I-910, Application for Civil Surgeon Designation
Use this form to apply for civil surgeon designation. You do not need to apply for civil surgeon designation if you fall under the limited blanket designations for military physicians and state and local health departments.
Please refer to the Form I-910 Instructions to determine whether you should use this form. For more information, see Volume 8, Part C, Chapter 3 of the USCIS Policy Manual, Blanket Civil Surgeon Designation.
The National Benefits Center is accepting applications for civil surgeon designation. We may exercise discretion in approving civil surgeon designations.
07/23/20. You can find the edition date at the bottom of the page on the form and instructions.
Dates are listed in mm/dd/yy format.
File with the USCIS Dallas Lockbox
U.S. Postal Service (USPS):
P.O. Box 660812
Dallas, TX 75266
FedEx, UPS, and DHL deliveries:
2501 S. State Highway
121 Business, Suite 400
Lewisville, TX 75067
Filing Tips: Go to our Form Filing Tips page for information on how to help ensure we will accept your application.
Complete all sections of the form. We will reject the form if these fields are missing:
- Part 1 – Information About You
- Previous designation as civil surgeon
- Family Name
- Given Name
- Date of Birth
- Part 2 – Clinical Office Locations
- Name of Clinic/Practice
- Physical Address of the Clinic/Practice
- Telephone Number
- Part 3. Information About Your Status in the United States
- Select only one box
- Part 4. Medical Degrees
- One full entry
- Part 5. Medical Licenses
- One full entry
- Part 6. Professional Experience
- One full entry
- Part 7. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature
- Applicant’s Daytime Telephone Number
- Applicant’s Signature
- Date of Signature
Don’t forget to sign your form. We will reject any unsigned form.
We accept fees 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.
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. Use our Fee Calculator to help determine your fee.
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; and
- Proof you meet the professional experience requirement because you have practiced medicine as a physician (MD or DO) for at least four years.
For detailed information about the medical examinations:
- Applicants – Visit our Finding a Medical Doctor page.
- Civil surgeons – Visit our Designated Civil Surgeons page for resources about the examination and useful links.
Email email@example.com to notify us of any changes about your civil surgeon designation (including any changes to contact information listed on the Civil Surgeon Locator).