USCIS Policy Manual

VOLUME 9: WAIVERS

PART C: WAIVERS FOR HEALTH-RELATED GROUNDS OF INADMISSIBILITY

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 examination 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 examination 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 grounds by submitting a Report of Medical Examination and Vaccination Record (Form I-693(http://www.uscis.gov/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.


Civil 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 applicants inadmissible on health-related grounds. The Immigration Act of 1957 created the first waiver provision for those 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 applicants 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)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2301) – Health-Related Grounds 

    • INA 212(g)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2813) – Bond and Conditions for Admission of Alien Excludable on Health-Related Grounds

    • 8 CFR 212.7(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-15905/0-0-0-16484.html#0-0-0-9201) – 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)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2813)

Application for Waiver of Grounds of Inadmissibility (Form I-601(http://www.uscis.gov/i-601)) (with the appropriate fee unless waived)

Admission as refugee under INA 207(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1625.html)

INA 207(c)(3)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1625.html#0-0-0-1909)

Application by Refugee for Waiver of Grounds of Excludability (Form I-602(http://www.uscis.gov/i-602)) (no fee associated) 

Refugee or asylee applying for adjustment of status under INA 209(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html)

INA 209(c)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html#0-0-0-2121)

Legalization under INA 245A(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-7668/0-0-0-7794.html) 

INA 245A(d)(2)(B)(i)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-7668/0-0-0-7794.html#0-0-0-6081)

Application for Waiver of Grounds of Inadmissibility Under Sections 245A or 210 of the Immigration and Nationality Act (Form I-690(http://www.uscis.gov/i-690)) (with the appropriate fee unless waived)

Special Agricultural Workers (SAW) under INA 210(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1866.html)

INA 210(c)(2)(B)(i)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1866.html#0-0-0-2239)

T and U nonimmigrant visa 

INA 212(d)(13)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2791) and INA 212(d)(14)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2797)

Application for Advance Permission to Enter as Nonimmigrant (Form I-192(http://www.uscis.gov/i-192)) (with the appropriate fee unless waived)

Other nonimmigrant visa 

INA 212(d)(3)(A)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2731)


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. The 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.


Chapter 2: Waiver of Communicable Disease of Public Health Significance 


A. General


The INA authorizes USCIS to exercise discretion in deciding whether to waive inadmissibility based on a communicable disease of public health significance.[15] See INA 212(g)(1) and INA 212(a)(1)(A)(i). INA 212(g)(1) was also amended to include a specific provision for battered immigrants. See section 1505(d) of the Victims of Trafficking and Violence Protection Act of 2000 (VTVPA), Pub. L. 106-386, 114 Stat. 1464 (October 28, 2000). For more information on the inadmissibility determination based on communicable disease of public health significance, see Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility, Chapter 6, Communicable Diseases of Public Health Significance [8 USCIS-PM B.6]. USCIS may grant this waiver in accordance with such terms, conditions,[16] A condition of granting a waiver for an applicant with a communicable disease of public health significance, such as tuberculosis, is that the applicant must agree to see a doctor immediately upon admission and make arrangements to receive private or public medical care for that disease. This requirement is reflected, for example, in the Application for Waiver of Grounds of Inadmissibility (Form I-601), TB Supplement. and controls, if any, that USCIS considers appropriate after consultation with the Secretary of HHS.[17] See INA 212(g)(1)(B). This includes the grant of a waiver based on requiring payment of a bond. 


Once the officer has verified that the applicant is inadmissible because of a communicable disease of public health significance and requires a waiver,[18] Note that an applicant who has been determined to have a Class A condition involving a communicable disease of public health significance may successfully complete treatment. If, after treatment, the civil surgeon or panel physician certifies that the applicant now has a Class B condition, the applicant is no longer inadmissible and does not need a waiver.  the officer must go through the following steps to adjudicate the waiver application:


  • Determine whether the applicant meets the eligibility requirements of the waiver;


  • Consult with CDC; and


  • Determine whether the waiver is warranted as a matter of discretion. 


B. Special Note on HIV


As of January 4, 2010, HIV infection is no longer defined as a communicable disease of public health significance according to HHS regulations.[19] See 42 CFR 34.2(b) as amended by 74 FR 56547 (November 2, 2009). Therefore, HIV infection does not make an applicant inadmissible if the immigration benefit is adjudicated on or after January 4, 2010, even if the applicant filed the immigration benefit application before January 4, 2010. Officers should administratively close any HIV waiver application that is filed before January 4, 2010 but adjudicated on or after January 4, 2010.


C. Waiver Eligibility and Adjudication 


1. Qualifying Relationship


To be eligible for the waiver, the applicant must be one of the following:



The officer should verify that the existence of the appropriate relationship is well supported in the applicant’s file. 


