View Information Collection Request (ICR) Package
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OMB Control No:
1405-0113
ICR Reference No:
202601-1405-002
Status:
Received in OIRA
Previous ICR Reference No:
202503-1405-005
Agency/Subagency:
STATE/AFA
Agency Tracking No:
Title:
Medical Examination for Visa or Immigration Benefit
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
Date Submitted to OIRA:
01/08/2026
Requested
Previously Approved
Expiration Date
36 Months From Approved
01/31/2026
Responses
477,236
331,236
Time Burden (Hours)
256,412
110,412
Cost Burden (Dollars)
115,385,400
49,685,400
Abstract:
Forms in this collection record the medical information necessary to determine whether an alien seeking entry to the United States has a medical or other condition affecting his or her eligibility for a visa or immigration benefit. Forms are completed by panel physicians on behalf of visa applicants; refugees; refugees and asylees (including “following-to-join"); and certain parolees.
Authorizing Statute(s):
US Code:
8 USC 1201(d)
Name of Law: Immigration and Nationality Act
US Code:
8 USC 1182(a)(1)
Name of Law: Immigration and Nationality Act
US Code:
8 USC 1182 (d)(5)
Name of Law: Immigration and Nationality Act
US Code:
8 USC 1522(b)(4)
Name of Law: Immigration and Nationality Act
US Code:
8 USC 1202(f)
Name of Law: Immigration and Nationality Act
US Code:
8 USC 1101
Name of Law: Immigration and Nationality Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
90 FR 12697
04/17/2025
30-day Notice:
Federal Register Citation:
Citation Date:
90 FR 12890
12/23/2025
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
4
IC Title
Form No.
Form Name
Medical Examination for Immigrant or Refugee Applicant
DS-3026, DS-2054, DS-3025, DS-3030
Vaccination Documentation Worksheet
,
Medical History and Physical Examination Worksheet
,
Medical Examination for Immigrant or Refugee Applicant
,
Tuberculosis Worksheet
Medical Examination for Immigrant or Refugee Applicant
DS-2054, DS-3025, DS-3026, DS-3030
Report of Medical Examination by Panel Physician
,
Vaccination Documentation Worksheet
,
Medical History and Physical Examination Worksheet
,
Tuberculosis Worksheet
Medical Examination for Immigrant or Refugee Applicant
DS-3025
Vaccination Documentation Worksheet
Medical Examination for Immigrant or Refugee Applicant
DS-2054, DS-3025, DS-3026, DS-3030
Report of Medical Examination by Panel Physician
,
Vaccination Documentation
,
Medical History and Physical Examination Worksheet
,
Tuberculosis Worksheet
ICR Summary of Burden
Total Request
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
477,236
331,236
0
35,588
110,412
0
Annual Time Burden (Hours)
256,412
110,412
0
35,588
110,412
0
Annual Cost Burden (Dollars)
115,385,400
49,685,400
0
16,014,600
49,685,400
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Changing Regulations
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The Department estimates that approximately 696,000 aliens will be required to undergo a medical examination to receive an immigrant visa or immigration benefit each year. An exam is valid for up to six months, after which, an individual may need to submit to a second exam. However, most aliens seeking to enter the United States will only be required to undergo a single examination.
Annual Cost to Federal Government:
$16,790,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Anabel Moreno-Mendez 571 720-4400
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
01/08/2026
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