# Vaccination Requirements

These Questions and Answers provide basic information about the general vaccination requirements for immigrants (including individuals seeking adjustment of status), and specifically about the assessment made by the civil surgeon to determine whether an applicant meets the vaccination requirements. These Questions and Answers do not address the vaccination assessments conducted by panel physicians overseas.

For refugees applying for adjustment of status, health department physicians may complete only the vaccination record portion of Form I-693, Report of Medical Examination and Vaccination Record, as blanket-designated civil surgeons.

## Background

Under the immigration laws of the United States, a noncitizen who applies for an immigrant visa abroad, or who seeks to adjust status to that of a lawful permanent resident while in the United States, is required to receive vaccinations to prevent the following diseases:
                - Mumps;
                - Measles;
                - Rubella;
                - Polio;
                - Tetanus and Diphtheria Toxoids;
                - Pertussis;
                - Haemophilus influenzae type B;
                - Hepatitis B;
                - COVID-19; and
                - Any other vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices (ACIP).

The ACIP is an advisory committee to the Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) that recommends immunizations for the general U.S. population. Since Dec.14, 2009, when the ACIP recommends new vaccines for the general U.S. population, CDC assesses whether these vaccines should be required for immigration purposes on a regular and on an as-needed basis according to specific criteria set by CDC.

CDC is responsible for publishing the Technical Instructions for Civil Surgeons. These documents and the HHS regulations set the requirements for the immigration medical examination and are binding on civil surgeons (See the CDC Vaccination Technical Instructions for Civil Surgeons and 42 C.F.R. Section 34.3). The Technical Instructions include a vaccination component, specifying how the civil surgeon has to conduct the vaccination assessment. The civil surgeon records the results of the immigration medical examination, including the results of the vaccination assessment, on USCIS Form I-693.

If a noncitizen applies for an immigrant visa abroad, that individual has to undergo an immigration medical examination conducted by a panel physician authorized by the U.S. Department of State (DOS). CDC issues separate instructions to panel physicians designated by DOS to conduct immigration medical examinations abroad. For more information about panel physicians, please consult CDC’s and DOS's websites

Technical Instructions for Panel Physicians | CDC

Medical Examinations FAQs (state.gov).

## Questions and Answers

**Q. Where can I find information about vaccinations in general?**A. CDC publishes information about vaccinations in general and information about the vaccine requirements for immigration purposes at www.cdc.gov/vaccines/.

**Q. Why do immigrants (including adjustment of status applicants) have to show proof they have received certain vaccinations?**A. Under the Immigration and Nationality Act (INA) section 212(a)(1)(A)(ii), a noncitizen who seeks admission as an immigrant or who seeks adjustment of status to that of a lawful permanent resident, who fails to show proof that they were vaccinated against vaccine-preventable diseases, is inadmissible and therefore ineligible for admission or adjustment of status.

**Q. How does the CDC decide which vaccines are required for immigration purposes?**A. Some of the vaccines that are required are specifically listed in INA section 212(a)(1)(A)(ii). In addition to these, the statute also requires that an individual receive any other vaccinations recommended by the ACIP. CDC uses the following criteria in determining which of these recommended vaccines should be required for immigration purposes:
                - The vaccine must be an age-appropriate vaccine as recommended by the ACIP for the general U.S. population; and
                - At least one of the following:	                   - The vaccine must protect against a disease that has the potential to cause an outbreak; or
                  - The vaccine must protect against a disease eliminated in the United States,or is in the process of being eliminated in the United States.

**Q. I am seeking adjustment of status but already completed an immigration medical examination abroad completed by a panel physician and also received some vaccines. Do I have to repeat the immigration medical examination and get the vaccines again?**A. Some applicants who have previously completed an immigration medical examination abroad, including applicants applying for adjustment of status as refugees, are not required to repeat the entire immigration medical examination when they apply for adjustment. Please read the instructions to Form I-693 to determine if you must repeat the immigration medical examination, including the vaccination assessment, based on your current status in the United States and the immigration category under which you are applying for adjustment of status. For more information see USCIS Policy Manual Applicability of Medical Examination and Vaccination Requirement.

