Guide · Immigration & USCIS

USCIS vaccine requirements for Form I-693.

Reviewed August 2026 · Based on the USCIS Policy Manual (Volume 8, Part B, Chapter 9), the USCIS Vaccination Requirements page, and the CDC Vaccination Technical Instructions for Civil Surgeons. Educational reference, not immigration or medical advice.

If you're adjusting status to a lawful permanent resident inside the United States, or applying for an immigrant visa abroad, you'll be asked to complete an immigration medical examination — Form I-693 — with a USCIS-designated civil surgeon. Part of that examination is a review of your vaccination history. The list of required vaccines is set by federal statute plus a handful of additions the CDC layers on top; both change occasionally. This guide is current as of August 2026.

What the law says: two categories of required vaccines

The Immigration and Nationality Act (INA) names a specific list of vaccines that all applicants must document¹. The CDC then adds a second list of vaccines that ACIP recommends for the general U.S. population, when they are age-appropriate.

Required by the INA (statute)

• Mumps, measles, and rubella (MMR)
• Polio
• Tetanus and diphtheria toxoids
• Pertussis
• Haemophilus influenzae type B (Hib)
• Hepatitis B

Required by CDC (additions to the INA list)

• Varicella
• Influenza (seasonal, October 1 – March 31)
• Pneumococcal pneumonia
• Rotavirus
• Hepatitis A
• Meningococcal

The USCIS Policy Manual is unambiguous about consequences: "If the applicant has not received any of the listed vaccinations and the vaccinations are age appropriate and medically appropriate, the applicant has a Class A medical condition and is inadmissible"¹.

The May 2024 polio change — the update most people miss

The most consequential recent change: as of May 1, 2024, the CDC Vaccination Technical Instructions require that "one dose of IPV should be given to anyone 2 months or older if they are not currently up to date according to ACIP recommendations, including adults who cannot show proof of the childhood vaccine series"².

Before this change, most adults were considered up to date on polio through their childhood series and no additional dose was expected. Under the new rule, if you can't produce childhood polio (IPV) documentation, the civil surgeon will administer one dose of IPV at the medical examination. The requirement applies to any Form I-693 signed on or after May 1, 2024.

Practically, this means: dig up your childhood immunization records before your appointment. If they show a completed polio series, you're fine. If they don't, expect the civil surgeon to give you a dose.

Titers can't get you out of the polio requirement — and here's the specific reason. Polio is caused by three distinct serotypes (types 1, 2, and 3), and USCIS requires documented immunity to all three. Wild poliovirus type 2 was declared eradicated by the World Health Organization in 2015, and commercial U.S. labs stopped running type 2 antibody testing after that. Every commercial polio titer we're aware of tests only types 1 and 3 — which means the report is incomplete for USCIS purposes and gets rejected. There is no reliable titer route for polio right now. If your childhood series isn't documented, the IPV dose is your path forward.

The COVID-19 change — no longer required

COVID-19 vaccination was added to the required list in October 2021 and removed on March 11, 2025. USCIS stopped issuing Requests for Evidence based on missing COVID-19 documentation as of January 20, 2025¹. If your Form I-693 is being adjudicated after those dates, COVID-19 is neither required nor relevant.

Age-appropriate is the operative phrase

The USCIS page states clearly: "You are required to document receipt of vaccines that are age appropriate for you"³. The civil surgeon reviews your records and determines which of the required vaccines apply to your age category. Some vaccines on the list — rotavirus, for instance — are only administered in infancy and won't apply to adult applicants. Others, like the annual flu shot, are only required during flu season (October 1 through March 31). If your immigration medical exam is on May 15, you won't be asked for a flu shot.

Single dose at the civil surgeon, follow-up elsewhere

Multi-dose series create a common misunderstanding. The USCIS page addresses this directly: "You are only required to receive a single dose of each vaccine when you visit the civil surgeon"³. If a vaccine requires three doses (like Hepatitis B), the civil surgeon administers one dose to complete the immigration exam and expects you to finish the series with your regular provider. On the form, the civil surgeon marks "insufficient time interval" — this is not a rejection.

Proof of immunity — when a titer replaces a vaccination

USCIS explicitly accepts serologic proof: "If you have any written evidence of immunity, you should take this documentation to your civil surgeon"³. A positive titer for MMR, varicella, hepatitis A, or hepatitis B is generally accepted in place of the corresponding vaccine.

Two practical notes:

• Bring the actual lab report, not a summary. The civil surgeon needs to see the assay, the value, and the reference range.
• Presumptive immunity based on birth year (the "born before 1957" MMR rule that applies in some clinical settings) is not called out on the USCIS or Policy Manual pages as a form of proof^1,3. Assume you need documentation or a titer regardless of birth year.

Medical contraindications

If a medical condition prevents you from safely receiving a required vaccine (severe allergy, immunocompromise, pregnancy for live vaccines), the civil surgeon annotates Form I-693 as contraindicated. The CDC Technical Instructions list every recognized contraindication and pregnancy-specific rule. Contraindication is not a waiver — the civil surgeon documents it on the form and the vaccine requirement is set aside.

The single most common cause of Form I-693 delays: applicants show up without their childhood immunization records, don't have a titer, and get sent home to gather documentation. If you're preparing for your civil surgeon visit, request your records first — most countries have their own version of a state immunization registry, and the U.S. state directory covers domestic records.

Adopted children — the one big exception

The Policy Manual notes an exception for certain internationally-adopted children under age 10 with IR-3, IR-4, IH-3, or IH-4 visa classifications¹. The adopting parent signs an affidavit that the child will receive required vaccinations within 30 days of admission to the U.S. or at the earliest medically appropriate time. This is the only broad exception to the general age-appropriate rule.

Preparing for your civil surgeon appointment

• Request your childhood immunization records from your country of origin's health ministry or your former pediatrician.
• If you were vaccinated in the U.S. as a child, request them from your state's IIS — see the state records directory.
• If you have a positive titer for MMR, varicella, hepatitis A, or hepatitis B, bring the actual lab report.
• Expect to receive at minimum: a Tdap dose (if not within 10 years), potentially an IPV dose (if your polio record is incomplete), and a flu shot if the visit is between October 1 and March 31.
• Choose a designated civil surgeon (not a random primary care doctor) — USCIS maintains the official directory.

Sources

1. USCIS Policy Manual — Volume 8, Part B, Chapter 9: Vaccination Requirement. Source for the INA-required list, CDC-added list, Class A medical condition rule, adopted-children exception, and COVID-19 removal timeline.
2. CDC — Vaccination Technical Instructions for Civil Surgeons. Source for the May 1, 2024 IPV addition.
3. USCIS — Vaccination Requirements (applicant-facing). Source for the "single dose at the civil surgeon," "age appropriate," and "written evidence of immunity" language.
4. CDC Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book), Appendix A. Source for the ≥ 4-week TB-test-after-live-vaccine guidance.