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PrintI-910, Application for Civil Surgeon Designation
Use this form to apply for civil surgeon designation. You may not need to apply for civil surgeon designation if you fall under a limited number of blanket designations.
Please refer to the instructions to determine whether you should use this form. For more information, see the USCIS Policy Manual Blanket Civil Surgeon Designation Guidance.
The National Benefits Center is accepting applications for civil surgeon designation. We have the authority to exercise discretion in approving civil surgeon applications based on local requirements. See 8 CFR 232.2. At this time, we do not foresee invoking any local restrictions, but reserve the right to apply such restrictions.
Number of Pages
Form 6; instructions 11.
Edition Date
05/29/18. You can find the edition date at the bottom of the page on the form and instructions.
Where to File
USCIS Dallas Lockbox
If you are filing at a USCIS Lockbox facility, please read these important Lockbox filing tips.
For U.S. Postal Service (USPS):
USCIS
P.O. Box 660812
Dallas, TX 75266
For FedEx, UPS, and DHL deliveries:
USCIS
Attn: I-910
2501 S. State Highway
121 Business
Suite 400
Lewisville, TX 75067
Filing Tips for Form I-910, Application for Civil Surgeon Designation
Complete all sections of the form. We will reject the form if these fields are missing:
-
Part 1 – Information About You
- Family Name
- Given Name
- Date of Birth
-
Part 2 – Clinical Office Locations
- Physical Address of the Clinic/Practice
-
Part 8 – Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant
- Preparer’s Signature (if applicable)
Don’t forget to sign your form! We will reject any unsigned form.
Filing Fee
$785. Fees are accepted in the form of a money order, personal check, or cashier’s check. When filing at a USCIS Lockbox facility, you may also 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. Please note that service centers are not able to process credit card payments.
There is no fee if you are a medical officer in the U.S. armed forces or a civilian physician employed by the U.S. government who examines service members, veterans, and their dependents at a military, Department of Veterans Affairs, or U.S. government facility in the United States.
Checklist of Required Initial Evidence (for informational purposes only)
Please do not submit this checklist with your Form I-910. It is an optional tool to use as you prepare your form, but does not replace statutory, regulatory, and form instruction requirements. We recommend that you review these requirements before completing and submitting your form. Do not send original documents unless specifically requested in the form instructions or applicable regulations.
If you submit any documents (copies or original documents, if requested) in a foreign language, you must include a full English translation along with a certification from the translator verifying that the translation is complete and accurate, and that they are competent to translate from the foreign language to English.
Did you provide the following?
- Information about your status in the United States
- Copies of medical degrees and current U.S. state or U.S. territory medical licenses
- Proof you meet the professional experience requirement because you have practiced medicine as a physician (MD or DO) for at least four years
Special Instructions
For detailed information about the medical examinations:
- Applicants – Visit the Finding a Medical Doctor page.
- Civil surgeons – Visit the Designated Civil Surgeons page for resources about the examination and useful links.
Email public.engagement@uscis.dhs.gov to notify USCIS of any changes about your civil surgeon designation (including any changes to contact information listed on the Civil Surgeon Locator).
