Report of Medical Examination and Vaccination Record

Instructions for Report of Medical Examination and
Vaccination Record
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-693
OMB No. 1615-0033
Expires 01/31/2015

What Is the Purpose of This Form?
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 applicants who are requesting immigration benefits are not inadmissible to the
United States on public health grounds. You can find a list of those health-related grounds in section 212(a)(1) of the
Immigration and Nationality Act (INA). The list is also available in these instructions in Item Number 9. under Part 3.
Frequently Asked Questions.
The results of your medical examination are confidential and are used primarily for immigration purposes. When required
by law, the civil surgeon may share your results with public health authorities. USCIS will generally not discuss your
medical issues with other individuals, such as your attorney or BIA-accredited representative, immigration officers, or
other government officials, unless they have a need to know the information.

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NOTE: If you are applying for adjustment of status as a refugee, a derivative of an asylee, or a K or V nonimmigrant visa
holder, before reading any further, see Part 3. Frequently Asked Questions, Item Numbers 2. - 5., of these instructions.

Table of Contents

Page

Part 1. Applicant's Instructions

1

Part 2. Civil Surgeon's Instructions

4

Part 3. Frequently Asked Questions

6

Part 4. Medical Evaluations

8

Part 5. Vaccination Requirements

9

Part 6. USCIS Information

10

Part 1. Applicant's Instructions
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.
1.

Carefully read all these instructions, including Part 3. Frequently Asked Questions.

2.

Contact a doctor who is designated by USCIS as a civil surgeon to make an appointment.

3.

Fill out Part 1. of the form. Do not sign the form until the civil surgeon tells you to sign it. You must sign in
the presence of the civil surgeon.

4.

Attend your medical examination appointment and all follow-up examinations, as required. If you have any
medical records, including vaccination records, take them with you to the initial appointment.

5.

The civil surgeon is required to give you the completed Form I-693 in a sealed envelope for you to submit to
USCIS. Do not accept the form from the civil surgeon unless it is in a sealed envelope. USCIS will return your
Form I-693 to you if it is not in a sealed envelope or if the envelope is opened or altered in any way. The civil
surgeon should also give you a copy of the completed Form I-693 for your records.

6.

Submit your completed Form I-693 in the sealed envelope to USCIS. Please see our Web site at www.uscis.dhs.gov/
I-693.

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A.

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.

B.

For all other applicants: Follow the application's instructions, follow the instructions that the office requesting
the medical examination gave you, or call the USCIS National Customer Service Center at 1-800-375-5283 for
the most current information on where to file this benefit request. For TTY (deaf or hard of hearing) call:
1-800-767-1833.

NOTE: The civil surgeon will ask you to verify your identity. Bring a valid government-issued photo identification
to your appointment (for example, your unexpired passport or driver's license). For applicants under 14 years of age,
acceptable documents for proof of identity must show his or her name, date and place of birth, parents' full names,
and any other identifying information about the applicant. Acceptable documents include birth certificates (with a
translation, if necessary) or affidavits.

How Do I Find a Designated Civil Surgeon in My Area?

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To find a designated civil surgeon in your area, call the USCIS National Customer Service Center at 1-800-375-5283.
Follow the instructions in the automated menu. The telephone service is available in English and Spanish. For TTY (deaf
or hard of hearing) call: 1-800-767-1833. A list of the designated civil surgeons in your area is also available at
www.uscis.gov (select "TOOLS," choose "Find a civil surgeon," enter your ZIP Code, and click "Find civil surgeons.")

General Instructions

USCIS provides forms free of charge through the USCIS Web site. In order to view, print, or fill out our forms, you
should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you
do not have Internet access, you may call the USCIS National Customer Service Center at 1-800-375-5283 and ask that
we mail a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.
Signature. Each benefit request must be properly signed and filed. USCIS will not accept a stamped or typewritten name
in place of a signature.
Filing Fee. There is no filing fee for this benefit request.

Evidence. At the time of filing, you must submit the evidence and supporting documentation listed in these instructions.
Copies. You may submit legible photocopies of documents requested, unless the instructions specifically state that you
must submit an original document. USCIS may request an original document at the time of filing or at any time during
processing of a benefit request. If you submit original documents when not required, the documents may remain a part of
the record, and USCIS will not automatically return them to you.
Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation. The translator must sign a certification that the English language translation is complete and accurate, and
that the translator is competent to translate from the foreign language into English.
How to Fill Out My Portion of Form I-693
1.

