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Interested Government Agency Waiver for J-1 Physicians Sponsored by ECFMG

International physicians completing their residency or fellowship training in J-1 status sponsored by ECFMG are automatically subject to the Department of State's requirement that they return to their home country for two years (sometimes known as "212e") before continuing their career in the US unless they obtain a waiver of this requirement. IFSIS will connect hiring departments with outside counsel to obtain an "interested government agency" (IGA) waiver of the two-year home residence requirement. We generally sponsor subspecialty waivers only through the Conrad/State 30 program (generally 4-8 available per year) and the Southeast Crescent Regional Commission (unlimited and year-round, but for placement at physical work locations in Montgomery County ONLY). In rare circumstances, UAB and HSF will consider waiver sponsorship Appalachian Regional Commission (ARC) or the Delta Regional Authority (DRA). Sponsorship with the latter two agencies will proceed only after an exhuastive internal evaluation of need and past utilization and a determination of the county in which the physician will be physically working for 40 hours per week. If your international candidate will be practicing in primary care (i.e., family practice, internal medicine, general pediatrics, or OB/GYN) or psychiatry, we will instead sponsor a waiver through the US Department of Health and Human Services (HHS). Read more about each waiver program below.

All waiver applications are assembled, prepared, and filed by outside counsel — not the IFSIS office. IFSIS will connect the hiring department and outside counsel to identify the best waiver option for your candidate according to timing and institutional need. Once a waiver program has been identified and your candidate has signed an offer letter, you will work directly with outside counsel on the waiver process. IFSIS will work with you in parallel to collect documents needed for the subsequent H-1B work authorization process specifically, and IFSIS will file the H-1B petitions for work authorization after the physician's waiver is approved. Please see the flowcharts below to help set expectations for the J-1 waiver process and attend our webinar on Zoom in February for questions specifically about the process. 

Waiver Comparison Chart

IGA waivers require physicians to commit to working in an underserved area or with an underserved medical population for a minimum of three years before applying to become a permanent resident. Physicians cannot apply for more than one IGA waiver at the same time. Due to uncertain processing times with the various federal agencies, IFSIS strongly recommends that candidates extend their DS-2019 for boards by filing a request online with ECFMG to allow the waiver process the maximum time to conclude. Physicians should consult their current institution's ECFMG Training Program Liaison (TPL) or ECFMG directly with questions about the DS-2019 extension process. IFSIS cannot assist. 

Conrad 30 (a/k/a "State 30" or ADPH waivers)

The ADPH administers the Conrad 30 J-1 waiver program; specifics and a complete documentation checklist can be found here. Under this program, there are only 30 slots available for J-1 waiver sponsorship statewide. At least ten slots are reserved for primary care and psychiatry, with the remaining 20 available (but not guaranteed) for subspecialties if not used for additional primary care and psychiatry applications. ADPH accepts applications for the 30 slots in two rounds: primary care on October 1 each year, and subspecialties on the first Monday of the first full work week in January each year. This means that waiver application packets must be completed and ready to deliver to the ADPH on those dates. There are no county-specific restrictions on this waiver program. Read more about the Conrad 30 requirements here: https://www.alabamapublichealth.gov/ruralhealth/j1visa.html

Each employer (i.e., UAB and HSF) is initially limited to only two subspecialty requests. If any of the 30 slots are still unused by approximately late February-early March, ADPH will allow employers to submit additional specialty J-1 waiver applicationsusually two more per employer. ADPH grants subspecialty waivers on a first-come, first-served basis based on documentation of community need. Again, specifics and a complete documentation checklist can be found here. An internal review and nomination process is conducted at UAB/HSF every July to allocate the institutions' four initial Conrad waiver slots based on department/division need. IFSIS will notify departments/divisions when the nomination process is open and will provide a nomination form and checklist. The review committee aims to make its decision by early August each year so that the Conrad process can begin as soon as possible for the January round of applications.

Southeast Crescent Regional Commission (SCRC) Waivers

This federal waiver program is limited to international physicians who will be placed in one of only in nine southern Alabama counties: Autauga, Baldwin, Coffee, Covington, Crenshaw, Dale, Geneva, Henry, Houston, Lee, Mobile, Montgomery, and Pike. In practice, this program is relevant only for physician placement at the UAB Multispecialty Clinic in Montgomery. SHELBY AND JEFFERSON COUNTIES ARE NOT VALID PLACEMENT LOCATIONS. Read more about the SCRC waiver requirements here: https://scrc.gov/programs/. These waivers are generally reviewed within 60 days for a $3,000 application fee. 

