Consulates — Embassy & Consulate Guide
Insights from chats
Observations of participants in the Telegram chats “Talent in Everyone”. Subjective experience but useful to understand the real picture. Full list of U.S. embassies and consulates: List of U.S. Posts.
Consulate specifics
They scrutinize every word of the case and may request documents multiple times.
Kyiv
They scrutinize every word of the case. They may request documents multiple times.
From the chat
From the chat
There can be technical issues with passport delivery and tough interviews.
Prague
There are occasional technical problems with registering passport delivery. Tough interviews are possible.
From the chat
Tough interview
They may send cases to administrative processing (AP) without obvious reasons, but successful re-interviews also happen.
Almaty
Sometimes they send cases to AP without clear reasons. But there are successful re-interviews.
From the chat
From the chat
Main consulate for Russians. 2–3 windows, 5–10 minute interview. Single applicants receive refusals more often.
Astana
Main consulate for Russians. Short interview (5–10 minutes), 2–3 windows. Observations: single applicants are refused more often, married couples are approved more often.
Applicant, December 2025
Applicant, EB-1 IT
Practice: Documents are usually not requested. A new photo is required (not from previous visas). Fingerprints are not re-taken.
Vizametric (Визаметрик): DOES NOT accept passports by mail — only in person. Power of attorney is not needed. Premium Delivery to Russia: 55,000 KZT via Emex.
They may say “approved” at the interview, but the status on CEAC remains Refused until checks are complete.
Bishkek
They may say “approved” at the interview, but the CEAC status will show Refused until checks are finished.
From the chat
Officers may be unfamiliar with talent visas; questions are asked only to the principal applicant.
Tbilisi
Officers may be unfamiliar with talent visas. Questions are asked only to the principal applicant.
From the chat
Interview takes place in two stages: first document submission, then the interview itself.
Paris
The interview takes place in two stages: first day for document submission, second day for the interview. This is the standard procedure.
From the chat
They may return passports and give a 6-page form with DS-260-style questions.
Ankara
They may return passports with the wording “we need a bit more time” and give a 6-page form.
From the chat
From the chat
They closely examine Russian passports and previous visas.
Jerusalem
They closely examine Russian passports and previous visas.
From the chat
Formal interviews; there are quick approvals without checks.
Montreal
Relatively formal interview. There are quick approvals without checks.
From the chat
If the topic matches the consul’s interests, AP can take just one day.
Malta
If the topic matches the consul’s interests: they may help.
From the chat
Passport delivery after AP (Kazakhstan)
After AP is completed you need to deliver the passport for visa stamping. Main problem: Vizametric DOES NOT accept passports by courier.
Important
Vizametric does not accept courier envelopes. A real person must personally deliver the passport to the office (Astana or Almaty).
Step-by-step instruction: email, courier to Kazakhstan, handover by a person, stamping, delivery back.
How to submit the passport after AP
Step-by-step:
- AP completes — you receive an email with instructions and a certificate
- You send the passport by courier to Kazakhstan
- Someone personally takes the passport to Vizametric (Astana or Almaty)
- Vizametric transfers it to the consulate — the visa is stamped
- Passport pickup or Premium Delivery back
Details:
- Who can submit: Anyone. Power of attorney is NOT required
- Documents: Print the instruction + Certificate (sent by email)
- In the envelope: Passport + one page of the certificate
- Separately: Give the second page of the certificate along with the envelope
- Where to submit: Any Vizametric office (Astana or Almaty)
- Domestic shipping within Kazakhstan: Included in the services paid to the consulate
Common mistake: Trying to send the passport by courier directly to Vizametric.
Correct way: Only in-person handover via a person.
Premium Delivery to Russia: 55,000 KZT via Emex. Pickup location can be changed.
How to collect the passport back
- Premium Delivery: 55,000 KZT (~$110) via Emex
- Alternative: Pick up in person or ask someone to pick up + forward
- Change pickup point: Can be changed in the personal account (e.g., from Astana to Almaty)
Stamping time: From 1–2 days to several weeks. Depends on consulate workload. CEAC status changes from Approved to Issued when the visa is stamped.
