J Visa - Interested Government Agency (IGA) Waiver
Irrespective of the statutory basis on which you are applying for the waiver, make sure to read the common waiver application procedures first.

Even though foreign physicians are not the only ones who can request Interested U.S. federal Government Agency (IGA) waiver, it is most common with foreign physicians as they are subject to two-year home-country physical presence requirement.

Interested U.S. Federal Government Agency (IGA) waiver can be obtained in various ways:
  1. Regular

    The interested U.S. federal government agency should send a letter, signed by the head of the agency, or his/her designee, directly to the Waiver Review Division (not through you) explaining why granting a waiver of the two-year home-country physical presence requirement is in the public interest of the U.S. and why it would be detrimental to the agency if you must return to your home country to fulfill the requirement.

    Any U.S. federal government agency may request a waiver on this basis. List of designated officials from interested U.S. federal government agencies. This is not a complete list of all U.S. federal agencies but only those that have provided with the names of individuals authorized to sign letters requesting waivers under this basis.

  2. Serve in a medically under-served area

    Interested U.S. Federal Government Agency on behalf of a foreign physician who agrees to serve in a medically under-served area should send the following documents directly to the Waiver Review Division and not through you.
    • Copies of all DS-2019/IAP-66 forms ever issued to you;
    • Your resume (curriculum vitae);
    • A signed contract between you and the facility where you will work for at least three years and 40 hours a week.
    • Evidence that the clinic/facility is located in a U.S. Department of Health and Human Services designated Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA);
    • Evidence of unsuccessful efforts made to recruit U.S. citizen physician for the position. Such evidence may include medical journal advertisements, labor certification, or language in a cover letter.
    • A statement signed and dated by you that read exactly as follows: "I, ______________ (your name) hereby declare and certify, under penalty of the provisions of 18USC.1101, that: (1) I have sought or obtained the cooperation of _______________ (enter name of U.S. Government agency which will submit/is submitting an Interested Government Agency Waiver request on your behalf to obtain a waiver of the two-year home-country physical presence requirement)); and (2) I do not now have pending nor will I submit another request to any U.S. Government department or agency or its equivalent, to act on my behalf in any matter relating to a waiver of my two-year home residence requirement.".
    • A letter of request from the head of the agency, or a designated official that includes the following:
      • Stating why it is in the public interest that you be granted a waiver
      • Stating the facility is located in a designated HPSA or MUA and provides medical care to Both Medicaid- and Medicare-eligible patients, and indigent uninsured patients.
      • Include the Federal Information Processing Standards country code and census tract or block numbering area number (assigned by the Bureau of Census) or the 9-digit zip code of the area where the facility is located.
    • Two self-addressed, stamped, legal-size envelopes;
    • Form G-28 or letter from a law office, if you designated an attorney to represent you.

    Only the following U.S. federal government agencies may request IGA waiver on behalf of foreign physicians to practices in HPSA or MUA:
    • Appalachian and Delta Regional Commissions, Department of Health and Human Services
    • Department of Interior for Indian Reservations
    • Department of Veterans Affairs (VA). VA hospitals don't have to be in underserved areas.

  3. Serve in a VA hospital

    Interested Government Agency Request from the Department of Veterans Affairs (VA) on behalf of an exchange visitor physician to serve in a VA hospital must include a signed memorandum of agreement between the physician and the hospital in lieu of a three-year contract. VA hospitals do not have to be in an underserved area.

Support for getting IGA Waiver
Several factors affect whether you would be able to get the IGA waiver:
  • Relationship:
    In most cases, IGAs will accept a waiver application either from a current or prospective employer of the J1 holder and not directly. Therefore, in most cases, you can't self-petition to IGA. That means, you will the support of not only your immediate supervisor but also of higher administrative officers. Employers may also need to provide the information about the project for which you are seeking employment and about the recruitment efforts they had made.
  • Role/Involvement:
    The more critical role you play in the project, more likely is your employer to support your waiver application and more likely that the IGA will support it as well. You may show your critical role by showing your contributions such as breakthrough achievement in research, publications, patents etc. Stronger recommendation letters you can get from your supervisors, better your chances are. If you can get recommendations from experts outside your immediate project, that would help establish that your accomplishments are well recognized in your field.
  • Time line:
    If you are deeply involved in the project and if the project still has quite some time to get completed, your chances would be higher as you leaving will have detrimental affect on the project. It would be the best to show your involvement in the project at least for two years. However, you should start preparing for your application at least 6 months before your application would actually be submitted.