INS on Civil Surgeons Designate, Vaccination Requirements
Memorandum For: All Regional Directors
All DDs (Including Foreign)
All OICs (Including Foreign)
All Port Directors (Including Foreign)
All Regional Counsels
All District Counsels
All Service Center Directors
INART, INGLYN
All ROINS
From: Jacquelyn A. Bednarz
Acting Associate Commissioner
Office of Adjudications
Subject: Designation of Health Departments as Civil Surgeons for Refugees Adjusting Status Under Section 209 of the Act; Vaccination Requirements for Refugees and Asylees; Waiver Criteria and Procedures
The purpose of this memorandum is to designate additional civil surgeons to facilitate the medical exam required for refugees seeking adjustment of status under section 209 of the Immigration and Nationality Act (Act). This memorandum also seeks to clarify (1) the vaccination requirements under section 212(a)(1)(A)(ii) of the Act for refugees, and (2) the criteria and procedures for processing waiver applications under section 209(c) of the Act filed by refugee and asylee adjustment applicants.
A. Clarification of the Medical Exam Requirements for Refugees and Asylees.
1. Vaccination for Refugees.
Section 212(a)(1)(A)(ii) of the Act refers to an alien who "seeks admission as an immigrant, or who seeks adjustment of status to the status of an alien lawfully admitted for permanent residence…" Refugees do not have a present proof of vaccination when applying for admission under section 207 of the Act because they are admitted as refugees, not as immigrants, at that time. Refugees must, however, satisfy the vaccination requirements when they apply for adjustment of status under section 209 of the Act, one year following their admission under section 207 of the Act. For ease of reading, the vaccination portion of the medical exam will be generically referred to as the "vaccination sign-off."
2. Medical Exam Requirements for Refugee and Asylee Adjustment Applicants.
a. Refugees.
The Service's regulations at 8 CFR Section 208.1(c) state that "[u]nless there were medical grounds for exclusion at the time of arrival, a United States Public Health Service medical examination is not required." Therefore, a refugee who received a medical exam upon admission as a refugee under section 207 of the Act generally does not need to repeat the entire medical exam. He or she does, however, need the vaccination sign-off from the civil surgeon when adjusting under section 209 of the Act, as section 212(a)(1)(A)(ii) of the Act requires all adjustment of status applicants to comply with the vaccination requirements. Service officers should not require refugees to repeat the entire medical exam if there were not medical grounds of inadmissibility that arose during the initial exam performed overseas.
b. Asylees.
Applicants for asylum under section 208 of the Act are not required to undergo a medical exam because they are already in the United States and are not seeking admission. If the asylum application is approved, and the alien applies for adjustment of status under section 209 of the Act one year later, a complete medical exam is required. The medical exam must include the vaccination sign-off in order to comply with section 212(a)(1)(A)(ii) of the Act. See 8 CFR Section 209.2(d).
B. Blanket Designation of Health Departments as Civil Surgeons for Refugees Applying for Adjustment of Status Under Section 209 of the Act.
The Service's regulations at 8 CFR Section 232.2(b) state that "[t]he district director shall select as many civil surgeons, including clinics and local, county and state health departments employing qualified civil surgeons as he determines to be necessary to serve the needs of the Service in a locality under his jurisdiction." A civil surgeon is defined both under the Act and by regulation as a licensed physician with no less than four years of professional experience. See section 232(b) of the Act, 8 CFR Section 232.2(b), and 42 CFR Section 34.2(b).
To ease some of the difficulties encountered by refugee adjustment applicants in their efforts to comply with the vaccination requirements, and to relieve district offices of the need to continually update their civil surgeon lists of health departments to reflect the current physicians on staff. Headquarters Office of Adjudication (HQADN) is designating all state and local health departments as civil surgeons for refugees applying for adjustment of status under section 209 of the Act. District offices are not required to maintain lists of individual health departments and the names of individual physicians employed by these health departments.
Pursuant to the understanding reached between the Service and the Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS), this HQADN blanket civil surgeon designation of state and local health departments covers only the vaccination sign-off for those refugees applying for adjustment of status under section 209 of the Act. The small percentage of refugees who require the entire medical exam, as provided in 8 CFR Section 209.1(b), will need to visit a private physician or health care facility designated in accordance with the standard procedures described in 8 CFR part 232.
Participation in this HQADN blanket civil surgeon designation is entirely voluntary and at the discretion of the individual health department. CDC will send to each health department the vaccination supplement to Form I-693 and the addendum to its publication, Technical Instructions for the Medial Examination of Aliens in the United States, which provides detailed instructions to the civil surgeons on performing the vaccination assessment.
Health departments participating in the HQADN blanket civil surgeon designation will place either the official stamp or raised seal (whichever is customarily used by that specific health department) on the supplement Form I-693. The attending health department physician shall sign the supplement to the I-693, and shall place it in a sealed envelope, in accordance with the standard procedures all civil surgeons are required to follow. Only physicians who meet the statutory and regulatory definition of "civil surgeon" will be authorized to sign the vaccination supplement. Because the medical exams performed for refugees overseas are generally valid for more than one year (8 CFR Section 209.1(c)), the validity of the vaccination supplement will not be limited to one year.
This HQADN blank civil surgeon designation of state and local health departments does not extend to asylees adjusting under section 209 of the Act, nor does it extend to any other applicant for adjustment of status under any other provision of the Act. These limitations are due to the cost and staffing implications for the health departments.
C. Clarification of Waiver Criteria and Procedures for Refugees and Asylees Adjusting Under Section 209 of the Act.
1. Waiver Criteria.
The waiver provisions for refugees adjusting under section 209 of the Act are broader than the general waiver provisions under section 212(g)(2)(A), (B), and (C) of the Act, which cover most immigrant visa applicants and adjustment of status applicants. (Refer to: January 17, 1997, wire, 96 Act 008, April 10, 1997, memo 96 Act 027, September 29, 1997, memo, 96 Act 055, and December 31, 1997, memo (unnumbered)). Section 209(c) of the Act gives the Attorney General the discretion to waive most grounds of inadmissibility, including all health grounds, for humanitarian purposes, to assure family unity, or when it is otherwise in the public interest.
Although refugees adjusting under section 209 of the Act are eligible for the broader exercise of discretion, it is nevertheless important, from the public health perspective and for the applicant's own safety, to know whether the applicant has already been vaccinated, and if not, whether receiving the vaccination(s) would be medically appropriate. A finding by the civil surgeon that one or more of the vaccinations would not be medically appropriate may be considered a humanitarian basis for granting the waiver for those vaccinations. See #C, 2 below.
2. Waiver Application Procedures Under Section 209 of the Act.
Refugees and asylees who state that compliance with the vaccination requirements would be contrary to their religious beliefs or moral convictions, and refugees and asylees who seek the waiver for other reasons that may be considered humanitarian reasons, would assure family unity, or would otherwise be in the public interest, must submit From I-602. A fee, however, is not required.
Further questions concerning the HQADN blanket civil surgeon designation or the vaccination requirements may be directed to Sophia Cox, Adjudication Officer, HQADN, at 202/514-5014.