Find out visa validity: Only after receiving the passport. It is not displayed anywhere in advance.
Avoid intermediaries without verified recommendations.
Where to find a person to hand over the passport
There are no verified contacts for intermediaries. There have been cases when a random intermediary blackmailed the passport owner.
Recommendation:
- Friends or relatives in Kazakhstan
- Colleagues, partners, clients
- Your company branches in Kazakhstan
- Telegram chat members (with caution)
Common mistake: Trusting unknown intermediaries from the internet.
Correct way: Only trusted people or official channels.
Interview structure
Arrive one hour early, submit documents, wait 30–60 minutes, interview itself 10–30 minutes.
Typical flow
Typical structure: arrive one hour before the appointment, submit documents, wait 30–60 minutes, interview itself 10–30 minutes.
From the chat
From the chat
They ask which language you prefer: Russian, English, or even Ukrainian.
Language choice
At the start they ask which language to conduct the interview in. You can choose Russian or English.
From the chat
From the chat
Some consulates require two visits: first documents, a week later the interview.
2-stage interview
In some consulates the interview occurs in two visits: first document submission, then the interview.
From the chat
Dependents at the interview
Usually questions are asked only to the principal, but they may request the spouse’s CV and even send the spouse to AP.
What they ask dependents
Usually only the principal applicant is questioned. But sometimes they may request the spouse’s CV or ask questions to them.
From the chat
From the chat
Refused for the principal and Ready for children — this is normal; it depends on the consulate.
Dependents’ statuses in CEAC
Statuses for the principal applicant and dependents can differ. This is normal.
From the chat
Passports: leave or take them back
You can ask to have your passport returned for travel; the consulate usually accommodates this.
Can you take your passport during AP?
Yes, you can ask to have your passport returned if you need to travel. The consulate usually accommodates this.
From the chat
From the chat
After AP completion you must bring the passport personally or send it by courier according to the instructions in the letter.
How to deliver the passport after AP
After AP completion you need to deliver the passport to the consulate: in person or by courier, depending on the instructions in the email.
From the chat
Pressure during the interview
The consul may ask the same question several times: answer consistently.
Repeated questions
The consul may ask the same question multiple times. This is a normal tactic: answer consistently.
From the chat
From the chat
Sometimes the consul tries to elicit a specific answer — pay attention to wording.
Consul pushing for a specific answer
Sometimes the consul tries to get a specific answer. Be careful with wording.
From the chat
Consuls vary: from friendly to very tough. Don’t take it personally.
Consuls’ manner
Consuls range from friendly to very strict. Don’t take the manner personally.
From the chat
From the chat
How to behave at the interview
Official guidance on interview preparation: State Department: Prepare for the Interview.
Main rule
Do not lie on the DS-160. If there is a negative factor, they will simply refuse and you can try again later. But if a lie is discovered — multi-year ban.
Visa officers are trained to detect lies. Calmness and steady eye contact are more important than rehearsed answers.
How to make a good impression
Visa officers closely observe behavior during the interview. Everything matters: speech tempo, facial expression, eye contact.
Applicant, Astana (received visa after a refusal)
What works:
- Calm, measured answers
- Direct eye contact
- Answer only the question asked
- Provide documents only when asked
Displaying English ability, pity stories and being pushy can harm your case.
What NOT to do at the interview
Applicant, Astana
Do not:
- Demonstrate English unnecessarily
- Tell pity stories
- Pressure the consul
- Volunteer information you were not asked for
- Hand over documents until requested
Speak in your native language if that makes you more confident — confidence matters more than showing off language skills.
Which language to speak?
Applicant, Astana
Recommendation: If your English is not fluent, choose Russian. Confidence in answers is more important than demonstrating language ability.
Screening is mainly done via the DS-160. Fill it out very carefully.
