Report of Medical Examination and Vaccination Record

OMB No. 1615-0033

Instructions for I-693, Report of Medical
Examination and Vaccination Record

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 you have one, at the top of each sheet and
indicate the number of the item that refers to your answer.

Section I. Applicant's Instructions
What Is the Purpose of Form I-693?
Generally, all applicants filing for adjustment of status to that
of a permanent resident must submit Form I-693 completed by
a designated civil surgeon. Form I-693 is used to report results
of a medical examination to U.S. Citizenship and Immigration
Services (USCIS). The examination is required to establish
that you are not inadmissible to the United States on public
health grounds. A list of those health grounds can be found in
section 212(a)(1) of the Immigration and Nationality Act. The
list is also available in Question 8 of Section III, Frequently
Asked Questions.

Step 5 - Submit Form I-693 in the sealed envelope to USCIS
according to the instructions on Form I-485,
Application to Register Permanent Residence or
Adjust Status. USCIS will return the form to you
and/or request another Form I-693 if it is not in an
envelope or if the envelope has been opened or
altered.

DRAFT
NOT
FOR
PRODUCTION

The results of your medical examination are confidential and
are used for immigration purposes only. When required to do
so by law, the civil surgeon may share your results with public
health authorities.
NOTE: If you are applying for adjustment of status as a
refugee, an asylee dependent, or as a "K" or "V"
nonimmigrant visa holder, see Questions 1 - 4 in Section III,
Frequently Asked Questions, before proceeding any further.

How Do I File Form I-693?

A separate Form I-693 is required for each applicant. There is
no filing fee for this form. Follow these steps:
Step 1 - Carefully read all these instructions, including
Section III, Frequently Asked Questions.

Step 2 - Call a designated physician (also known as a civil
surgeon) to make an appointment.
Step 3 - Fill out Part 1 of the form. Do not sign the form.
Step 4 - Attend your medical exam appointment and all
follow-up exams, as may be required. Sign Form
I-693 in front of the civil surgeon.

NOTE: The civil surgeon will ask you to verify your
identity. Take a government-issued photo identification to
your appointment (example: your valid unexpired passport or
driver's license.) For applicants under 14 years of age, USCIS
will accept other proof of identity that shows name, date and
place of birth, parents' full names, and any other identifying
information about the applicant. Acceptable documents
include birth certificates (with translations, if necessary) or
affidavits. Also take any vaccination records you may have to
the appointment.

How Do I Find a Designated Civil Surgeon in
the Area Where I Live?

To find a designated civil surgeon in your area, you can call
the USCIS National Customer Service Center (NCSC) at
1-800-375-5283 and follow the instructions in the automated
menu. Service is available in English and Spanish. A list of
the designated civil surgeons in your area can also be
generated by going to www.uscis.gov and clicking on “Find a
Medical Doctor (Civil Surgeon)” under Customer Tools:
Before I File.

How Do I Fill Out My Portion of Form I-693?
1. Use black ink only. Type or print clearly. If an item does
not apply to you, write "N/A" unless the specific
instruction states otherwise.

Form I-693 Instructions (Rev. 04/19/11) Y

2. You must fill out only Part 1 and identifying
information at the top of each page. The civil surgeon
and any other doctors, clinics, or health departments
receiving a referral are required to complete the remaining
parts of the form.
A. Part 1 - Information About You - Fill out this part
before your medical exam appointment.
B. Identifying information at top of each page - Fill out
your name and A-number, if applicable, at the top of
each page of Form I-693. The civil surgeon will check
that this information matches Part 1.
C. Name - Use your legal name. If you have two last
names, include both and use a hyphen (-) between the
names, if appropriate.
D. Home Address - Give your physical street address.
This must include a street number and name or a rural
route number. Do not put a post office box (P.O. Box)
number here.
E. Date of Birth - Use eight numbers to show your date
of birth (example: May 1, 1979, must be written
05/01/1979).
F. Place of Birth - Give the name of the city/town/village
where you were born.
G. Country of Birth - Give the name of the country
where you were born.
H. A-Number - This is your alien registration file
number. If you are not sure if you have one, look at
any letters or notices you have received from the
Department of Homeland Security (DHS). Look for a
number that begins with a letter "A" and is followed
by 8 or 9 numbers (example: A 000 000 000). If you do
not have one or if you cannot remember what it is,
leave this space blank.
I. U.S. Social Security Number - If you do not have a
U.S. Social Security Number, leave this blank.
J. Certification - Do not sign here until the civil surgeon
tells you to do so.

