Form I-693 Rules (2026): every USCIS requirement, sourced and dated

Form I-693 is filed with Form I-485

In effect since December 2, 2024

Since December 2, 2024, you must submit Form I-693, or a partial Form I-693 such as the vaccination record, together with your Form I-485. USCIS may reject a Form I-485 filed without it.

So the exam comes before you file, not after. USCIS says it made this change to reduce the number of Requests for Evidence it issues before deciding a Form I-485.

Some applicants submit only part of the form. For example, certain refugees who completed a medical exam abroad submit the vaccination record and a few other parts. USCIS lists who does on its Form I-693 page, and an immigration attorney can confirm what applies to your case.

The sealed envelope: mail and online filing

The civil surgeon must give you the completed Form I-693 in a sealed envelope. Do not accept it if it is not sealed. If you file Form I-485 by mail, submit that original sealed envelope with your application. If you file Form I-485 online, USCIS instructs you to open the sealed envelope and upload the completed Form I-693. Keep the original form and the envelope until USCIS makes a final decision. USCIS may review them at an interview or ask you to submit them.

For mail filings, the Form I-693 instructions say USCIS will return a form that is not in a sealed envelope, or whose envelope has been opened or altered.

USCIS has not published a start date for the online upload instruction. On July 24, 2026, USCIS added online filing options for Form I-485 and listed Form I-693 among the forms that can be submitted with it by PDF upload.

Ask the clinic for a separate copy for your records.

How long Form I-693 is valid

In effect since June 11, 2025

A Form I-693 signed by a civil surgeon on or after November 1, 2023 is valid only while the application it was submitted with is pending. If that application is withdrawn or denied, the form is no longer valid, and a future application needs a new one. This applies to applications pending or filed on or after June 11, 2025.

A form signed before November 1, 2023 keeps its evidentiary value for 2 years from the date of the civil surgeon’s signature.

Even when a form is still valid, a USCIS officer who has reason to believe your medical condition has changed may ask for more evidence or a new or updated Form I-693.

The Form I-693 instructions still describe a two-year period. USCIS says the Policy Manual guidance is controlling and supersedes prior guidance.

Required tests by age

CDC’s Technical Instructions for civil surgeons set the lab tests: an IGRA blood test for tuberculosis for everyone 2 and older, a syphilis test for ages 18 to 44, and a gonorrhea test for ages 18 to 24. Outside those ages, the syphilis and gonorrhea tests are done only if there is reason to suspect infection.

A positive IGRA, known HIV infection, or signs or symptoms of tuberculosis means a chest x-ray. HIV testing is not a requirement of the exam. Civil surgeons are told not to give urine drug tests routinely; they assess each applicant’s history instead.

USCIS reviews a form against the CDC instructions in effect on the date the civil surgeon signed it. For example, an officer should not require these tests from someone who reached the testing age only after the form was signed.

Required vaccines

The civil surgeon checks your records against the vaccines CDC requires for your age. Not every vaccine applies to every person. COVID-19 vaccination is no longer on the list.

• Diphtheria, tetanus & pertussis
• Polio
• Measles, mumps & rubella
• Varicella (chickenpox)
• Hepatitis A
• Hepatitis B
• Meningococcal
• Pneumococcal
• Rotavirus
• Hib
• Influenza (Sept 1 – Mar 31 only)

Influenza vaccine is required only during flu season. CDC’s civil surgeon FAQ says flu season for this exam runs from September 1 to March 31. The USCIS Policy Manual still describes October 1 to March 31. Outside flu season, the civil surgeon records that it is not flu season.

On January 22, 2025, USCIS announced that, as of January 20, 2025, officers would no longer issue Requests for Evidence or deny applications over a missing COVID-19 vaccination record. CDC removed COVID-19 from the required list on March 11, 2025.

If you have no records, blood tests called titers can show immunity to measles, mumps, rubella, hepatitis A, hepatitis B, polio and varicella. A polio titer must cover all three poliovirus types.

An incomplete form generally gets a Request for Evidence

USCIS lists what every Form I-693 must meet: all required parts completed, signatures from the civil surgeon and the applicant, a form that is still valid, and a sealed envelope as the instructions describe. If a form falls short, USCIS guidance tells officers to issue a Request for Evidence to correct it.

Rejection applies in narrower cases. USCIS says it will reject an unsigned form, may reject a form with missing pages or pages from a different edition, and may reject a Form I-485 filed without the required Form I-693.

For forms the civil surgeon signs on or after July 3, 2025, USCIS accepts only the 01/20/25 edition of Form I-693.

To answer the request, the civil surgeon either corrects the original form, which you and the civil surgeon sign and date again, or completes a new one. Either way, the civil surgeon seals it in an envelope for USCIS.

How long you have to answer a Request for Evidence

USCIS gives up to 12 weeks (84 days) to respond to a Request for Evidence, and regulations do not allow officers to extend it. An officer can set a shorter deadline that fits what is being requested.

If a request is not answered by the deadline, USCIS may deny the application. Sending only some of the requested evidence is treated as a request for a decision on the record.

While USCIS waits for your response, its processing clock is paused. It resumes when USCIS receives the response.

A Notice of Intent to Deny allows up to 30 days.

Only a USCIS-designated civil surgeon can complete the form

Apart from physicians who are Public Health Service officers, only a physician USCIS has designated as a civil surgeon can do the immigration medical exam in the United States and complete Form I-693. The physician must be designated at the time of the exam.

Only currently licensed doctors of medicine (M.D.) and doctors of osteopathy (D.O.) can be designated. A medical license alone is not enough.

USCIS officers check designation against the Find a Civil Surgeon list. You can search the same list before you book.

Search USCIS Find a Civil Surgeon