Importance of the DS-160
Applicant, Astana
A preliminary decision is often made before the interview based on the DS-160. The interview mostly confirms what was written in the form.
When something goes wrong
Sometimes the consul does not have the petition: print all 500 pages just in case!
'I don't have your case'
Sometimes the consul does not have your petition. Print the entire petition just in case!
From the chat
From the chat
An officer might see a talent visa for the first time: this is not a reason to panic.
Officer unfamiliar with the visa
Sometimes an officer sees a talent visa for the first time. This is not a reason to panic.
From the chat
Sometimes they say “approved” at the interview, but then delays occur: visas ran out or the case is too large.
'Approved' at interview, then problems
It happens that they say “approved” at the interview, but later delays or problems arise.
From the chat
From the chat
The consul may ask questions about the medical exam results, especially if there are issues noted by the IOM.
Medical checks at the interview
The consul may ask about the medical exam (IOM) results. Especially if there are Class B notes.
From the chat
More on the medical exam, Class A/B and consul questions about health: see the “Medical exam and Class B” section below.
Visa after approval
After AP the visa often gets the note “Clearance Received” and validity may be shortened to 3 months.
Clearance Received note
After AP the visa usually receives the note “Clearance Received.” The visa validity period may be shortened.
From the chat
From the chat
Refused after the interview — not a denial but the start of processing; it later changes to Administrative Processing.
Refused status — don’t panic
The Refused status in CEAC after the interview: this is not a denial but the start of processing. It later changes to Administrative Processing.
From the chat
What to bring
Print the entire petition: the consul may not have it!
Petition
Print the entire petition! The consul may not have it.
From the chat
Without a printed resume they may send you to AP right at the interview.
Resume
Be sure to bring a printed resume. Without it they may send you to AP.
From the chat
From the chat
A Letter of Intent may trigger questions: be prepared to explain how you know the signatory.
Letters of Intent
A Letter of Intent may provoke additional questions. Be ready to explain how you know the signatory.
From the chat
Color of the 221(g) slip
Rumors say white is better than red, but there is no official confirmation.
White, pink, red — what do they mean?
The 221(g) slip color can vary by consulate. Rumors say white is better than red, but there is no official confirmation.
From the chat
From the chat
From the chat
Repeat interview
Getting scheduled for a repeat interview after AP is difficult: the system may not accept bookings, you need a letter to the embassy.
Called for a repeat interview after AP
Sometimes after prolonged AP they call you for a repeat interview. Booking can be difficult.
From the chat
From the chat
From the chat
Communication with the consulate
Once a month is optimal. More often — you risk getting an angry reply or a block.
How often to write to the consulate
You can write, but not too often. Once a month is optimal. More often — you risk annoying them.
From the chat
From the chat
From the chat
From the chat
TAL-related requests
If your specialty is on the TAL list, they may request a resume, dissertations and contacts of your academic supervisor.
What they request at interview for TAL
If your specialty is on the TAL list, they may request additional documents right at the interview.
From the chat
From the chat
From the chat
Metallurgy, aerospace and related TAL specialties: checks can take 2+ years.
Metallurgy, aerospace — long checks
Some TAL specialties undergo especially long checks.
From the chat
From the chat
Medical exam (IOM)
In Moscow it takes 1.5 hours, they do not give you the envelope — they send it themselves. Meningitis vaccine is not required!
IOM in Moscow
From the chat
From the chat
More on the medical exam, Class A/B and IOM contacts: see the “Medical exam and Class B” section below.
IOM results can be delayed and postpone the interview: get the exam done in advance.
IOM in Warsaw
From the chat
From the chat
Important: Get the IOM early — results may be delayed.
For prolonged AP they may request updated medical exams and police certificates.
IOM validity and expiration
From the chat
From the chat
DS-5535 form
DS-5535 means Department of State review; be prepared for roughly a year-long process.
When DS-5535 is issued
The DS-5535 form can be given at the interview or sent later. It means an in-depth State Department check.
