United States immigration law requires all applicants for lawful permanent resident (either adjustment of status in U.S. or immigrant visa abroad) to obtain certain vaccinations (listed below) against vaccine-preventable diseases, prior to the issuance of an immigrant visa, adjudication of permanent residence.

Most nonimmigrant visa applicants are not required to comply with the vaccination requirements to get visa.

If the applicant is in the U.S., vaccinations are administered by Civil Surgeon. If the applicant is outside the U.S., vaccinations are administered by Panel Physician. This document will refer them as 'designated physician' for ease of understanding.

Following vaccinations are required:

• Mumps
• Measles
• Rubella
• Polio
• Tetanus
• Diphtheria toxoids
• Pertussis
    - Acellular pertussis-containing vaccines are available for use in persons at least 10 years age.
• Influenza
    - Given annually to children 6 through 59 months of age;
      It continues to be required for adults 50 years of age or older.
• Hepatitis B
    - Given to all applicants from birth through 18 years of age.
• Haemophilus Influenzae type B
• Varicella
• Pneumococcal
• Rotavirus
    - Given orally to children 6 through 32 weeks of age.
• Hepatitis A
    - Given to children 12 through 23 months of age.
• Meningococal
    - Tetravalent meningococcal conjugate vaccine should be given to persons 11 through 18 years of age.
      Tetravalent meningococcal polysaccharide vaccine is an acceptable alternative.
• Human Papillomavirus
    - Given to girls and women 11 through 26 years of age.
• Zoster
    - Given to persons 60 years of age or older.
• Any other vaccinations recommended by the Advisory Committee for Immunization Practices (ACIP).

In order to assist the designated physician, and to avoid delays in the processing, all applicants should have their vaccination records available for the designated physician's review at the time of the medical examination. This is especially important for pre-school and school-age children. Applicants should consult with their regular health care provider to obtain a copy of their immunization record, if one is available. If you do not have a vaccination record, or if you never had certain vaccines, the designated physician will work with you to determine which vaccinations you may need to meet the requirement. In certain cases where the designated physician can not administer in their office or hospital, he/she will guide where you can get them, such as local public health department. After evaluation by the designated physician, you may alternatively go to your family doctor to get the required vaccines administered and show the records to the designed physician to note on Form I-693.

Certain waivers of the vaccination requirement are available upon the recommendation of the designated physician. Only a designated physician can determine which of the listed vaccinations are medically appropriate for you, given your age, medical history and current medical condition. e.g., if you are pregnant, Mumps, Measles, Rubella (MMR) will not be given to you or your husband. USCIS can grant this waiver based on the designated physician's certification on the vaccination supplement. You don't have to file a separate waiver application or pay a fee.

A vaccine is "not medically appropriate if:

1. the vaccine is not recommended for your specific age group;
2. there is a medical reason why it would not be safe to have the vaccine; e.g., allergies to eggs and yeast, pregnancy, hypersensitivity to prior vaccines, or other medical reasons;
3. you are unable to complete the entire series of a required vaccine within a reasonable amount of time.

If you initially did not have documents proving you received all the required vaccines but later submit those documents, or if the designated physician certifies that it is not medically appropriate for you to have one or more of the missing vaccine(s), USCIS may grant you a waiver based on the civil surgeon's certification on the vaccination requirement.

Do not try to fulfill your vaccination requirements before you meet the designated physician, in case it is not medically appropriate for you to have one or more of the required vaccines.

Also look at medical examination for

Adjustment of Status

Consular Processing

It will provide more information about the designated civil surgeons (in the US) and panel physicians (outside the US).

Technical instructions for designated physicians

If you have firmly held religious or moral beliefs that do not permit vaccinations and you oppose vaccinations in any form, you may still be eligible for immigration benefit. You will need to apply for a waiver of vaccination requirements by applying Form I-601, Application for Waiver of Grounds of Excludability, with fee.
Refugees, instead, should file Form I-602, Application by Refugee for Waiver of Grounds of Excludability, and there is no fee. If you believe there is any other humanitarian reason (to assure family unity or when it would otherwise be in the public interest) why USCIS should waive the vaccination requirements for you, you need to submit Form I-602 with your adjustment of status application.

When the applicant is child, decision may be taken according to parent's beliefs.

Orphans age 10 and under who are applying for IR-3 and IR-4 visas at a US consulate don't have to comply with vaccination requirements before issuance of immigrant visa. However, the adoptive parent must sign an affidavit that the child will be vaccinated within 30 days of arrival or at the earliest time that it is medical appropriate.
Adoptive parents who can't sign the affidavit in good faith because of certain beliefs, look at the section above, to apply for a waiver on behalf of a child.

If you cannot afford the vaccinations, there is no waiver available for that reason.