2. Documentation for CDC’s Review 


As stated above, USCIS can only grant this waiver after it has consulted with CDC. However, CDC’s review of necessary documents does not constitute a waiver approval. CDC may recommend that USCIS should make the waiver subject to appropriate terms, conditions, or controls. 


To obtain CDC’s review of a waiver application, the officer should forward the following documents to CDC: 



Officers should only send copies, not originals, because CDC will retain the documents.

3. Sending Documents to CDC 


The documents should be mailed to the following address: 


Centers for Disease Control and Prevention (CDC)

Division of Global Migration and Quarantine

1600 Clifton Road, Mailstop E 03

Atlanta, GA 30333

Attention: Quality Assessment Program (QAP)/Waivers

 

If the officer determines that a waiver case warrants expeditious review by CDC, the case may be faxed to (404) 639-4441 or emailed to cdcqap@cdc.gov(mailto:cdcqap@cdc.gov), Attention: Quality Assessment Program (QAP)/Waivers, Urgent. If sent via email, the documents should be sent in password protected file(s). If sent via fax, the fax cover sheet should request that the case be reviewed expeditiously and that CDC’s response be sent via fax. The officer should also email CDC at cdcqap@cdc.gov(mailto:cdcqap@cdc.gov), advising that an expedited request was sent via fax. 


4. CDC Response


Once CDC receives and reviews the documents, CDC will forward a response letter with results of the review to the requesting USCIS office. CDC will not return any of the documents provided by USCIS; CDC will only send its recommendation in the response to the requesting USCIS office. 


CDC’s usual processing time for review and response to the requesting USCIS office is approximately 4 weeks. If CDC’s response appears delayed, the officer may contact CDC at cdcqap@cdc.gov(mailto:cdcqap@cdc.gov) to obtain a status update.


Upon receipt, the officer should review CDC’s response letter to determine next steps.


If CDC’s response letter indicates that CDC was satisfied with the initial documentation and that it does not require additional information, then the officer may proceed to the next step of the waiver adjudication. If CDC was not satisfied with the documentation, it may request additional information or recommend additional conditions to be met before the waiver may be granted. In such a case, the officer should issue a Request for Evidence (RFE) for the applicant to provide the additional information or to demonstrate that he or she made the arrangements required by CDC. 


If CDC requests it, the officer will need to submit the information obtained through the RFE to CDC to determine whether the additional information is sufficient. CDC will provide a response letter to the requesting USCIS office advising if the additional information is sufficient.


Once CDC indicates no additional information is needed, the officer may proceed with the next step of the waiver adjudication.


Note: For Class A TB waivers, CDC’s response letter will provide a specific recommendation whether CDC supports the granting of a waiver. 


5. Discretion 


As is generally the case for waivers, a waiver for communicable diseases of public health significance requires an officer to consider whether the grant of the waiver is warranted as a matter of discretion. Hardship to a qualifying relative is not required for this waiver.[26] See INA 212(g)(1).


CDC’s response in support of granting the waiver should ordinarily be sufficient to warrant a favorable exercise of discretion for the grant of the waiver. However, if an applicant declares openly his or her unwillingness to commit to treatment, the waiver may be denied as a matter of discretion.[27] If CDC certifies that an applicant who obtained an INA 212(g) waiver has failed to comply with any terms, conditions, or controls on the waiver, the applicant is subject to removal per INA 237(a)(1)(C)(ii). The U.S. health care provider treating the particular condition should provide a summary of the applicant’s initial evaluation to CDC or notify CDC that the applicant has failed to report for care. Generally, no further follow-up is required by the officer. If CDC does not issue a favorable recommendation, the officer generally should not grant the waiver as a matter of discretion.


By statute, it is USCIS’s decision whether to make the waiver subject to terms, conditions, or controls. A CDC recommendation concerning terms, conditions, or controls on the granting of the waiver ordinarily carries great persuasive weight. 


Once a final decision (approval or denial) is made on the waiver, the officer should inform CDC of the decision. The officer should provide a brief statement indicating the final action and date of the action and forward it to CDC by any of the following methods:


Mail: 

Centers for Disease Control and Prevention (CDC)

Division of Global Migration and Quarantine

1600 Clifton Road, Mailstop E 03

Atlanta, GA 30333

Attention: Quality Assessment Program (QAP)/Waivers


Fax: (404) 639-4441


Email: cdcqap@cdc.gov(mailto:cdcqap@cdc.gov) 


D. Step-by-Step Checklist


Step-by-Step Checklist

Step 1

Check for qualifying relationship to determine whether the applicant is eligible for the waiver.

Step 2

Gather the necessary documentation for CDC review.

Step 3

Send documentation to CDC.

Step 4

Review CDC response.

