised of offices of the former Immigration and
Naturalization Service (INS).

How Should You Prepare This Application?
A. Type or print legibly in black ink.
B. If you need extra space to complete any item, attach
continuation sheet, indicate the item number, and date
and sign each sheet.
C. Answer all questions fully and accurately. If any item
does not apply, please write "none."

Where to File?
The application must be filed in duplicate. Mail this
application to the:
Nebraska Service Center
P.O. Box 87140
Lincoln, NE 68501-7140

What Is the Filing Fee?
The filing fee for the Form I-905 is $230.00.
You may submit a check or money order for the application
Form I-905.
Use the following guidelines when you prepare your check or
money order for the Form I-905:
1. The check or money order must be drawn on a bank or
other financial institution located in the United States
and must be payable in U.S. currency; and
2. Make the check or money order payable to U.S.
Department of Homeland Security, unless:
A. If you live in Guam and are filing your petition
there, make it payable to Treasurer, Guam.
B. If you live in the U.S. Virgin Islands and are filing
your petition there, make it payable to
Commissioner of Finance of the Virgin Islands.
C. If you live outside the United States, Guam, or the
U.S. Virgin Islands, contact the nearest U.S.
consulate or embassy for instructions on the
method of payment.
NOTE: Please spell out U.S. Department of Homeland
Security; do not use the initials "USDHS" or "DHS."
How to Check If the Fees Are Correct.
The form fees on this form are current as of the edition date
appearing in the lower right corner of this page. However,
because USCIS fees change periodically, you can verify if the
fees are correct by following one of the steps below:
1. Visit our website at www.uscis.gov, select
"Immigration Forms" and check the appropriate fee;
2. Review the Fee Schedule included in your form
package, if you called us to request the form; or
3. Telephone our National Customer Service Center at
1-800-375-5283 and ask for the fee information.

How Will USCIS Process This Application?
After the application is filed, USCIS will review the
application for completeness. If the application is
complete, USCIS will forward a copy of the application
to the Secretary of Health and Human Services (HHS) for
an opinion.

Form I-905 Instructions (Rev. 07/30/07) Y

After HHS provides an opinion, USCIS will render a
decision on the application. You will be notified in
writing of the decision. If the application is denied, you
will be provided with information on how the decision
can be appealed.
If the application is approved, it will be approved for five
years. You must apply for reauthorization to issue
certificates before your authorized period of time expires
Your continued eligibility to issue certificates will be
reviewed periodically by USCIS.

What Are the Standards to Obtain
Authorization to Issue Certificates?
Structure of the organization.
1. The organization shall be incorporated as a legal
entity.

B At least one voting public member to represent the
interests of consumers and protect the interests of
the public at large. The public member shall not
be a member of the discipline or derive significant
income from the discipline, its related
organizations or the organization issuing the
certificate.
The organization must have a balanced representation such
that the individuals from the same health care discipline, the
voting public members and any other appointed individuals
have an equal say in matters relating to credentialing and/or
examinations.

3.

4.

The organization must select representatives of the discipline
using one of the following recommended methods, or
demonstrate that it has a selection process that meets the intent
of these methods:

A The organization shall be independent of any
organization that functions as a representative of the
occupation or profession in question or serves as or is
related to a recruitment/placement organization.

A Be selected directly by members of the
discipline eligible to practice in the United
States;
B Be selected by members of a membership
organization representing the discipline or by
duly elected representatives of a membership

B USCIS shall not approve an organization that is
unable to render impartial advice regarding an
individual's qualifications regarding training
experience and licensure.
C The organization must also be independent in all
decision making matters pertaining to evaluations
and/or examinations that it developes including, but
not limited to:
Policies and procedures; eligibility requirements and
application processing; standards for granting certificates and
their renewal; examination content, development and
administration; examination cut-off scores, excluding those
pertaining to English language requirements; grievance and
disciplinary processes; governing body and committee
meeting rules; publications about qualifying for a certificate
and its renewal; setting fees for application and all other
services provided as part of the screening process; funding
spending and budget authority related to the operation of the
certification organization; ability to enter into contracts and
grant arrangements; ability to demonstrate adequate staffing
and management resources to conduct the program(s
including the authority to approve selection of, evaluate and
initiate dismissal of the chief staff member.

