United States immigration law requires all applicants for lawful permanent resident (either adjustment of status in U.S. or immigrant visa abroad) to obtain certain vaccinations (listed below) against vaccine-preventable diseases, prior to the issuance of an immigrant visa, adjudication of permanent residence. If you refuse to take the vaccines required for immigration purposes, your petition for permanent residency may be denied.

Most nonimmigrant visa applicants are not required to comply with the vaccination requirements to a get visa.

If the applicant is in the U.S., vaccinations are administered by Civil Surgeon. If the applicant is outside the U.S., vaccinations are administered by Panel Physician. This document will refer them as 'designated physician' for ease of understanding.

Following vaccinations are required:

• Mumps
• Measles
• Rubella
• Polio
• Tetanus and Diphtheria toxoids
• Pertussis
    - Acellular pertussis-containing vaccines are available for use in persons at least 10 years age.
• Influenza Type B
    - Given annually to children 6 through 59 months of age;
      It continues to be required for adults 50 years of age or older.
• Hepatitis B
    - Given to all applicants from birth through 18 years of age.
• Seasonal flu if you have the medical examination completed between October 1 and March 31.
• Effective Dec 14, 2009, Zoster and Human Papillomavirus (HPV) are not required. Therefore, even if your medical examination was done before that and you didn't take those vaccines, you are fine.
• Any other vaccinations recommended by the Advisory Committee for Immunization Practices (ACIP).

In order to assist the designated physician, and to avoid delays in the processing, all applicants should have their vaccination records available for the designated physician's review at the time of the medical examination. This is especially important for pre-school and school-age children. Applicants should consult with their regular health care provider to obtain a copy of their immunization record, if one is available. If you do not have a vaccination record, or if you never had certain vaccines, the designated physician will work with you to determine which vaccinations you may need to meet the requirement. In certain cases where the designated physician can not administer in their office or hospital, he/she will guide where you can get them, such as local public health department. After evaluation by the designated physician, you may alternatively go to your family doctor to get the required vaccines administered and show the records to the designed physician to note on Form I-693.

If you are immune to vaccine-preventable diseases, and if you know of the immunity because your private health care provider has tested you, if you have any written evidence of immunity, you can take this documentation to the designated physician so that he/she can determine which vaccines you need to received.

If you have a medical condition that prevents you from receiving a vaccine that is appropriate for your age, the designated physician will decide and annotate the form accordingly and mark the vaccine as contraindicated. A contraindication is a condition that prevents you from receiving a particular vaccine.

If the designated physician can not administer all the required vaccinations at once, he/she will ask you to come back later to complete it before the form can be completed.

Certain waivers of the vaccination requirement are available upon the recommendation of the designated physician. Only a designated physician can determine which of the listed vaccinations are medically appropriate for you, given your age, medical history and current medical condition. e.g., if you are pregnant, Mumps, Measles, Rubella (MMR) will not be given to you or your husband. USCIS can grant this waiver based on the designated physician's certification on the vaccination supplement. You don't have to file a separate waiver application or pay a fee.

A vaccine is "not medically appropriate" if:

1. the vaccine is not recommended for your specific age group;
2. there is a medical reason why it would not be safe to have the vaccine; e.g., allergies to eggs and yeast, pregnancy, hypersensitivity to prior vaccines, or other medical reasons;
3. you are unable to complete the entire series of a required vaccine within a reasonable amount of time.

If you initially did not have documents proving you received all the required vaccines but later submit those documents, or if the designated physician certifies that it is not medically appropriate for you to have one or more of the missing vaccine(s), USCIS may grant you a waiver based on the civil surgeon's certification on the vaccination requirement.

Do not try to fulfill your vaccination requirements before you meet the designated physician, in case it is not medically appropriate for you to have one or more of the required vaccines.

Also look at medical examination for

Adjustment of Status

Consular Processing

It will provide more information about the designated civil surgeons (in the U.S.) and panel physicians (outside the U.S.).

Technical instructions for designated physicians

Waiver for vaccinations may be available to you, if:

• You are opposed to vaccinations in any form - that is, you cannot obtain a waiver based on an objection only as to one vaccination
• Your objection must be based on religious beliefs or moral convictions; and
• The religious or moral beliefs must be sincere.

You will need to apply for a waiver of vaccination requirements by applying Form I-601, Application for Waiver of Grounds of Excludability, with fee.
Refugees, instead, should file Form I-602, Application by Refugee for Waiver of Grounds of Excludability, and there is no fee. If you believe there is any other humanitarian reason (to assure family unity or when it would otherwise be in the public interest) why USCIS should waive the vaccination requirements for you, you need to submit Form I-602 with your adjustment of status application.

When the applicant is child, decision may be taken according to parent's beliefs.

Orphans age 10 and under who are applying for IR-3 and IR-4 visas at a U.S. consulate don't have to comply with vaccination requirements before issuance of an immigrant visa. However, the adoptive parent must sign an affidavit that the child will be vaccinated within 30 days of arrival or at the earliest time that it is medical appropriate.
Adoptive parents who can't sign the affidavit in good faith because of certain beliefs, look at the section above, to apply for a waiver on behalf of a child.

You are responsible for paying for all the vaccinations you take, directly to the healthcare provider. Before get the vaccines, you should ask them for its prices. If you cannot afford the vaccinations, there is no waiver available for that reason.