From the chat
From the chat
From the chat
Anecdotes
Came to the interview in sweatpants — the petition was approved. Dress code doesn’t affect the result.
Forgot pants
From the chat
Medical exam and Class B
What Class A and Class B mean: a primer for newcomers
When you apply for a U.S. immigrant visa (EB-1, EB-2 NIW, O-1, etc.) or a green card, you must undergo a medical exam. The doctor conducting it (civil surgeon in the U.S. or panel physician abroad) fills out a special form (I-693) and must indicate whether you have medical conditions that could affect your application.
These classifications, Class A and Class B, are established by U.S. federal law and detailed in two key documents:
- Immigration and Nationality Act (INA): Section 212(a)(1) defines medical grounds of inadmissibility
- Federal regulations (42 CFR Part 34): describes the medical exam and classification procedure
Class A = stop, Class B = questions about how you will pay for treatment.
| Class | What it means | What happens |
|---|---|---|
| Class A | “Stop signal” | You are inadmissible for a visa/green card. You must either be treated or obtain a waiver |
| Class B | “Yellow flag” | The visa is NOT automatically denied. But the officer may ask: “How will you pay for treatment?” (public charge analysis) |
Why this matters
Many people panic when they learn about these classes: “I have diabetes / depression / hypertension — will I be denied?”
No. These conditions are Class B. They are NOT grounds for automatic denial. You only need to show that you can pay for your treatment.
Class A is different: active tuberculosis, drug addiction, mental disorder with dangerous behavior. These cases are a minority.
Important
Depression by itself NEVER causes inadmissibility. But depression combined with a documented suicide attempt — that’s Class A. The key word is harmful behavior.
Primary sources: U.S. law (INA), Federal regulations, CDC Technical Instructions for physicians
Class A = automatic inadmissibility. Waivers are possible for most, EXCEPT drug addiction.
Class A: inadmissible conditions (detailed list)
Class A conditions AUTOMATICALLY make an applicant inadmissible:
1. Communicable diseases of public health significance:
- Active tuberculosis
- Infectious syphilis
- Gonorrhea
- Infectious Hansen’s disease (leprosy until 7 days of treatment)
- Quarantinable diseases by Presidential order
Historical: HIV was removed from the list in January 2010. Chancroid, granuloma inguinale and lymphogranuloma venereum were removed in 2016.
2. Failure to have required vaccinations:
Inability to document vaccination against required diseases (MMR, polio, tetanus/diphtheria, pertussis, hepatitis B and other ACIP-recommended vaccines).
3. Physical or mental disorder with harmful behavior:
BOTH elements MUST be present: diagnosed disorder + harmful behavior posing a threat. Neither element alone causes inadmissibility!
Examples of harmful behavior: suicide attempts, threats to others, DUI, domestic violence, significant property damage, violent assaults.
4. Use of or addiction to controlled substances (CSA):
THE MOST STRICT CATEGORY: Any use of drugs beyond experimental. Includes marijuana REGARDLESS of state legalization. For CSA substances harmful behavior is NOT required. NO WAIVER is available for standard immigrant visa applicants and adjustment of status.
Class B does NOT make you inadmissible. It is noted for public charge analysis.
Class B: public charge risk (detailed list)
Official definition of Class B: A physical or mental disorder that is “serious in degree or persistent in nature,” may interfere with the ability to work, study or care for oneself, and may require extensive medical treatment in the future.
TB classifications:
| Class | Description | Medical exam validity |
|---|---|---|
| B0 | Abnormal CXR, no active TB | 3 months |
| B1 Pulmonary | Completed treatment for pulmonary TB | 3 months |
| B1 Extrapulmonary | Completed treatment for extrapulmonary TB | 3 months |
| B2 | Latent TB infection | 6 months |
| B3 | Contact with an active TB case | 6 months |
Examples of Class B conditions:
- Diabetes (controlled)
- Hypertension
- Asthma
- Depression (without harmful behavior)
- Anxiety
- High cholesterol
- Obesity
- Heart disease
- Bipolar disorder (managed)
- Substance use disorders in remission (12+ months by DSM-5 criteria)
Critical point: Diagnoses marked Class B are recorded on the immigrant visa and may trigger CDC follow-up after arrival, but they NEVER by themselves lead to medical inadmissibility.