C Be selected by a membership organization
representing the discipline from a list of
acceptable candidates supplied by the
credentialing body.
5.

6.

The organization shall be separate from the accreditation
and educational functions of the discipline, except for
those entities recognized by the Department of Education
as having satisfied the requirement of independence.

7.

The organization shall publish and make available a
document that clearly defines the responsibilities of the
organization and outlines any other activities
arrangements or agreements of the organization that are
not directly related to the certification of health care
workers.

An organization whose fees are based on whether an
applicant receives a visa may not be approved.
The organization shall include the following
representation in the portion of its organization
responsible for overseeing certification and, where
applicable examinations:

2.

A

Individuals from the same health care discipline as the
alien health care worker being evaluated who are eligible
to practice in the United States; and

The organization shall use formal procedures for the
selection of members of the governing body which
prohibit the governing body from selecting a majority of
its successors. Not-for-profit corporations which have
difficulty meeting this requirement may provide in their
applications evidence that the organization is independent
and free of material conflicts of interest regarding whether
an alien receives a visa.

Resources of the Organization.
1.

The organization shall demonstrate that its staff has the
knowledge and skills necessary to accurately assess the
education, work experience, licensure of health care
workers and the equivalence of foreign educational
institutions, comparable to those of U.S. trained health
care workers and institutions.
Form I-905 Instructions (Rev. 07/30/07) Y Page 2

2.

The organization shall demonstrate the availability of
financial and material resources to effectively and
thoroughly conduct regular and ongoing evaluations on
an international basis.

3.

If the health care field is one for which a majority of
the States require a predictor test, the organization shall
demonstrate the ability to conduct examinations in those
countries with educational and evaluation systems
comparable to the majority of States.

4.

The organization shall have the resources to publish
and make available general descriptive materials on the
procedures used to evaluate and validate credentials
including eligibility requirements, determination
procedures, examination schedules, locations, fees
reporting of results, and discplinary and grievance
procedures.

8.

Responsibilities to Applicants Applying
for an Initial Certificate or Renewal.
1.

The organization shall not discriminate among applicants
as to age, sex, race, religion, national origin, disability or
marital status and shall include a statement of
nondiscrimination in announcements of the evaluation
examination procedures and renewal certification process.

2.

The organization shall provide all applicants with copies
of formalized application procedures for evaluation
examination and shall uniformly follow and enforce such
procedures for all applicants. Instructions shall include
standards regarding English language requirements.

3.

The organization shall implement a formal policy for the
periodic review of eligibility criteria and application
procedures to ensure that they are fair and equitable.

4.

Where examinations are used, the organization shall
provide competently proctored examination sites at least
once annually.
The organization shall report examination results to
applicants in a uniform and timely fashion.

Candidate Evaluation and Testing Mechanisms.
1. The organization shall publish and make available a
comprehensive outline of the information, knowledge or
functions covered by the evaluation/examination
process including information regarding testing for
English language competency.
2. The organization shall use reliable evaluation
examination mechanisms to evaluate individual
credentials and competence that is objective, fair to all
candidates, job related and based on knowledge and
skills needed in the discipline.
3. The organization shall conduct ongoing studies to
substantiate the reliability and validity of the evaluation/
examination mechanisms.
4.

5.

6.

7.

The organization shall implement a formal policy of
periodic review of the evaluation/examination mechanism
to ensure ongoing relevance of the mechanism with the
respect to knowledge and skills needed in the discipline.
The organization shall use policies and procedures to
ensure that all aspects of the evaluation/examination
procedures, as well as the development and
administration of any tests, are secure.
The organization shall institute procedures to protect
against falsification of documents and misrepresentation
including a policy to request each applicant's transcript(s)
and degree(s) directly from the educational licensing
authorities.
The organization shall establish policies and procedures
that govern the length of time the applicant's records
must be kept in their original format.

