Influenza (Flu)

Required for Form I-693 (USCIS medical exam) for adjustment of status, refugee/asylee status, and certain other immigration benefits.

What it protects against

Seasonal influenza.

Who must receive it

Required ages 6 months and older, annually, when vaccine is available (typically August–May).

Dose schedule

1 dose per flu season. Children 6 months–8 years getting flu vaccine for first time may need 2 doses.

Cost

$0 with insurance (always covered). Without insurance: $20–$50 at pharmacies (CVS, Walgreens, Walmart, Costco); FREE at most county health departments during flu season; FREE pharmacy days advertised in Spanish-language media each fall.

See Where to get immigration vaccinations for free and low-cost options.

Side effects

Sore arm, mild fatigue, low fever. You cannot get flu from the shot.

Blood test alternative (titer)

Not applicable — annual vaccination is what’s tracked.

Important notes

Required ONLY if your medical exam falls between October 1 and March 31 AND flu vaccine is available. If your exam is in summer when flu vaccine is not in season, this requirement is waived for that exam.

Bring to your civil surgeon

  • Yellow international vaccination card (cartilla de vacunacion) if vaccinated abroad
  • Pediatrician/clinic records from any US doctor visits
  • State immunization registry printout if available
  • Translation NOT required for vaccine cards — doses and dates are universal

Civil surgeons can administer missing doses during your I-693 exam, but pricing is typically HIGHER than going to a county health department or pharmacy beforehand.

Last verified: 2026-09-24.

General health and procedural information from CDC Civil Surgeon Technical Instructions and USCIS Policy Manual. Not medical or legal advice. Consult your physician for medical guidance and a licensed immigration attorney for case-specific questions.

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. The civil surgeon sets the exam fee, and fees vary from one civil surgeon to another.

CDC’s Technical Instructions for Civil Surgeons (page last updated March 11, 2025) 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 and meningococcal (children). HPV is NOT on the CDC required list — neither is zoster — so no civil surgeon can require an HPV series for immigration purposes. Which vaccines are required depends on the applicant’s age and vaccination history: each must be age-appropriate as recommended by ACIP for the general US population. A Form I-693 signed by a civil surgeon on or after November 1, 2023 stays valid only while the application it was filed with is pending (USCIS Policy Manual Vol. 8 Pt. B Ch. 4, effective June 11, 2025); one signed before November 1, 2023 keeps evidentiary value for 2 years from the signature date.

Verify the current USCIS Fee Schedule at uscis.gov/g-1055 (Form G-1055) before filing Form I-485. Tuberculosis (TB) screening with an IGRA blood test is required for all I-693 applicants 2+ years old; a chest X-ray is required after a positive IGRA, known HIV infection, or signs or symptoms of TB.

For Civil Surgeon designation questions or vaccination requirement disputes: USCIS Contact Center 1-800-375-5283 Monday-Friday 8:00am-8:00pm Eastern Time. Form I-693 (the civil surgeon places it in a sealed envelope): since December 2, 2024 it must be submitted with Form I-485, or USCIS may reject the I-485 — by mail, in the original sealed envelope; online filers open the envelope, upload the form and keep the original and envelope. If the application your Form I-693 was filed with is withdrawn or denied, you need a newly completed and signed Form I-693 for any future application.

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.