J Visa – Designated State Health Agency Request Waiver

J Visa - Designated State Health Agency Request Waiver

Irrespective of the statutory basis on which you are applying for the waiver, make sure to read the common waiver application procedures first. 

This waiver is only for physicians and is also known as Conrad State 30 Program.


A designated State Public Health Department or its equivalent may request a waiver on behalf of physicians (foreign medical graduate) who is subject to two-year home-country physical presence requirement, provided:

  • you have been offered a full-time job at a health care facility in a designed health care professional shortage area or at a health care facility which serves patients from such a designated area
  • you agree in writing to work at that facility for a total of forty hours per week and for a minimum of three years
  • you agree to begin work at that facility within 90 days of the approval of the waiver.


The following documents must be sent directly to the Waiver Review Division. They should not provide those documents to you so that you can in turn forward them.

  • Evidence that the facility is in a Health Professional Shortage Area or a Medically Underserved Area
  • A signed contract between the facility and you that has head of the facility’s and your signature. It must state that you will work with them for at least 40 hours a week and for at least three years.
  • Your resume (curriculum vitae)
  • Copies of all DS-2019/IAP-66 forms ever issued to you
  • A letter from the state public health department’s designated official (designated by the state governor) which states that it is in the public interest that you remain in the U.S. It must include the following:
    1. Your name
    2. Your country of last legal permanent residence
    3. Name and address of medical facility
    4. U.S. Department of Health and Human Services designated Health Professional Shortage Area (HPSA) ID number of medical shortage area
    5. That the facility wishes to hire you.
  • Two self-addressed stamped, legal-size envelopes.
  • Form G-28 or letter from a law office, if you designated an attorney to represent you.

Note: If you received funding from your home country government to participate in the exchange program, they must additionally submit a No Objection Statement directly to the Waiver Review Division. The No Object Statement must clearly state that it is for a Request by a Designated State Public Health Department (or its equivalent), or a Conrad State 30 Program, waiver.


For quicker processing, the State Health Department may submit both its and the applicant’s required documentation together. 

If State Public Health Department agrees to sponsor you for such a waiver, they will forward the Conrad State 30 Program request directly to the Waiver Review Division. 

If such waiver is granted, the participant will be working for those 3 years on H1B visa.


Each State Public Health Department is allowed to request 30 such waivers per federal fiscal year. 10 of the 30 requests may be for exchange visitor physicians who will serve at facilities which may not be located within a designated health care professional shortage area but which serve patients who live within such a designated area.

State Variations

Each state may have slightly different requirements. The states have discretion to decide whether to impose additional requirements. Please review the list of State Public Health Departments. 

Some states may have the following additional requirements:

  • Don’t recommend waiver for specialists. May vary the definition of primary care physicians.
  • Require a minimum commitment of four years instead of the standard three years.
  • Require additional clauses in the contract, such as non-compete, liquidated damages, etc.
  • Require that statements from medical facilities confirming acceptance of Medicaid- or Medicare-eligible patients as well as indigent, uninsured patients.
  • Proof of English language ability through TOEFL/TSE test scores.

Further information at 3RNet.org.

State vs Federal

While physicians can request Federal IGA Waiver or Conrad State 30 Program waiver based on providing medical service in an underserved area in the U.S., there are two key differences:

  • Only three U.S. federal government agencies may request IGA waiver on behalf of foreign physicians to practice in HPSA or MUA
  • Each designated State Public Health Department, or its equivalent, may make only 30 such waiver requests per year


This type of J-1 waiver has been very helpful in maintaining access to healthcare in many rural communities when other recruitment efforts to hire a U.S. citizen have failed. When such a physician works in HPSA or MUA, it helps both the physician and the community, as the physician can get to stay in the U.S. while the rural community gets a doctor that they really need.

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