The organization shall publish and make available, a
least annually, a summary of all screening activities for
each discipline including at least the number of
applications received, number of applicants evaluated,
number receiving certificates, number who failed and the
number receiving renewals.

5.
6.

The organization shall provide applicants who failed
either the evaluation or examination with information on
general areas of deficiency.

7.

The organization shall implement policies and procedures
to ensure that each applicant's examination results are held
confidential and delineate the circumstances under which
the applicant's certification status may be made public.

8.

The organization shall have a formal policy for
renewing the certification, if an individual's original
certification has expired before the individual first seeks
admission to the United States or applies for adjustment of
status. Such procedures shall be restricted to updating
information on licensure to determine the existence of any
adverse action and the need to re-establish English
competency.

9.

The organization shall publish due process policies and
procedures for applicants to question eligibility
determinations, examination or evaluation results, and
eligibility status.

10.

The organization shall provide all qualified applicants
with a certificate in a timely manner.
Form I-905 Instructions (Rev. 07/30/07) Y Page 3

Maintenance of Comprehensive
and Current Information.
1. The organization shall maintain comprehensive and
current information of the type necessary to evaluate
foreign educational institions and accrediting bodies for
purposes of ensuring that the quality of foreign
educational programs is equivalent to those training the
same occupation in the United States. The organization
shall examine, evaluate, and validate the academic and
clinical requirements applied to each country's
accrediting body or bodies, or in countries not having
such bodies, of the educational institution itself.
2.

The organization shall also evaluate the licensing and
credentialing system(s) of each country or licensing
jurisdiction to determine which systems are equivalent to
that of the majority of the licensing juridictions in the
United States.

Criteria for Maintaining Accreditation.
1.

The organization shall advise USCIS of any changes in
purpose, structure, or activities of the organization or its
program(s).

2.

The organization shall advise USCIS of any major
changes in the evaluation of credentials and examination
techniques, if any, or in the scope or objectives of such
examinations.

3.

The organization shall, upon request, submit to USCIS,
or any organization designated by USCIS, information
requested of the organization and its programs for use in
investigating allegations of noncompliance with standards
and for general purposes of determining continued approval as
an independent credentialing organization.

4.

The organization shall establish performance outcome
measures that track the ability of the certificate holders to
pass U. S. licensure or certification examinations.

Ability to Conduct Examinations
Fairly and Impartially.
An organization undertaking the administration of a
predictor examination, or a licensing or certification
examination shall demonstrate the ability to conduct such
examination fairly and impartially.

The purpose of the process is to ensure that certificate
holders pass U. S. licensure or certification examinations at
the same pass rate as graduates of the U. S. programs. Failure
to establish such measures, or having a record showing an
inability of persons granted certificates to pass U. S. licensure
examinations at the same rate as graduates of U. S. programs,
may result in a ground for termination of approval.

Criteria for Awarding and
Governing Certificate Holders.
1.

The organization shall issue a certificate after the
education, experience, license and English language
competency have been evaluated and determined to be
equivalent to their U. S. counterparts. In situations where
aU. S. nationally recognized licensure or certification
examination, or a test predicting the success on
thelicensure or certification examination, is offered
overseas the applicant must pass the examination or
predictor test prior to receiving certification.
Passage of a test predicting the success on the licensure
or certification examination may be accepted only if a
majority of the states (and Washington, D.C.) licensing
the profession in which the alien intends to work
recognize such a test.

2. The organization shall have policies and procedures for
the revocation of certificates at any time if it is
determined that the certificate holder was not eligible to
receive the certificate at the time it was issued. If the
organization revokes an individual's certificate, it must
notify USCIS, via the Nebraska Service Center, and the
appropriate state regulatory authority with jurisdiction
over the individual's health care profession. The
organization may not re-issue a certificate to an
individual whose certificate has been revoked.

