Navigating the vaccination requirements for your green card application can feel overwhelming. The rules change, the forms are technical, and a single error on your medical exam paperwork can delay your case by months—or worse, result in a denial. At Siri & Glimstad, we help applicants across the country understand exactly what vaccines are required for immigration purposes, when waivers are available, and how to avoid the common pitfalls that trip up even well-prepared applicants.
Key Takeaways
- Most green card applicants must prove they have received specific, age-appropriate vaccines listed by the Centers for Disease Control and Prevention (CDC) for U.S. immigration. Failure to comply can make an applicant inadmissible under the INA.
- As of March 11, 2025, COVID 19 vaccination is no longer required for immigration purposes. However, other core vaccines—including MMR, polio, Tdap/Td, varicella, influenza (during flu season), and others—still are.
- Medical and religious or moral waivers exist, but these are document-heavy requests where an experienced immigration lawyer can be critical to success.
- The designated civil surgeon’s completion of Form I 693 is central to proving vaccine compliance. Errors or omissions on this form frequently cause Requests for Evidence (RFEs), delays, or denials.
What Vaccines Are Currently Required for a Green Card in 2026?
The CDC sets the official list of required vaccines for immigration medical exams, and United States Citizenship and Immigration Services (USCIS) follows those technical instructions for all green card applicants who must submit Form I 693. The list focuses on vaccine preventable diseases that pose significant public health risks and have outbreak potential in the United States.
Core vaccine groups typically required in 2026 (if age appropriate):
| Vaccine | Disease Protected Against |
|---|---|
| MMR | Measles, mumps, rubella |
| IPV/OPV | Polio |
| DTaP/Tdap/Td | Tetanus, diphtheria, pertussis |
| Hib | Haemophilus influenzae type b |
| Hepatitis A & B | Hepatitis A & B |
| PCV/PPSV | Pneumococcal disease |
| MenACWY | Meningococcal disease |
| Varicella | Chickenpox (varicella disease) |
| Rotavirus | Rotavirus (infants only) |
| Influenza | Seasonal flu |
Not every applicant needs all the vaccines. The civil surgeon uses a CDC vaccination chart organized by age and risk factors to determine which shots must appear on the I 693 as “given,” “immune,” or “not medically appropriate.”
Missing age appropriate vaccines without a valid waiver will be coded as a “Class A” medical condition under the Immigration and Nationality Act, making the applicant inadmissible until corrected or a waiver is approved. Siri & Glimstad can help applicants understand which vaccines they personally must show and whether any waivers or alternative evidence (like laboratory titers) may apply.
Who Decides Which Vaccines Are Required for U.S. Immigration?
The Advisory Committee on Immunization Practices (ACIP), part of Health and Human Services, recommends vaccines for the general U.S. population. However, the CDC and the Department of State select a narrower list that becomes mandatory for immigration purposes.
Key points about authority:
- Legal authority comes from INA (Immigration and Nationality Act)
- USCIS officers follow CDC “Vaccination Technical Instructions for Civil Surgeons” and the official vaccination chart when adjudicating cases
- The CDC criteria require that a disease must be vaccine preventable, capable of causing an outbreak, and pose a risk to public health to be included on the immigration list
- The list can change—HPV and zoster vaccine were removed in 2009, and COVID 19 was removed in 2025
An immigration-focused firm like Siri & Glimstad monitors CDC and USCIS policy updates so clients are not relying on outdated online information.
How Does the Immigration Medical Exam and Form I‑693 Handle Vaccines?
Most adjustment of status applicants inside the U.S. must see a USCIS-designated civil surgeon who conducts the immigration medical examination, reviews vaccination history, administers any missing vaccines, and then completes and signs Form I 693 (the medical examination report).
Form I 693 vaccination record requirements:
The form includes a vaccination assessment section where every required, age appropriate vaccine must have at least one entry marked:
- Given – vaccine administered during the exam
- Completed series – full vaccination course previously documented
- Immune – immunity proven via lab test or disease history
- Not medically appropriate – contraindication or age mismatch
- Waiver requested – religious or moral objections noted
USCIS will reject an I 693 as incomplete if the vaccination chart is blank in required rows, or if the results box at the bottom is not properly completed. This leads to RFEs, delays, or denials. According to USCIS FY2024 data, approximately 15% of I 693 RFEs were vaccine-related.