November 2025 changes: Public Charge
In November 2025 the State Department issued a directive, tightening health-related considerations when evaluating whether an applicant is likely to become a public charge.
The key question officers ask: “Does the applicant have sufficient financial resources to cover medical care for their expected lifetime without resorting to public benefits?”
Conditions under increased scrutiny
According to the State Department directive, the following conditions are now considered risk factors:
- Obesity: noted as a cause of asthma, sleep apnea and hypertension
- Diabetes
- Cardiovascular diseases
- Hypertension
- Respiratory diseases
- Cancer
- Mental health conditions: depression, anxiety
- Asthma
- Neurological diseases
This is NOT an automatic denial
The mere presence of a chronic condition does NOT make a person automatically inadmissible. Controlled conditions (diabetes, hypertension, etc.) are NOT grounds for denial. The key factor is the ability to pay for treatment.
Practical example: A diabetic will not be denied just because they need insulin, but may be denied if covering the cost of insulin would require Medicaid.
Depression managed with medication: at most Class B. Depression plus a suicide attempt: potentially Class A.
Mental health: what’s a problem and what’s not
Usually NOT problematic:
- Depression and anxiety disorders under control with medication or therapy
- PTSD: given special consideration due to prevalence among migrants
- Non-suicidal self-harm: explicitly excluded from the definition of “harmful behavior” in CDC Technical Instructions
Require additional documentation:
- Bipolar disorder and schizophrenia: require documentation of treatment and 12+ months stability
- History of psychiatric hospitalization: records requested, but NOT automatic disqualification
- Prior suicide attempts: qualify as harmful behavior. However, if 12+ months have passed, the condition is stable and ongoing treatment exists, it can be downgraded to Class B
Successful case 1: Applicant with lifelong mental health issues and a history of self-harm received a visa. Documents: letter from therapist with diagnosis and positive prognosis, private psychiatric evaluation, employer recommendations, two years of tax returns.
Successful case 2 (bipolar disorder): Initially received an RFE requesting psychiatric follow-up within one week after arrival in the U.S. Solution: civil surgeon evaluation, psychiatrist letter with appointment date and favorable prognosis, submission of a complete new I-693. Result: RFE satisfied, visa approved.
Pattern in successful cases: Proactive documentation of treatment adherence, stability period, favorable prognosis from qualified mental health professionals.
Sources: CDC Technical Instructions - Mental Health, USCIS Policy Manual Vol.8 Part B Chapter 7
Marijuana remains federally illegal regardless of state legalization. No waiver.
Substance use: the strictest area
Marijuana: special risk
Marijuana remains federally illegal REGARDLESS of state legalization. This includes recreational use, medical marijuana and CBD with THC.
Any substance use disorder involving controlled substances (Schedule I–V), including marijuana, opioids, cocaine, methamphetamine, triggers Class A inadmissibility WITHOUT requiring harmful behavior.
The only path forward: demonstrate sustained remission
- 12 consecutive months without meeting diagnostic criteria (except craving)
- Complete abstinence
- Verified by at least 4 random drug tests over the 12-month period
Medication-assisted treatment (MAT) for opioid dependence:
Use of methadone or buprenorphine as part of MAT is NOT considered ongoing drug use under CDC Technical Instructions: an important clarification for applicants in recovery.
Alcohol: different standard
Alcohol is NOT a CSA substance. Alcohol use disorder (AUD) by itself is NOT grounds for inadmissibility. AUD becomes Class A only when combined with harmful behavior (most often DUI).
