OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Medical Examination for Visa or Immigration Benefit

OMB 1405-0113 · STATE/AFA.

OMB 1405-0113

Forms in this collection record the medical information necessary to determine whether an alien seeking entry to the United States has a medical or other condition affecting his or her eligibility for a visa or immigration benefit. Forms are completed by panel physicians on behalf of visa applicants; refugees; refugees and asylees (including “following-to-join"); and certain parolees.

The latest form for Medical Examination for Visa or Immigration Benefit expires 2029-04-30 and is listed under ICR 202601-1405-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form DS-3030 Tuberculosis WorksheetForm and Instruction
Form DS-2054 Medical Examination for Immigrant or Refugee ApplicantForm and Instruction
Form DS-3026 Medical History and Physical Examination WorksheetForm and Instruction
Form DS-3025 Vaccination Documentation WorksheetForm and Instruction
Form DS-3025 Medical Examination for Immigrant or Refugee ApplicantForm and Instruction
Form DS-3030 Tuberculosis WorksheetForm and Instruction
Form DS-3026 Medical History and Physical Examination WorksheetForm and Instruction
Form DS-3025 Vaccination Documentation WorksheetForm and Instruction
Form DS-2054 Report of Medical Examination by Panel PhysicianForm and Instruction
Form DS-2054 Medical Examination for Immigrant or Refugee ApplicantForm and Instruction
Form DS-3025 Vaccination Documentation WorksheetForm and Instruction
Form DS-3025 Medical Examination for Immigrant or Refugee ApplicantForm and Instruction
Form DS-3030 Tuberculosis WorksheetForm
Form DS-3026 Medical History and Physical Examination WorksheetForm
Form DS-3025 Vaccination DocumentationForm
Form DS-2054 Report of Medical Examination by Panel PhysicianForm
Form DS-2054 Medical Examination for Immigrant or Refugee ApplicantForm
(010) Tab 9 - Consolidated Public Comments Received from 60-day FRN - MED Forms - 2025.docxSupplementary Document
(010) Tab 9 - Consolidated Public Comments Received from 60-day FRN - MED Forms - 2025.docx Supplementary Document
(004) Tab 3 - Legal Authorities - 30-day PRA - MED Forms - 2025.docxSupplementary Document
(004) Tab 3 - Legal Authorities - 30-day PRA - MED Forms - 2025.docx Supplementary Document
FW COVID 19 Vaccine Update.msgSupplementary Document
FW COVID 19 Vaccine Update.msg Supplementary Document
DS-3025 nonsub change justification.docxJustification for No Material/Nonsubstantive Change
(004) Tab 3 -- Legal Authorities -- 30 Day Paper Medical.docxSupplementary Document
(004) Tab 3 -- Legal Authorities -- 30 Day Paper Medical.docx Supplementary Document
SIGNED T3837-21 - PRA Emergency Approval for COVID-19 Vaccine.pdfSupplementary Document
SIGNED T3837-21 - PRA Emergency Approval for COVID-19 Vaccine.pdf Supplementary Document
Justification for Emergency Approval.docxSupplementary Document
Justification for Emergency Approval.docx Supplementary Document
Legal Authorities.docxSupplementary Document
Legal Authorities.docx Supplementary Document
Supporting Statement -OMB Passback - MED Forms - 2026.docxSupporting Statement A
(003) Tab 2 - Supporting Statement - 30-day PRA - MED Forms - 2025.docxSupporting Statement A
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form and Instruction
Medical Examination for Immigrant or Refugee Applicant Form
Medical Examination for Immigrant or Refugee Applicant Form
Medical Examination for Immigrant or Refugee Applicant Form
Medical Examination for Immigrant or Refugee Applicant Form
Medical Examination for Immigrant or Refugee Applicant Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202601-1405-002 Revision of a currently approved collection 2026-01-08 Approved with change
202503-1405-005 No material or nonsubstantive change to a currently approved collection 2025-03-20 Approved without change
202207-1405-004 Revision of a currently approved collection 2022-07-21 Approved without change
202112-1405-010 Revision of a currently approved collection 2021-12-20 Approved with change
202010-1405-004 Revision of a currently approved collection 2020-10-23
201709-1405-003 Revision of a currently approved collection 2017-09-15 Approved without change
201501-1405-001 No material or nonsubstantive change to a currently approved collection 2015-01-05 Approved without change
201410-1405-004 No material or nonsubstantive change to a currently approved collection 2014-10-29 Improperly submitted and continue
201407-1405-004 Revision of a currently approved collection 2014-07-21 Approved without change
201105-1405-007 Revision of a currently approved collection 2011-06-07 Approved without change
201005-1405-004 Revision of a currently approved collection 2010-05-10 Approved without change
200911-1405-003 Revision of a currently approved collection 2009-11-23 Approved without change
200904-1405-002 Revision of a currently approved collection 2009-04-09 Approved without change
200901-1405-001 No material or nonsubstantive change to a currently approved collection 2009-01-26 Withdrawn and continue
200801-1405-004 Revision of a currently approved collection 2008-01-31 Approved without change
200707-1405-001 Revision of a currently approved collection 2007-07-03 Approved without change
200601-1405-003 No material or nonsubstantive change to a currently approved collection 2006-01-24 Approved without change
200504-1405-004 No material or nonsubstantive change to a currently approved collection 2005-04-27 Approved without change
200402-1405-002 Extension without change of a currently approved collection 2004-02-05 Approved with change
200104-1405-004 No material or nonsubstantive change to a currently approved collection 2001-04-11 Approved without change
200004-1405-003 Revision of a currently approved collection 2000-04-25 Approved without change
199907-1405-009 Existing collection in use without an OMB Control Number 1999-07-09 Approved without change

OMB Details

Medical Examination for Immigrant or Refugee Applicant

Federal Enterprise Architecture: International Affairs and Commerce - Foreign Affairs

Information collection instruments
FormNameElectronic accessType
Form DS-3026Medical History and Physical Examination WorksheetFillable PrintableForm and instruction
Form DS-3030Tuberculosis WorksheetFillable PrintableForm and instruction
Form DS-3025Vaccination Documentation WorksheetFillable PrintableForm and instruction
Form DS-2054Medical Examination for Immigrant or Refugee ApplicantFillable PrintableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.