Medical Examination for Immigrant or Refugee Applicant

OMB 1405-0113

Forms for this collection are completed by panel physicians for refugees and aliens seeking immigrant visas to the U.S. The collection records medical information necessary to determine whether refugees or immigrant visa applicants have medical conditions affecting the public health and requiring treatment.

The latest form for Medical Examination for Immigrant or Refugee Applicant expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DS-3025 Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Form DS-2054 Medical Examination for Immigrant or Refugee Applicant Form
(004) Tab 3 -- Legal Authorities -- 30 Day Paper Medical.docx Supplementary Document
SIGNED T3837-21 - PRA Emergency Approval for COVID-19 Vaccine.pdf Supplementary Document
Justification for Emergency Approval.docx Supplementary Document
Legal Authorities.docx Supplementary Document
(003) Tab 2 -- Supporting Statement -- 30 Day Paper Medical .docx Supporting Statement A
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form

All Historical Document Collections

202207-1405-004 Approved without change	Revision of a currently approved collection	2022-07-21
202112-1405-010 Approved with change	Revision of a currently approved collection	2021-12-20
202010-1405-004	Revision of a currently approved collection	2020-10-23
201709-1405-003 Approved without change	Revision of a currently approved collection	2017-09-15
201501-1405-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-01-05
201410-1405-004 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2014-10-29
201407-1405-004 Approved without change	Revision of a currently approved collection	2014-07-21
201105-1405-007 Approved without change	Revision of a currently approved collection	2011-06-07
201005-1405-004 Approved without change	Revision of a currently approved collection	2010-05-10
200911-1405-003 Approved without change	Revision of a currently approved collection	2009-11-23
200904-1405-002 Approved without change	Revision of a currently approved collection	2009-04-09
200901-1405-001 Withdrawn and continue	No material or nonsubstantive change to a currently approved collection	2009-01-26
200801-1405-004 Approved without change	Revision of a currently approved collection	2008-01-31
200707-1405-001 Approved without change	Revision of a currently approved collection	2007-07-03
200601-1405-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2006-01-24
200504-1405-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2005-04-27
200402-1405-002 Approved with change	Extension without change of a currently approved collection	2004-02-05
200104-1405-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2001-04-11
200004-1405-003 Approved without change	Revision of a currently approved collection	2000-04-25
199907-1405-009 Approved without change	Existing collection in use without an OMB Control Number	1999-07-09