Triggers for mandatory substance-use evaluation:
- One DUI arrest within the last 5 years, OR
- Two or more DUIs within the last 10 years
Important distinction:
- If a civil surgeon diagnoses AUD AND there is a history of DUI (constituting harmful behavior) = Class A inadmissibility
- If AUD is NOT diagnosed: a DUI alone does not create medical inadmissibility (though it may have criminal immigration consequences)
Remission from AUD: 12 months without meeting DSM criteria, 12 months since last harmful behavior. Complete abstinence is NOT required — reduced use that no longer meets diagnostic criteria is sufficient.
NO waiver for drug addiction for immigrant visa applicants and adjustment of status. Exception: refugees and asylees have special legislative provisions for waivers.
Documentation for substance-use history:
- Treatment records from rehab or counseling programs
- Attendance records for support groups (AA/NA)
- Therapist/psychiatrist letters documenting recovery
- Family statements confirming sobriety
- Results of random drug tests (minimum 4 tests for CSA substances)
- Employment records showing stable functioning
Civil surgeons may also defer diagnosis for 3–6 months in borderline cases, requiring at least 3 drug tests during the deferral period.
Source: USCIS Policy Manual
Vaccinations: what’s required
COVID-19 vaccination REMOVED
As of March 11, 2025 COVID-19 vaccination is NO LONGER required for immigrant visas (consular processing). For AOS within the U.S. it was waived as of January 22, 2025.
Sources: State.gov (consular) · USCIS (AOS)
Required vaccinations for U.S. immigrant visas (2025), per CDC Technical Instructions:
- MMR: measles, mumps, rubella
- Polio
- Tetanus/Diphtheria
- Pertussis
- Hepatitis A
- Hepatitis B
- Haemophilus influenzae type b
- Rotavirus (for infants)
- Pneumococcal
- Meningococcal
- Varicella (or documented history of disease)
- Influenza (seasonal)
Serologic titers (antibody tests) are accepted in lieu of repeat vaccination for seven diseases, including MMR and varicella.
The consulate uses forms DS-3025/3026, USCIS uses I-693. Since December 2024 I-693 is mandatory with I-485.
Differences: consular vs USCIS (forms and procedures)
Consular processing abroad:
Panel physicians complete DS-3025/3026 and note Class B diagnoses on the Machine Readable Immigrant Visa (MRIV).
Annotation “Class B Req. Attn. of USPHS at POE”: triggers CDC notification upon arrival and may lead to state health department follow-up (especially for TB classifications).
Instructions for mental health findings: When mental disorders are detected abroad, they may require mandatory psychiatric follow-up within one week after arrival in the U.S. Failure to comply is a common cause for an RFE.
USCIS internal processing:
Civil surgeons (find one here) complete form I-693 for adjustment of status applicants.
Policy change since December 2, 2024: The I-693 form MUST be filed concurrently with I-485. USCIS may reject I-485 filings submitted without the medical exam form.
Class B and public charge: Class B diagnoses documented by civil surgeons do not by themselves lead to denial. However, officers assess them under INA 212(a)(4): can you financially support yourself?
Recommendation: If the civil surgeon notes conditions that may require extensive future care, proactively provide proof of health insurance, financial resources, or family support.
Since June 2025: I-693 is valid only while the application is pending. Since October 2024: new TB testing requirements.
Policy changes 2024–2025: I-693 and TB screening
Changes in I-693 validity:
| Period | Rule |
|---|---|
| April 2024 – June 2025 | Forms signed after Nov 1, 2023 were valid indefinitely |
| June 11, 2025 – present | Valid only while the application is pending |
Current rule: If the application is denied or withdrawn — I-693 immediately expires and a new exam is required for future filings.
TB screening updates (from Oct 1, 2024):
- Molecular testing is required on initial sputum samples
- IGRA testing is required for applicants aged 2+ examined in countries with WHO TB incidence ≥ 20 per 100,000
What to bring to the medical exam
For all applicants:
- Passport
- Photos (per consulate requirements)
- Proof of payment
- Immunization history (if available)
If you have chronic conditions:
- Medical records: history of illness, diagnoses
- Letter from your treating physician: diagnosis confirmation, current status and stability, treatment plan, prognosis
- List of current medications with dosages
- Test results (if recent)
If you have mental health conditions:
- Documentation from psychiatrist/psychologist
- Proof of remission (if applicable)
- Treatment history for the last 12 months
- Confirmation of absence of harmful behavior
IOM in Moscow takes about 1.5 hours; they use City Polyclinic No.220 and do not accept international payments.
