15986 Federal Register / Vol. 74, No. 66 / Wednesday, April 8, 2009 / Notices 

1For purposes of this Notice, ‘‘potential to cause 

an outbreak’’ means the occurrence of more cases 

of disease than could be anticipated in a given area 

or among a specific group of people over a 

particular period of time. In general, and as 

observed through previous experience, an outbreak 

is associated with a public health response. 

(7) Information on control measures 

(e.g., engineering controls, work 

practices, PPE) being taken to minimize 

worker exposure to CNTs. 

Dated: March 31, 2009. 

James D. Seligman, 

Chief Information Officer, Centers for Disease 

Control and Prevention. 

[FR Doc. E9–7941 Filed 4–7–09; 8:45 am] 

BILLING CODE 4163–19–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

Criteria for Vaccination Requirements 

for U.S. Immigration Purposes 

AGENCY: Centers for Disease Control and 

Prevention (CDC), Department of Health 

and Human Services (HHS). 

ACTION: Notice with comment period. 

SUMMARY: The Centers for Disease 

Control and Prevention (CDC) is seeking 

public comment on a set of proposed 

criteria to be used in determining which 

vaccines recommended by the Advisory 

Committee on Immunization Practices 

(ACIP) for the general United States 

population should be required for 

immigrants seeking admission into the 

United States or seeking adjustment of 

status to that of an alien lawfully 

admitted for permanent residence. 

Under section 212 of the Immigration 

and Nationality Act (INA) (8 U.S.C. 

1182), an alien who seeks admission as 

an immigrant, or who seeks adjustment 

of status to one lawfully admitted for 

permanent residence, must present 

documentation for having received 

vaccination for ‘‘vaccine-preventable 

diseases, which shall include at least 

the following diseases: mumps, measles, 

rubella, polio, tetanus and diphtheria 

toxoids, pertussis, Haemophilus 

influenzae type B and hepatitis B, and 

any other vaccinations against vaccinepreventable diseases recommended by 

the Advisory Committee on 

Immunization Practices.’’ Because the 

INA explicitly requires vaccinations for 

some vaccine-preventable diseases 

(mumps, measles, rubella, polio, tetanus 

and diphtheria toxoids, pertussis, 

Haemophilus influenzae type B and 

hepatitis B), CDC will continue to 

require those vaccinations for 

immigrants seeking admission into the 

United States or seeking to adjust their 

status to that of legal permanent 

resident. CDC has developed specific 

criteria to determine which other 

vaccinations recommended by ACIP for 

the general population will be required 

for such immigrants. Through this 

notice, CDC proposes to begin use of the 

following criteria: 

1. The vaccine must be an ageappropriate vaccine as recommended by 

ACIP for the general U.S. population, 

and 

2. At least one of the following: 

a. The vaccine must protect against a 

disease that has the potential to cause 

an outbreak.1

b. The vaccine must protect against a 

disease that has been eliminated in the 

United States, or is in the process for 

elimination in the United States. 

The evolution of vaccine development 

has progressed to include those 

targeting specific groups and chronic 

morbidity and mortality. Therefore, CDC 

is now developing specific criteria to be 

applied against each vaccine in lieu of 

requiring all ACIP recommended 

vaccines for immigration purposes. CDC 

has taken a scientific, evidence-based, 

public health approach in developing 

these criteria, and has considered the 

unique characteristics of the time and 

place of the medical screening process 

for U.S. immigration purposes. 

Using specific scientific-based criteria 

to determine the relevant vaccines 

required for U.S. immigration purposes 

will ensure CDC decision-making 

regarding vaccination requirements is 

grounded in public health necessity and 

need in light of a growing list of 

vaccines for infectious and noninfectious diseases. 

After consideration of public 

comments received through this notice, 

as well as those received during an 

ACIP meeting held at CDC February 25– 

26, 2009, CDC will publish a notice 

regarding implementation of the final 

criteria for determining which vaccines 

recommended by ACIP for the U.S. 

population will be required for 

immigrants in accordance with section 

212(a)(1)(A)(ii) of the Immigration and 

Nationality Act, Section 212 (8 U.S.C. 

1182(a)(1)(A)(ii)). 

CDC will continue to work closely 

with the Department of Homeland 

Security and the Department of State in 

the implementation of the vaccination 

requirements for U.S. immigration 

purposes. 

DATES: Written comments must be 

received on or before May 8, 2009. 

Comments received after April 8, 2009 

will be considered to the extent 

possible. 

