Health Care Worker Certification

Noncitizens seeking admission as a nonimmigrant or immigrant primarily to perform labor as a health care worker, other than as a physician, are not admissible to the United States unless they present certification from a USCIS-approved credentialing organization verifying that they have met the minimum requirements for education, training, licensure, experience, and English proficiency in their field.

Specifically, the certification verifies the noncitizen has:

  1. Education, training, licensing, and experience that:
    • Are comparable with that required for an American health care worker of the same type;
    • Are authentic and, in the case of a license, unencumbered; and
    • Meet all applicable statutory and regulatory requirements for admission into the United States (this verification is not binding on DHS).
  2. The necessary level of competence in oral and written English as shown by passage of one or more nationally recognized, commercially available, standardized test of the noncitizen’s ability to speak and write; and
  3. Passed either:
    • A predictor test (if the majority of States licensing the profession in which the noncitizen intends to work recognize a test predicting a worker’s success on the profession’s licensing or certification examination), or
    • The occupation’s actual licensing or certification examination.
Health Care Occupations Requiring a Certification

The following health care occupations require a certification under 8 CFR 212.15(c):

  • Licensed practical nurses, licensed vocational nurses, and registered nurses;
  • Physical therapists;
  • Occupational therapists;
  • Speech-language pathologists and audiologists;
  • Medical technologists (also known as clinical laboratory scientists);
  • Medical technicians (also known as clinical laboratory technicians); and
  • Physician assistants.

Please note: Nurses have an alternative certification process. A foreign nurse may present a certified statement from the Commission on Graduates of Foreign Nursing Schools (CGFNS) or an approved equivalent independent credentialing organization if it verifies that the foreign nurse:

  1. Has a valid and unrestricted license in the State of intended employment;
  2. Intends to be employed in a state that verifies that foreign licenses are authentic and unencumbered;
  3. Passed the National Council Licensure Examination (NCLEX); and
  4. Graduated from certain English language nursing programs.

See section 212(r) of the Immigration and Nationality Act (INA).

Providing Valid Health Care Worker Certification

Noncitizen workers in an affected health care occupation must present a valid health care worker certification each time they:

  • Seek admission into the United States,
  • Change status,
  • Extend status, or
  • Adjust status. 

The certification requirement is no longer applicable once the worker is a lawful permanent resident.

Organizations Authorized to Issue Health Care Worker Certifications

The following organizations are authorized to issue certifications for the following health care occupations:

  • The Commission on Graduates of Foreign Nursing Schools (CGFNS) is authorized to issue certifications to all 7 health care occupations.
  • The National Board for Certification in Occupational Therapy (NBCOT) is authorized to issue certifications for occupational therapists.
  • The Foreign Credentialing Commission on Physical Therapy (FCCPT) is authorized to issue certifications for physical therapists.
  • Josef Silny & Associates, Inc. (JSA) is authorized to issue certifications for nurses.

These organizations are approved by the Secretary of Homeland Security in consultation with the Secretary of Health and Human Services. See Pub. L.  No. 107-296, 116 Stat. 2135.

Submitting Health Care Worker Certifications

Immigrant petitions:

For immigrant petitions, there is a two-step process after obtaining a labor certification from the Department of Labor, if applicable (employers seeking to hire professional nurses or physical therapists apply for Schedule A, Group I certification by filing an uncertified labor certification and visa petition directly with USCIS):

Step 1: Generally, the Form I-140, Immigrant Petition for Alien Worker, is first filed by an employer on behalf of the prospective noncitizen worker. In adjudicating the I-140 petition, USCIS reviews all eligibility requirements. In addition to evaluating the petitioner’s continuing ability to pay the proffered wage, this review includes examination of the beneficiary’s qualifications (for example, education, experience, licensure, and/or training as set forth in the job opportunity’s requirements on the labor certification and the preference category and Schedule A Group I requirements as applicable).

For physical therapists, 20 CFR 656.15(c)(1) requires that the employer include evidence to establish that the beneficiary currently has (and had at the time of filing) a permanent license to practice in the state of intended employment or, in the alternative, a letter or statement, signed by an authorized state physical therapy licensing official in the state of intended employment with the petition submission to USCIS.  The letter must confirm that the noncitizen is qualified to take that state’s written licensing examination for physical therapists.

For nurses, 20 CFR 656.15(c)(2) requires that the employer include CGFNS certification, a full and unrestricted (permanent) license to practice nursing in the state of intended employment, or passage of NCLEX-RN as part of the petition submission to USCIS.

Schedule A Group I applications require other evidentiary submissions such as a prevailing wage determination covering the proffered position in the geographic location where the work will be performed and a notice of filing either posted at the facility or location of the employment or, if applicable, sent to the appropriate bargaining unit.

Step 2: If the noncitizen worker is in the United States, they may file a Form I-485, Application to Register Permanent Residence or Adjust Status. It is only upon the filing of an I-485 that the health care worker certification is required and will be used to determine admissibility for adjustment of status. While the noncitizen worker may receive interim benefits such as a work permit and travel permission with the favorable exercise of discretion, the filing and adjudication of the Form I-485 is dependent upon an immigrant visa number being available and the validity of the underlying visa petition.
If the noncitizen worker is living outside the United States or living in the United States, but chooses to apply for an immigrant visa abroad, USCIS will send the approved petition to the Department of State’s (DOS) National Visa Center (NVC), where it will remain until an immigrant visa number is available. The noncitizen worker must present the health care certification to the consular officer at the time the visa is issued.

