Influenza (Flu) — Immigration medical exam vaccine

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.

Related

• Immigration medical exam (Form I-693) overview
• Where to get immigration vaccinations
• Vaccine costs with and without insurance
• Vaccine exemptions and waivers
• I-485 Adjustment of Status

Last verified: 2026-05-25.

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.

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.