ADDRESSES: You may submit written 

comments to the following address: 

Division of Global Migration and 

Quarantine, Centers for Disease Control 

and Prevention, U.S. Department of 

Health and Human Services, Attn: 

Immigration Vaccination Requirements, 

1600 Clifton Road, NE., MS E–03, 

Atlanta, Georgia, 30333. 

You may also submit written 

comments via e-mail to 

DGMQpubliccomments@cdc.gov. 

FOR FURTHER INFORMATION CONTACT: 

David M. McAdam, Division of Global 

Migration and Quarantine, Centers for 

Disease Control and Prevention, U.S. 

Department of Health and Human 

Services, 1600 Clifton Road, NE., MS E– 

03, Atlanta, Georgia 30333; telephone 

404–498–1600. 

SUPPLEMENTARY INFORMATION: 

Background 

Medical examinations for immigration 

purposes are authorized under section 

232 of the Immigration and Nationality 

Act (INA) (8 U.S.C. 1222) Under 

sections 212(a)(1) and 232 of the INA (8 

U.S.C. 1182(a)(1) and 1222), and section 

325 of the Public Health Service Act (42 

U.S.C. 252), the Department of Health 

and Human Services (HHS) establishes 

requirements for the medical 

examination. The Secretary of HHS has 

delegated this authority to the Centers 

for Disease Control and Prevention 

(CDC), and it is administered by CDC’s 

Division of Global Migration and 

Quarantine (DGMQ). These 

requirements are codified in 42 CFR 

part 34, Medical Examination of Aliens. 

Panel physicians and civil surgeons, 

through contractual agreements and by 

designations with the Department of 

State and the Department of Homeland 

Security, respectively, conduct the 

medical examinations in accordance 

with these regulations and as provided 

for in Technical Instructions (TIs) 

issued by CDC/DGMQ. The vaccination 

requirements for U.S. immigration 

purposes are listed in the Technical 

Instructions (see http://www.cdc.gov/ 

ncidod/dq/technica.htm). 

Under section 212(a)(1)(A)(ii) of the 

Immigration and Nationality Act (8 

U.S.C. 1182(a)(1)(A)(ii)), an alien who 

seeks admission as an immigrant, or 

who seeks adjustment of status to one 

lawfully admitted for permanent 

residence, must present documentation 

for having received vaccination for 

‘‘vaccine-preventable diseases, which 

shall include at least the following 

diseases: mumps, measles, rubella, 

polio, tetanus and diphtheria toxoids, 

pertussis, Haemophilus influenzae type 

B and hepatitis B, and any other 


rwilkins on PROD1PC63 with NOTICES
Federal Register / Vol. 74, No. 66 / Wednesday, April 8, 2009 / Notices 15987 

2For purposes of this Notice, ‘‘potential to cause 

an outbreak’’ means the occurrence of more cases 

of disease than could be anticipated in a given area 

or among a specific group of people over a 

particular period of time. In general, and as 

observed through previous experience, an outbreak 

is associated with a public health response. 

vaccinations against vaccinepreventable diseases recommended by 

the Advisory Committee on 

Immunization Practices[(ACIP).]’’ The 

ACIP is a committee chartered under the 

Federal Advisory Committee Act 

(FACA). The ACIP makes vaccine 

recommendations for the U.S. 

population to the CDC Director, who, in 

accordance with FACA, is ultimately 

responsible for accepting, rejecting, or 

modifying those recommendations. Any 

immigrant or applicant applying for 

adjustment of status in the U.S., who is 

unable to present proof of vaccination, 

is inadmissible into the United States 

unless the immigrant or applicant 

receives the required vaccines or applies 

for and receives a statutory waiver. Such 

waivers may be issued if, for example, 

during the medical examination, the 

examiner determines that a vaccination 

is not medically appropriate. 

Since 1996, when the vaccination 

requirement was added to the INA, all 

vaccinations routinely recommended by 

ACIP for the U.S. population have been 

required for immigrants subject to the 

INA vaccination requirement. Although 

this vaccination requirement has been 

in effect since 1996, the continued 

evolution of vaccine development has 

led CDC to reassess the appropriateness 

for each recommended vaccine in the 

context of U.S. immigration in the 

interest of public health. 

