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 Health Professional Shortage Areas (HPSAs) with a score of 7 or above.
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 be willing to provide either primary care or mental health services in an eligible facility within a HHS-designated shortage area.
- In order to target communities and populations with the greatest need for primary care and mental health services, HHS will only consider an application for waiver from a facility in or with a primary care or mental health Health Professional Shortage Area (HPSA) score of 7 or higher
- Withdrawn HPSAs and Medically Underserved Area or Population (MUA/P) designations are not accepted
- The facility must be offer full-time employment in the practice of the physician’s specialty
- There must be no more than one year between completion of the primary care residency and the start work date [as per HHS regulation 45 CFR 50. 5(b)].
- In the case of a physician who, upon completion of the residency, immediately enter into fellowship training in geriatrics, addiction medicine, or child and adolescent psychiatry are eligible to apply for a waiver; the one-year window required in 45 CFR 50.5(b) commences upon completion of this additional training.
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)
- ECFMG Certification
- Copy of a full and unrestricted license to practice OR a copy of an application for licensure in the state where the physician will practice
- 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 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)
- Evidence of employer's regional and national recruitment efforts, including names of non-foreign physicians applying and/or interviewed and reasons why they were not hired
- 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 with a HPSA score of 7 or higher, 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; see 22 CFR 41.63(c)(4)(ii) for format / required information):
- Must include required DOS/22 CFR language
- Must include site identifiers (HPSA or FQHC Identifier number, FIPS county code, census tract or 9-digit ZIP code
- Letter of need (U.S. Department of State requirement)
- Administrative documentation: Copies of all Forms IAP-66 and/or DS-2019 and current visa status materials
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
- Signed Physician Statement
- All Forms DS-2019s and/or IAP-66
- U.S. Citizenship and Immigration Service (USCIS) Form G-28 (if represented by counsel)
- Healthcare Facility Cover Letter
- Proof of HPSA Designation (HRSA Data Warehouse printout of all practice locations)
- Proof of Healthcare Facility Existence
- Executed Employment Contract (including practice location(s), contract length, start date of employment, full-time status, prevailing wage documentation, and no non-compete/restrictive covenant)
- Employer Attestation (separate document from facility letter; see 22 CFR 41.63(c)(4)(ii) for format / required information)
- Recruitment effort documentation
- Current Curriculum Vitae (CV) - do not include SSN
- Credentials including:
- ECFMG Certificate
- Diplomas
- Residency completion
- Eligibility for Licensure
- Results of USMLE 1,2, &3 (MD) or COMLEX Levels 1, 2, &3 (DO)
- Documentation of completion of fellowship / additional training (as applicable)
- Copy of a full and unrestricted license to practice OR a copy of an application for licensure in the state where the physician will practice
- Prevailing wage information
- State health department support/acknowledgment letter
- Letter of need from medical facility
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).
For more information, see frequently asked questions.
Submit an 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).
- Email research waiver requests to J1EVResearchWaivers@hhs.gov.
- Upload clinical care waiver requests to the National Institutes of Health (NIH) Box.
We will provide an updated Clinical Care Waiver Checklist soon.
For questions related to the submission of clinical care waiver requests, please reach out to J1PhysClinicalWaiver@hrsa.gov.