I-905, Application for Authorization to Issue Certification for Health Care Workers
Use this form if you work with an organization and want to apply for authorization to issue certificates to health care workers.
Form Details
Dates are listed in mm/dd/yy format.
If you complete and print this form to mail it, make sure that the form edition date and page numbers are visible at the bottom of all pages and that all pages are from the same form edition. If any of the form’s pages are missing or are from a different form edition, we may reject your form.
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Mail your application to:
Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501-2521
You can find the filing fee for Form I-905 by visiting our Fee Schedule page.
You can pay the fee with a money order, personal check, cashier’s check or pay by credit card or debit card using Form G-1450, Authorization for Credit Card Transactions. If you pay by check, you must make your check payable to the U.S. Department of Homeland Security.
When you send a payment, you agree to pay for a government service. Filing fees are final and nonrefundable, regardless of any action we take on your application, petition, or request, or if you withdraw your request. If you pay by credit card or debit card, you cannot later dispute the payment.
If you are submitting multiple forms, pay each filing fee separately. We are transitioning to electronically processing immigration benefit requests, which requires us to use multiple systems to process your package. We may reject your entire package if you submit a single, combined payment for multiple forms.
Filing Tips: Review our Tips for Filing Forms by Mail page for information on how to ensure we will accept your form.
Don’t forget to sign your form. We will reject any unsigned form.
You must submit two complete copies of this application.