Vaccination Requirements for U.S. Permanent Residence Applicants

A summary of the Centers for Disease Control and Prevention's vaccination Technical Instructions for civil surgeons — the doctors who examine people applying to adjust their status to U.S. permanent residence. The instructions follow CDC regulations and replace all earlier vaccination instructions and updates.

Which vaccines are required

A vaccine is required for applicants only if it is age-appropriate under the Advisory Committee on Immunization Practices (ACIP) recommendations for the general U.S. population, and it protects against a disease that either:

• can cause an outbreak — more cases than expected in a place, group or period, or, for endemic diseases, incidence above the usual level; or
• has been eliminated, or is being eliminated, in the United States.

So not every routinely recommended vaccine is required. The list is: diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, rotavirus, Haemophilus influenzae type b (Hib), hepatitis A, hepatitis B, meningococcal disease, varicella, pneumococcal disease and influenza.

Requirements by age

From CDC's Table 1, effective March 11, 2025.

The table covers only status-adjustment requirements; the number and spacing of doses follow ACIP's standard schedules.

At the exam, applicants are not expected to finish every series — that can take months or years. The civil surgeon gives at least one dose of each required vaccine the applicant is not up to date on: the next dose due in a series, or the first dose if none has been given, and counsels the applicant to complete the series on schedule. Vaccines ACIP recommends only for particular conditions or situations, such as pregnancy or travel, are not required — for example, an adult with sickle cell disease need not receive Hib vaccine for this purpose.

The steps

1. Review the applicant's medical history and vaccination records.
2. Decide whether laboratory confirmation of immunity is needed.
3. Work out which vaccines are needed from age, records, documented immunity and the table.
4. Check for contraindications and precautions.
5. Give any vaccines needed.
6. Complete Form I-693, the Report of Medical Examination and Vaccination Record, and give it to the applicant in a sealed envelope for U.S. Citizenship and Immigration Services, plus a copy of the vaccination record for the applicant.

Records and immunity

• Acceptable records are a personal vaccination record or a copy of a medical chart with entries by a physician or other appropriate medical staff, showing the full date (month, day and year) of each dose, unaltered and with plausible dates. Self-reported doses without written records do not count.
• Applicants must supply reliable English translations of records.
• Vaccines received abroad can be assumed to be of adequate potency, but the schedule should match ACIP's.
• Laboratory evidence of immunity is accepted for measles, mumps, rubella, hepatitis A, hepatitis B, polio (titers must cover all three poliovirus types) and varicella, when vaccination records are lacking. Tests must use FDA-approved or CLIA-certified kits, following the manufacturer's instructions.
• A reliable history of varicella — an epidemiologic link to a typical or lab-confirmed case, or lab confirmation at the time — counts as immunity; otherwise the applicant is tested or vaccinated.

Refugees

Refugees need no vaccines to enter the United States, but must meet the requirements when they apply to adjust status. The civil surgeon confirms refugee status from the applicant's I-94 arrival record (checked against other ID, since many refugees have no passport), assesses vaccinations only, and gives any required vaccines. Since 1998, USCIS has let health departments with qualified physicians act as civil surgeons for refugees' vaccination assessments — but not for people granted asylum, who need a full exam by a designated civil surgeon.

Contraindications, precautions and waivers

A contraindication is a condition likely to cause a life-threatening problem if the vaccine is given; a precaution is one that may raise the chance of a serious reaction or weaken the immune response. Civil surgeons should generally defer a vaccine when either applies, following ACIP guidance and CDC's pregnancy guidance, and record the reason.

Every applicant will have some vaccine that is not medically appropriate. A Blanket Waiver — which the civil surgeon documents on Form I-693, with no application needed — covers four reasons:

• Not age-appropriate — for example, adults who never had Hib or rotavirus vaccine as children need not get them now;
• Contraindication;
• Insufficient time interval — too soon for the next dose, more doses needed to finish a series, or too soon after another live vaccine;
• Not flu season — when influenza vaccine is unavailable, usually in summer.

Non-medical reasons: an applicant objecting on religious or moral grounds must apply to USCIS for an individual waiver; an applicant who refuses a medically appropriate dose is recorded as not meeting the requirements.

Other duties and resources

• Handling and storage matter: vaccines stored badly lose potency (see the CDC "Pink Book" and CDC's storage and handling guidance).
• Adverse events may be reported to the Vaccine Adverse Event Reporting System (VAERS) — 1-800-822-7967 or https://vaers.hhs.gov/.
• The National Childhood Vaccine Injury Act requires giving each person (or a minor's parent or representative) the relevant Vaccine Information Statement, available in many languages.
• ACIP schedules are updated every year. Questions go to CDC's Division of Global Migration Health: civilsurgeons@cdc.gov.

Sources

• Centers for Disease Control and Prevention, "Vaccination Technical Instructions for Civil Surgeons." https://www.cdc.gov/immigrant-refugee-health/hcp/civil-surgeons/vaccination.html
• CDC, "Table 1: Vaccine Requirements According to Applicant Age for Civil Surgeons," print version: https://www.cdc.gov/immigrant-refugee-health/media/pdfs/Vaccine-Requirements-According-to-Applicant-Age-civil-surgeons-p.pdf
• The age table is taken from CDC's print version, because the web table's merged cells did not survive import.
• Rewritten in hubnx's own words.