Type or print legibly in black ink.

2.

If you need extra space to complete any item within your Form I-693, attach a separate sheet of paper; type or print
your name and Alien Registration Number (A-Number) (if any) at the top of each sheet; indicate the Page Number,
Part Number, and Item Number to which your answer refers; and sign and date each sheet.

3.

Complete only Part 1. of your Form I-693 and the identifying information at the top of each page. The civil
surgeon and any other doctors, clinics, or health departments that you are referred to will complete the remaining
parts of your Form I-693.

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4.

Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been
married and the question asks "Provide the name of your current spouse") type or print "N/A," unless otherwise
directed. If your answer to a question which requires a numeric response is zero or none (for example, "How many
children do you have?" or "How many times have you departed the United States?"), type or print "None," unless
otherwise directed.

Specific Instructions
Form I-693 is divided into seven parts. These instructions will help you complete Form I-693.
Part 1. Information About You
Complete this part before your medical examination appointment. Fill out your name and A-Number (if any) at the top of
each page of Form I-693. The civil surgeon will check that this information matches Part 1.
Item Number 1. Name. Use your legal name, which is the name that appears on your birth certificate, unless it was
changed after birth by a legal action such as marriage or a court order. Do not provide a nickname. If you have two last
names, include both and use a hyphen (-) between the names, if appropriate.

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Item Number 2. Home Address. Give your physical street address. This must include a street number and name or a
rural route number. Do not provide a post office box (PO Box) number here.
Item Number 3. Gender. Select the box that indicates whether you are male or female.

Item Numbers 4. - 6. Other Contact Information. Provide your daytime telephone number, mobile telephone number
(if any), and email address (if any).
Item Number 7. Date of Birth. Use eight numbers to show your date of birth in mm/dd/yyyy format (for example, type
or print May 1, 1979 as 05/01/1979).
Item Number 8. Place of Birth. Give the name of the city, town, or village where you were born.
Item Number 9. Country of Birth. Give the name of the country where you were born.

Item Number 10. Alien Registration Number (A-Number) (if any). This is your alien registration file number. If you
are not sure if you have one, look at any letters or notices that you have received from the Department of Homeland
Security (DHS). Look for a number that begins with a letter "A" followed by 8 or 9 digits (example: A 000 000 000). If
you do not have one, or if you cannot remember what it is, leave this space blank.
Item Numbers 11. - 13. Applicant's Certification, Statement, and Signature. Do not complete these Item Numbers
or sign the benefit request until the civil surgeon tells you to do so. You must sign Form I-693 in the presence of the
civil surgeon. Read the Applicant's Certification. Select the appropriate box to indicate that you either read this benefit
request yourself or someone interpreted it for you. You must also affirm that you have read and understand (or that the
interpreter read to you, and you understand) the Applicant's Certification. Further, you must sign and date your benefit
request ONLY in the presence of the civil surgeon. If you are under 14 years of age, a parent or legal guardian may sign
your Form I-693. If you are 14 years of age or older, you must sign Form I-693 yourself. A legal guardian also may sign
for a mentally incompetent person.
Item Number 14. Identification Information. Do NOT complete these fields. The civil surgeon must provide this
information.
Part 2. Interpreter's Contact Information, Certification, and Signature
Item Numbers 1. - 6. If you used anyone as an interpreter to read the instructions and questions in Part 1. of this benefit
request to you in a language in which you are fluent, the interpreter must fill out this section, provide his or her name, the
name and address of his or her business or organization (if any), his or her daytime telephone number, and his or her email
address (if any). The interpreter must also certify that he or she has read the Applicant's Certification to you in the same
language in which you are fluent. The interpreter must sign and date this benefit request.
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Part 2. 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
examination and all laboratory reports on Form I-693 where indicated, and for signing the civil surgeon's
certification provided on the form.
You must take reasonable steps to ensure that the person appearing for the medical examination is the same person
applying for the requested immigration benefit. All applicants must present a valid government-issued photo
identification or another form of government-recognized identity documentation. You must note in Part 1., Item
Number 14., the form of identification presented and identification 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 examination.
You should direct the applicant to complete and sign in Part 1., Item Numbers 11. - 13., in your presence. You
should also ensure that the applicant's name and A-Number (if any) are at the top of each page of the Form I-693 and
match the information provided in Part 1.

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2.

