United States: When Should Adjustment Of Status Applicants Complete Their Form I-693 Medical Exam?

The Form I-693, Report of Medical Examination and Vaccination Record, is a report prepared by an authorized civil surgeon that includes the results of various medical examinations performed on an applicant by the civil surgeon, as well as a record of the applicant's vaccinations. Those applying for permanent resident status from within the United States by filing a Form I-485 application ("adjustment of status") must complete the Form I-693 as part of their application process, to establish that the applicant is not inadmissible to the United States on public health grounds.

Applicants are posed with two options. On the one hand, they may file the Form I-693 with their initial adjustment of status application, providing it to USCIS at the start of the process. On the other hand, if an applicant decides to file their adjustment of status application without Form I-693, USCIS will request it later in the process, either by issuing a Request for Evidence ("RFE") or by asking the applicant to bring it to their interview, should USCIS require the applicant to attend a final interview before adjudicating their application. This leads to the question of whether it is advantageous to submit Form I-693 with the initial I-485 application, or whether it is better to wait and file it at a later point. Each option has its own pros and cons.

Deciding when to complete the Form I-693 medical exam

According to USCIS, filing the Form I-693 concurrently with the Form I-485 will result in faster adjudication. With that in mind, many applicants may wish to file the Form I-693 with their initial application to avoid delays on the back end of their green card process. This may be particularly true for employment-based cases, as USCIS is currently waiving interviews for most of these applications. In those cases, by filing the Form I-693 with the initial I-485 application, USCIS would be able to adjudicate the case without issuing a Request for Evidence for the missing medical exam, thereby avoiding those delays.

For marriage-based cases, however, there is arguably minimal benefit to providing the Form I-693 upfront, as the applicant is almost guaranteed to have a final interview scheduled. Marriage-based green card applicants can simply bring a recently completed Form I-693 with them to their interview and avoid any risk of having the report expire earlier in the process.

The two-year validity period of the Form I-693

The Form I-693 is valid for two years from the date it is signed by the civil surgeon. In most cases, the I-485 application will be adjudicated by USCIS within a two-year time frame, so if a valid Form I-693 was filed with the Form I-485, there is a good chance that it will remain valid for the entire process.

However, USCIS processing times fluctuate constantly, and the adjudication of an adjustment of status application may take longer than expected. It is difficult to predict the processing times of any individual adjustment of status application, and there is a risk that it will take longer than two years for USCIS to adjudicate an application, which means a Form I-693 filed with the initial application will have expired. If the Form I-693 expires before USCIS has adjudicated the application, the applicant would need to complete a new medical exam, costing them additional time and money.

If an applicant instead opts to file their adjustment of status application without a Form I-693, USCIS will issue a request for it later in the process. If an applicant takes this route, it may guarantee that the exam doesn't expire, but it does run the risk of increasing the overall processing times of the application, as USCIS will not be able to adjudicate the green card application until after the applicant has completed the medical exam and submitted it to USCIS.

The "60-day rule"

When having a Form I-693 medical exam completed, applicants should also be mindful of how much time passes between completion of the exam and the submission of the Form I-693 to USCIS. Ordinarily, the medical exam must be submitted to USCIS within 60 days of when it is signed by the civil surgeon. Therefore, it is always best practice for applicants to complete their medical exam near the date they intend to file it with USCIS, so that there is little risk of 60 days passing before USCIS receives it.

Currently, there is a waiver of the 60-day rule, which is in effect until September 30, 2022. While this waiver is in effect, the medical exam can be submitted to USCIS beyond the 60-day timeframe. Nevertheless, the overall two-year validity period of the Form I-693 is still worth considering, and it is still advisable to have the exam completed near the date of intended filing to reduce the risk of it expiring before the application has been adjudicated.

The 60-day rule is still provided in the USCIS policy manual, so it is likely to return to that standard after September 30.

For more information about the history of the I-693 medical exam and its specific requirements, please see our blog post, "The Medical Exam Demystified."

Our Immigration Law Practice Group includes immigration attorneys that work across New York state in our Albany, Buffalo, Ithaca, Long Island, New York City, Rochester and Syracuse offices.

Our immigration lawyers focus on strategies – including immigrant visas for permanent U.S. resident status and temporary visas for foreign nationals – to ensure that companies are able to hire, transfer, and retain the brightest and best non-U.S. talent.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.