How Do I Submit Form I-693 to USCIS?

2.

Adjustment of status applicants. If you are applying for
adjustment of status, submit Form I-693 according to the
instructions on Form I-485, Application to Register for
Permanent Residence or Adjust Status.

3. Other applicants. Follow the instructions on or included
with the application form or the instructions given to you
by the office requesting the medical exam.

Section II. Civil Surgeon's Instructions
What Are My Responsibilities as a Designated
Civil Surgeon?
1. Truthfully and Accurately Report the Results. You are
responsible for reporting the results of the medical exam
and all laboratory reports on Form I-693 where indicated,
and for signing the civil surgeon's certification provided on
the form.
In this regard, you must take reasonable steps to ensure
that the person appearing for the medical exam is the same
person applying for the requested immigration benefit. All
applicants must present a valid government-issued photo
identification, and the civil surgeon must annotate in Part
1 the form of identification presented and ID number, if
applicable. The law imposes severe penalties for
knowingly and willfully falsifying or concealing a material
fact or using any false documents in connection with this
medical exam.
The civil surgeon should also ensure that the applicant's
name and A-number, if applicable, at the top of each page
of the Form I-693 matches the information provided in
Part 1.
2. Follow HHS Guidelines. USCIS has designated you as a
civil surgeon with the understanding that you will perform
the medical exam according to U.S. Department of Health
and Human Services' regulations. These regulations include
the specific guidelines found in Technical Instructions for
the Medical Examination of Aliens in the United States
(Technical Instructions), published by the Centers for
Disease Control and Prevention (CDC) in Atlanta,
Georgia. The Technical Instructions (including periodic
updates posted by CDC) are available on the CDC Web site
at http://www.cdc.gov/immigrantrefugeehealth/exams/
ti/civil/technical-instructions-civil-surgeons.html.

1. The civil surgeon is required to give you the completed
Form I-693 in a sealed envelope. Do not accept the form
from the civil surgeon if it is not in a sealed envelope.
USCIS will return the form to you if it is not in an envelope
or if the envelope has been opened or altered.
Form I-693 Instructions (Rev. 04/19/11) Y Page 2

3. Make Referrals and File Case Reports, as Required.
According to CDC's Technical Instructions, you are
required to:
A. Refer the applicant to the local health department if the
chest x-ray suggests TB or other circumstances are
present as described in CDC's Technical Instructions.
B. Ensure that any applicant diagnosed with syphilis is
treated with the standard treatment regimen described
in CDC's Technical Instructions.
C. Ensure that testing and therapy are given for diagnoses
of chancroid, gonorrhea, granuloma inguinale, or
lymphogranuloma venereum.
D. Refer the applicant to a Hansen's disease specialist for
evaluation to confirm a suspected diagnosis of
Hansen's disease (leprosy).
E. File a case report with the appropriate public health
authorities if a case report is required by local laws or
regulations. You must also advise the applicant that a
case report is being filed.

How Do I Fill Out My Portion of This Form?
The applicant fills out Part 1 of Form I-693 before the
medical exam appointment. You, the civil surgeon, are
responsible for ensuring the remaining parts are completed
and signed, as follows.
1. Civil Surgeon Worksheet - You must fill out this
worksheet and provide the results of each component of the
medical exam relating to: communicable diseases of public
health significance, physical or mental disorders with
associated harmful behavior, drug abuse or drug addiction,
and vaccinations. You must also include the results of any
lab work or other studies required to determine whether the
applicant is inadmissible on health grounds. You must
instruct applicants who have had a tuberculin skin test
(TST) to return to your office within 48-72 hours to have
the TST read.
2. Referral to Health Department or Other Doctor. If you
refer the applicant to a local health department or to
another physician or clinic, you must also fill out section 5
of the Civil Surgeon Worksheet in Form I-693. The health
care professional receiving the referral must fill out and
sign the section 6 of the worksheet.