Step 5

Analyze whether the waiver should be granted as a matter of discretion.

Step 6

Inform CDC of waiver decision.


Chapter 3: Waiver of Immigrant Vaccination Requirement 


A. General


An applicant seeking an immigrant visa at U.S. Consulate or an applicant seeking adjustment of status in the United States who is found inadmissible for not being vaccinated[28] See INA 212(a)(1)(A)(ii). may be eligible for the following waivers:


  • The applicant has, by the date of the decision on the visa or adjustment application, received vaccination against the vaccine-preventable disease(s) for which he or she had previously failed to present documentation;[29] See INA 212(g)(2)(A).



  • The requirement of such a vaccination would be contrary to the applicant’s religious beliefs or moral convictions.[31] See INA 212(g)(2)(C). 


Each of these waivers has its own requirements.[32] These waivers are described in more detail in Section C, Blanket Waiver for Missing Vaccination Documentation [9 USCIS-PM C.3(C)]; Section D, Blanket Waiver if Vaccine is Not Medically Appropriate [9 USCIS-PM C.3(D)]; and Section E, Waiver due to Religious Belief or Moral Conviction [9 USCIS-PM C.3(E)]. Unlike some other waivers, no qualifying relative is required for the applicant to be eligible for a waiver of the immigrant vaccination requirement.


The first two waivers are often referred to as “blanket waivers.” USCIS grants blanket waivers if a health professional indicates that an applicant has received the required vaccinations or is unable to receive them for medical reasons. If USCIS grants blanket waivers, the applicant does not have to file a form or pay a fee. 


The waiver on account of religious or moral objection must be filed on the appropriate form and accompanied by the correct fee.

B. Use of Panel Physician’s or Civil Surgeon's Report 


The determination whether an applicant is inadmissible for lack of having complied with the vaccination requirement is made by reviewing the panel physician’s or civil surgeon’s vaccination assessment in the medical examination report.[33] See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B] for more information on the admissibility determination.


C. Blanket Waiver for Missing Vaccination Documentation[34] See INA 212(g)(2)(A).


Applicants who received the vaccinations for which documents were missing when they initially applied for adjustment of status or for an immigrant visa may be given a blanket waiver. 


A streamlined procedure applies for this waiver; no form is needed. If a required vaccine is lacking, the officer should issue a Request for Evidence (RFE). The RFE should instruct the applicant to return to the civil surgeon for corrective action that demonstrates the applicant has received the required vaccine(s). 


If the RFE response demonstrates that the missing vaccine(s) was received, the officer will deem the waiver granted. No annotation is needed on either the medical exam form, or any related form or worksheet. 

D. Blanket Waiver if Vaccine is Not Medically Appropriate[35] See INA 212(g)(2)(B).

1. Situations Specified in the Law[36] See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility, Chapter 9, Vaccination Requirement [8 USCIS-PM B.9].


If the civil surgeon or the panel physician certifies that a vaccine is not medically appropriate for one or more of the following reasons, the officer may grant a blanket waiver (without requesting a form and fee):


  • The vaccine is not age appropriate;

  • The vaccine is contraindicated;

  • There is an insufficient time interval to complete the vaccination series; or 

  • It is not the flu season, or the vaccine for the specific flu strain is no longer available.


Once the civil surgeon or panel physician annotates that the vaccine(s) is not medically appropriate, no further annotation is needed and the officer may proceed with granting the waiver. The civil surgeon’s or panel physician’s annotation on the vaccination assessment sufficiently documents that the requirements for the waiver have been met; the officer does not need to make any further annotation on the vaccination report.

2. Nationwide Vaccination Shortage[37] See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility, Chapter 9, Vaccination Requirement [8 USCIS-PM B.9] for more information on blanket waivers based on a nationwide vaccination shortage.


USCIS will grant a blanket waiver in the case of a vaccination shortage only if CDC recommends that USCIS should do so, and USCIS has published the appropriate guidance on its website. CDC will only make such a recommendation to USCIS after verifying that there is indeed a nationwide vaccination shortage and issuing the appropriate statement on its website for civil surgeons. In turn, USCIS will issue the appropriate statement on its website. 


The term “nationwide vaccine shortage” does not apply to the medical examination conducted by a panel physician overseas. If a vaccine is not available in the applicant’s country, the panel physician will annotate the vaccination assessment with the term “not routinely available.” If an officer encounters this annotation, the officer may grant a blanket waiver based on this annotation alone. 


E. Waiver due to Religious Belief or Moral Conviction[38] See INA 212(g)(2)(C).

1. General


USCIS may grant this waiver when the applicant establishes that compliance with the vaccination requirements would be contrary to his or her religious beliefs or moral convictions. Unlike other waivers of medical grounds of inadmissibility, there is no requirement that CDC review this waiver.


