Report of Medical Examination and Vaccination Record

OMB 1615-0033

The information on the application will be used by USCIS in considering eligibility for adjustment of status under 8 CFR part 209, 8 CFR 210.5, 245.5 and 245a.3.

The latest form for Report of Medical Examination and Vaccination Record expires 2022-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form I-693 Report of Medical Examination and Vaccination Record Form
I-693-011 REV Supporting Statement 20221003.docx Supporting Statement A
I693-011-INS-TOC-REV-OMBReview-10032022.docx Supplementary Document
I693-011-FRM-TOC-REV-OMBReview-10032022.docx Supplementary Document
I693-011 30dayFRN 87 FR 50348 2022-17529.pdf Supplementary Document
I-693-011-REV-60-DayFRN-87-FR-35241_2022-12411.pdf Supplementary Document
SORN 007 Benefits Info Sys 2016 10 19.pdf Supplementary Document
SORN 001 AFileIndexNFTS 2017 09 18.pdf Supplementary Document
privacy-pia-uscis-067-civilsurgeon-june1,2017.pdf Supplementary Document
privacy-pia-003-uscis-iddmp-sept24,2013.pdf Supplementary Document
Reference citations.doc Supplementary Document
Report of Medical Examination and Vaccination Record Form

All Historical Document Collections

202209-1615-003 Approved without change	Revision of a currently approved collection	2022-12-27
202201-1615-003 Approved without change	Extension without change of a currently approved collection	2022-02-18
202108-1615-004 Approved with change	Revision of a currently approved collection	2021-09-08
201901-1615-011 Approved without change	Revision of a currently approved collection	2019-02-08
201710-1615-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2017-10-04
201703-1615-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2017-04-28
201609-1615-004 Approved with change	Revision of a currently approved collection	2016-09-29
201412-1615-012 Approved with change	Revision of a currently approved collection	2015-01-28
201209-1615-001 Approved with change	Revision of a currently approved collection	2012-10-31
201107-1615-005 Approved with change	Revision of a currently approved collection	2011-07-26
201006-1615-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2010-06-16
200912-1615-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2009-12-29
200907-1615-004 Approved with change	Revision of a currently approved collection	2009-07-21
200803-1615-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2008-03-26
200710-1615-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2007-10-09
200703-1615-007 Approved without change	Revision of a currently approved collection	2007-05-24
200603-1615-002 Approved without change	Extension without change of a currently approved collection	2006-03-13
200506-1615-006 Approved without change	Reinstatement without change of a previously approved collection	2005-06-23
200504-1615-002 Improperly submitted and continue	Extension without change of a currently approved collection	2005-04-29
200303-1615-035 Approved without change	Extension without change of a currently approved collection	2003-03-01