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.

Form 6; instructions 11.

05/29/18.  Starting 08/14/2018, we will only accept the 05/29/18 edition. Until then, you can use the 12/23/16 edition. You can find the edition date at the bottom of the page on the form and instructions.

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.

$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.

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).