Applicants must submit the I-693 to USCIS sealed, and as of November 1, 2023, the e form does not expire if signed after that date. . Timing of the medical exam relative to your green card filing matters significantly. Currently, the medical exam must be included with the I-485 filing at the same time or else the I-485 may be rejected by USCIS.
Siri & Glimstad routinely reviews clients’ medical examination and vaccination records before filing by confirming with the civil surgeon’s office what has been recorded. We can intervene if a surgeon misunderstands the vaccination rules or waiver categories.
Under What Conditions Is Each Vaccine Required?
The exact vaccines required depend on the applicant’s age at the time of the medical exam. The civil surgeon uses a CDC age-based chart (Table 1 in the Technical Instructions) to decide what is age appropriate.
MMR (Measles, Mumps, Rubella):
- Generally required for applicants 12 months and older
- Children typically need two doses
- Adults born before 1957 are often presumed immune under CDC immunization practices
- Laboratory evidence (IgG titers) is acceptable instead of vaccination
Polio (IPV/OPV):
- Children must be up to date per age
- Adults may need proof or catch-up doses depending on prior records and country of origin
- Lab titers covering all three poliovirus types may be accepted as immunity evidence (but note that titer testing for type 2 polio is not available, essentially making polio immunity impossible to prove)
Tetanus, Diphtheria, and Pertussis (DTaP, DT, Td, Tdap):
- An initial series and 10-year boosters are expected
- Missing tetanus and diphtheria toxoids boosters can lead to inadmissibility until updated
- Civil surgeons will typically give Tdap or Td if records are incomplete
Varicella (Chickenpox):
- Either documented vaccination, positive varicella IgG blood test, or reliable documented history of prior varicella disease is acceptable
- If no proof exists, two varicella vaccine doses are usually required for age-eligible applicants
Hepatitis B, Pneumococcal, Meningococcal, Hib, Rotavirus:
- Each applies to specific infant, child, or adult age ranges
- Not all vaccines on the ACIP schedule are required for immigration—only those the CDC includes for immigration purposes
Seasonal Influenza (Flu):
- The seasonal flu vaccine is required only for exams conducted within the season
- Failure to receive at least one dose of influenza vaccine during this window can trigger a Class A finding unless clearly not medically appropriate
- Outside this seasonal window, flu vaccine is not required
Siri & Glimstad can help clients map their age and medical history to the current CDC immigration vaccine chart so there are no surprises at the civil surgeon visit.
Is COVID‑19 Still Required for Green Card Applicants?
COVID 19 vaccination is no longer required as of early 2025.
Key dates:
- CDC removed COVID 19 from the immigration vaccine list on March 11, 2025
- USCIS stopped issuing RFEs, NOIDs (Notices of Intent to Deny), or denials based on COVID 19 vaccination status after January 22, 2025 for cases within the US, and after March 11, 2025 for consular cases.
For older cases where Form I 693 was signed before these policy changes, prior COVID 19 entries on the form should generally be disregarded when adjudicating after the effective removal date.
Siri & Glimstad can help applicants who previously received RFEs or denials related to COVID 19 vaccination understand whether their cases can be reopened, appealed, or refiled under the updated rules.
When Is a Vaccine Considered “Not Medically Appropriate” for Immigration Purposes?
Civil surgeons can legally mark a vaccine as “not medically appropriate” on Form I 693 for several reasons. These markings count as a “blanket waiver” that does not require a separate application by the immigrant.
Age inappropriateness: If the applicant is too young or too old for a particular vaccine according to the CDC chart, the civil surgeon marks it as “not age appropriate.” USCIS will not hold the missing dose against the applicant.
Medical contraindications: Severe allergies, certain chronic medical conditions, and prior serious reactions can make specific vaccines unsafe. The civil surgeon must document the contraindication and select the correct waiver box on the form.. This applies to less than 0.01% of applicants based on VAERS data.