If, upon review of the medical documentation, the officer finds that the applicant is missing a vaccine and a blanket waiver is not available, the officer should ask the applicant why the vaccine is missing. The officer may request clarification during an interview or by sending an RFE. 


If the applicant indicates that he or she does not oppose vaccinations based on religious beliefs or moral convictions, the applicant may be inadmissible if he or she refuses to obtain the missing vaccine(s). The officer should issue an RFE if the applicant is willing to obtain the vaccine.


If the applicant indicates that he or she opposes vaccinations, the officer should inform the applicant of the possibility of the waiver. The officer should explain the basic waiver requirements for a religious belief or moral conviction waiver, as outlined below. The officer should, at that time, issue an RFE[39] An officer should only issue one RFE, requesting all the necessary information, including the request for the waiver application. for the waiver application. 


Upon receipt of the waiver documentation, the officer should proceed with the adjudication of the waiver.

2. Requirements


With the adjudication of this waiver, USCIS has always taken particular caution to avoid any perceived infringement on personal beliefs and First Amendment rights to free speech and religion. To best protect the public health, USCIS, in consultation with CDC, has established the following three requirements that an applicant (or, if the applicant is a child, the applicant’s parents) has to demonstrate through documentary evidence: 


The applicant must be opposed to all vaccinations in any form.[40] The requirement that the religious or moral objection must apply to all vaccines has been in effect since 1997. The former INS created this policy in light of principles developed regarding conscientious objection to the military draft and challenges to State-mandated vaccinations for public school students. 


The applicant has to demonstrate that he or she opposes vaccinations in all forms; the applicant cannot “pick and choose” between the vaccinations. The fact that the applicant has received certain vaccinations but not others is not automatic grounds for the denial of a waiver. Instead, the officer should consider the reasons provided for having received those vaccines. 


For example, the applicant's religious beliefs or moral convictions may have changed substantially since the date the particular vaccinations were administered, or the applicant is a child who may have already received certain vaccinations under the routine practices of an orphanage. These examples do not limit the officer’s authority to consider all credible circumstances and accompanying evidence. 


The objection must be based on religious beliefs or moral convictions.


This second requirement should be handled with sensitivity. On one hand, the applicant's religious beliefs must be balanced against the benefit to society as a whole. On the other hand, the officer should be mindful that vaccinations offend certain persons' religious beliefs. 


The religious belief or moral conviction must be sincere.


To protect only those beliefs that are held as a matter of conscience, the applicant must demonstrate that he or she holds the belief sincerely, and in subjective good faith of an adherent. Even if these beliefs accurately reflect the applicant's ultimate conclusions about vaccinations, they must stem from religious or moral convictions, and must not have been framed in terms of a particular belief so as to gain the legal remedy desired, such as this waiver. 


While an applicant may attribute his or her opposition to a particular religious belief or moral conviction that is inherently opposed to vaccinations, the focus of the waiver adjudication should be on whether that claimed belief or moral conviction is truly held, that is, whether it is applied consistently in the applicant’s life. 


The applicant does not need to be a member of a recognized religion or attend a specific house of worship. Note that the plain language of the statute refers to religious beliefs or moral convictions, not religious or moral establishments. 


It is necessary to distinguish between strong religious beliefs or moral convictions and mere preference. Religious beliefs or moral convictions are generally defined by their ability to cause an adherent to categorically disregard self-interest in favor of religious or moral tenets. The applicant has the burden of establishing a strong objection to vaccinations that is based on religious beliefs or moral convictions, as opposed to a mere preference against vaccinations. 

3. Evidence 


The applicant’s objection to the vaccination requirement on account of religious belief or moral conviction may be established through the applicant’s sworn statement. In this statement, the applicant should state the exact nature of those religious beliefs or moral convictions and establish how such beliefs would be violated or compromised by complying with the vaccination requirements. 


Additional corroborating evidence supporting the background for the religious belief or moral conviction, if available and credible, should also be submitted by the applicant and considered by the officer. For example, regular participation in a congregation can be established by submitting affidavits from other members in the congregation, or evidence of regular volunteer work. 


The officer should consider all evidence submitted by the applicant.


4. Discretion


As is generally the case for waivers, a waiver of the vaccination requirement requires an officer to consider whether the grant of the waiver is warranted as a matter of discretion. 


A favorable exercise of discretion is generally warranted if the applicant establishes that he or she objects to the vaccination requirement on account of religious beliefs or moral convictions. 


F. Step-by-Step Checklist


A blanket waiver may be available to the applicant. The officer should check whether the applicant is eligible for a blanket waiver before proceeding to this checklist. 

Adjudication Vaccination Requirement Waiver

Based on Religious Beliefs or Moral Convictions

Step

If YES …

If NO …

Step 1: Review the evidence for any indication that the applicant opposes the vaccination requirement based on religious beliefs or moral convictions.