**Q. How do I know which vaccines are required for immigration purposes?**A. A civil surgeon is required to follow the Technical Instructions for Civil Surgeons,. CDC publishes the vaccination requirements and immigration medical examination instructions (including a detailed table listing all required vaccines) at www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/vaccination-civil-technical-instructions.html

**Q. Do I have to receive all the required vaccines, even though I have been vaccinated before?**A. No. The civil surgeon will review your vaccination records at the time of your immigration medical examination to see whether you have proof of required vaccinations against vaccine-preventable diseases that are appropriate for your age category. It is important that you take any written vaccination documentation you may have to the civil surgeon when you have your immigration medical examination.

If you lack any vaccinations required for your age category, the civil surgeon will administer the vaccines as needed. In the alternative, you can also choose to obtain the required vaccines from your private healthcare provider. However, because only a civil surgeon is authorized to complete the vaccination assessment on the Form I-693, you must return to the civil surgeon with the proof that you have received the missing vaccines.

In addition, some individuals are immune to vaccine-preventable diseases, and they know of the immunity because their private healthcare provider has tested them. If you have any written evidence of immunity, you should take this documentation to your civil surgeon. This will enable the civil surgeon to determine which vaccines you need to receive.

**Q. Do I have to receive all the vaccines on CDC's vaccination list for the immigrant population, or only the ones that are age appropriate?**A. You are required to document receipt of vaccines that are age appropriate for you. The civil surgeon will annotate Form I-693 to indicate that you were not required to receive a particular vaccine because it was not age appropriate at the time of the immigration medical examination.

**Q. Do I have to receive all the vaccines that are on CDC's list and that are age appropriate, if I have a medical condition that prevents me from receiving the required vaccines?**A. If you have a medical condition that prevents you from receiving a vaccine that is appropriate for your age, the civil surgeon will annotate the Form I-693 accordingly and mark the vaccine as contraindicated. A contraindication is a condition that prevents you from receiving a particular vaccine. CDC lists in its Technical Instructions what is considered a contraindication. It is up to the civil surgeon to determine whether you have such a condition that prevents you from receiving a particular vaccine at the time of the immigration medical examination.

**Q. Certain vaccine series can only be completed with multiple visits to the civil surgeon. Am I required to complete the entire series before the civil surgeon can sign the Form I-693?**A. You are only required to receive a single dose of each vaccine when you visit the civil surgeon. You are encouraged to follow up with your private health care provider to complete the series. Once you have received the single dose appropriate at the time, the civil surgeon can sign and certify the Form I-693. The COVID-19 vaccine is the exception to this requirement. You must complete the COVID-19 vaccine primary series (for example, 1 or 2 doses, depending on which vaccine, in adults; 2 or 3 doses, depending on age and which vaccine, in children) and provide documentation of vaccination to the civil surgeon in person before completion of the medical examination. For more information about the COVID-19 vaccination requirement see the CDC Technical Instructions.

**Q. I am pregnant and do not wish to receive any vaccinations. Do I still have to get them to be able to obtain permanent resident status in the United States?**A. If you are pregnant, the CDC's Technical Instructions direct the civil surgeon how to evaluate the vaccines you are able to receive during pregnancy. If the civil surgeon cannot safely administer a required vaccine, they will annotate the Form I-693 by marking the vaccine as contraindicated. See the CDC “Guidelines for Vaccinating Pregnant Women” page for information on pregnancy and vaccinations in general. If the Technical Instructions mandate that a specific vaccine is not contraindicated by pregnancy, but you want to wait to receive the vaccine until after your pregnancy, you may choose to delay the completion of your immigration medical examination until that time. Once you receive the required vaccine(s) and all other requirements, the civil surgeon can then sign and complete your immigration medical examination. However, you should be aware that this could delay the processing of your application for adjustment of status.

**Q. Can the civil surgeon safely administer all vaccines that are required all at once?**A. The civil surgeon will let you know if you can receive all the vaccines at once, or if there is a concern based on your particular medical condition that will not allow you to receive all required vaccines at once.

**Q. When does the flu season start for purposes of the seasonal flu vaccine requirement? Since the seasonal flu vaccine is required, do I have to get the seasonal flu vaccine if it is not the flu season?**A. For purposes of the immigration medical examination, the civil surgeon is required to administer the flu vaccine when it is available to them. This availability differs by location, but the vaccine is usually available from October until March. If your immigration medical examination is during a period when the flu vaccine is available to your civil surgeon, you must receive it. If you have an immigration medical examination completed when the flu vaccine is not available to your civil surgeon, then you are not required to document that you have received the seasonal flu vaccine for immigration purposes.

