Immigration Health Forms

6 forms available. Fill online with BeneFill. Auto-fill from your profile and download completed PDFs.

Declaration of Self-Sufficiency

I-944 · USCIS

hard

Declaration demonstrating applicant would not become a public charge. Status varies with policy shifts; was rescinded under Biden administration. Check USCIS.gov for current requirements.

50% auto-fill70 min saved100 fieldsSubmission guide included

I-485 Medical / Public Charge Component

I-485 (medical sections) · USCIS

hard

Application to Register Permanent Residence or Adjust Status includes questions related to public charge determination, health insurance, and use of public benefits.

53% auto-fill45 min saved75 fieldsSubmission guide included

I-693 Vaccination Supplement

I-693 Supplement · USCIS

moderateDr. sig

Partial I-693 documenting vaccination history and any vaccines administered during the civil surgeon examination.

75% auto-fill14 min saved40 fieldsSubmission guide included

Overseas Medical Examination for Immigrant/Refugee

DS-2054 · U.S. Department of State

hardDr. sig

Medical Examination for Immigrant or Refugee Applicant completed overseas by DOS-designated panel physicians for immigrant visa applicants.

56% auto-fill45 min saved80 fieldsSubmission guide included

Report of Immigration Medical Examination

I-693 · U.S. Citizenship and Immigration Services (USCIS)

hardDr. sig

Report of Immigration Medical Examination and Vaccination Record required for adjustment of status to lawful permanent residency. Covers communicable disease screening (TB, syphilis), vaccination review, and medical history. Submitted in sealed envelope with Form I-485.

59% auto-fill45 min saved85 fieldsSubmission guide included

Vaccination Documentation Worksheet (Overseas)

DS-3025 · U.S. Department of State

moderateDr. sig

Vaccination Documentation Worksheet used for overseas immigrant visa medical exams by panel physicians.

75% auto-fill17 min saved40 fieldsSubmission guide included