Explain (during the interview or through an RFE) the waiver requirements and request that the applicant file a waiver, if he or she has not already done so. Proceed to Step 3.

RFE or interview to ascertain reasons why vaccines were not given. Proceed to Step 2A.

Step 2A: Did the applicant oppose the vaccines?

Explain to the applicant (at interview or through RFE) the waiver requirements and request that the applicant file a waiver if not already done so. Proceed to Step 3.

Proceed to Step 2B.

Step 2B: Is the applicant willing to obtain the missing vaccine?

Issue an RFE for corrective action of the vaccination assessment. Upon receipt of response to RFE, determine whether the vaccine requirement has been met. If the applicant is still missing vaccines, and no blanket waiver is available, begin at Step 1 again. 

Applicant is inadmissible based on INA 212(a)(1)(A)(ii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2309) (irrespective of the grant of any blanket waivers).

Step 3: Review the waiver application to determine whether the applicant opposes the vaccination requirement in any form.

Proceed to Step 4.

The waiver should be denied and the applicant is inadmissible based on INA 212(a)(1)(A)(ii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2309) (irrespective of the grant of any blanket waivers).

Step 4: Review the waiver application to determine whether the applicant opposes the vaccination requirement on account of religious belief or moral conviction.

Proceed to Step 5. 

The waiver should be denied and the applicant is inadmissible based on INA 212(a)(1)(A)(ii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2309) (irrespective of the grant of any blanket waivers).

Step 5: Analyze whether the waiver application reflects that the applicant’s belief is sincere. 

Proceed to Step 6.

The waiver should be denied and the applicant is inadmissible based on INA 212(a)(1)(A)(ii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2309) (irrespective of the grant of any blanket waivers).

Step 6: Analyze whether the waiver should be granted as a matter of discretion; ordinarily, the finding that the applicant holds sincere religious or moral objections should be sufficient for a grant of the waiver.

Grant the waiver.

The waiver should be denied and the applicant is inadmissible based on INA 212(a)(1)(A)(ii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2309) (irrespective of the grant of any blanket waivers). 


Chapter 4: Waiver of Physical or Mental Disorder Accompanied by Harmful Behavior[41] See INA 212(g)(3).

A. General


If the applicant has a physical or mental disorder and behavior associated with the disorder that poses, may pose, or has posed a threat to the property, safety, or welfare of the applicant or others, the applicant must file a waiver to overcome this ground of inadmissibility.[42] See INA 212(a)(1)(A)(iii). See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B] for more information on the inadmissibility determination based on physical or mental disorders with associated harmful behavior.


The officer should remember that the physical or mental disorder alone (that is, without associated harmful behavior) or harmful behavior alone (without it being associated with a mental or physical disorder) is not sufficient to find the applicant inadmissible on health-related grounds.


USCIS may grant this discretionary waiver in accordance with such terms, conditions, and controls (if any) that USCIS imposes after consulting with the Secretary of Health and Human Services (HHS).[43] See INA 212(g)(3). A condition could include the payment of a bond. 


A common condition of granting a waiver for an applicant with a physical or mental disorder with associated harmful behavior is that the applicant must agree to see a U.S. health care provider immediately upon admission and make arrangements to receive care and treatment.


The officer must determine whether the applicant is eligible for the waiver, consult with CDC, and determine whether the waiver is warranted as a matter of discretion. 


B. Waiver Eligibility and Adjudication 

1. Qualifying Relationship


Unlike waivers for communicable diseases of public health significance, waivers for physical or mental disorders with associated harmful behaviors do not require a qualifying relationship.

 

2. Documentation for CDC’s Review 


As noted above, USCIS can only grant this waiver after it has consulted with CDC. However, CDC’s review of the necessary documents does not constitute a waiver approval. CDC may recommend that USCIS should make the waiver subject to appropriate terms, conditions, or controls. 


To obtain CDC’s review of the waiver application, the officer should forward the following documents to CDC: 



Officers should only send copies, not originals, because CDC retains the documents. 

3. Sending Documents to CDC 


The documents should be mailed to the following address: 


Centers for Disease Control and Prevention (CDC)

Division of Global Migration and Quarantine

1600 Clifton Road, Mailstop E 03

Atlanta, GA 30333

Attention: Quality Assessment Program (QAP)/Waivers

 

If the officer determines that a waiver case warrants expeditious review by CDC, the case may be faxed to (404) 639-4441 or emailed to cdcqap@cdc.gov(mailto:cdcqap@cdc.gov), Attention: Quality Assessment Program (QAP)/Waivers, Urgent. If sent via email, the documents should be sent in password protected file(s). If sent via fax, the fax cover sheet should request that the case be reviewed expeditiously and that CDC’s response be sent via fax. The officer should also email CDC at cdcqap@cdc.gov(mailto:cdcqap@cdc.gov), advising that an expedited request was sent via fax.

