Report of Medical Examination and Vaccination Record

OMB 1615-0033

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.

All Historical Document Collections
Approved with change
Revision of a currently approved collection 2021-09-08
Approved without change
Revision of a currently approved collection 2019-02-08
Approved without change
No material or nonsubstantive change to a currently approved collection 2017-10-04
Approved without change
No material or nonsubstantive change to a currently approved collection 2017-04-28
Approved with change
Revision of a currently approved collection 2016-09-29
Approved with change
Revision of a currently approved collection 2015-01-28
Approved with change
Revision of a currently approved collection 2012-10-31
Approved with change
Revision of a currently approved collection 2011-07-26
Approved without change
No material or nonsubstantive change to a currently approved collection 2010-06-16
Approved without change
No material or nonsubstantive change to a currently approved collection 2009-12-29
Approved with change
Revision of a currently approved collection 2009-07-21
Approved without change
No material or nonsubstantive change to a currently approved collection 2008-03-26
Approved without change
No material or nonsubstantive change to a currently approved collection 2007-10-09
Approved without change
Revision of a currently approved collection 2007-05-24
Approved without change
Extension without change of a currently approved collection 2006-03-13
Approved without change
Reinstatement without change of a previously approved collection 2005-06-23
Improperly submitted and continue
Extension without change of a currently approved collection 2005-04-29
Approved without change
Extension without change of a currently approved collection 2003-03-01

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