Nonimmigrant petitions:

For nonimmigrant petitions seeking admission, an extension of stay, or a change of status, there are two considerations:

Consideration 1: The petitioner files a Form I-129, Petition for a Nonimmigrant Worker, or Form I-129CW, Petition for a CNMI-Only Nonimmigrant Transitional Worker, for approval of the noncitizen worker’s classification as a nonimmigrant. In adjudicating the petition for the classification requested, USCIS reviews all eligibility requirements, including licensure, if applicable. The health care certification must be presented at the time of visa issuance or admission (if the noncitizen worker is visa-exempt).

Consideration 2: If the noncitizen is already in the United States, the Form I-129 may also serve as a  petition to extend the period of the noncitizen's authorized stay or to change their status. Although the Form I-129 petition classification may be approved, the request for an extension of stay or change of status will be denied if the petitioner fails to submit the health care worker certification required by law.  See 8 CFR 212.15(a).

Please note:  USCIS does not accept a health care worker certification as the sole evidence that the foreign worker has met the minimum requirement for the given position and is, therefore, eligible for the requested visa classification. While the health care worker certification verifies the worker’s credentials for admissibility into the United States under INA 212(a)(5)(C), it is not binding on DHS. See 8 CFR 212.15(f)(1)(iii).

Role of Certification in the USCIS Adjudication Process

USCIS uses the certification to verify the worker’s credentials for admissibility into the United States.  See INA 212(a)(5)(C). Additionally, USCIS must ensure that the health care worker meets educational requirements for the classification and any applicable licensure requirements.  In reviewing the worker’s educational documents, USCIS considers the education credential evaluator’s opinion in conjunction with a review of the noncitizen’s relevant education credentials (if submitted), and other available credible material regarding the equivalency of the education credentials to college degrees obtained in the United States.

In the course of the adjudication, USCIS may refer to educational equivalency resources to clarify an individual’s academic credentials, although information from such sources is not binding. Note that even if   it is established s that a bachelor’s degree from the home country of the noncitizen worker represents a level of education that is equivalent to a bachelor's degree in the United States, it is possible that the degree would not qualify the individual for the EB-2 advanced degree category unless they also have five years of post-baccalaureate progressive experience. In such cases, USCIS may issue a Request for Evidence asking the petitioner to provide evidence demonstrating that the beneficiary has either a United States advanced degree or foreign equivalent degree or has a United States bachelor’s degree or a foreign equivalent degree, and evidence in the form of letters from current or former employer(s) showing that the beneficiary has at least five years of progressive post-baccalaureate experience in the specialty.

USCIS Criteria for Educational Equivalency

The USCIS criteria for educational equivalency are explained in the eligibility requirements for the specific nonimmigrant or immigrant classification.

For instance, employment-based second preference immigrant petitions (EB-2) for members of the professions holding an advanced degree must establish, among other requirements, that the worker has met the minimum requirements for the classification as well as the position.  Specifically, the beneficiary must have an advanced degree, which is a U.S. academic or professional degree, or it may be a foreign equivalent degree above that of baccalaureate.  See 8 CFR 204.5(k)(2).  If the labor certification lists an advanced degree as acceptable for the position, the educational requirement may include a U.S. bachelor’s degree or a foreign equivalent degree followed by  five years of progressive experience.  See 8 CFR 204.5(k)(2).  If a doctoral degree is customarily required by the specialty, the noncitizen must have a United States doctorate or a foreign equivalent degree.  See 8 CFR 204.5(k)(2).

To demonstrate that the noncitizen is a professional holding an advanced degree, the petition must be accompanied by:

  • (A) An official academic record showing that the noncitizen has a United States advanced degree or a foreign equivalent degree; or
  • (B) An official academic record showing that the noncitizen has a United States baccalaureate degree or a foreign equivalent degree, and evidence in the form of letters from current or former employer(s) showing that the noncitizen has at least five years of progressive post-baccalaureate experience in the specialty.  See 8 CFR 204.5(k)(3)(i).
Health Care Credentialing Organizations’ Criteria for Educational Equivalency

The credentialing organizations’ educational equivalency criteria are also guided by the statutory and regulatory requirements for the particular nonimmigrant or immigrant classification. The certification process sets guidelines for educational equivalency that focus on the:

  • Verification of the noncitizen’s education;
  • Verification of all licenses to practice in the occupation; and
  • Compliance with English language proficiency requirements.  

The credentialing organizations must evaluate the noncitizen’s education to ensure that it: 

  • Is comparable to a U.S. education,
  • Meets the minimum educational requirements for licensure (in the State of intended employment), and
  • Meets the minimum educational requirements for the requested classification. 

However, the credentialing organization’s evaluation is not binding on DHS.  See 8 CFR 212.15(f)(1)(iii). 

Renewing the Health Care Certification

A foreign worker’s certification must be used for any admission into the United States, extension or change of status within the United States, or adjustment of status within five years of the date that it is issued.  See 8 CFR 212.15(n)(4).  For this reason, the certification is only valid for five years. This ensures that the individual continues to meet the regulatory requirements for issuance of the certification. Therefore, if the foreign worker has not used the certification because they have not been admitted to the United States or adjusted their status within five years of when the certification was obtained, a new certification is required at the time they seek adjustment of status, to change or extend status with USCIS, or when seeking visa issuance by DOS or admission at the port of entry.

Please note that certification does not remove requirements for licensure, if applicable.

However, the credentialing organization must have a formal policy for renewing the certification if an individual’s original certification expires before admission to the United States or application for adjustment of status.  See 8 CFR 212.15(k)(4)(viii).  The credentialing organization is limited to updating information on licensure to determine the existence of any adverse actions and the need to re-establish English competency, and therefore does not re-evaluate the educational credentials when renewing the certification.

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