3. Part 3 - Civil Surgeon's Certification. You must sign the
certification after the medical exam is complete. Fill out
the identifying information in this part before referring an
applicant for further tests or evaluation. Do not sign and
date this part until the referral/follow-up evaluation (if
required) has been completed and the applicant has been
medically cleared. Stamped signatures are not acceptable,
your signature must be original.
For health departments performing the vaccination
assessment for refugee adjustment applicants ONLY:
You must also complete Part 3 of Form I-693. The actual
(original) or stamped signature of the physician on staff at
the health department must be present in Part 3.
Signatures by attending nurses, physician assistants, or
other medical professionals that are not licensed physicians
will be rejected. Health departments must also place either
the official stamp or raised seal, whichever is customarily
used, in Part 3 where indicated.

How Do I Complete Form I-693 If I Need to
Make a Referral?
Advise the applicant that the appropriate follow-up must be
obtained before medical clearance can be granted. In section 5
of the Civil Surgeon Worksheet (Referral to Health
Department or Other Doctor), include the name, address, and
telephone number of the physician or public health service
facility that will conduct further evaluation or provide
treatment. Specify the type of examination and additional tests
or treatment the applicant should receive. Complete your
identifying information in Part 3, but do not sign or date.
Make a copy of Form I-693 for your records and give the
original form to the applicant in a sealed envelope.

What Do I Do After the Medical Exam and
Follow-Up (If Required) Are Completed?
You and the applicant must sign your respective
certifications. After the medical exam (and any follow-up if
required) is complete, write the results in Part 2 of the Form
I-693 as they relate to the specific component of the medical
exam. The applicant must sign the certification in Part 1, and
you must sign the civil surgeon's certification in Part 3. Do
not sign the form or have the applicant sign the form until
the applicant has met all health follow-up requirements.

Form I-693 Instructions (Rev. 04/19/11) Y Page 3

Make two copies of the completed and signed Form I-693,
and any supporting documentation (such as x-ray reports
or other reports) that you submit to USCIS. You should
keep a copy of Form I-693 and any supporting documentation
that you submit to USCIS for your records. Give the other
copy of the completed and signed Form I-693 and any
supporting documentation to the applicant. The vaccination
portion of Form I-693 will serve as the applicant's official
vaccination record and may be retained by the applicant for
future use in establishing compliance with vaccination
requirements (example: school, day care, employment, etc.).

2. What if I am a K nonimmigrant visa holder and already
had a medical exam overseas?

Prepare the original of the completed and signed Form
I-693 for submission to USCIS. Place the original of the
completed and signed Form I-693 and any supporting
documentation (such as x-ray reports or other reports) into an
envelope, and then seal the envelope. On the front of the
envelope, write in capital letters: "DO NOT OPEN. FOR
USCIS USE ONLY." On the back of the envelope, write
your initials across the seal where the flap of the envelope and
the envelope meet. Seal the entire flap with clear cellophane
tape; make sure that the tape, in addition to the flap, also
covers your initials. Give the sealed envelope to the applicant.

1. You are not required to have another medical
examination as long as your Form I-485,
Application to Register Permanent Residence or
Adjust Status, is filed within one year of your
overseas medical examination, and the medical
examination did not reveal a Class A medical
condition, or if you did have a Class A medical
condition, you received a waiver of inadmissibility
and have complied with the terms and conditions on
the waiver.

The applicant must submit the envelope to USCIS.
IMPORTANT: USCIS will not accept Form I-693 if it is
not in a sealed envelope or if the envelope is altered in any
way.
Return all supporting medical documents that were not
required to be included in the sealed envelope to the
applicant.

Section III. Frequently Asked Questions

If you were admitted as a:
A. K-1 fiancé(e) or a K-2 child of a K-1 fiancé(e); or as a
B. K-3 spouse of a U.S. citizen or a K-4 child of a K-3
spouse of a U.S. citizen; and
C. You received a medical examination prior to
admission, then:

2. Even if a new medical examination is not required,
you must still show proof that you complied with
the vaccination requirements. If the vaccination
record (DS 3025) was not properly completed and
included as part of the original overseas medical
examination report, you will have to have the
vaccination report completed by a designated civil
surgeon. In this case, you are required to submit the
vaccination record and page 1 of Form I-693.
3. What if I am a V nonimmigrant visa holder and already
had a medical exam overseas?