**Q. Who pays for the vaccinations?**A. You are responsible for paying the appropriate fee for all vaccinations. If the civil surgeon is administering the vaccinations, you are responsible for paying the appropriate fee directly to the civil surgeon, as agreed upon with the civil surgeon. You should ask about the price of the vaccinations before the immigration medical examination or the administration of the vaccinations. USCIS does not regulate the fees charged by civil surgeons for the completion of an immigration medical examination. Rates may vary by civil surgeon. It may be helpful to call several local civil surgeons to compare fees. For more information on how to obtain a good faith estimate prior to your appointment, please visit: Understanding costs in advance.

**Q. Can I be forced to be vaccinated for immigration purposes?**A. If you refuse to receive the vaccines required for immigration purposes, as mandated by the immigration laws of the United States, your application for legal permanent resident status may be denied.

**Q. What will happen if I refuse to receive one or all of the required vaccines?**A. Tell the civil surgeon if you do not wish to receive the required vaccines or a particular vaccine. You should also tell the civil surgeon the reason you do not wish to receive the vaccine(s). In this case, a waiver may be available to you, but only under the following circumstances:
                - You are opposed to all vaccinations in any form– a waiver may not be granted if you only object to specific vaccinations;
                - Your objection must be based on religious beliefs or moral convictions; and
                - The religious or moral beliefs must be sincere.

The form used to apply for a waiver depends on the adjustment category under which you are seeking legal permanent residence status. For example, refugees and asylees seeking adjustment of status should file Form I-602, Application by Refugee for Waiver of Grounds of Excludability. Individuals seeking adjustment of status based on an approved Form I-130, Petition for Alien Relative, or Form I-140, Immigrant Petition for Alien Worker, are required to file Form I-601, Application for Waiver of Grounds of Inadmissibility.

**Q. My civil surgeon says that a vaccine is currently not available. What should I do?**A. Ask the civil surgeon whether another health care provider may have the vaccine. If another physician or department or pharmacy carries the vaccine and can administer the vaccine, you should get the vaccine and request documentation that you have received the vaccine. Bring the written record back to the civil surgeon so that they can complete the Form I-693.

HHS/CDC monitors which vaccines are not available in the United States, or which vaccines may experience a shortage. If CDC determines there is a nation-wide shortage of a vaccine, it will recommend to USCIS to post a message on uscis.gov to explain to applicants and civil surgeons whether the vaccine is required and under what circumstances. The information is available on USCIS’ Form I-693 page, the Immigration Medical Examination page, or the Designated Civil Surgeon page.

**Q. Will USCIS accept a Form I-693 if the vaccination chart is incomplete?**A. No. The vaccination chart should have at least one entry in each row for each vaccine. If the vaccination chart is not properly completed at the time of the immigration medical examination, USCIS may return the Form I-693 to you with instructions on how to correct it.

If you refuse a vaccine because of religious or moral reasons, the civil surgeon will mark this on the Form I-693. In this case, you are inadmissible and will have to apply for a waiver of inadmissibility.

**Q: Where can I find more information about the vaccination requirements for immigration purposes and how these requirements affect the completion of Form I-693?**A. CDC publishes the Technical Instructions for Civil Surgeons, including the vaccination requirements, at  www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.htmlFor more information about the civil surgeon program, the completion of Form I-693, or the adjustment of status application, please visit uscis.gov, or call the USCIS Contact Center at 800-375-5283 (TTY 800-767-1833).

**Q: I am an Afghan National who was paroled into the United States under Operation Allies Welcome (OAW). What medical requirements apply to me so that I can maintain the conditions of my parole status?**A: Afghan Nationals paroled into the United States under Operations Allies Welcome can refer to www.uscis.gov/humanitarian/information-for-afghan-nationals under, “Afghan National Parolee Vaccination Status and Immigration Medical Examinations” in order to determine which specific medical requirements apply to them so that they can maintain the conditions of their parole.

## Related Links

                - Vaccination Technical Instructions for Civil Surgeons | CDC  Form I-693, Report of Medical Examination and Vaccination Record
                - CDC: Vaccines and Immunizations
                - 42 CFR Part 34.4 Medical notifications
                - CDC: Guidelines for Vaccinating Pregnant Women

12/21/2022

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