I-910, Application for Civil Surgeon Designation
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Use this form to apply for civil surgeon designation. You do not need to apply for civil surgeon designation if you fall under the limited blanket designations for military physicians and state and local health departments.
Please review the Form I-910 Instructions to determine whether you should use this form. For more information, see Volume 8, Part C, Chapter 3 of the USCIS Policy Manual, Blanket Civil Surgeon Designation.
USCIS is accepting applications for civil surgeon designation. Applications must be filed in accordance with the instructions for Form I-910. Note that we may exercise discretion in approving civil surgeon designations.
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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File with the USCIS Dallas Lockbox
U.S. Postal Service (USPS):
USCIS
Attn: I-910
P.O. Box 660812
Dallas, TX 75266
FedEx, UPS, and DHL deliveries:
USCIS
Attn: I-910 (Box 660812)
2501 S. State Highway
121 Business, Suite 400
Lewisville, TX 75067
You can find the filing fee for Form I-910 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. Use our Fee Calculator to help determine your fee.
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.
Please do not submit this checklist with your Form I-910. The checklist is an optional tool to use as you prepare your form, but does not replace statutory, regulatory, and form instruction requirements. We recommend that you review these requirements before completing and submitting your form. Do not send original documents unless specifically requested in the form instructions or applicable regulations.
If you submit any documents (copies or original documents, if requested) in a foreign language, you must include a full English translation along with a certification from the translator verifying that the translation is complete and accurate, and that they are competent to translate from the foreign language into English.
Did you provide the following?
- Information about your immigration status in the United States;
- Copies of medical degrees and current U.S. state or U.S. territory medical licenses; and
- Proof that you meet the professional experience requirement because you have practiced medicine as a physician (MD or DO) for at least four years.
Complete all sections of the form. We will reject the form if these fields are missing:
- Part 1 – Information About You
- Previous designation as civil surgeon
- Family Name
- Given Name
- Date of Birth
- Gender
- Part 2 – Clinical Office Locations
- Name of Clinic/Practice
- Physical Address of the Clinic/Practice
- Telephone Number
- Part 3. Information About Your Status in the United States
- Select only one box
- Part 4. Medical Degrees
- One full entry
- Part 5. Medical Licenses
- One full entry
- Part 6. Professional Experience
- One full entry
- Part 7. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature
- Applicant’s Daytime Telephone Number
- Applicant’s Signature
- Date of Signature
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
For detailed information about the medical examinations:
- Applicants – Visit our Find a Civil Surgeon page.
- Civil surgeons – Visit our Designated Civil Surgeons page for resources about the examination and useful links.
Email public.engagement@uscis.dhs.gov to notify us of any changes about your civil surgeon designation (including any changes to contact information listed on the Civil Surgeon Locator).