1. What if I am a refugee and already had a medical exam
overseas?

If you were admitted to the United States or obtained
status while in the United States as a:

If you were admitted to the United States as a refugee and are
now applying for adjustment of status one year following your
first admission, you do not need to repeat the entire medical
exam you had overseas, unless a Class A medical condition
was found during that exam.

A. V-1 spouse of a permanent resident or awaiting a V-1
visa; or as a

If a complete medical exam is not required, you only need to
comply with the vaccination requirements. This means you
only need to submit the vaccination record and page 1 of Form
I-693. Contact your State or local refugee health coordinator
to find out whether it may be possible for you to have the
vaccination portion of Form I-693 completed by a State or
local health department. The State or local health department
must also complete Part 3 of the form.

C. V-3 child of a V-2 unmarried son or daughter of a V-1
spouse of a permanent resident; and

B. V-2 child of a V-1 spouse of a permanent resident; or
as a

Form I-693 Instructions (Rev. 04/19/11) Y Page 4

D. You received a medical examination prior to admission
or obtaining V status, then:
1. You are not required to have another medical
examination as long as your Form I-485,
Application to Register Permanent Residence or
Adjust Status, is filed within one year of your
overseas medical examination, and the medical
examination did not reveal a Class A medical
condition, or if you did have a Class A medical
condition, you received a waiver of inadmissibility
and have complied with the terms and conditions on
the waiver.
2. Even if a new medical examination is not required,
you still must show proof that you complied with
the vaccination requirements. If the vaccination
record was not properly completed and included as
part of the original medical examination report, you
will have to have the vaccination report completed
by a designated civil surgeon. In this case, you are
required to submit the vaccination record and page
1 of Form I-693.
4. What if I am an asylee dependent applying for
adjustment of status and already had a medical exam
overseas?
If you were admitted to the United States as an asylee
dependent, you generally do not need to repeat the entire
medical exam you had overseas at the time of submission
of Form I-485, provided that:
A. No Class A condition was found during the exam; and
B. You have applied for adjustment of status within one
year of eligibility to file.

6. How do I know whether a doctor is a designated civil
surgeon?
Doctors found through the USCIS National Customer
Service Center (NCSC) phone line or through the USCIS
Web site are generally current in their designation as civil
surgeons. If unsure, applicants should confirm with their
doctors as to their civil surgeon status.
7. Who pays for the medical exam?
The applicant is responsible for paying all costs of the
medical exam, including the cost of any follow-up tests or
treatment that may be required. Payments are made
directly to the civil surgeon or other health care facility.
8. What are the medical grounds of inadmissibility?
The medical grounds of inadmissibility under U.S.
immigration laws are divided into four categories:
a. Communicable diseases of public health significance;
b. Lack of required vaccinations;
c. Physical or mental disorders with harmful behavior; and
d. Drug abuse or addiction.
The civil surgeon is required to perform a general physical
examination and specific evaluations, as described below.

Communicable Diseases of Public Health Significance
The civil surgeon is required to perform specific tests for TB
and syphilis. The medical exam also indicates an evaluation
for other sexually transmitted diseases and Hansen's Disease
(leprosy).

You will, however, be required to comply with the
vaccination requirement and submit the vaccination
record and page 1 of Form I-693 with your Form I-485.
5. May any doctor perform the required medical exam?
Only a doctor who has been specially designated by
USCIS as a civil surgeon may perform the medical exam.
USCIS will not accept Form I-693 completed by a doctor
who is not a currently designated civil surgeon.