Pregnancy and immunocompromised states: Some live vaccines (such as MMR or varicella) are not given during pregnancy or to severely immunocompromised individuals (e.g., HIV patients with CD4 count below 200). Once marked as contraindicated at the time of the medical exam, the applicant is not later required to receive them if the condition changes.
Non-availability: Panel physicians abroad can mark vaccines as “not routinely available” when a vaccine simply cannot be obtained locally. USCIS generally treats this as a basis for a blanket waiver and should not issue RFEs solely for that reason.
Mis-marked or missing “not medically appropriate” entries can create needless Class A findings. Siri & Glimstad can review cases where clients suspect a mistake and advise on corrective steps or legal arguments.
Can I Get a Waiver If I Object to Vaccines or Cannot Receive Them?
There are two main waiver types: automatic (blanket) waivers recorded by the civil surgeon on the I 693 (sometimes called medical waivers), and individual waivers that must be actively requested from USCIS using Form I‑601 or other processes.
Blanket waivers (sometimes called medical waivers): These cover age inappropriateness, medical contraindications, lack of routine availability abroad, and nationwide shortages confirmed by CDC. Applicants do not need to file any separate waiver forms in these situations—the civil surgeon handles documentation on the I 693.
Religious or moral conviction waivers: Applicants with sincere religious beliefs or moral convictions opposing vaccines may apply for an individual waiver using Form I‑601. You must show a consistent, long-standing objection—not just opposition to one particular vaccine.
Practical steps:
- The civil surgeon must properly complete the vaccination chart (including the “waiver requested” box where appropriate) before filing I‑601
- USCIS scrutinizes these waivers carefully, looking at prior vaccination history and the specificity of religious or moral beliefs
- Prior vaccinations in your applicant’s vaccine history may disqualify a religious exemption claim if not appropriately addressed
Legal counsel from an immigration-focused law firm like Siri & Glimstad is especially important for I‑601 vaccine waivers. These require detailed declarations, supporting evidence, and precise legal arguments under the INA. Our attorneys have achieved high approval rates on waiver applications through tailored evidence strategies.
Refugees and certain adopted children under 10 may have special vaccine exemption pathways, which should be analyzed with an immigration lawyer familiar with these nuanced categories.
What If I Don’t Have Vaccination Records or They Are in Another Language?
USCIS does not accept self-reported vaccine doses without documentation. The civil surgeon must see written evidence or laboratory proof of immunity during the medical examination process.
Foreign or missing records:
- Collect all clinic cards, hospital records, and childhood immunization booklets
- If records are missing, civil surgeons can either re-vaccinate or order blood tests (titers) to verify immunity for certain diseases like measles, mumps, rubella, hepatitis A/B, polio, and varicella
- Titer testing typically costs $100-300 per disease but can avoid unnecessary revaccination
Translations: The applicant is responsible for providing accurate English translations of foreign vaccine records per 8 CFR 103.2(b)(3). Some civil surgeon offices may help, but it is safer to use a certified translator to avoid errors or USCIS questions about your examination and vaccination record.
Strategy: Talk to an immigration attorney before the physical examination if you know records are incomplete or lost. You can decide whether to pursue titers, re-vaccination, or a combination, while considering medical risks and legal implications.
Siri & Glimstad can help clients with complex record issues plan ahead so the civil surgeon visit and I 693 completion go smoothly, reducing the risk of RFEs or delayed green card approvals.
How Do Vaccination Issues Affect Admissibility and My Green Card Timeline?
Failure to comply with required vaccination rules produces a “Class A” medical condition under the INA, which makes an applicant inadmissible until the defect is cured or a waiver is granted. According to USCIS FY2025 data, approximately 12% of adjustment of status denials were medical-related, with vaccines being the primary issue.
USCIS review process:
- Officers review the vaccination section of Form I 693 to verify that each required vaccine is either documented, waived, or properly completed as not medically appropriate
- Incomplete charts often trigger RFEs, NOIDs, or denials
- Response deadlines for RFEs can approach 3 months—missing these deadlines can be fatal to your case
Timing considerations:
- Vaccines required are those that were age appropriate and in season (for influenza) at the time of the medical evaluation
- USCIS also considers whether the applicant has since aged out of certain requirements by the time of adjudication
Civil surgeon errors: Errors such as failing to check the results box, leaving rows blank, or checking the incorrect waiver boxes can unfairly harm applicants. These may need legal advocacy to correct through RFE responses, supplemental exams, or motions to reopen.