4. CDC Response


Once the documents are received by CDC, the documents are reviewed by CDC’s consultant psychiatrist and results of that review are forwarded to the requesting USCIS office. CDC will not return any of the documents provided by USCIS.


CDC’s usual processing time for review and response to the requesting USCIS office is approximately 4 weeks. If CDC’s response appears delayed, the officer may contact CDC at cdcqap@cdc.gov(mailto:cdcqap@cdc.gov) to obtain a status update.


Upon receipt, the officer should review CDC’s response to determine next steps. 


If CDC agrees in its response that the applicant has a Class A condition, CDC will send to the USCIS requesting office CDC 4.422-1 forms, Statements in Support of Application for Waiver of Inadmissibility Under Section 212(a)(1)(A)(iii)(I) or 212(a)(1)(A)(iii)(II) of the Immigration and Nationality Act. The officer must provide the CDC 4.422-1 forms[47] The CDC 4.422-1 forms are used to identify an appropriate U.S. health care provider for the waiver applicant. The forms are generated for the specific waiver applicant by CDC. Part II must be completed by U.S. health care provider and Part III must be completed by the applicant and/or the applicant’s sponsor. to the applicant (or the applicant’s sponsor) for completion. Once the CDC forms are completed and returned to USCIS, the officer must return the completed forms to CDC for review and endorsement. 

Once CDC receives the completed forms, it reviews them to determine whether the applicant has identified an appropriate U.S. health care provider and that the health care provider has completed the forms. If the appropriate U.S. health care provider has been identified, CDC will endorse the forms and return them to the requesting USCIS office. 

If CDC’s response indicates that the applicant is “Class B” or “no Class A or B,” it is CDC’s recommendation that the applicant does not require a waiver for the medical condition.


If CDC’s response indicates that additional information is needed in order to complete the review, the officer should issue a Request for Evidence (RFE) for the applicant to provide additional information as specified by CDC. The officer should submit the information obtained through the RFE to CDC. CDC will provide a response to USCIS regarding the additional information. Once CDC indicates that no additional information is needed, the officer may proceed with the adjudication of the waiver.

5. Discretion


As is generally the case for waivers, a waiver for mental or physical conditions with associated harmful behavior requires an officer to consider whether the grant of the waiver is warranted as a matter of discretion.[48] Neither a qualifying relationship nor a finding of hardship is required.  


CDC’s review and endorsement of the identified U.S. health care provider should ordinarily be sufficient to warrant a favorable exercise of discretion for the grant of the waiver. However, if an applicant declares openly his or her unwillingness to commit to treatment, the waiver may be denied as a matter of discretion.[49] If CDC certifies that a person who obtained an INA 212(g) waiver has failed to comply with any terms, conditions, or controls on the waiver, the person is subject to removal per INA 237(a)(1)(C)(ii). The U.S. health care provider treating the particular condition should provide a summary of the applicant’s initial evaluation to CDC as provided on CDC 4.422-1 form. Generally, no further follow-up is required by the officer.  If CDC does not favorably endorse the identified U.S. health care provider, the officer should generally not grant the waiver as a matter of discretion.


By statute, it is USCIS’s decision whether to make the waiver subject to terms, conditions or controls. A CDC recommendation concerning terms, conditions, or controls on the granting of the waiver ordinarily has great persuasive weight, but is not binding on USCIS. 


USCIS should inform CDC of the decision (approval or denial) of the waiver. The officer does so by completing the CDC response letter that CDC provided when it returned the endorsed CDC forms to the officer. 

 

C. Step-by-Step Checklist


Step-by-Step Checklist

Step 1

Gather the necessary documentation for CDC review.

Step 2

Send documentation to CDC.

Step 3

Review CDC response.

Step 4

If applicable, have CDC 4.422.1 forms completed by the applicant and return them for endorsement by CDC.

Step 5

Analyze whether the waiver should be granted as a matter of discretion.


Chapter 5: Waiver of Drug Abuse and Addiction

A. Adjustment of Status and Immigrant Visa Applicants


In general, no waiver is available for adjustment of status and immigrant visa applicants who are found inadmissible because of drug abuse or drug addiction.[50] There are specific statutory provisions that permit USCIS to waive this ground, such as those applying to asylees and refugees seeking adjustment, and Legalization and SAW applicants. These waivers are specific to those classes of immigrants and are outside the scope of this chapter, which focuses only on waivers available under INA 212(g). See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B] for more information on inadmissibility on account of drug abuse or drug addiction.  