Form I-693 Instructions (Rev. 04/19/11) Y Page 5

To Test For:

Then:

Tuberculosis
(TB)

All applicants two years of age and older are required to be tested for tuberculosis (TB) with an initial screening
test. Civil surgeons may require an applicant younger than two years of age to undergo testing if there is
evidence of contact with a person known to have TB or other reasons to suspect TB. The physician may use
either the Tuberculin Skin Test (TST) or an Interferon Gamma Release Assay (IGRA).
1. Tuberculin Skin Test (TST) given by the Mantoux technique. After the skin test, you will need to return to
the civil surgeon within 48 to 72 hours to have the result read. If you have a reaction of four millimeters of
less, generally, you will not need any further tests for TB. A chest x-ray is required when the reaction to the
TST is five millimeters or more. The civil surgeon will explain the medical requirements to you in more
detail.
2. IGRA: Civil surgeons have the option of using IGRA in place of the TST (see update to the Technical
Instructions at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/updates/index.html). You will
not have to return to the civil surgeon's office for the result to be read. The result is generally available
within 24 hours. If the test is negative or indeterminate/borderline/equivocal, you generally will not need any
further tests to TB. Depending on the result of the test, further evaluation with a chest x-ray may be required.
There are several IGRAs recognized by CDC for purposes of this immigration medical examination: the
QuantiFERON® - TB Gold (QFT-G) test: the QuantiFERON® - TB Gold in Tube (QFT-G IT) test; and the
T-Spot® TB test. In the future, CDC may recognize additional tests: if it does, it will publish the information
in its Technical Instructions available on CDC's Web site at http://www.cdc.gov/immigrantrefugeehealth/
exams/ti/civil/technical-instructions-civil-surgeons.html. Tests not listed in the materials published on this
link may not be used for purposes of this immigration medical examination.
The civil surgeon will explain the medical requirements and the suitability and availability of IGRA testing to
you in more detail.

Syphilis

All applicants 15 years of age and older must have a blood test for syphilis. Civil surgeons may require
applicants under 15 years of age to be tested if there is reason to suspect the possibility of infection.

Form I-693 Instructions (Rev. 04/19/11) Y Page 6

If you are found to have a communicable disease of public
health significance, the civil surgeon will advise you how to
obtain any necessary treatment. It also may be necessary for
you to apply for a waiver of inadmissibility. USCIS will
advise you if this is necessary. To obtain more information
about this waiver, visit the USCIS Web site at www.uscis.gov.

Vaccination Requirements
All applicants for adjustment of status must present documents
showing they have been vaccinated against a broad range of
vaccine-preventable diseases. The civil surgeon will review
your vaccination history with you to determine whether you
have all the required vaccinations. Make sure you take your
vaccination records with you to your appointment with the
civil surgeon.
NOTE: Do not attempt to meet the requirements before you
are evaluated by the civil surgeon, in case it is not medically
appropriate for you to have one or more of the required
vaccines.
By law, the required vaccines for the immigration population
are the vaccines as recommended by the ACIP for the
immigrant population. You may obtain a list of the required
vaccines from CDC's Web site at http://www.cdc.gov/
immigrantrefugeehealth/exams/diseases-vaccines-included.
html.
If you never received or are unable to prove you received
certain vaccines, the civil surgeon can administer them to you.
After evaluation by the civil surgeon, you also have the option
of asking your family doctor to administer those vaccines to
you and showing the records to the civil surgeon to note on
Form I-693.
If you initially did not have documents proving you received
all the required vaccines but later submit those documents, or
if the civil surgeon certifies that it is not medically appropriate
for you to have one or more of the missing vaccine(s), USCIS
may grant you a waiver based on the civil surgeon's
certification on the vaccination supplement.
HHS has determined that a vaccine is "not medically
appropriate" if :
a. The vaccine is not recommended for your specific age
group;
b. There is a medical reason why it would not be safe to
have the vaccine (for example, allergies to eggs and
yeast, hypersensitive to prior vaccines, other medical
reasons);

c. You are unable to complete the entire series of a
required vaccine within a reasonable amount of time; or
d. For the influenza vaccine, it is not the flu season.
If you object to receiving the recommended vaccinations
because of your sincerely held religious beliefs or moral
convictions, you may apply for a waiver of these
requirements. If you hold these objections, inform the civil
surgeon that you will apply for a waiver. If the waiver
application is denied, you may be ineligible for the
immigration benefit that you are seeking. To obtain more
information about these waivers, visit the USCIS Web site at
www.uscis.gov.