IOM in Moscow: contacts and procedure
The International Organization for Migration (IOM) in Moscow handles medical exams for U.S. immigrants:
- Address: Rastorguevsky Lane 3, City Polyclinic No.220, 4th floor, office 412
- Email to schedule: eappointment@iom.int
- Email for post-exam questions: meddoc@iom.int
- Note: International payments currently not supported
Russian psychiatric dispensary (ПНД) records are not transferred to the U.S.: American doctors only assess what they see.
Concern about psychiatric registration (ПНД)
A frequent question from applicants in Russia: “If I was registered in the psychiatric dispensary (ПНД), will Americans find out?”
Answer: no. U.S. immigration physicians do not have access to Russian medical databases. They evaluate only:
- Your current behavior at the exam
- Documents you voluntarily provide
- Your answers to direct questions
If you are not taking psychotropic medications and show no signs of instability — the PND history will not surface. But if you take medications — disclose it honestly and provide documentation of stability.
The consul will ask about insurance, treatment costs and the plan to pay medical expenses in the U.S.
Consul questions about health: what to prepare for
For chronic conditions, the consul may ask:
- What is your condition?
- How long have you had it?
- What treatment do you receive?
- How much does your treatment cost?
- Do you have health insurance in the U.S.?
- How do you plan to pay medical expenses?
- Who is your sponsor and what is their income?
Documents to prepare:
- Proof of U.S. health insurance
- Bank statements (3–6 months)
- Proof of income/salary
- I-864 Affidavit of Support from a sponsor
- Employer letter confirming salary and insurance
Common mistake: Your answers contradict DS-160, the medical exam, or doctors’ documents.
Correct approach: Ensure all documents and answers are consistent.
A waiver is possible for most Class A conditions. Processing time: 12–18 months, approval: 70%+.
I-601 waiver for Class A conditions
Applicants with Class A diagnoses (EXCEPT drug addiction) may apply for a waiver:
Who can file:
- Qualifying relative: Spouse OR parent who is a U.S. citizen or lawful permanent resident (children generally do NOT qualify)
- Extreme hardship to the qualifying relative if the applicant is denied
- CDC consultation: USCIS refers the case to the Division of Global Migration Health CDC for psychiatric review (about 4 weeks)
- Identified U.S. medical provider for post-entry treatment
Conditions for approval: Agree to attend a U.S. medical provider for ongoing treatment. A bond may be required.
Timing and statistics:
- Average processing time: 12–18 months
- Medical cases requiring CDC review: +4 weeks
- Well-documented cases: approval rate over 70%
NO waiver for drug addiction! The only path is to demonstrate sustained remission by DSM-5 criteria with documented abstinence and testing.
A public charge denial is not the end. You can post a bond or submit additional documentation.
What to do if denied for Public Charge
Possible actions:
- Request internal review: provide fuller economic evidence, clear medical reports, updated employment documentation
- Public bond: if found inadmissible for public charge but admissible otherwise, you can post a bond in the amount specified by USCIS. After bond payment the green card may be issued
- Submit additional documents: letters from prospective employers, proof of assets, insurance policies, family letters confirming support
I-864 income threshold (March 2025):
| Household size | Minimum annual income (125% of poverty) |
|---|---|
| 2 people | $26,437 |
| 3 people | $33,312 |
| 4 people | $40,187 |
| 5 people | $47,062 |
| 6 people | $53,937 |
With chronic conditions it’s recommended to show income significantly above the minimum threshold.
Source: USCIS I-864 Form
Forum experience
Source: VisaJourney.
More experience
Source: VisaJourney.
