Chapter 1: Purpose and Background

A. Purpose​

USCIS balances public health interests against family unity and the needs of the applicant in adjudicating waivers of medical inadmissibility​. For this reason, one of the terms and conditions imposed on all applicants with the grant of a waiver is to receive treatment so that the ​medical ​condition no longer poses a public health risk.​

B. Background​

A medical exam​ination​ is generally required for all immigrant visa and some nonimmigrant visa applicants, as well as for refugees, and adjustment of status applicants. The purpose of the medical exam​ination​ is to determine if an applicant has a ​medical​ condition(s) that ​renders him or her inadmissible to ​the United States.​

Generally, applicants​establish their admissibility on medical​ ground​s​ by submitting ​a ​Report of Medical Examination and Vaccination Record​ (​Form I-693​)​, or Medical Examination for Immigrant or Refugee Applicant (1991 TB ​Technical Instructions​)​ (Form DS-2053)​ or Medical Examination for Immigrant or Refugee Applicant (2007 TB ​Technical Instructions​)​ (Form DS-2054)​, ​and related worksheets​.​ [1] As of October 1, 2013, panel physicians only use DS-2054.

C​ivil surgeons or panel physicians complete these documents after the medical examination of the applicant,​ [2] See INA 212 and INA 232. certifying the presence or absence of physical or mental conditions that may render the ​applicant​ inadmissible.​Two types of certifications may indicate to USCIS that the applicant may be inadmissible: a “Class A” and a “Class B” condition. ​

A Class A condition is conclusive evidence that an applicant is inadmissible on health-related grounds.​A Class B condition, unlike a Class A condition, does not make an applicant inadmissible on health-related grounds but may lead the officer to conclude that the ​applicant​ is inadmissible on other grounds (​such as ​public charge).​ [3] See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B] for more information on Class A and B conditions.

Before ​1957​,​ no waiver was available to ​applicant​s inadmissible on health-related grounds. The Immigration Act of 1957 created the first waiver provision for th​ose afflicted with tuberculosis ​who​ had close relatives in the ​United States​.​ [4] See Pub. L. 85-316, 71 Stat. 639 (Sept. 11, 1957). In addition, the 1965 amendments to the INA authorized the waiver of inadmissibility and admission of certain ​applicant​s in this category who had close relatives in the ​United States​.​ [5] See Pub. L. 89-236, 79 Stat. 911 (Oct. 3, 1965).

The Immigration Act of 1990​ [6] See Pub. L. 101-649, 104 Stat. 4978 (Nov. 29, 1990). relaxed the requirements for a familial relationship before a medical waiver could be granted. In addition, over time, other provisions were added to the 1952 Immigration Act that allowed for other waivers of medical grounds depending on the ​immigration ​benefit ​sought​.​

C. Scope​

If an applicant is inadmissible because of a medical condition,​ [7] Under INA 212(a)(1)(A), four categories of medical conditions may render an applicant inadmissible: (1) Communicable disease of public health significance (2) For immigrants, failure to show proof of required vaccinations(3) Physical or mental disorder with associated harmful behavior(4) Drug abuse or addictionSee Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B] for more information. he or she may have a waiver available. The availability of a waiver depends on the legal provisions governing the immigration benefit the applicant seeks. ​

This Part C only addresses ​the processes used for​ the medical waiver available to persons seeking an immigrant visa or adjustment of status based on a family- or employment-based petition.​ [8] Under INA 212(g).All medical grounds of inadmissibility have a corresponding waiver ​under​this section​except​for​ inadmissibility based on drug abuse or addiction.​ [9] See INA 212(g), which specifically waives INA 212(a)(1)(A)(i)-INA 212(a)(1)(A)(iii) but omits reference to INA 212(a)(1)(A)(iv).

Applicants for other immigration benefits categories, such as refugees and ​asylees​ seeking adjustment,​ [10] Under INA 209. Legalization or SAW applicants,​ [11] Under INA 245A and INA 210. or applicants under other special programs, may have additional or other means to waive grounds of medical inadmissibility,​including inadmissibility ​for drug abuse or addiction​.​ [12] For example, an asylee or a refugee seeking adjustment of status who is found to be a drug abuser or addict may apply for a waiver of inadmissibility under INA 209(c). INA 209(c) waivers are not addressed in this Part.,​ [13] While these other waivers may be briefly discussed in this chapter, more detailed discussion can be found in the program-specific waiver chapters in this volume.

Many of the processes mentioned​ in this Part C​ are also applicable to other ​medical ​waivers, such ​as those​ obtained by ​asylees​ or refugees seeking adjustment of status.​

D. Legal ​Authorities​

INA 212(a)(1)​ – Health-Related Grounds ​

INA 212(g)​– Bond and Conditions for Admission of Alien Excludable on Health-Related Grounds​

8 CFR 212.7​ – Waiver of Certain Grounds of Inadmissibility​

E. Forms Used When Applying For a Medical Waiver​

Applicants for the immigration benefits listed below may apply for a medical waiver by using the following USCIS forms:​ [14] For further information on waivers other than the medical waiver described in this Part, please see the program-specific waiver chapters in this volume.

Applying for Waiver ​of​ Health-Related Ground of Inadmissibility​

Immigration Benefits Category​

Statutory Authority for Waiver​

Relevant Form​

Adjustment of status or immigrant visa ​

INA 212(g)​

Application for Waiver of Grounds of Inadmissibility​ (​Form I-601​)​ (with the appropriate fee unless waived)​

Admission as refugee under ​INA 207​

INA 207(c)(3)​

Application by Refugee for Waiver of Grounds of Excludability​ (​Form I-602​)​ (no fee associated)​

Refugee or asylee applying for adjustment of status under ​INA 209​

INA 209(c)​

Legalization under ​INA 245A​

INA 245A(d)(2)(B)(i)​

Application for Waiver of Grounds of Inadmissibility Under Sections 245A or 210 of the Immigration and Nationality Act​ (​Form I-690​)​ (with the appropriate fee unless waived)​

Special Agricultural Workers (SAW) under ​INA 210​

INA 210(c)(2)(B)(i)​

T and U nonimmigrant visa ​

INA 212(d)(13)​ and ​INA 212(d)(14)​

Application for Advance Permission to Enter as Nonimmigrant​(​Form I-192​)​ (with the appropriate fee unless waived)​

Other nonimmigrant visa ​

INA 212(d)(3)(A)​

F. Role of Centers for Disease Control and Prevention (CDC)​

Any waiver application to overcome a medical ground of inadmissibility (other than lack of a required vaccination) must be sent to ​the U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC) ​for review before USCIS can determine whether to grant or deny the waiver.​

CDC​’s favorable response​ does not constitute ​a ​waiver approval​. T​he purpose of CDC’s review ​is to ensure that ​

The civil surgeon or panel physician examined, diagnosed, and classified the applicant according to the ​Technical Instructions​; and​

The applicant (or person assuming the responsibility on behalf of the applicant) has identified a suitable health care provider in the ​United States​ who will provide medical care and treatment for the medical condition if a waiver is granted.​

CDC’s response​, however,​ carries significant weight in determining what terms, conditions, or controls should be placed on the waiver, and whether ​USCIS should approve the​ waiver​.​