Follow U. S. Department of Health and Human Services (HHS) regulations and Centers for Disease Control
and Prevention (CDC) guidelines. As a USCIS-designated civil surgeon, you are required to perform the medical
examination according to HHS regulations. These regulations include the specific guidelines found in the Technical
Instructions for the Medical Examination of Aliens in the United States, published by the CDC. The Technical
Instructions (including periodic updates posted by the CDC) are available at www.cdc.gov/immigrantrefugeehealth/
exams/ti/civil/technical-instructions-civil-surgeons.html.

3.

Make referrals and file case reports, as required. According to the CDC's Technical Instructions, you are
required to:
A.
B.
C.
D.
E.

Refer the applicant to the local health department if a chest X-ray suggests TB or other circumstances
described in the CDC's Technical Instructions.

Ensure that any applicant diagnosed with syphilis is treated with the standard treatment regimen described in
the CDC's Technical Instructions.
Ensure that applicants are tested for chancroid, gonorrhea, granuloma inguinale, or lymphogranuloma
venereum, and given therapy, if diagnosed.

Refer the applicant to a Hansen's disease specialist for evaluation to confirm a suspected diagnosis of Hansen's
disease (leprosy).
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, as a Civil Surgeon, Fill Out My Portion of This Form I-693?
You, as the civil surgeon, are responsible for ensuring that Form I-693 is completed and signed as follows.
1.

Part 1. Applicant's Certification. You are responsible for verifying the identity of the applicant and noting in
Part 1., Item Number 14., the form of identification that the applicant presents to you. You are also required to
check the top of each page of Form I-693 to make sure the name and A-Number (if any) are correct. Finally, you
must require the applicant to sign the Applicant's Certification in your presence. The applicant should not sign
Part 1. until the medical examination is completed and all health-related follow-up requirements, if any, are met.

2.

Part 3. Summary of Medical Examination. After the medical examination and any required follow-up, summarize
the results in Part 3.

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3.

Part 4. Civil Surgeon's Certification. You must sign the certification after the medical examination is complete.
Fill out your identifying information in this part before referring an applicant for further tests or evaluation. Do not
sign and date this part until the referral or follow-up evaluation (if required) is completed and the applicant is
medically cleared. Your signature must be original. Stamped signatures or typewritten names are not acceptable.
For health departments performing the vaccination assessment for refugee adjustment applicants ONLY:
You must complete Part 4. of Form I-693. The original or stamped signature of the physician on staff at the health
department must be present in Part 4. USCIS will reject signatures by attending nurses, physician assistants, or
other medical professionals who are not licensed physicians. Health departments must also place either the official
stamp or raised seal, whichever is customarily used, in Part 4. where indicated.
Military physicians performing the medical examination for members and veterans of the U.S. Armed Forces
or U.S. Coast Guard and certain eligible dependents must also complete Part 4. The original or stamped
signature of the military physician operating under the blanket civil surgeon designation must appear in Part 4.
USCIS will reject signatures by attending nurses, physician assistants, or other medical professionals who are not
licensed physicians. Military treatment facilities must also place either their official stamp or raised seal in Part 4.
where indicated.

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4.

Part 5. Civil Surgeon Worksheet and Part 7. Vaccination Record. You must fill out this worksheet and provide
the results of each component of the medical examination 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-related 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.

5.

Part 6. Referral Evaluation. If you refer the applicant to a local health department or to another physician or clinic,
you must also fill out Item Number 5. Required Referral to Health Department or Other Doctor in Part 5. Civil
Surgeon Worksheet in Form I-693. The health care professional receiving the referral must fill out and sign Part 6.
Referral Evaluation. Do not complete Item Number 5. in Part 5. if the referral is recommended and not required.

How Do I Complete Form I-693 If I Need to Make a Required Referral?

Advise applicants that they must complete all health-related follow-up requirements before you can certify Form I-693.
You must fill out Item Number 5. Required Referral to Health Department or Other Doctor in Part 5. Civil
Surgeon Worksheet with the contact information of the physician or public health facility that will conduct further
evaluation or provide treatment. You should also specify the type of examination and additional tests or treatment that the
applicant should receive in the Remarks section of Item Number 5. The health care professional receiving the referral
must fill out and sign Part 6. Referral Evaluation. Do not complete Item Number 5. in Part 5. if the referral is
recommended and not required. Complete your identifying information in Part 4., but do not sign or date the form.
Make a copy of the Form I-693 for your records and give the original to the applicant in a sealed envelope. (See the next
section for additional instructions for sealing the envelope.)