Physical or Mental Disorders
Are all physical or mental disorders considered healthrelated grounds of inadmissibility?
No. The emphasis is more on the behavior associated with the
physical or mental disorder, instead of the physical or mental
disorder itself. This means that the civil surgeon must
determine that there is behavior associated with the disorder
that is harmful either to you, to others, or to property. If you
have had a history of a physical or a mental disorder, there
must be associated harmful behavior that is likely to recur in
order for you to be considered inadmissible.
The civil surgeon will ask you general questions during the
medical exam to determine whether you have such a
condition. Depending on the outcome of the initial exam, the
civil surgeon may find it necessary to refer you to a specialist
for further testing.
If the civil surgeon finds that you have a physical or mental
disorder with associated harmful behavior, you may apply for
a waiver according to the terms, conditions, and controls
determined necessary by USCIS in consultation with HHS.
To obtain more information about these waivers, visit the
USCIS Web site at www.uscis.gov.

Drug Addiction/Drug Abuse
What are the guidelines for determining whether
someone is a drug abuser/drug addict?
The civil surgeon will review your medical history during the
medical exam and ask you questions necessary to determine
whether you are currently using or have used in the past any
drugs or other psychoactive substances. The medical
guidelines for determining drug abuse and drug addiction are
determined by HHS.

Form I-693 Instructions (Rev. 04/19/11) Y Page 7

If the civil surgeon determines you have a medical condition
of drug addiction/abuse, you are not eligible to apply for a
waiver unless you are applying for adjustment of status one
year after you were admitted as a refugee, or you are applying
for adjustment of status one year after you were granted
asylum. If you are ineligible to apply for a waiver, but are
later found by the civil surgeon to be in remission from the
drug abuse or drug addiction (as determined by HHS), you
may proceed with your adjustment-of-status application, if
eligible.

Processing Information
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

Section IV. USCIS Information
How Do I Get USCIS Forms and Related
Information?
You can get USCIS forms and immigration-related
information on the USCIS Web site at www.uscis.gov. You
may order USCIS forms by calling our toll-free number at
1-800-870-3676. You may also obtain forms and information
by telephoning our National Customer Service Center at
1-800-375-5283.
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.

Address Changes
If you have 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.
NOTE: Do not submit a change of address request to the
USCIS Lockbox facilities because the Lockbox facilities do
not process change of address requests.

We may request more information or evidence, or we may
request that you appear at a USCIS office for an interview.
Unless specifically required that an original document be filed
with an application or petition, an ordinary legible photocopy
(standard 8 1/2 x 11 letter size) may be submitted. Original
documents submitted when not required will remain a part of
the record.
Decision
The decision on Form I-693 involves a determination of
whether you have established eligibility for the requested
benefit. You will be notified of the decision in writing.

USCIS Privacy Act Statement
AUTHORITIES: The information requested on this benefit
request, and the associated evidence, is collected under the
Immigration and Nationality Act, section 101, et seq.
PURPOSE: The primary purpose for providing the requested
information on this benefit request is to determine if you have
established eligibility for the immigration benefit for which
you are filing. The information you provide will be used to
grant or deny the benefit sought.
DISCLOSURE: The information you provide is voluntary.
However, failure to provide the requested information, and
any requested evidence, may delay a final decision or result in
denial of your benefit request.
ROUTINE USES: The information you provide on this
benefit request may be shared with other Federal, State, local,
and foreign government agencies and authorized organizations
following approved routine uses described in the associated
published system of records notices [DHS-USCIS-007 Benefits Information System and DHS-USCIS-001 - Alien
File (A-File) and Central Index System (CIS), which can be
found at www.dhs.gov/privacy]. The information may also be
made available, as appropriate, for law enforcement purposes
or in the interest of national security.
Form I-693 Instructions (Rev. 04/19/11) Y Page 8

Penalties
If you knowingly and willfully falsify or conceal a material
fact or submit a false document with this Form I-693, we will
deny Form I-693 and may deny any other immigration benefit.
In addition, you will face severe penalties provided by law and
may be subject to criminal prosecution.

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 2 hours, 30 minutes
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 Products Division, Office of the Executive
Secretariat, 20 Massachusetts Ave., N.W., Washington, DC
20529-2020. OMB No. 1615-0033. This form expires
April 30, 2012. Do not mail your application to this
address.

Form I-693 Instructions (Rev. 04/19/11) Y Page 9