Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 591 - VISA WAIVER PROGRAM FOR INTERNATIONAL MEDICAL GRADUATES › Subpart B - PROCEDURES FOR J-1 VISA WAIVER REQUESTS › Section 591.120 - Application Materials and Processing

Current through Register Vol. 48, No. 28, July 12, 2024
a) Application materials are available from
				the Department's web site at:
https://dph.illinois.gov/content/dam/soi/en/web/idph/forms/topics-services/life-stages-populations/rural-underserved-populations/j1-waiver-program/j-1waiver-application922021.pdf
.
Applications shall be sent to:
J-1 Visa Waiver Program
Illinois Department of Public Health
Center for Rural Health
535 West Jefferson Street, Ground Floor
Springfield, Illinois 62761-0001
or electronically to: dph.j1waiver@illinois.gov.
b) The application materials shall
				include the following:
1) A statement from the
				physician's employer describing prior recruitment difficulties, the expected
				practice arrangement for the physician, and the impact on the medical facility
				and the patients it serves if the waiver is not approved;
2) An attestation from each medical facility
				where the physician will work that it accepts all patients regardless of the
				ability to pay, accepts Medicaid and Medicare on assignment, and uses a
				sliding-fee scale based on federal poverty guidelines to discount services to
				low-income uninsured persons. The attestation must also state that these
				discounts are offered to all patients of all providers at the medical facility
				and not only to the patients of the J-1 waiver applicant. This is not required
				for forensic pathologists who apply for a J-1 waiver and propose to work at a
				medical examiner's office;
3) A
				copy of the executed employment contract between the physician and the
				employer.
A) The contract shall include:
i) The name and address of the medical
				facility where the physician will work (if the physician will work at more than
				one medical facility, the contract shall contain this information for each
				facility);
ii) If the physician
				will work at more than one medical facility, a statement on which medical
				facility the physician will predominately work. For purposes of this Part,
				predominately means the physician will work at least 21 hours (per week) at
				this medical facility;
iii) A
				statement that the physician will practice full-time.
iv) A statement that any amendments to the
				contract will adhere to State and federal J-1 visa waiver
				requirements;
v) A statement that
				termination of the physician may be only for cause;
vi) A statement that the physician will begin
				working at the medical facility within 90 days after receiving the waiver,
				completing graduate medical education, or receiving employment authorization
				(whichever is later) from the U.S. Department of Homeland Security, Citizenship
				and Immigration Services;
vii) A
				list of benefits and insurance to be provided to the physician;
viii) A statement that the employer will not
				add additional work locations without approval of the Department; and
ix) A statement that the contract will be in
				effect for, at a minimum, three years.
B) The employment contract shall not include
				the following, in accordance with
				22 CFR
				41.63(i):
i) A non-compete clause;
ii) A liquidated damages clause; or
iii) A termination without cause
				provision.
4)
				A statement from the employer that the salary offered to the physician is
				equivalent to that offered to all other physicians with equivalent skills and
				experience recruited by employer;
5) A letter from the chief medical officer or
				other high-level hospital executive verifying that hospital admitting
				privileges will be granted to the physician and, if not, how admissions of the
				physician's patients will be arranged. If the physician will work at multiple
				hospitals, each hospital shall submit this letter in the application;
6) A letter from at least one local
				organization or agency, such as the chamber of commerce, local health
				department, or other community-based organization, demonstrating support for
				the physician's waiver application;
7) A copy of the applicant's Illinois medical
				license or application for an Illinois medical license;
8) A copy of the applicant's completed U.S.
				Department of State, J-1 Visa Waiver Recommendation Application
				(DS-3035);
9) A copy of the
				applicant's curriculum vitae;
10) A
				copy of the IAP-66/DS-2019 Form (Certificate for Exchange Visitor J-1 Status)
				for each year the applicant was in J-1 status;
11) Copies of the applicant's U.S. Customs
				and Border Protection I-94 Entry and Departure Cards;
12) Form G-28, Notice of Entry of Appearance
				as Attorney or Accredited Representative (if applicant is represented by an
				attorney);
13) A personal statement
				from the applicant regarding the applicant's reasons for not wishing to fulfill
				the two-year country of nationality legal residence requirement;
14) For specialists who apply through the J-1
				visa waiver flex option, documentation that a shortage exists in their
				specialty for patients they propose to serve who reside in an HPSA, that is
				greater than the norm. This shortage is determined by creating a ratio of
				physicians to the population using a listing of physicians in that specialty
				who provide service in the HPSA and the population of the HPSA using the most
				recent data available. If the ratio of physician to population is greater than
				1:10,000, a greater shortage of that specialty exists in the HPSA than is the
				norm. Documentation may include, but not be limited to, the following:
A) A listing of specialists who provide
				service in the HPSA; or
B) If there
				are no specialists who provide service in the HPSA, the applicant shall provide
				a summary listing the number of patients in the HPSA who migrated out of the
				HPSA to seek service. This summary shall be for the most recent 12-month period
				and shall include the travel time and distance these patients incurred to
				obtain service;
15) For
				specialists who apply through the J-1 visa waiver flex option, documentation
				comparing wait times for an appointment with a physician of the same specialty
				for patients who reside in the HPSA they propose to serve. Documentation may
				include, but not be limited to, the following:
A) A listing of specialists who provide
				service in the HPSA, including the average wait time for an appointment;
				or
B) If there are no specialists
				who provide service in the HPSA, the applicant shall provide a summary listing
				the number of patients who migrated out of the HPSA to seek service. The
				summary shall be for the most recent 12-month period and shall include the
				average wait time for an appointment;
16) A completed and notarized Certification
				Statement A regarding the contractual requirements set forth in section
				214(k)(1)(B) and (C) of the Immigration and Nationality Act;
17) A completed and notarized Certification
				Statement B describing the applicant's obligation to the applicant's country of
				nationality or country of last legal residence. If the applicant has a
				contractual obligation to return to the applicant's country of nationality or
				country of last legal residence, the applicant shall obtain a letter from that
				country stating no objection to the applicant remaining in the United
				States;
18) A completed and
				notarized Certification Statement C attesting that the applicant's medical
				license has never been suspended or revoked and that the applicant is not
				subject to any criminal investigation or proceedings by any medical licensing
				authority;
19) A completed and
				notarized Certification Statement D regarding the accuracy of the application
				materials; and
20) A completed and
				notarized Certification Statement E regarding medical specialty status.
				(Certification Statements A through E are included in the waiver application
				form provided by the Department.)