Siri & Glimstad’s immigration team regularly handles cases where vaccine issues are the only remaining barrier to a green card. We can help strategize whether to redo the immigration medical, request a waiver, or challenge an erroneous adverse finding.
When Should I Involve an Immigration Lawyer About Vaccine Requirements?
You should seek legal help if:
- You seek a religious or moral waiver and must file Form I‑601, or your application has been delayed or denied based on alleged failure to meet vaccination requirements
- You are pregnant or immunocompromised and your civil surgeon refuses to mark contraindicated vaccines correctly or insists on unnecessary shots contrary to CDC vaccination technical instructions
- Prior forms, consular medical exams abroad with a panel physician, or refugee/asylee adjustments have conflicting vaccination annotations
- A consulate or USCIS office appears to be applying outdated vaccine rules to your immigrant visa or legal permanent residence status application
Take action now: Siri & Glimstad offers consultations on immigration vaccination issues, waiver strategies, and vaccine-related rights. We represent clients nationwide in both USCIS and consular processing contexts. If you’re facing following vaccinations requirements that seem unclear, received an RFE about missing vaccines, or need help with a religious or moral exemption, contact us to discuss your case before your deadline passes.
Frequently Asked Questions
Do all green card applicants have to meet the same vaccination requirements?
Most family-based, employment-based, diversity lottery, and certain humanitarian applicants must meet CDC vaccination requirements. However, the exact vaccines required vary by age, medical condition, and sometimes status category. For example, refugees adjusting status have specific procedures including a 90-day post-entry catch-up period for certain vaccinations. A few narrow groups—such as some adopted children under 10 with affidavits promising future vaccination—may have modified requirements. These should be analyzed case-by-case with an immigration attorney familiar with the nuances of immigration services procedures.
Are vaccines required for both consular processing and adjustment of status?
Yes. Immigrants applying abroad at a U.S. consulate see a panel physician who follows parallel CDC technical instructions and records vaccines on Form DS-3025. Those adjusting status in the U.S. see a designated civil surgeon who completes Form I 693. Although the forms differ, the underlying CDC vaccine list and age-based requirements are intended to be consistent across both processes for immigration medical exams.
Will USCIS accept laboratory proof of immunity instead of vaccine shots?
For certain diseases—including measles, mumps, rubella, hepatitis B, hepatitis A, polio (all three serotypes), and varicella—civil surgeons may rely on FDA-approved or CLIA-certified antibody tests to document immunity in place of vaccination. This can be helpful for applicants with incomplete vaccination history. Not every vaccine has an accepted laboratory substitute (pertussis titers, for example, are not reliable). The decision to order titers from a private healthcare provider instead of vaccinating should be discussed with the civil surgeon and, when there are legal implications or medical risks, with an attorney.
What happens if a vaccine is temporarily unavailable in my area?
If there is a true nationwide shortage and CDC confirms it through Disease Control and Prevention alerts, USCIS may allow civil surgeons to mark a blanket waiver based on non-availability. Local shortages may require the applicant to seek additional vaccines from another healthcare provider or local health department and return with proof. Applicants facing obstacles obtaining a required vaccine should document their efforts and consider speaking with Siri & Glimstad about whether a non-availability argument or alternative strategy is viable.
Can vaccination problems be fixed after I submit my green card application?
In many cases, yes. USCIS can issue an RFE asking for an updated I 693 or additional proof, and applicants can sometimes redo the medical exam or cure missing vaccines. RFEs have approximately a 75% resolution rate when handled properly. However, prior denials may require motions to reopen (with success rates around 25% if civil surgeon error is proven), appeals, or refiling. Anyone who receives an RFE, NOID, or denial tied to vaccination issues should consult with an immigration attorney quickly—response deadlines are strict, and the legal arguments can be highly technical under the Nationality Act.
