This page describes required documentation and the process for an institution requesting a waiver of the two-year foreign residence requirement for J-1 physicians who will either:
- conduct research
- provide clinical primary care or general psychiatric services in federally designated underserved areas
The waiver authority is established under INA §212(e) as amended and implemented in regulation at 45 CFR Part 50. The U.S. Department of State regulations and procedures (22 CFR 41.63) also governs related statements and recruitment evidence.
Who Can Apply
Exchange Visitor (Physician) Eligibility
Institutions may apply for a waiver of the foreign residence requirement for Exchange Visitors that meet the below eligibility criteria.
The exchange visitor must meet the requirements of 45 CFR 50.4.
Under HHS clinical care waiver guidance (45 CFR 50.5), the physician must:
- Have completed an approved residency program in one of these specializations:
- Family Medicine
- General Internal Medicine
- General Pediatrics
- Obstetrics & Gynecology
- General Psychiatry
- Must include Health Professional Shortage Area (HPSA), Medically Underserved Area or Population (MUA/P), or Federally Qualified Health Centers (FQHC) identifier number(s) for the practice site(s)
Physicians who have completed additional qualifying training (for example, geriatrics, addiction medicine, child and adolescent psychiatry) may be eligible when training and start-of-service timing comply with 45 CFR 505.5(b).
Documents Required from Exchange Visitors (Physicians)
The following documents must be provided by the Exchange Visitor (physicians) for inclusion by Applicants (Institutions).
Download a printable version of the Exchange Visitor (Physician) Checklist to ensure that all required documents are submitted to your institution for inclusion in the application.
- Form DS-3035 data sheet / barcode page (from the U.S. Department of State)
- Copies of all Form DS-2019 and/or Form IAP-66 forms issued during J-1 status
- Current Curriculum Vitae (CV)
- Proof of credentials:
- Diplomas
- Residency completion
- If used to establish eligibility:
- USMLE Steps 1-3 results (MD) or COMLEX Levels 1-3 Results (DO)
- Additional training documents (if used to establish eligibility)
- Signed physician statement (verbatim required): “I, (insert full name of exchange visitor), hereby declare and certify, under penalty of the provisions of 18 U.S.C. 1001, that I do not now have pending nor am I submitting during the pendency of this request, another request to any United States Government department or agency or any State Department of Public Health, or equivalent, other than (insert Name of U.S. Government Agency requesting waiver*) to act on my behalf in any matter relating to a waiver of my two-year home-country physical presence requirement.” (*i.e., for a waiver requested from the Department of Health and Human Services, use Department of Health and Human Services)
Signed physician statement must be signed and dated by the physician. See 22 CFR 41.63.
Documents Required from Applicants (Institutions)
The following documents must be included by applicants (institutions) requesting a waiver of the J-1 visa foreign residence requirement.
Download a printable version of the appropriate checklist to ensure that all documents are part of the submitted application.
All institutions must submit:
- U.S. Department of State (Form DS-3035) data sheet/barcode page with the case number (provided by the Exchange Visitor)
- HHS Form 426: Application for waiver of the two-year foreign residence requirement.
- Submitter cover letter: The letter should identify the submitting institution and contact.
- USCIS Form G-28 (if represented by counsel): Notice of entry of appearance as attorney or accredited representative.
Additional Requirements by Waiver Type
- Evidence of high priority activity: Detailed program description explaining how the program or activity is high priority and is of national or international significance in an area of interest to HHS (see 45 CFR 50.4(a)).
- Evidence of essential/integral value: Description of the probable future of the program if the waiver is not granted, including specific evidence showing how the loss of the Exchange Visitor's services would seriously restrain the initiation, continuation, completion, or success of the program or activity (see 45 CFR 50.4(b)).
- Evidence of outstanding qualifications: Documentation of the exchange visitor's qualifications such as (see 45 CFR 50.4 (c)):
- Evidence of recruitment efforts: Include evidence that indicates the applying institution made genuine efforts to recruit for the Exchange Visitor's position and was unable to find a suitable candidate (see 22 CFR 41.63).
- Clearly demonstrate a suitable replacement for the exchange visitor cannot be found through recruitment or any other means, and the position cannot be filled by any individual who is not subject to the foreign residence requirement.
- The following information will be assessed to determine adequacy of evidence:
- Clearly defined staffing need to explain continuity of research
- Adequate recruitment timeframe given the specialty and location
- Breadth of advertising to reach candidate audiences
- Active outreach activities to engage candidates
- Competitive, flexible compensation package offered
- Provide candidate tracking showing consistency and outcomes
- Contract/continuity terms supporting required services
- Legal/compliance safeguards evident for recruitment
- Administrative documentation: Provide copies of all Forms IAP-66 and/or DS-2019 and current visa status materials.
- Healthcare facility letter on official letterhead:
- Signed and dated by the facility director
- Must include HPSA, MUA/MUP or FQHC identifier number(s) for the practice site(s)
- Must include confirmation of required healthcare facility patient-access policies (i.e., ability to pay, Medicare/Medicaid/CHIP acceptance where applicable, sliding fee scale, usual/customary rates)
- State health department acknowledgment/support letter (or copy of request if pending)
- Executed employment contract:
- Must be signed by facility head and physician, dated, and notarized
- Must meet all required terms: three-year term, 40 hours/week, start within three months of approval, eligible site(s) specified, termination only for cause, and no non-compete/restrictive covenant
- Prevailing wage documentation
- Proof of healthcare facility existence (e.g., articles of incorporation, business license, or equivalent)
- Employer attestation (separate document from facility letter):
- Must include required DOS/22 CFR language
- Must include site identifiers (HPSA, MUA/MUP or FQHC number, FIPS county code, census tract or 9-digit ZIP code)
- Letter of need (U.S. Department of State requirement)
How to Submit an Application
Submit all materials in a single email/transmission as PDF files. Group attachments as separate PDFs as noted below:
- Research Admin Attachment containing:
- U.S. Department of State (Form DS-3035) data sheet/barcode page with the case number
- Cover Letter
- Form HHS 426
- Form All DS-2019s
- U.S. Citizenship and Immigration Service (USCIS) Form G-28 (if represented by counsel)
- Supplemental information letter noting evidence of regulatory eligibility
- Evidence of recruitment
- Curriculum Vitae (CV)
- Clinical Care Admin Attachment containing:
- U.S. Department of State (Form DS-3035) data sheet/barcode page with the case number
- Form HHS 426
- Physician Statement
- All Forms DS-2019s
- U.S. Citizenship and Immigration Service (USCIS) Form G-28 (if represented by counsel)
- Healthcare Facility Cover Letter
- Proof of HPSA Designation and Healthcare Facility Existence
- Executed Employment Contract (including work location, contract length, starting date of employment, full-time status, and prevailing wage documentation)
- Employer Attestation
- Recruitment effort documentation
- Proof of HPSA Designation and Healthcare Facility Existence
All applications must include the U.S. Department of State (DS-3035) case number and barcode to be eligible for review.
Do not include social security numbers (SSNs) or unnecessary sensitive data to minimize inclusion of personally identifiable information (PII).
Submit Your Application
Send completed applications as PDF files in a single submission (subject line: LAST NAME-FIRST INITIAL_DoS BARCODE NUMBER_DATE OF SUBMISSION MM-DD_YYYY) to the appropriate email.
- Research waivers: J1EVResearchWaivers@hhs.gov
- Clinical care waivers: J1EVClinicalHealthCareWaivers@hhs.gov