What Should I Do After the Medical Examination and Health-Related Follow-Up Requirements
(If Required) Are Completed?
After the medical examination and any health-related required follow-up is complete, summarize the results in Part 3. of
Form I-693. Do not sign Form I-693 until the applicant has met all health-related follow-up requirements. After that,
sign the civil surgeon's certification in Part 4., Item Number 6.
Make two copies of the completed and signed Form I-693 and any supporting documents. Keep one copy for your
records. Give the other copy to the applicant. The vaccination portion of Form I-693 will serve as the applicant's official
vaccination record for future use (for example, school or employment purposes).

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Prepare the original of the completed and signed Form I-693 for submission to USCIS.
Follow these steps:
1.

Place the Form I-693 and any supporting documentation into an envelope.

2.

Seal the envelope.

3.

On the front, write in capital letters: "DO NOT OPEN. FOR USCIS USE ONLY."

4.

On the back, write your initials across the seal where the flap meets the envelope.

5.

Seal the entire flap with clear tape. Make sure the tape covers your initials as well as the flap.

6.

Give the sealed envelope to the applicant.

The applicant must submit the sealed envelope to USCIS.
IMPORTANT: USCIS will not accept Form I-693 unless it is in a sealed envelope that is not opened or altered in
any way.

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Return to the applicant all supporting medical documents that you were not required to include in the sealed
envelope.

Part 3. Frequently Asked Questions
1.

Who must submit Form I-693?

Most applicants filing for adjustment of status to become a lawful permanent resident must submit Form I-693
completed by a designated civil surgeon. Certain other applicants may also be required to submit Form I-693
completed by a civil surgeon.
2.

What if I am a refugee and already had a medical examination overseas?

If you are now applying for adjustment of status under INA 209 one year after your first admission, you only need to
repeat the entire examination if the panel physician found a class A medical condition during your overseas
examination. If you need a new medical examination because of a class A medical condition, you also need to
comply with the vaccination requirements found in Form I-693.
Even if you do not need a complete medical examination, you still need to comply with the vaccination requirements.
This means you only need to submit Part 7. Vaccination Record and Parts 1., 2., and 4. of Form I-693. Contact your
state or local refugee health coordinator to find out whether a state or local health department can complete the Part 7.
of Form I-693. The health department must also complete Part 4. of the benefit request.
3.

What if I am a K nonimmigrant visa holder and already had a medical examination overseas?
If you were admitted as a:
A.

K-1 fiancé(e) or a K-2 child of a K-1 fiancé(e); or

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:
(1)

You are not required to have another medical examination as long as you file your Form I-485 within one
year of an overseas medical examination, and:
(a) The panel physician did not find a class A medical condition during your overseas examination; or
(b) The panel physician did find a class A medical condition, you received a waiver of inadmissibility,
and you have complied with the terms and conditions of the waiver.

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(2)

4.

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 Part 7. Vaccination
Record completed by a designated civil surgeon. In this case, you must submit Parts 1., 2., 4., and 7. of
Form I-693.

What if I am a V nonimmigrant visa holder and already had a medical examination overseas?
If you were admitted to the United States or obtained status while in the United States as a:
A.

V-1 spouse of a lawful permanent resident or are waiting for a V-1 visa; or

B.

V-2 child of a V-1 spouse of a lawful permanent resident; or

C.

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

D.

You received a medical examination prior to admission or obtaining V status, then:

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(1)

You are not required to have another medical examination as long as you file your Form I-485 within one
year of an overseas examination, and:

(a) The panel physician did not find a class A medical condition; or

(b) The panel physician did find a class A medical condition, you received a waiver of inadmissibility,
and you have complied with the terms and conditions of the waiver.

(2)

5.

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 Part 7. Vaccination Record completed
by a designated civil surgeon. In this case, you must submit Parts 1., 2., 4., and 7. of Form I-693.

What if I am an asylee derivative applying for adjustment of status and already had a medical examination
overseas?
If you were admitted to the United States as an asylee derivative, you generally do not need to repeat, at the time you
submit Form I-485, the entire medical examination you had overseas, provided that:
A.
B.

The panel physician found no class A condition during your overseas examination; and
You are applying for adjustment of status within one year of becoming eligible to file.

You must, however, comply with the vaccination requirement and submit Part 7. Vaccination Record and Parts 1.,
2., and 4. of Form I-693 with your Form I-485.
6.

May any doctor perform the required medical examination?

