Vaccine exemptions and waivers for the immigration medical exam

Vaccine exemptions and waivers

USCIS recognizes three types of exemptions from required vaccinations:

1. Medical — vaccine medically contraindicated (granted by civil surgeon directly on I-693)
2. Religious — sincere religious belief opposed to vaccines (requires Form I-601 waiver, USCIS adjudication)
3. Moral conviction — sincere moral or ethical belief opposed to vaccines (requires Form I-601 waiver, USCIS adjudication)

1. Medical exemption

Granted by the civil surgeon on the I-693 itself. No separate form required. Typical reasons:

• Pregnancy — deferral on live vaccines (MMR, varicella). Must complete after delivery.
• Severe allergic reaction to a vaccine component (anaphylaxis to eggs for flu vaccine, neomycin allergy for MMR, etc.).
• Immunocompromise — cancer treatment, organ transplant, HIV with low CD4, congenital immunodeficiency. Live vaccines (MMR, varicella, rotavirus) contraindicated.
• Age outside required range — e.g., adult over 19 not required to have Hep A, Hib (in most cases).
• Vaccine in short supply at the time of the exam.

The civil surgeon notes the exemption and reason on the I-693. USCIS accepts these without requiring an I-601 waiver.

2. Religious exemption (requires I-601 waiver)

Granted if the applicant demonstrates that opposition to vaccines is based on religious beliefs that:

• Are sincere
• Are religious in nature (not personal preference disguised as religion)
• Universally opposed to all vaccines (cannot pick and choose — must be opposed in principle to ALL vaccinations)

Filed using Form I-601 (Application for Waiver of Grounds of Inadmissibility), with $1,050 filing fee. USCIS reviews case-by-case.

Examples that have been granted: members of small religious groups with documented universal opposition to vaccination (Christian Scientists, certain Old Order sects).

Examples that have been DENIED: Catholic and mainline Protestant applicants who claim religious exemption (these religions do not universally oppose vaccination); applicants who are vaccinated themselves but cite religion as reason to refuse certain vaccines for political reasons.

3. Moral conviction exemption (requires I-601 waiver)

Granted if the applicant demonstrates sincere moral or ethical opposition to vaccines that is:

• Not based on personal opinion or political belief
• Equivalent in strength and consistency to a religious conviction
• Universally opposed to all vaccines

Same I-601 process and fee. Approval is rare — USCIS scrutinizes whether the opposition is genuine and consistent.

Vaccine hesitancy, political opposition to vaccination policy, or generalized distrust of pharmaceuticals do NOT qualify.

I-601 waiver process

1. Civil surgeon documents the missing vaccine on I-693 as a refusal (do NOT skip the I-693 — it must show the refusal)
2. File Form I-601 with USCIS along with adjustment of status application (I-485)
3. Filing fee: $1,050 (subject to change — verify on uscis.gov/i-601 before filing)
4. Evidence required:
   • Sworn statement from applicant explaining beliefs and history
   • Documentation of religious affiliation (membership records, clergy letter, etc.)
   • Evidence of consistency (have you previously refused vaccines for yourself or family members?)
   • Evidence that opposition is universal (not just specific vaccines)
5. USCIS decision: weeks to months. Interview may be required.

What happens if waiver is denied

• You must either receive the vaccine(s) or risk denial of I-485
• Some applicants choose to receive the vaccine after waiver denial rather than be denied adjustment
• You can appeal a waiver denial (Form I-290B, $675 fee)

What COVID-19 was — historical note

From October 2021 to January 22, 2025, COVID-19 vaccine was required for I-693. Many I-601 waivers were filed during this period. The requirement was rescinded January 22, 2025 — COVID-19 vaccine is NOT currently required. Any pending I-601 waivers based solely on COVID-19 refusal became moot.

What this does NOT cover

• Vaccine exemptions for SCHOOLS (different rules, state-by-state, see Enroll children in US school)
• Vaccine exemptions for HEALTHCARE WORKERS (employer policy, not USCIS)
• Vaccine exemptions for INTERNATIONAL TRAVEL (yellow fever, etc. — not USCIS)

When to consult an attorney

I-601 waivers based on religious or moral conviction have HIGH denial rates and HIGH stakes (denial can derail your green card application). Consult an experienced immigration attorney BEFORE filing if you intend to claim religious or moral exemption.

See Find immigration attorney and Legal aid by state for low-cost options.

Related

• Immigration medical exam (Form I-693) overview
• I-485 Adjustment of Status
• Find immigration attorney
• Legal aid by state
• USCIS notice codes

Last verified: 2026-05-25.

General procedural information from USCIS Policy Manual Vol 8, Part B, Ch 9. Not medical or legal advice. I-601 waivers are case-specific and high-stakes — consult a licensed immigration attorney before claiming religious or moral exemption.

Related procedural information

• Consulate of your country in the US — passport renewal, consular ID, document apostille
• ITIN — file federal taxes without SSN — required regardless of immigration status
• USCIS form library — federal immigration forms (I-130, I-485, N-400, etc.)
• Find an immigration attorney — pro bono lists + AILA + BIA-recognized
• Know Your Rights — ICE encounters — constitutional protections

USCIS Form I-693 medical exam context (2025-2026)

The USCIS Form I-693 (Report of Immigration Medical Examination and Vaccination Record) is required for adjustment-of-status applicants (Form I-485) and certain refugee/asylee categories. Civil Surgeons designated by USCIS conduct the exam. Find a Civil Surgeon at uscis.gov/tools/find-a-civil-surgeon. Costs range from $100-$500 (with average $200-$350) depending on region — NOT covered by USCIS or any government program.

CDC’s Technical Instructions for Civil Surgeons (most recent major update 2023) specify required vaccinations: tetanus-diphtheria, pertussis (Tdap/DTaP), MMR (measles-mumps-rubella), polio, varicella (chickenpox), influenza (seasonal), pneumococcal (age-dependent), Hib (children), Hepatitis A + B, rotavirus + meningococcal (children), HPV (age 9-26 catch-up). Adults typically need 4-8 vaccines; full pediatric schedule for children. Form I-693 results are valid for 2 years from signature date.

H.R.1 / OBBBA changes (2026-05-29) did NOT affect I-693 procedures, but USCIS Form Fee changes effective 2026-05-29 may affect related adjustment-of-status processing — verify USCIS Fee Schedule at uscis.gov/g-1055 (Form G-1055) before filing I-485. Tuberculosis (TB) screening required for all I-693 applicants 2+ years old; chest X-ray for positive skin/blood tests.

For Civil Surgeon designation questions or vaccination requirement disputes: USCIS Contact Center 1-800-375-5283 Monday-Friday 8:00am-8:00pm Eastern Time. For sealed I-693 transport (DO NOT OPEN — Civil Surgeon places in sealed envelope; USCIS rejects opened envelopes): submit with I-485 or in response to RFE within 60 days. Lost or expired I-693 requires fresh examination ($$$$ again).

For low-cost / free vaccination sources: community health centers (FQHCs at /benefits/community-health-centers-by-state/) provide vaccines on sliding-fee scale; many counties offer free immunization clinics. CDC Vaccines for Children (VFC) program: 1-800-232-4636 (1-800-CDC-INFO) for children whose parents/guardians cannot afford vaccines.