Instructions For Application For Civil Surgeon Designation (Form I-910) (Page 10 of 10) in pdf

Instructions For Application For Civil Surgeon Designation (Form I-910) Page 10

Paperwork Reduction Act

An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection

of information, unless it displays a currently valid Office of Management and Budget (OMB) control number. The public

reporting burden for this collection of information is estimated at 2 hours per response, including the time for reviewing

instructions, gathering the required documentation and information, completing the application, attaching necessary

documentation, and submitting the application. Send comments regarding this burden estimate or any other aspect of this

collection of information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services,

Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts Avenue NW, Washington, DC 20529-

2140; OMB No. 1615-0114. Do not mail your completed Form I-910 to this address.

Is Your Application Complete?

Ensure that you have completed the following actions before you file Form I-910 with USCIS.

□ Did you fill out the application properly, leaving spaces blank on any questions that did not apply to you?

□ Did you provide an original, handwritten signature and date your application?

□ If you had someone else prepare the application on your behalf, did that person complete Part 8., and sign and date

the application?

□ If that person was an attorney, did the attorney submit For G-28 with the application?

□ Did you include a check or money order according to the What Is the Filing Fee section of these Instructions?

□ Did you attach the required documentation or evidence including proof of your immigration status in the United

States, copies of current state medical licenses and medical degrees, and proof that you meet the professional

experience requirement because you have practiced medicine as a physician (M.D. or D.O.) for at least four years?

□ If you intend to perform immigration medical examinations in more than one location, did you provide details for

each additional location in Part 9. Additional Information?

Form I-910 Instructions 12/23/16 N

Page 10 of 10

Instructions For Application For Civil Surgeon Designation (Form I-910) Page 10