J-1 WAIVERS FOR PHYSICIANS TO DELIVER MEDICAL SERVICES IN DESIGNATED UNDERSERVED AREAS OR AT VA HOSPITALS
J-1 WAIVERS FOR PHYSICIANS TO DELIVER MEDICAL SERVICES IN DESIGNATED UNDERSERVED AREAS OR AT VA HOSPITALS
Physicians who receive clinical medical residency training in the U.S. pursuant to a J-1 exchange visitor visa are required to return to their home country for two years before they are eligible to apply for an H-1B visa or permanent residency. J-1 visa physicians need not complete this two-year home requirement if they are approved for a waiver to deliver medical services in a designated underserved area or at a VA hospital.
Obtaining a J-1 waiver is a three-step process. The first step is to obtain a recommendation for a waiver from an interested government agency (IGA) or interested state agency. This recommendation is then forwarded to the United States Department of State Waiver Review Division in Washington, D.C. (formerly known as the USIA), which in turn issues its recommendation to the U.S. Citizenship and Immigration Services (USCIS), which provides approval of an Application to Waive Foreign Residence Requirements (Form I-612).
The federal agencies which most often act as IGAs include the Appalachian Regional Commission (ARC) and Delta Regional Authority (DRA), which recommend waivers for shortage areas in specified counties within the Appalachian and Delta region states, respectively, and the Veterans Administration (VA), which recommends waivers for physicians to work in Veterans Administration hospitals (which may or may not be located within designated shortage areas). Any federal agency may sponsor a waiver, but these three are the most widely used. Please note that effective December 19, 2002, the Department of Health and Human Services (DHHS) became an IGA for purposes of processing waivers that are based upon delivering medical services in designated underserved areas.
In addition, the United States Congress, under the leadership of Senator Conrad, has mandated that all states (as well as the District of Columbia and certain territories, such as Puerto Rico and Guam) may act as interested state agencies (State 30 Program), recommending up to thirty (30) waivers for J-1 physicians per state each fiscal year. These waiver recommendations are available in addition to any VA, ARC or DHHS waivers that may be issued for locations within that state. Despite this authority, not all states have chosen to create a State 30 Program, although some previous “hold out” states have opened programs in response to the U.S. Department of Agriculture’s closure in February 2002.
In order to qualify for a waiver through any program (except the VA program), the general rule is that the intended practice site be located in a federally designated shortage area, meaning a Mental Health or Primary Care Health Professional Shortage Area (HPSA) or a federally designated Medically Underserved Area (MUA) or Medically Underserved Population (MUP). While the HPSA designation is universally accepted, certain states do not recognize the MUA/MUP designation. Both HPSA and MUA/MUP areas are designated by the U.S. Department of Health and Human Services, but the methods of determination differ. In addition, President Bush recently signed a significant piece of legislation that permits each state department of health to sponsor up to five J-1 waivers per year for physicians not working in medically underserved areas but who serve patients who reside in medically underserved areas.
The ARC program is limited to physicians who have completed residency training in a primary care field, which is generally defined as internal medicine, family practice, general practice, pediatrics, general psychiatry or obstetrics and gynecology, and the physician must agree to practice such primary care. Regulations in certain states preclude participation in a waiver program if subsequent fellowship training was received, even where it is intended that primary care be practiced exclusively in order to meet the waiver obligation. In contrast, the VA, DRA and certain State 30 programs may recommend waivers for physicians to practice a subspecialty to serve their waiver commitment. Our office will consult the regulations of the state of intended practice in order to determine the feasibility of a waiver application in that area. In some cases, a particular practice site may present the option of multiple waiver programs through which to apply.
Most J-1 Visa Waivers typically require a three year service obligation. However, certain states, such as West Virginia, require a four-year contract. All waiver programs require a showing that the employer has made efforts to recruit a U.S. physician prior to offering a position to a J-1 physician. In most cases, this translates into a requirement that the employer produce documentation evidencing extensive recruitment efforts during the six-month period preceding the date of the contract with the J-1 physician and submission of the waiver application. In some states, such as Utah, recruitment efforts documentation must span one year in order for the application to be considered. Recruitment efforts must also take specific forms in some programs. For example, the ARC requires that the employer advertise in both national and statewide newspapers/medical journals and send job opportunity notices to all residency programs in the state of intended practice.