B. Remission


Although a waiver is unavailable for medical inadmissibility due to drug abuse or addiction, an applicant may still overcome this inadmissibility if his or her drug abuse or addiction is found to be in remission. After being found inadmissible due to drug abuse or drug addiction, an applicant may undergo a re-examination at a later date at his or her own cost. If, upon re-examination, the civil surgeon or panel physician certifies, per the applicable HHS regulations and CDC’s Technical Instructions, that the applicant is in remission, the applicant is no longer inadmissible as a drug abuser or addict. 




Footnotes


1. [^] 

 As of October 1, 2013, panel physicians only use DS-2054.

2. [^] 

 See INA 212(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html) and INA 232(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-5339.html).

3. [^] 

 See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB.html)] for more information on Class A and B conditions.

4. [^] 

 See Pub. L. 85-316, 71 Stat. 639 (Sept. 11, 1957).

5. [^] 

 See Pub. L. 89-236, 79 Stat. 911 (Oct. 3, 1965).

6. [^] 

 See Pub. L. 101-649, 104 Stat. 4978 (Nov. 29, 1990).

7. [^] 

 Under INA 212(a)(1)(A)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2303), 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 addiction

See Volume 8, AdmissibilityPart B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB.html)] for more information. 

8. [^] 

 Under INA 212(g)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2813).

9. [^] 

 See INA 212(g)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2813), which specifically waives INA 212(a)(1)(A)(i)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2305)-INA 212(a)(1)(A)(iii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2311) but omits reference to INA 212(a)(1)(A)(iv)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2317).

10. [^] 

 Under INA 209(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html).

11. [^] 

 Under INA 245A(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-7668/0-0-0-7794.html) and INA 210(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1866.html).

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)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html#0-0-0-2121). INA 209(c)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html#0-0-0-2121) 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.

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.

15. [^] 

 See INA 212(g)(1)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2817) and INA 212(a)(1)(A)(i)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2305). INA 212(g)(1)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2817) was also amended to include a specific provision for battered immigrants. See section 1505(d) of the Victims of Trafficking and Violence Protection Act of 2000 (VTVPA), Pub. L. 106-386, 114 Stat. 1464 (October 28, 2000). For more information on the inadmissibility determination based on communicable disease of public health significance, see Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility, Chapter 6, Communicable Diseases of Public Health Significance [8 USCIS-PM B.6(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB-Chapter6.html)].

16. [^] 

 A condition of granting a waiver for an applicant with a communicable disease of public health significance, such as tuberculosis, is that the applicant must agree to see a doctor immediately upon admission and make arrangements to receive private or public medical care for that disease. This requirement is reflected, for example, in the Application for Waiver of Grounds of Inadmissibility (Form I-601(http://www.uscis.gov/i-601)), TB Supplement.

17. [^] 

 See INA 212(g)(1)(B)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2817).

18. [^] 

 Note that an applicant who has been determined to have a Class A condition involving a communicable disease of public health significance may successfully complete treatment. If, after treatment, the civil surgeon or panel physician certifies that the applicant now has a Class B condition, the applicant is no longer inadmissible and does not need a waiver

19. [^] 

 See 42 CFR 34.2(b)(http://www.uscis.gov/sites/default/files/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-44228.html) as amended by 74 FR 56547 (November 2, 2009).

20. [^] 

 USCIS interprets the references to “unmarried son or daughter” as embracing both those sons and daughters who qualify as “children” because they are not yet 21 years old and sons and daughters who are over 21, so long as they are not married. 

21. [^] 

 USCIS interprets “minor unmarried lawfully adopted child” as a clarifying, not as a restricting, provision. Therefore, an applicant is eligible to apply for this waiver if he or she qualifies as the “child” of a citizen or permanent resident (or a  person who has received an immigrant visa) under any provision of INA 101(b)(1)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-101/0-0-0-434.html#0-0-0-1131). This includes, but is not limited to, both children adopted abroad to be admitted in class IR3 or IH3 and children whose adoption will be finalized in the United States to be admitted in class IR4 or IH4. 

22. [^] 

 Under INA 204(a)(1)(A)(iii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1272.html#0-0-0-1331) or INA 204(a)(1)(A)(iv)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1272.html#0-0-0-1711) or INA 204(a)(1)(B)(ii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1272.html#0-0-0-1731) or INA 204(a)(1)(B)(iii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1272.html#0-0-0-1735), including derivative children of the person. This includes self-petitioning spouses and children eligible for classification under INA 204(a)(1)(A)(v)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1272.html#0-0-0-1715) or INA 204(a)(1)(B)(iv)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1272.html#0-0-0-1745).

23. [^] 

 TB is currently the only communicable disease of public health significance that requires a supplement.

24. [^] 

 For instance, evidence of the family relationship.