Information regarding the passage rates of certificate
holders shall be maintained by the organization and
provided to HHS on an annual basis, to USCIS as part of
the five-year reauthorization application, and at any other
time upon request by HHS or USCIS.
5.

The organization shall be in ongoing compliance with
other policies specified by USCIS.

Are There Any Limitations If
This Application Is Approved?
If your application is approved, it will be approved for a
period of five years. USCIS will conduct a review of your
organization every five years to ensure continued compliance
with the standards described. The review will occur
concurrent with the adjudication of your request for
reauthorization to issue health care worker certificates. If
USCIS determines that you are not complying with the terms
of authorization, or if other adverse information is brought to
USCIS's attention, USCIS may proceed to terminate your
authorization to issue health care worker certificates.

What Is Our Authority for
Collecting This Information.
We request the information on this form to carry out the
immigration laws contained in Title 8, U.S. Code, Section
1186.
Form I-905 Instructions (Rev. 07/30/07) Y Page 4

We need this information to determine whether a person is
eligible for immigration benefits. The information the
organization or individuals on behalf of the organization
provides may also be disclosed to other federal, state, local
and foreign law enforcement and regulatory agencies.
The organization, or individuals on behalf of the organization,
do not have to give this information. However, refusal to give
some or all of it may result in denial of the application.

Address Changes.
If you change your address and you have an application or
petition pending with USCIS, you may change your address
on-line at www.uscis.gov, click on "Change your address with
USCIS" and follow the prompts or by completing and mailing
Form AR-11, Alien's Change of Address Card, to:
U.S. Citizenship and Immigration Services
Change of Address
P.O. Box 7134
London, KY 40742-7134
For commercial overnight or fast freight services only, mail
to:
U.S. Citizenship and Immigration Services
Change of Address
1084-I South Laurel Road
London, KY 40744

Processing Information.
Acceptance. Any application that is not signed or
accompanied by the correct fee will be rejected with a
notice that the application is deficient. You may correct
the deficiency and resubmit the application. However, an
application is not considered properly filed until accepted
by USCIS.
Initial Processing. Once the application has been
accepted, it will be checked for completeness, including
submission of the required initial evidence. If you do not
completely fill out the form or file it without the required
initial evidence, you will not establish a basis for
eligibility and we may deny your application.
Requests for More Information. We may request more
information or evidence, or we may request that you
appear at a USCIS office for an interview. We may also
request that you submit the originals of any copy. We will
return these originals when they are no longer needed.
Decision. The decision on the Form N-300 involves a
determination of whether you have established eligibility
for the requested benefit. You will be notified of the
decision in writing.

USCIS Forms and Information.
To order USCIS forms, call our toll-free number at
1-800-870-3676. You can also get USCIS forms and
information on immigration laws, regulations and procedures
by telephoning our National Customer Service Center at
1-800-375-5283 or visiting our internet website at www.uscis.
gov.
As an altenative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
our internet-based system, InfoPass. To access the system,
visit our website. Use the InfoPass appointment scheduler and
follow the screen prompts to set up your appointment.
InfoPass generates an electronic appointment notice that
appears on the screen.

Penalties.
If you knowingly and willfully falsify or conceal a material
fact or submit a false document with this request, we will
deny the benefit you are filing for, and may deny any other
immigration benefit. In addition, you will face severe
penalties provided by law, and may be subject to criminal
prosecution.

Privacy Act Notice.
We ask for the information on this form, and associated
evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies. Failure
to provide this information, and any requested evidence, may
delay a final decision or result in denial of your Form I-905.

Paperwork Reduction Act.
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a currently valid
OMB control number. The public reporting burden for this
collection of information is estimated at 4 hours per response,
including the time for reviewing instructions, completing and
submitting the form. Send comments regarding this burden
estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: U.S.
Citizenship and Immigration Services, Regulatory
Management Division, 111 Massachusetts Avenue, N.W., 3rd
Floor, Suite 3008, Washington, DC 20529. OMB No.
1615-0086. Do not mail your application to this address.
Form I-905 Instructions (Rev. 07/30/07) Y Page 5