The significance of a USCIS approved Application to Waive Foreign Residence Requirements is limited to the waiver of the two-year home requirement. It does not, however, place the J-1 physician into a legal nonimmigrant status, nor does it imply authorization to work in the U.S. Therefore, it is imperative that the J-1 physician obtains H-1B approval as well. Upon completion of the J-1 Visa waiver service obligation, the applicant will be eligible to obtain permanent resident status.
http://j-1-visa-ds-2109-ds-7002.blogspot.com/2018/03/j-1-visa-ds-2109-ds-7002.html
Physicians who receive clinical medical residency training in the U.S. pursuant to a J-1 exchange visitor visa are required to return to their home country for two years before they are eligible to apply for an H-1B visa or permanent residency. J-1 visa physicians need not complete this two-year home requirement if they are approved for a waiver to deliver medical services in a designated underserved area or at a VA hospital.
Obtaining a J-1 waiver is a three-step process. The first step is to obtain a recommendation for a waiver from an interested government agency (IGA) or interested state agency. This recommendation is then forwarded to the United States Department of State Waiver Review Division in Washington, D.C. (formerly known as the USIA), which in turn issues its recommendation to the U.S. Citizenship and Immigration Services (USCIS), which provides approval of an Application to Waive Foreign Residence Requirements (Form I-612).
The federal agencies which most often act as IGAs include the Appalachian Regional Commission (ARC) and Delta Regional Authority (DRA), which recommend waivers for shortage areas in specified counties within the Appalachian and Delta region states, respectively, and the Veterans Administration (VA), which recommends waivers for physicians to work in Veterans Administration hospitals (which may or may not be located within designated shortage areas). Any federal agency may sponsor a waiver, but these three are the most widely used. Please note that effective December 19, 2002, the Department of Health and Human Services (DHHS) became an IGA for purposes of processing waivers that are based upon delivering medical services in designated underserved areas.
In addition, the United States Congress, under the leadership of Senator Conrad, has mandated that all states (as well as the District of Columbia and certain territories, such as Puerto Rico and Guam) may act as interested state agencies (State 30 Program), recommending up to thirty (30) waivers for J-1 physicians per state each fiscal year. These waiver recommendations are available in addition to any VA, ARC or DHHS waivers that may be issued for locations within that state. Despite this authority, not all states have chosen to create a State 30 Program, although some previous “hold out” states have opened programs in response to the U.S. Department of Agriculture’s closure in February 2002.
In order to qualify for a waiver through any program (except the VA program), the general rule is that the intended practice site be located in a federally designated shortage area, meaning a Mental Health or Primary Care Health Professional Shortage Area (HPSA) or a federally designated Medically Underserved Area (MUA) or Medically Underserved Population (MUP). While the HPSA designation is universally accepted, certain states do not recognize the MUA/MUP designation. Both HPSA and MUA/MUP areas are designated by the U.S. Department of Health and Human Services, but the methods of determination differ. In addition, President Bush recently signed a significant piece of legislation that permits each state department of health to sponsor up to five J-1 waivers per year for physicians not working in medically underserved areas but who serve patients who reside in medically underserved areas.
The ARC program is limited to physicians who have completed residency training in a primary care field, which is generally defined as internal medicine, family practice, general practice, pediatrics, general psychiatry or obstetrics and gynecology, and the physician must agree to practice such primary care. Regulations in certain states preclude participation in a waiver program if subsequent fellowship training was received, even where it is intended that primary care be practiced exclusively in order to meet the waiver obligation. In contrast, the VA, DRA and certain State 30 programs may recommend waivers for physicians to practice a subspecialty to serve their waiver commitment. Our office will consult the regulations of the state of intended practice in order to determine the feasibility of a waiver application in that area. In some cases, a particular practice site may present the option of multiple waiver programs through which to apply.
Most J-1 Visa Waivers typically require a three year service obligation. However, certain states, such as West Virginia, require a four-year contract. All waiver programs require a showing that the employer has made efforts to recruit a U.S. physician prior to offering a position to a J-1 physician. In most cases, this translates into a requirement that the employer produce documentation evidencing extensive recruitment efforts during the six-month period preceding the date of the contract with the J-1 physician and submission of the waiver application. In some states, such as Utah, recruitment efforts documentation must span one year in order for the application to be considered. Recruitment efforts must also take specific forms in some programs. For example, the ARC requires that the employer advertise in both national and statewide newspapers/medical journals and send job opportunity notices to all residency programs in the state of intended practice.
The significance of a USCIS approved Application to Waive Foreign Residence Requirements is limited to the waiver of the two-year home requirement. It does not, however, place the J-1 physician into a legal nonimmigrant status, nor does it imply authorization to work in the U.S. Therefore, it is imperative that the J-1 physician obtains H-1B approval as well. Upon completion of the J-1 Visa waiver service obligation, the applicant will be eligible to obtain permanent resident status.
http://j-1-visa-ds-2109-ds-7002.blogspot.com/2018/03/j-1-visa-ds-2109-ds-7002.html
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