Implementation of Specific Vaccination 

Criteria 

The ACIP recommendations regarding 

vaccines are extremely important for 

optimizing individual health status, 

protecting the public health of the 

Nation, and providing technical 

guidance for State-based mandates for 

school, child care, employment and 

other settings. However, to date, the 

ACIP recommendations have been 

applied to persons undergoing medical 

examination for U.S. immigration 

without consideration for the unique 

characteristics of such screening, which 

include the urgency of time in which 

the vaccination is required and the 

location of the individual immigrant, or 

group of immigrants, at the time of the 

medical examination. While the ACIP 

vaccination recommendations are 

appropriate for the general U.S. 

population, CDC is proposing specific 

criteria to determine which ACIPrecommended vaccines are appropriate 

as a requirement at the time and place 

of medical examination for immigration. 

For example, within these criteria, 

vaccinations will be administered to 

applicants if they are considered to be 

‘‘age-appropriate’’ as recommended by 

ACIP for the general U.S. population 

(i.e. the applicant is within the ACIPrecommended age groups of the vaccine 

at the time of the examination). Once it 

is determined that a vaccine is ageappropriate, the vaccine will only be 

administered if it is determined to be 

appropriate in the immigration setting 

due to the potential of diseases to cause 

outbreaks and/or to be introduced into 

the United States, where they have been 

eliminated or are in the process of 

elimination. In contrast, all other ACIP 

recommended vaccines should be 

administered once the applicant is 

admitted to the United States according 

to CDC immunization schedule and 

State-based vaccination mandates. 

Therefore, CDC is proposing to 

implement the vaccination requirements 

provided for in section 212(a)(1)(A)(ii) 

of the INA as follows: Because section 

212(a)(1)(A)(ii) explicitly requires 

vaccinations for listed vaccinepreventable diseases (mumps, measles, 

rubella, polio, tetanus and diphtheria 

toxoids, pertussis, Haemophilus 

influenzae type B and hepatitis B), CDC 

will continue to require those 

vaccinations for immigrants seeking 

admission into the United States or 

seeking to adjust their status to the 

status of legal permanent resident. CDC 

will use the criteria below for 

determining which additional vaccines 

recommended by ACIP for the general 

population will be required for such 

immigrants. All vaccines will remain 

subject to statutory waivers, if 

applicable. In addition, CDC will review 

the list of vaccines recommended by 

ACIP for the general U.S. population on 

a regular basis and apply the specific 

criteria to determine which additional 

vaccines will be required for U.S. 

immigration purposes. 

CDC proposes to use the following 

criteria: 

1. The vaccine must be an ageappropriate vaccine as recommended by 

ACIP for the general U.S. population, 

and 

2. At least one of the following: 

a. The vaccine must protect against a 

disease that has the potential to cause 

an outbreak.2

b. The vaccine must protect against a 

disease that has been eliminated in the 

United States, or is in the process for 

elimination in the United States. 

Through the issuance of revised 

Technical Instructions and other 

standard operating procedures, CDC 

upon application of the criteria will 

notify the panel physicians and civil 

surgeons who conduct the medical 

examination of any changes to the 

vaccination requirements for U.S. 

immigration purposes. 

Dated: April 1, 2009. 

James D. Seligman, 

Chief Information Officer, Centers for Disease 

Control and Prevention. 

[FR Doc. E9–7934 Filed 4–7–09; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Office of Community Services; Notice 

To Award a Non-Competitive 

Successor Grant to Neighborhood 

Assets 

AGENCY: Administration for Children 

and Families (ACF), Department of 

Health and Human Services (HHS). 

ACTION: Notice to award a noncompetitive successor grant to 

Neighborhood Assets. 

CFDA#: 93.602. 

Project Period: September 30, 2004 to 

September 29, 2009. 

Award Amount: 100,000. 

Statutory Authority: The Assets for 

Independence Act (Title IV of the 

Community Opportunities, Accountability, 

and Training and Educational Act of 1998, as 

amended, Pub. L. 105–285, 42 U.S.C. 604 

note). 

SUMMARY: Notice is hereby given that 

the Administration for Children and 

Families (ACF), Office of Community 

Services (OCS) will award a noncompetitive successor grant to 

Neighborhood Assets, a non-profit 

organization located in Spokane, 

Washington. The Assets for 

Independence program supports 

grantees that provide low-income 

individuals and families with access to 

special matched savings accounts called 

individual development accounts (IDAs) 

and other asset-building tools such as 

financial literacy education and 

coaching and training on money 

management and consumer issues. The 

award will enable the Neighborhood 

Assets to implement an Assets for 

Independence project serving lowincome families in Spokane, 

Washington. This action is taken as the 

original grantee, Spokane Neighborhood 

Action Programs, has relinquished the 

grant. 

FOR FURTHER INFORMATION CONTACT: Mr. 

James Gatz, Manager, Assets for 


rwilkins on PROD1PC63 with NOTICES