Frequently Asked Questions (FAQs)

An immigrant is an individual admitted to the United States (or any other country) for lawful permanent residence. Permanent residents may also commonly be referred to as immigrants. The Immigration and Nationality Act (INA) defines an immigrant as any person legally admitted for permanent residence in the United States, except for persons legally admitted under specific nonimmigrant categories (INA section 101(a)(15)).

A person who moves away from their place of usual residence, whether within a country or across an international border, temporarily or permanently. People migrate for a variety of reasons. The term “migrant” is defined by the International Organization for Migration as an umbrella term and is not defined under international law. It includes several well-defined legal categories, such as migrant workers and international students.

A refugee is any person who:

• is outside of the country of their nationality,
• does not have a nationality,
• is outside the country where they last lived and who is unable or unwilling to return to and unable or unwilling to avail themselves of the protection of that country because of persecution, or a well-founded fear of persecution, on account of race, religion, nationality, membership in a particular social group, or political opinion.

According to the Immigration and Nationality Act (INA), a “refugee” does not include any person who ordered, incited, assisted, or otherwise participated in the persecution of any person on these grounds.

Most refugees resettled in the United States are referred by the United Nations High Commissioner for Refugees. Other refugees apply directly to the United States for resettlement and may be accepted under programs for specific populations. Refugees are required to apply for Lawful Permanent Resident status one year after entry into and physical presence in the United States.

An asylee is a person already in the United States or at a port of entry who is found to be unable or unwilling to return to his or her country of nationality or to seek the protection of that country because of persecution, or a well-founded fear of persecution, as defined in the refugee category above.

A certified victim of trafficking is an individual who has been subjected to a severe form of human trafficking and has been certified by the U.S. Department of Health and Human Services, Office of Refugee Resettlement (ORR), based on the Trafficking Victims Protection Act of 2000. A Certified Victim of Trafficking is eligible for ORR-funded services and benefits to the same extent as refugees.

A parolee is an individual who appears to be inadmissible but who is permitted entry into the United States for urgent humanitarian reasons or if entry is determined to be of significant public benefit. Under the immigration laws, parole does not constitute formal admission to the United States. It confers only temporary status to the parolee, requiring him or her to depart the United States when the conditions supporting the parole cease to exist (INA 212(d)(5)(a)).

A Cuban or Haitian entrant is

• any individual granted parole status by the Department of Homeland Security as a Cuban or Haitian entrant; and
• any other national of Cuba or Haiti who:
  • was paroled into the United States and has not acquired any other status under the INA;
  • is the subject of exclusion or deportation proceedings under the INA; or
  • has an application for asylum pending with the Immigration and Naturalization Service, and for whom a final, non-appealable, and legally enforceable order of deportation or exclusion has not been entered (45 CFR § 401.2).

An internally displaced person (IDP) is a person who has been forced to flee their home for the same reasons as a refugee but has not crossed an internationally recognized border.

Under the Immigration and Nationality Act and the Public Health Service Act, the Secretary of Health and Human Services promulgates regulations outlining the requirements for the medical examination of applicants seeking admission into the United States and those applying for permanent resident status. CDC’s Division of Global Migration Health (DGMH) provides the Department of State (DOS) and the U.S. Citizenship and Immigration Services (USCIS) of the Department of Homeland Security (DHS) with Technical Instructions for all physicians performing overseas and U.S.-based medical screening examinations for immigrants and refugees. The Technical Instructions outline the scope of the medical examination. The purpose of the medical examination is to identify, for the DOS and USCIS, applicants with health-related grounds of inadmissibility.

The Refugee Act of 1980 (Section 412 of the Immigration and Nationality Act) created the Federal Refugee Resettlement Program to provide for the resettlement of refugees and assist refugees in achieving economic self-sufficiency as soon as possible after arrival in the United States.

CDC’s DGMH has been delegated certain responsibilities under this act. These responsibilities include:

• providing for the identification of refugees who have been determined to have medical conditions affecting public health and requiring treatment;
• assuring that State and/or local health officials at the resettlement destination of each refugee are promptly notified of the refugee’s arrival and provided with all applicable medical records;
• providing for such monitoring of refugees identified with medical conditions affecting public health and requiring treatment, ensuring that they receive appropriate and timely treatment; and developing and implementing methods for monitoring and assessing the quality of medical screening and related health services provided to refugees awaiting resettlement to the United States.

Information regarding immigration laws and regulations can be found on the U.S. Citizenship and Immigration Services (USCIS) website. Additional information regarding CDC and DGMH legal authority can be found on the CDC Immigrant and Refugee Health website.

Regulations concerning refugee adjustment of status and the medical examination requirement can be found in the Code of Federal Regulations at 8 CFR part 209.1. See also United States Citizenship and Immigration Service website and INA Section 245.

CDC does not have the authority to assign immigration status. Please contact the United States Citizenship and Immigration Service for additional information and assistance.

For medical examinations conducted outside the United States, select the Technical Instructions for Panel Physicians. For medical examinations conducted inside the United States, select the Technical Instructions for Civil Surgeons.

A list of civil surgeons (doctors in the United States who perform medical examinations for persons adjusting their status to permanent residency) is available at USCIS – Find a Doctor.

Form I-693 Report of Medical Examination and Vaccination Record is available on the USCIS website.

No, refugees are not required to meet vaccination requirements before coming to the United States. However, refugees must comply with the vaccination requirements when applying for status adjustment to become Lawful Permanent Residents. Vaccines are strongly recommended for refugees to protect against vaccine-preventable diseases, avoid delays in movement, and because school-aged children may be required to meet school-entry vaccination requirements upon school enrollment in the United States. More information is available about the Vaccination Program for U.S.-bound refugees, including an immunization schedule.

No, asylees are not required to have any vaccinations to be granted asylum by the United States. However, asylees must comply with the vaccination requirements if they apply for adjustment of status to Lawful Permanent Resident.

To promote healthy resettlement, CDC provides supplemental guidance to panel physicians caring for U.S.-bound refugees. The Overseas Refugee Health Guidance provides panel physicians with supplemental guidance on vaccination, pre-departure and treatments for malaria.

On November 2, 2009, the Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC) published a final rule that removed HIV infection from the list of communicable diseases of public health significance. As of January 4, 2010, HIV infection is no longer considered a Class A inadmissible condition. Therefore, refugees are no longer required to be tested for HIV infection as part of the U.S. immigration medical examination process.

Although hepatitis panels are not routinely done on refugees overseas, U.S.-bound refugees receive screening for hepatitis B virus infection (using HBsAg) before vaccination if they participate in the Vaccine Program for U.S. Bound Refugees.

Currently, the guidance for states for the domestic follow-up examination for newly arrived refugees is the 1995 ORR Medical Screening Protocol (State Letter 95-37). Many states have added requirements in addition to the ORR protocol. The Department of Health and Human Services is now drafting guidance for an expanded domestic protocol for states.

Current domestic medical screening guidance for newly arrived refugees is available on CDC’s Immigrant and Refugee Health website.

Post-arrival medical screening for immigrants and refugees with TB conditions is not mandatory, but it is highly recommended that the assessment be done. Any follow-up examination should be completed within 30 days post-arrival.

The Electronic Disease Notification (EDN) system is a web-based system that notifies state or local health officials when immigrants with notifiable conditions and refugees arrive in their jurisdictions. EDN provides medical information recorded on the DS form during the application process to these health officials for stateside follow-up. EDN was launched on March 20, 2006 and is deployed to all states.

Please contact the EDN help desk. The e-mail address is edn@cdc.gov, and the phone number is 1-866-226-1617.