Department of Health and Human Services (HHS) Waivers

HHS sponsors unlimited J-1 waivers ONLY for hospitalists and primary care physicians. This program does not accept physicians who are more than 12 months beyond their residency training. In other words, to be eligible for this type of waiver, the candidate cannot have completed any fellowship training prior to their UAB/HSF appointment as clinical faculty. There are no county-specific restrictions on this waiver program. Read more about the HHS waiver requirements here: https://www.hhs.gov/about/agencies/oga/about-oga/what-we-do/visitor-exchange-program/supplementary-b-clinical-care.html

Appalachian Regional Commission (ARC) Waivers 

This waiver program was designed for and prefers hospitalists/primary care physicians. However, the ARC will entertain waiver applications for subspecialists if and only if the institution can show three-year past service data meeting specific thresholds for service to Medicare, Medicaid, and medically indigent patient populations, in addition to the usual statement of need and a justification for any deviance from meeting the three-year thresholds. ARC waiver applications will be considered only after careful, exhuastive scrutiny and internal evaluation of institutional data pertaining to the specific department/division in question, in consultation with outside counsel. ARC waiver applications undergo a first-pass review and signature process with the ADPH in Montgomery before being forwarded to ARC for next-level federal review. The ARC closes every August for their internal audit, adding processing time. (The application must still then undergo Department of State and Department of Homeland Security/USCIS review as well after ARC recommends the waiver.) This waiver program is available for physicians who will physically work in the following Alabama counties covered by the ARC footprint: Bibb, Blount, Calhoun, Chambers, Cherokee, Chilton, Clay, Cleburne, Colbert, Coosa, Cullman, De Kalb, Elmore, Etowah, Fayette, Franklin, Hale, Jackson, Jefferson, Lamar, Lauderdale, Lawrence, Limestone, Macon, Madison, Marion, Marshall, Morgan, Pickens, Randolph, St. Clair, Shelby, Talladega, Tallapoosa, Tuscaloosa, Walker, and Winston. Read more about the ARC waiver requirements here: https://www.arc.gov/j-1-visa-waivers/

Delta Regional Authority (DRA) Waivers

This federal waiver program is available for candidates who will physically work for an average of 40 hours per week/160 hours per month specifically and only in the following Alabama counties: Barbour, Bullock, Butler, Choctaw, Clarke, Conecuh, Dallas, Escambia, Greene, Hale, Lowndes, Macon, Marengo, Monroe, Perry, Pickens, Russell, Sumter, Washington, and Wilcox. SHELBY AND JEFFERSON COUNTIES ARE NOT VALID PLACEMENT LOCATIONS. It is unlimited and open to all subspecialties. If your candidate will not physically work in these counties as described above, they are not eligible for this waiver program.

If Your Candidate Does Not Receive a Waiver

If it appears that the candidate's waiver will not be approved in time to preserve the anticipated start date for H-1B employment, IFSIS can evaluate the CV for potential O-1 work authorization. O-1 sponsorship will be evaluated on a case-by-case basis and is not guaranteed. Even if USCIS approves O-1 work authorization for a candidate while the waiver process is ongoing, the department will still need to pay additional USCIS filing fees and file H-1B work authorization petitions after the waiver is approved so that the candidate can begin the three required years of service in H-1B status under the regulations. Time worked while in O-1 status does not "count" toward the three required years of waiver service. Read more about the O-1 process here: https://www.uab.edu/global/faculty-staff/international-faculty-staff/o-1-work-authorization.

J-1 Waiver Compliance Forms 

The above waiver programs generally require sponsored physicians and sponsoring employers to submit verification forms during the first week of waiver service employment and every six months thereafter until the physician completes three full years of waiver service. The date of waiver service is calculated from the first day of employment with the waiver-sponsoring employer (i.e., UAB if UAB sponsored the waiver and HSF if HSF sponsored the waiver). Please docket these submission dates on your Outlook calendar or preferred task-tracking software. Forms for each of the programs can be found at the links below. 

Conrad 30 waiver form: https://www.alabamapublichealth.gov/ruralhealth/assets/state_30_phys_status_rpt_fillableform.pdf

ARC waiver forms: https://www.arc.gov/wp-content/uploads/2024/04/J-1-Visa-Placement-Verification-Form.pdf (due the first week of the physician's employment in H-1B status) AND https://www.alabamapublichealth.gov/ruralhealth/assets/state_30_phys_status_rpt_fillableform.pdf (for every six months thereafter until the physician completes three years of H-1B employment)

SCRC waiver forms: https://scrc.gov/wp-content/uploads/2022/07/J-1-Waiver-Compliance-Guidelines.pdf (due June 15 and December 15 annually regardless of waiver service employment start date)

DRA waiver forms: https://dra.gov/wp-content/uploads/2023/03/8._Physician_Employment_Verification_Form_2.pdf (due the first week of the physician's employment in H-1B status AND every six months thereafter until the physician completes three years of H-1B employment):



Please consult outside counsel for all questions concerning waiver completion documents. Outside counsel must review all waiver service forms before they are submitted to the waiver-sponsoring agency. Outside counsel handles all aspects of the J-1 waiver process. Please email outside counsel directly with questions about waiver service verification forms.  

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