Only a doctor who was designated by USCIS as a civil surgeon may perform the medical examination. USCIS will
not accept a Form I-693 completed by a doctor who is not a currently designated civil surgeon.
7.

How do I know if a doctor is a designated civil surgeon?
Doctors found through the USCIS Web site at www.uscis.gov or through the USCIS National Customer Service
Center are generally current in their designation as civil surgeons. Applicants who are unsure should ask doctors to
confirm their status as a civil surgeon.

8.

Who pays for the medical examination?
You, the applicant, are responsible for paying all costs of the medical examination, including the cost of any followup tests or treatment that are required. Make payments directly to the civil surgeon or other health care provider.

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9.

What are the health-related grounds of inadmissibility?
U.S. immigration law divides the health-related grounds of inadmissibility into the following four general categories:
A.

Communicable diseases of public health significance;

B.

Lack of proof of having received required vaccinations;

C.

Physical or mental disorders with associated harmful behavior or a history of associated harmful behavior; and

D.

Drug abuse or addiction.

See INA 212(a)(1)(A). HHS regulations classify these and other medical conditions into class A or B conditions.
Class A conditions result in inadmissibility while class B conditions do not. See 42 CFR 34.2(d) - (e).

Part 4. Medical Evaluations
1.

Communicable Diseases of Public Health Significance

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The civil surgeon is required to perform specific tests for tuberculosis and syphilis. The medical examination also
requires the civil surgeon to evaluate for other sexually transmitted diseases and Hansen's disease (leprosy).
If you have a communicable disease of public health significance, the civil surgeon will advise you on how to obtain
treatment. USCIS will inform you of whether you also need to apply for a waiver of inadmissibility. To learn more
about this waiver, visit the USCIS Web site at www.uscis.gov.
A.

Testing for Tuberculosis

All applicants 2 years of age and older require testing for tuberculosis (TB) with an initial screening test. Civil
surgeons may require an applicant younger than 2 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)

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 check the result. If you have a reaction of 4 millimeters or less, you will
generally not need any further tests for TB. If the reaction is 5 millimeters or more, you are required to
have a chest X-ray. The civil surgeon will explain the medical requirements to you in more detail.

(2)

IGRA: Civil surgeons have the option to use an IGRA in place of the TST (see the update to the Technical
Instructions at www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/updates/index.html). You will not
have to return to the civil surgeon's office to check the result. The result is generally available within 24
hours. If the test is negative or indeterminate, borderline, or equivocal, you generally will not need any
further tests for TB. In other cases, you may require further evaluation with a chest X-ray.
The CDC recognizes the following IGRAs 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, the CDC may recognize additional tests; if it does, it will publish the
information in its Technical Instructions at www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/
technical-instructions-civil-surgeons.html. Civil surgeons may use only tests listed in the materials
published at this link for this examination.
NOTE: The civil surgeon will explain the medical requirements and the suitability and availability of
IGRA testing to you in more detail.

B.

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

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2.

Physical or Mental Disorders
The presence of a physical or mental disorder alone does not make you inadmissible on health-related grounds.
The civil surgeon must also determine that there is behavior associated with the disorder that is harmful to you, to
others, or to property. USCIS will only consider you inadmissible if there is a current associated harmful behavior
or a history of associated harmful behavior that is likely to recur.
The civil surgeon will ask you general questions during the medical examination to determine whether you have
such a condition. The civil surgeon may refer you to a specialist for further evaluation, if necessary.
If the civil surgeon finds that you have a physical or mental disorder with associated harmful behavior, you may
apply for a waiver. If the waiver is granted, you may be subject to terms, conditions, and controls as determined by
USCIS in consultation with HHS. For more information about these waivers, visit the USCIS Web site at
www.uscis.gov.

3.

Drug Addiction and Drug Abuse

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HHS sets the medical guidelines for determining drug abuse and drug addiction. The civil surgeon will review
your medical history during the medical examination and ask you questions necessary to determine whether you are
currently using any drugs or other psychoactive substances or have used them in the past.
If the civil surgeon determines you have a substance-related disorder, 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 granted asylum. If
you are ineligible to apply for a waiver, but a civil surgeon later finds your drug abuse or addiction is in remission,
you are no longer inadmissible and may proceed with your immigration benefit application, petition, or request, if
otherwise eligible.

