Generally, if you are in the US in J-1 immigration status, received financial support from your home country government or directly from a US government agency, are from a country or have a skill on the US Department of State's "skills list," or have completed any medical training in the US sponsored by ECFMG as an "alien physician," you must return to your home country for two years before you can change immigration status in the US from J-1 to H-1B, or become a permanent resident. This is known as the "two-year home residence requirement" or sometimes "212e."
The only way to avoid this requirement and continue your career in the US is to request a waiver, which must be approved by both the US Department of State and US Citizenship and Immigration Services (USCIS) before an employer can file an H-1B work authorization petition on your behalf. Without a timely J-1 waiver, O-1 work authorization is the only option.
Interested Government Agency Waiver for J-1 Physicians Sponsored by ECFMG
If you are currently completing your medical training in the US in J-1 status sponsored by ECFMG, you are automatically subject to the 212e requirement. IFSIS will work with your hiring department to obtain an "interested government agency" (IGA) waiver of the two-year home residence requirement. Waivers are available mainly through the Conrad/State 30 program (generally 4-8 per year), the Appalachian Regional Commission (ARC, unlimited and year-round), and the Southeast Crescent Regional Commission (unlimited and year-round, but for placement at physical work locations in Montgomery County ONLY). If you will be practicing in primary care/family medicine, we may also be able to offer waiver sponsorship through the US Department of Health and Human Services (HHS).
All waiver applications are assembled, prepared, and filed by outside counsel — not the IFSIS office. IFSIS will work with your hiring department and outside counsel to identify the best waiver option for you according to timing and institutional need. Once a waiver program has been identified and you have 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 H-1B process specifically and will file H-1B work authorization petitions on your behalf after the waiver is approved. We will provide a flowchart to help set expectations for the J-1 waiver process and invite you to a webinar on Zoom for questions specifically about the process. Physicians who are selected for waiver sponsorship will receive an email calendar invitation to an IFSIS webinar in October each year.
IGA waivers require physicians to commit to working in an underserved area or with an underserved medical population for a minimum of three years, specifically in H-1B immigration status, before becoming eligible to apply for permanent residence. You 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 you extend your DS-2019 for boards to be able to remain in the US over the summer after completing your training and to allow the waiver process the maximum time to conclude. There is never any "guarantee" that a clinical faculty start date can be achieved by 7/1, or even 8/1, each year due to the vagaries of agency processing times, no matter how early a waiver application is filed. In Alabama, Conrad waiver applications cannot be filed any earlier than the first week of January each year. Please consult your current institution's ECFMG Training Program Liaison (TPL) or ECFMG directly with questions about the DS-2019 extension process. It is always best to do this before your waiver application has been received by the US Department of State. IFSIS cannot assist.
If it appears that a waiver cannot be approved in time to preserve the anticipated start date for your employment, and in consultation with your department about timelines, IFSIS can evaluate your CV for potential O-1 work authorization. O-1 sponsorship will be evaluated on a case-by-case basis and is not guaranteed. Read more about the O-1 process here: https://www.uab.edu/global/faculty-staff/international-faculty-staff/o-1-work-authorization.
Clinical Faculty Completing Third Year of J-1 Waiver Service Who Are Eligible for Permanent Residence
IFSIS strives to outline a permanent residence strategy to secure an approved Form I-140 for each clinical faculty member before the end of the third year of J-1 waiver service. We generally file I-140s for clinical faculty in either the EB-2 PERM (if 100% clinical) or EB-1B category, depending on your academic appointment, research/publication/clinical trials portfolio, and CV. Even with an approved Form I-140 (which is merely the employer's part of the permanent residence process), you will not be eligible to file your personal Form I-485 to apply for permanent residence until BOTH a) you have completed your third year of employment in H-1B status AND b) your priority date is "current" in the Department of State's monthly visa bulletin. See the Permanent Residence section of our website at https://www.uab.edu/global/faculty-staff/international-faculty-staff/permanent-residence for more information.
There are three important next steps to prepare for the permanent residence process:
- Review, obtain signatures, and be ready to email a waiver completion form to the federal agency that sponsored your J-1 waiver.
For waivers sponsored by the Delta Regional Authority (DRA), you will need to provide TWO forms downloadable from the DRA website here:
Completion Request Form: https://dra.gov/wp-content/uploads/2023/03/12._Completion_Request_Form_2.pdf
Physician Compliance Closing Survey: https://dra.gov/wp-content/uploads/2023/03/11a._Physician_Compliance_Closing_Survey.pdf
If your J-1 waiver was sponsored by the Conrad State 30 program managed by the Alabama Office of Primary Care and Rural Health (formerly managed by the Alabama Department of Public Health), you will need to provide a waiver service completion form from the Conrad 30 website here: https://www.alabamapublichealth.gov/ruralhealth/assets/state-30-phys-status-rpt-07-10-2014-.2-fillable-form-.pdf
If your waiver was sponsored by the HHS, you do not need to complete any service or completion forms.
Please ask your department administrator the exact date of your three-year service (i.e., three years from the date you began working specifically for the waiver-sponsoring employer, which could be either UAB or HSF depending on your specific waiver situation).
Please refer all questions about service verification/completion forms to
2. Review the I-485 Checklist carefully and assemble documents necessary for your personal green card application.
Email
3. Request a Form I-485 Supplement J from
Please email
Waiver for J-1 Research Scholars or Others Funded by Their Home Government
If you are currently in J-1 Research Scholar, Short-Term Scholar, Professor, Specialist, or other relevant J-1 category, you will need to consult the initial Form DS-2019 stamped by a US Consular Officer at your J-1 visa interview and the physical J-1 visa stamp placed into your passport to see if either or both of them are marked "subject to 212," "two-year home residency applies," or "Section 212e applies." If so, or if there is conflicting information between the DS-2019 and the visa, you have two options:
- write to the Department of State and request an advisory opinion asking them to clarify whether you are, in fact, subject to the two-year home residence requirement, or
- assume that USCIS will rely on the document indicating that you are subject to 212e, cut your losses, and begin the process of applying for a "no objection" waiver of this requirement.
The no-objection waiver process requires you to obtain a letter from your home country government, submit it to the US Department of State, and wait for USCIS approval of the waiver. More information can be found on the Department of State website. IFSIS cannot assist with no-objection waiver applications, since they do not require express employer sponsorship and are a matter between you, your home country, and the US Department of State.
J-1 Immigration Advisors with the UAB Office of International Student and Scholar Services (
Other Types of Waivers
Some individuals will qualify for a waiver of the 212e requirement based on hardship to a US citizen or permanent resident spouse or child (a "hardship" waiver) or fear of persecution if you had to return to your home country (a "persecution" waiver). IFSIS cannot assist with hardship and persecution waiver applications, since they do not require employer sponsorship and are purely personal matters between you, your family, your home country, and the US Department of State. IFSIS strongly recommends that you consult an immigration attorney to strategize about your chances of success in either of these two waiver categories.