25. [^] 

 Report of Medical Examination and Vaccination Record (Form I-693(http://www.uscis.gov/i-693)); Medical Examination for Immigrant or Refugee Applicant (1991 TB Technical Instructions) (Form DS-2053) or the Medical Examination for Immigrant or Refugee Applicant (2007 TB Technical Instructions) (Form DS-2054), and related worksheets.

26. [^] 

 See INA 212(g)(1)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2817).

27. [^] 

 If CDC certifies that an applicant who obtained an INA 212(g)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2813) waiver has failed to comply with any terms, conditions, or controls on the waiver, the applicant is subject to removal per INA 237(a)(1)(C)(ii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-5684.html#0-0-0-4463). The U.S. health care provider treating the particular condition should provide a summary of the applicant’s initial evaluation to CDC or notify CDC that the applicant has failed to report for care. Generally, no further follow-up is required by the officer.

28. [^] 

 See INA 212(a)(1)(A)(ii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2309).

29. [^] 

 See INA 212(g)(2)(A)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2825).

30. [^] 

 See INA 212(g)(2)(B)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2827).

31. [^] 

 See INA 212(g)(2)(C)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2829).

32. [^] 

 These waivers are described in more detail in Section C, Blanket Waiver for Missing Vaccination Documentation [9 USCIS-PM C.3(C)(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume9-PartC-Chapter3.html#S-C)]; Section D, Blanket Waiver if Vaccine is Not Medically Appropriate [9 USCIS-PM C.3(D)(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume9-PartC-Chapter3.html#S-D)]; and Section E, Waiver due to Religious Belief or Moral Conviction [9 USCIS-PM C.3(E)(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume9-PartC-Chapter3.html#S-E)].

33. [^] 

 See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB.html)] for more information on the admissibility determination.

34. [^] 

 See INA 212(g)(2)(A)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2825).

35. [^] 

 See INA 212(g)(2)(B)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2827).

36. [^] 

 See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility, Chapter 9, Vaccination Requirement [8 USCIS-PM B.9(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB-Chapter9.html)].

37. [^] 

 See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility, Chapter 9, Vaccination Requirement [8 USCIS-PM B.9(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB-Chapter9.html)] for more information on blanket waivers based on a nationwide vaccination shortage.

38. [^] 

 See INA 212(g)(2)(C)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2829).

39. [^] 

 An officer should only issue one RFE, requesting all the necessary information, including the request for the waiver application.

40. [^] 

 The requirement that the religious or moral objection must apply to all vaccines has been in effect since 1997. The former INS created this policy in light of principles developed regarding conscientious objection to the military draft and challenges to State-mandated vaccinations for public school students. 

41. [^] 

 See INA 212(g)(3)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2831).

42. [^] 

 See INA 212(a)(1)(A)(iii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2311). See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB.html)] for more information on the inadmissibility determination based on physical or mental disorders with associated harmful behavior.

43. [^] 

 See INA 212(g)(3)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2831).

44. [^] 

 For instance, evidence of the family relationship.

45. [^] 

 Report of Medical Examination and Vaccination Record (Form I-693(http://www.uscis.gov/i-693)); Medical Examination for Immigrant or Refugee Applicant (1991 TB Technical Instructions) (Form DS-2053) or the Medical Examination for Immigrant or Refugee Applicant (2007 TB Technical Instructions) (Form DS-2054), and related worksheets.

46. [^] 

 The Instructions to Form I-601(http://www.uscis.gov/i-601) detail the contents that should be included in the doctor’s report.

47. [^] 

 The CDC 4.422-1 forms are used to identify an appropriate U.S. health care provider for the waiver applicant. The forms are generated for the specific waiver applicant by CDC. Part II must be completed by U.S. health care provider and Part III must be completed by the applicant and/or the applicant’s sponsor.

48. [^] 

 Neither a qualifying relationship nor a finding of hardship is required. 

49. [^] 

 If CDC certifies that a person who obtained an INA 212(g)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2813) waiver has failed to comply with any terms, conditions, or controls on the waiver, the person is subject to removal per INA 237(a)(1)(C)(ii)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-5684.html#0-0-0-4463). The U.S. health care provider treating the particular condition should provide a summary of the applicant’s initial evaluation to CDC as provided on CDC 4.422-1 form. Generally, no further follow-up is required by the officer. 

50. [^] 

 There are specific statutory provisions that permit USCIS to waive this ground, such as those applying to asylees and refugees seeking adjustment, and Legalization and SAW applicants. These waivers are specific to those classes of immigrants and are outside the scope of this chapter, which focuses only on waivers available under INA 212(g)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006/0-0-0-2364.html#0-0-0-2813). See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB.html)] for more information on inadmissibility on account of drug abuse or drug addiction.