Form I 193 – Fill Out and Use This PDF

U.S. Citizenship and Immigration Services (USCIS) Form I-693, also known as the Report of Medical Examination and Vaccination Record, is a document used to boost an individual's immigration petition status. It acts as a medical record while gaining benefits such as refugees, accordance with immigration rules and regulations. This report consists of physical examination performed solely by a designated civil surgeon who has been approved through USCIS to administer this type of test. The form is needed for applying permanent residency or even in filing nonimmigrant confirmations and applications. Additionally, it functions as proof that tuberculosis (TB) tests have been completed, along with MMR immunizations that are recorded at Sections 4 & 5 of the form respectively.

Form I 193 PDF Details

If you are traveling outside of the United States, you will likely need to fill out a Form I 193, also known as the Application for Waiver of Passport and/or Visa. This form is used to request a waiver from the passport or visa requirements for international travel. There are many reasons why someone might need to fill out this form, and each situation is unique. If you are unsure whether or not you need to submit a Form I 193, it is best to speak with an immigration lawyer or representative. The process of obtaining a waiver can be complex, so it is important to have all of the necessary information before you begin.

Question	Answer
Form Name	Form I 193
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	uncollected, 193 form, Washington, form i 193

Form Preview Example

U.S. Department of Homeland Security

OMB No. 1653-0004

I-193, Application for Waiver of Passport and/or Visa

Bureau of Citizenship and Immigration Services

FEE STAMP

(See Instructions on Reverse)

FILE NO.

MY NAME IS: (Last)

(First)

(Middle)

2. MY UNITED STATES ADDRESS IS:

(Apt. No.)

(Number and Street)

(City)

(State)

(Zip Code)

MY PERMANENT ADDRESS ABROAD IS:

THE COUNTRY OF WHICH I AM A CITIZEN, SUBJECT OR NATIONAL IS:

PLACE OF BIRTH:

DATE OF BIRTH (mm/dd/yyyy):

DATE OF ARRIVAL:

PORT OF ARRIVAL:

MANNER OF ARRIVAL: (Name of Vessel, Airline, etc.)

PLACE VISA PREVIOUSLY ISSUED:

DATE:

CLASSIFICATION:

VALID TO:

PLACE PASSPORT ISSUED:

DATE:

VALID TO:

10.

THE REASON I AM NOT IN POSSESSION OF

PASSPORT

VISA IS AS FOLLOWS:

(CONTINUE ON REVERSE, IF NECESSARY)

DATE OF THIS APPLICATION:

I CERTIFY THAT THE ABOVE IS TRUE AND CORRECT.

CITY AND

(Signature of Applicant)

Signature of person preparing form, if other than applicant.

I declare that this document was prepared by me at the request of the applicant and is based on all information of which I have any knowledge.

(Signature)(Address)(Date)

		APPLICANT NOT TO WRITE BELOW THIS LINE

Application approved. Waiver granted					Application disapproved.
Under Section 211(b)
by authority of				(DHS)
by authority of				(DHS)	DATE
					DATE
Under Section 212(d)(4)					OF
Under Section 212(d)(4)					ACTION
by authority of				(DHS)

with concurrence of					DD
		(State Department)			OR
Admitted as			until		OIC
Admitted as			until		OFFICE
	(Nonimmigrant Class)				OFFICE
	(Nonimmigrant Class)

Form I-193 (Rev. 04/30/04)N (Prior versions may be used until 09/30/04)

Instructions

FEE:

A fee of $250.00 must be paid for filing this application. It cannot be refunded regardless of the action taken on the application. Do not mail cash. All fees must be submitted in the exact amount. Payment by check or money order must be drawn on a bank or other institution located in the United States and be payable in United States currency.

If the applicant resides in Guam, a check or money order must be payable to the "Treasurer, Guam." If the applicant resides in the U.S. Virgin Islands, a check or money order must be payable to the "Commissioner of Finance of the Virgin Islands."

All other applicants must make a check or money order payable to the U.S. Department of Homeland Security.

When a check is drawn on an account of a person other than the applicant, the name of the applicant must be entered on the face of the check. If the application is submitted from outside the United States, remittance may be made by a bank international money order or foreign draft drawn on a financial institution in the United States and payable to the U.S. Department of Homeland Security in United States currency.

Personal checks are accepted subject to collection. An uncollected check will render the application and any document issued pursuant thereto invalid. A charge of $30.00 will be imposed if a check in payment of a fee is not honored by the bank on which it is drawn.

AUTHORITY:

The authority for collection of the information requested on this form is contained in 8 U.S..C. 1182. Submission of the information is voluntary. The collected information will be used principally by the U.S. Department of Homeland Security to determine whether the applicant is eligible for entry into the United States under the provisions of Section 211, 212, 214, 235 and 251 of the Immigration and Nationality Act. The information solicited may, as a matter of routine use, be disclosed to other federal, state, local, and foreign law enforcement and regulatory agencies. To elicit further information required by DHS to carry out its functions during the course of investigation, this information may also be disclosed to the U.S. Department of Defense including any component thereof (if the applicant has served, or is serving in the Armed Forces of the United States), the U.S. Department of State, Central Intelligence Agency, Interpol and individuals and organizations. Failure to provide any or all of the solicited information may result in the denial of the application.

REPORTING BURDEN:

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Bureau of Citizenship and Immigration Services, HQRFS, 425 I Street, N.W., Room 4304, Washington, DC 20529; OMB No. 1653-0004. Do not mail your completed application to

this address.

Form I-193 (Rev. 04/30/04)N (Prior versions may be used until 09/30/04) Page 2

Form I 193 – Fill Out and Use This PDF

Form I 193 PDF Details

Form Preview Example

Form I 193 isn’t the one you’re looking for?

Related Documents