I-905, Application for Authorization to Issue Certification for Health Care Workers
Use this form if you work with an organization and want to apply for authorization to issue certificates to health care workers.
Form Details
Dates are listed in mm/dd/yy format.
If you complete and print this form to mail it in, make sure that the form edition date and page numbers are visible at the bottom of all pages and that all pages are from the same edition of the form. If any of the form’s pages are missing or are from a different edition of the form, we may reject your form.
If you need help downloading and printing forms, read our instructions.
Mail your application to:
Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501-2521
You may pay the fee with a money order, personal check, cashier’s check or pay by credit card using Form G-1450, Authorization for Credit Card Transactions. If you pay by check, you must make your check payable to the U.S. Department of Homeland Security.
When you send a payment, you agree to pay for a government service. Filing and biometric service fees are final and nonrefundable, regardless of any action we take on your application, petition, or request, or if you withdraw your request.
Pay each filing fee separately. We are transitioning to electronically processing immigration benefit requests, which requires us to use multiple systems to process your package. Because of this, you must pay each filing fee separately for any form you submit. We may reject your entire package if you submit a single, combined payment for multiple forms.
Filing Tips: Go to our Tips for Filing Forms by Mail page for information on how to help ensure we will accept your application.
Don’t forget to sign your form. We will reject any unsigned form.
You must submit two complete copies of this application.