About stability
Source: VisaJourney. Documentation of stability matters more than the presence of a diagnosis.
Preparation checklists
Before the medical exam:
- Gather all medical records
- Get a letter from your treating physician confirming stability
- Prepare a list of all medications with dosages
- Compile immunization history
- Schedule the medical exam well in advance
Before the interview (for chronic conditions):
- Prepare proof of U.S. health insurance
- Collect bank statements (at least 3–6 months)
- Obtain a letter from your employer about salary and insurance
- Prepare an estimate of treatment costs in the U.S.
- Verify consistency across all documents (DS-160, medical exam, interview)
- Ensure I-864 is properly completed and income is sufficient
Documents to prove financial ability:
- Bank accounts
- Pay stubs
- Tax returns
- Property documents
- Investments/stocks
- U.S. insurance policy
- I-864 from a sponsor
For a history of substance abuse:
- Treatment records from rehabilitation
- Attendance records for support groups (AA/NA)
- Letters from therapist/psychiatrist documenting recovery
- Family statements confirming sobriety
- Drug test results (minimum 4 over 12 months)
- Employment records showing stable functioning
Key takeaways
- Class A vs Class B: critical distinction. Class A requires waivers or clearance; Class B allows applicants to proceed with consideration of public charge
- Mental health: conditions alone, even serious ones like bipolar disorder or schizophrenia, DO NOT cause inadmissibility without documented harmful behavior
- Substances: substance use disorders involving controlled substances, including marijuana, receive the strictest scrutiny WITH NO AVAILABLE WAIVER — only demonstrating remission is the path forward
- 12 months: this threshold recurs as a guideline to show control or remission
- Documentation wins: investing in thorough documentation (doctor letters, psychiatric evaluations, employer recommendations, treatment records) consistently yields better outcomes than hoping issues won’t be noticed
- The system rewards disclosure with documentation, not concealment
Official sources: USCIS I-693 Form · USCIS Policy Manual Vol.8 · CDC Technical Instructions · CDC Panel Physicians · 9 FAM 302.2 Health Grounds · State Department FAQs
New State Department directive: health and visas (November 2025)
In Oct–Nov 2025 the U.S. State Department circulated an internal cable to all posts. The essence: consular officers should now more closely consider health when reviewing immigrant visa applicants.
Sources:
- NPR (Nov 12): Part of a broader campaign: mass arrests, refugee restrictions, quota limits. Cable asks: “Do dependents have disabilities, chronic illnesses or special needs that prevent the applicant from working?”
- CBS News (Nov 6): ~10% of the world population has diabetes; cardiovascular disease is the leading killer. The directive conflicts with FAM, which bars denials based on “what if.”
- KFF Health (Nov 6): “You are required to consider the applicant’s health.” Officers should consider the health of family members too, including children.
- Axios (Nov 13): Officers must assess whether the applicant has funds to pay for care “for the remainder of life.”
What is Public Charge?
Public charge is an old concept in U.S. immigration law. The idea: the U.S. does not want to admit people who are likely to rely on government benefits instead of working and supporting themselves.
Previously the public charge assessment focused mainly on age, education, skills, occupation and financial resources (income, savings, sponsor). Now health has been added as an emphasized factor.
Who is affected?
Only immigrant visas (permanent residence): EB-1A, EB-1B, EB-1C, EB-2 NIW, EB-2, EB-3, family visas, DV lottery.
NOT affected: non-immigrant visas such as B1/B2, H-1B, F-1, etc.
Important about family: officers consider the health not only of the applicant but also of family members immigrating with them.
Aaron Reichlin-Melnick, American Immigration Council
What to do if you have a chronic condition?
Don’t panic. But prepare:
- Letter from a physician — condition controlled, favorable prognosis, able to work
- Health insurance — show you have or will have coverage in the U.S.
- Finances — income, savings, Affidavit of Support
- Work history — have worked with the condition and will be able to work
- Mental health — treatment and 12+ months of stability
See also: