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

OMB No. 1615-0086; Expires 08/31/2011

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
Read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a separate
sheet of paper. Write your name and Alien Registration Number (A-number), 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?

General Instructions

For an organization to apply for authorization to issue
certificates to health care workers.

1. Type or print legibly in black ink.

Who May File This Form?
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.

1. Which Occupations Require Certification?
The occupations requiring health care worker certification
are:
A. Licensed practical nurses, licensed vocational nurses,
and registered nurses;

2. If extra space is needed to complete any item, attach a
continuation sheet, write your name, A-Number, if any, at
top of each sheet of paper, indicate the item number, and
date and sign each sheet.
3. Answer all questions fully and accurately. State that an
item is not applicable with "N/A." If the answer is none,
write "None."

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

B. Occupational therapists;
C. Physical therapists;
D. Speech language pathologists and audiologists;

What Is the Filing Fee?

E. Medical technologists (clinical laboratory scientists);

The filing fee for Form I-905 is $230.

F. Physician assistants; and

You may submit a check or money order.

G. Medical technicians (clinical laboratory technicians).

Use the following guidelines when you prepare your check or
money order for Form I-905:

2. 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.

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.
NOTE: Spell out U.S. Department of Homeland Security;
do not use the initials "USDHS" or "DHS."
3. If you live outside the United States, Guam, or the U.S.
Virgin Islands, contact the nearest U.S. Embassy or
consulate for instructions on the method of payment.

Form I-905 Instructions (Rev. 08/07/09) Y

How to Check If the Fees Are Correct
The form fee on this form is 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 Web site at www.uscis.gov, select "FORMS" and
check the appropriate fee; or
2. 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.
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 5 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 must be incorporated as a legal entity.
A. The organization must 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.
B. USCIS must 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 develops including, but not
limited to:

i. Policies and procedures; eligibility requirements and
application processing; standards for granting
certificates and their renewal; examination content,
development, and administration; examination cutoff 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.
ii. An organization whose fees are based on whether an
applicant receives a visa may not be approved.
2. The organization must include the following representation
in the portion of its organization responsible for
overseeing certification and, where applicable,
examinations:
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
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 must not be a
member of the discipline or derive significant income
from the discipline, its related organizations, or the
organization issuing the certificate.
3. 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.
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. Be selected directly by members of the discipline
eligible to practice in the United States;

Form I-905 Instructions (Rev. 08/07/09) Y Page 2

B. Be selected by members of a membership organization
representing the discipline or by duly elected
representatives of a membership; or
C. Be selected by a membership organization representing
the discipline from a list of acceptable candidates
supplied by the credentialing body.
5. The organization must 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.
6. The organization must be separate from the accreditation
and educational functions of the discipline, except for
those entities recognized by the U. S. Department of
Education as having satisfied the requirement of
independence.
7. The organization must 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.

Resources of the Organization
1. The organization must 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.
2. The organization must 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 must
demonstrate the ability to conduct examinations in those
countries with educational and evaluation systems
comparable to the majority of States.

4. The organization must 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 disciplinary and grievance
procedures.

Candidate Evaluation and Testing Mechanisms
1. The organization must 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 must 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 must conduct ongoing studies to
substantiate the reliability and validity of the evaluation/
examination mechanisms.
4. The organization must 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.
5. The organization must 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.
6. The organization must 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.
7. The organization must establish policies and procedures
that govern the length of time the applicant's records must
be kept in their original format.
8. The organization must publish and make available, at
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.

Form I-905 Instructions (Rev. 08/07/09) Y Page 3

Responsibilities to Applicants Applying for an Initial
Certificate or Renewal

Maintenance of Comprehensive and Current
Information

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

1. The organization must maintain comprehensive and
current information of the type necessary to evaluate
foreign educational institutions 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
must 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 must provide all applicants with copies of
formalized application procedures for evaluation
examination and must uniformly follow and enforce such
procedures for all applicants. Instructions must include
standards regarding English language requirements.
3. The organization must 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 must
provide competently proctored examination sites at least
once annually.
5. The organization must report examination results to
applicants in a uniform and timely fashion.
6. The organization must provide applicants who failed either
the evaluation or examination with information on general
areas of deficiency.
7. The organization must 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 must 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 must 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 must publish due process policies and
procedures for applicants to question eligibility
determinations, examination or evaluation results, and
eligibility status.

2. The organization must 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 jurisdiction in the
United States.

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

Criteria for Awarding and Governing Certificate
Holders
1. The organization must 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 a
U. S. nationally recognized licensure or certification
examination, or a test predicting the success on the
licensure 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.

10. The organization must provide all qualified applicants
with a certificate in a timely manner.

Form I-905 Instructions (Rev. 08/07/09) Y Page 4

2. The organization must 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.

Criteria for Maintaining Accreditation
1. The organization must advise USCIS of any changes in
purpose, structure, or activities of the organization or its
program(s).
2. The organization must 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 must, 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 must establish performance outcome
measures that track the ability of the certificate holders to
pass U. S. licensure or certification examinations.
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.
Information regarding the passage rates of certificate
holders must be maintained by the organization and
provided to HHS on an annual basis, to USCIS as part of
the 5-year reauthorization application, and at any other
time upon request by HHS or USCIS.
5. The organization must 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 5 years. USCIS will conduct a review of your
organization every 5 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.
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 changed your address, you must inform USCIS of your
new address. For information on filing a change of address go
to the USCIS Web site at www.uscis.gov/addresschange or
contact the National Customer Service Center at
1-800-375-5283.

Processing Information
Any form that is not signed or accompanied by the correct
fee will be rejected with a notice that the form is deficient.
You may correct the deficiency and resubmit the form. An
application or petition is not considered properly filed until
accepted by USCIS.

Form I-905 Instructions (Rev. 08/07/09) Y Page 5

Initial processing. Once a form 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
form.

Requests for more information or interview. 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 required.
Decision. The decision on a form 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 Web site at
www.uscis.gov.
As an alternative 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 Web site. 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.

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 and 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
Products Division, Office of the Executive Secretariat, 20
Massachusetts Avenue, N.W., Washington, DC 20529-2020,
OMB No. 1615-0086. This form expires August 31, 2011. Do
not mail your application to this address.

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

Form I-905 Instructions (Rev. 08/07/09) Y Page 6