Part 5. Vaccination Requirements

All applicants for adjustment of status must present documents showing they were vaccinated against a broad range of
vaccine-preventable diseases. The civil surgeon will review your vaccination history with you to determine whether you
have had 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 the civil surgeon evaluates you, in case any of the required
vaccines are not medically appropriate for you.
You can find a list of the required vaccines at www.cdc.gov/immigrantrefugeehealth/exams/medical-examinationfaqs.html.#6.
If you never received certain vaccines, or you are unable to prove you received them, the civil surgeon can give them to
you. You also have the option to ask your family doctor to administer those vaccines to you after your evaluation by the
civil surgeon. If you choose that option, show 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,
USCIS may grant you a waiver based on the civil surgeon's certification on Part 7. Vaccination Record of Form I-693.
USCIS may also grant you a waiver if the civil surgeon certifies that it is not medically appropriate for you to have one or
more of the required vaccines.
HHS has determined that a vaccine is "not medically appropriate" if :
1.

The vaccine is not recommended for your specific age group;

2.

There is a medical reason why it would not be safe to have the vaccine (for example, you are allergic to eggs and/or
yeast or you had bad reactions to prior vaccines);

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3.

You are unable to complete the entire series of a required vaccine within a reasonable amount of time; or

4.

For the influenza vaccine, it is not the flu season.

If you object to required vaccinations because of 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
USCIS denies the waiver application, we may also deny the immigration benefit that you are seeking. For more
information about these waivers, visit the USCIS Web site at www.uscis.gov.

Part 6. USCIS Information
USCIS Forms and Related Information
To ensure you are using the latest version of this benefit request, visit the USCIS Web site at www.uscis.gov where you
can obtain the latest USCIS forms and immigration-related information. If you do not have Internet access, you may
order USCIS forms by calling our toll-free number at 1-800-870-3676. You may also obtain forms and information by
calling our USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call:
1-800-767-1833.

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Instead of waiting in line for assistance at your local USCIS office, you can now schedule an appointment through our
Internet-based system, InfoPass, at infopass.uscis.gov. 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

You must notify the agency adjudicating your benefit of your new address within 10 days of moving from your previous
residence. For information on filing a change of address with USCIS, go to the USCIS Web site at www.uscis.gov/
addresschange or contact the USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of
hearing) call: 1-800-767-1833.
NOTE: Do not submit a change of address request to the USCIS Lockbox facilities because these facilities do not
process change of address requests.

Processing Information
Initial Processing

Once USCIS accepts your Form I-693, we will check it for completeness. If you do not completely fill out the the benefit
request, USCIS may reject or deny your Form I-693.
Requests for More Information

The agency reviewing your Form I-693 may request more information or evidence to support your benefit request. The
agency may also request that you provide the originals of any copies you submit. The agency will return any requested
originals when they are no longer needed.
Decision
The decision on Form I-693 involves a determination of whether you have established eligibility for the associated
immigration benefit you are seeking. The agency reviewing your Form I-693 will notify you of the decision in writing.

Form I-693 Instructions 06/04/14

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Penalties
If you knowingly and willfully falsify or conceal a material fact or submit a false document with Form I-693, the agency
reviewing your Form I-693 may deny the associated immigration benefit. In addition, you will face severe penalties
provided by law and may be subject to criminal prosecution. USCIS may also revoke a physician's civil surgeon
designation if he or she knowingly falsifies or conceals any material fact on a Form I-693 or includes any false documents
or information to support any findings in the record.

USCIS Privacy Act Statement
AUTHORITIES: The information requested on this benefit request, and the associated evidence, is collected under
section 212(a)(1)(A) of the Immigration and Nationality Act, as amended INA 101, et seq.
PURPOSE: The primary purpose for providing the requested information on this benefit request is to report results of a
medical examination and provide vaccination records to USCIS. DHS will use the information you provide to determine
whether you have any health conditions that may affect your eligibility for adjustment of status to that of a lawful
permanent resident.

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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: DHS may share the information you provide on this benefit request with other Federal, state, local,
and foreign government agencies and authorized organizations in accordance with approved routine uses, as 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 you can find at www.dhs.gov/privacy]. DHS may also
make the information available, as appropriate, for law enforcement purposes or in the interest of national security.

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 and 30 minutes per response, including the time for reviewing instructions, gathering
required documentation and information, completing the benefit request, preparing statements, attaching necessary
documentation, and submitting the benefit request. 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 Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC
20529-2140. OMB No. 1615-0033. Do not mail your completed Form I-693 to this address.

Form I-693 Instructions 06/04/14

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