Independent form guide. BrieflyGo is not affiliated with or endorsed by IRS, USCIS, SSA, DOL, or any U.S. government agency. Official forms are sourced from public government websites.
Official form guide
Form I-910: Application for Civil Surgeon Designation
USCIS Form I-910 is the Application for Civil Surgeon Designation, used by physicians who want to perform immigration medical exams for benefit applications in the United States. The form requires a U.S. clinic physical address.
Need help with Form I-910?
Open it in the AI Editor for field guidance, checks, and PDF export.
Need help? AI Editor guides you through every field of Form I-910.
Start filling →Form Overview
USCIS Form I-910 - Application for Civil Surgeon Designation
USCIS Form I-910 is the Application for Civil Surgeon Designation, used by physicians who want to perform immigration medical exams for benefit applications in the United States. The form requires a U.S. clinic physical address.
Risk Radar
Scan points- 1A stamped or typed name instead of a handwritten signature will cause USCIS to reject the application.
- 2Leaving the clinic physical address blank or providing a non‑U.S. address in Part 2.
- 3Omitting the Alien Registration Number in Item 13 when the physician has one.
- 4Submitting a stamped or typewritten signature rather than a handwritten one.
- 5Failing to attach a full English translation for any foreign‑language document.
Plain English
This form lets a doctor apply to become a civil surgeon so they can conduct immigration medical exams and complete Form I-693. You list your clinic locations, contact details, and sign the application. Any foreign‑language documents must include a certified English translation.
Submission Date
- Filing date: Not stated in the official source
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
AI co-pilot
Fill it faster. Catch mistakes before you file.
What this form is for
- Use this form when you are a physician seeking civil surgeon designation to perform immigration medical examinations for immigration benefit applications in the United States and complete Form I-693.
- Do not use it when you are a military or public health department physician who qualifies for blanket civil surgeon designation, or when you perform medical examinations unrelated to immigration benefits for detainees.
- Check Form G-1055 instead when you need fee information for this application.
Form selector
Use this form or another form?
Need to know the filing fee for civil surgeon designation
Specifies the correct fee amount and payment method
✓ Confirm the fee listed on Form G-1055 matches current USCIS requirements
Performing the required immigration medical examination after designation
Medical exam results must be submitted on the designated form for immigration benefits
✓ Ensure Form I-693 is completed and signed per instructions
Confirm payment method and fee schedule for the application
Incorrect fee leads to rejection
✓ Verify fee amount on Form G-1055 matches your payment
Deadline or filing window
Not stated in the official source
Checklist
What you need before filling it out
Clinical Office Locations (Part 2)
Address of each clinic where exams will be performed · Physician's practice records
Alien Registration Number (A-Number) (Item 13)
A-Number or "N/A" · USCIS correspondence
Signature of applicant
Handwritten ink signature · Applicant's own signature
Fee payment evidence
Proof of payment as required by Form G-1055 · Receipt or check
Preparer's information (if applicable)
Preparer's name, address, business name · Form I-910 Part 9
Before you submit
- 1Verify the form revision date reads 01/20/25.
- 2Complete all required fields in Part 2 Clinical Office Locations.
- 3Include your A-Number or write “N/A” in Item 13.
- 4Attach fee payment evidence as required by Form G-1055.
- 5Sign the form with a handwritten ink signature.
- 6If using a preparer, ensure the preparer’s signature and contact info are filled.
- 7Review that no typed or stamped signatures appear.
- 8Ensure any additional sheets are labeled with name, CSID number, page, part, and item numbers.
- 9Save or print a copy of the completed application for your records.
- 10Check the USCIS website for the current filing address before mailing.
How to file this form
- 1Download the latest Form I-910 from the USCIS website.
- 2Fill out all required sections, including clinical office locations and A-Number.
- 3Attach the required fee payment proof and any supporting documents.
- 4Sign the form with a handwritten ink signature (or a scanned copy of the signed form).
- 5Mail the completed application to the address listed on the USCIS I-910 filing page.
- 6Retain a copy of the mailed package and the receipt notice as proof of filing.
Known limitations
- 1Civil surgeon designation is not required for physicians performing medical examinations for detainees within ICE, CBP, or other government entities.
- 2Military or public health department physicians who qualify for blanket civil surgeon designation should not use Form I-910.
- 3Public health department physicians may only use blanket designation for refugees, not for asylees seeking adjustment of status.
Field map
Compact field-by-field guide
Applicant Info
3 items
Your current legal name.
MM/DD/YYYY.
Alien Registration Number if previously assigned.
Details
1 items
The specific reason or legal basis for filing this form.
Evidence
1 items
List of documents supporting this application.
Signatures
2 items
Sign under penalty of perjury.
MM/DD/YYYY.
Almost done reviewing the fields?
Fillable formOpen in Editor->The form shows a revision date of 01/20/25 and an expiration of 03/31/2027; the instructions direct users to the USCIS website for the most current filing information.
What changed or needs a fresh check
- Edition date — confirm the revision date reads 01/20/25 as shown in Instructions p.1
- Fee — Not stated in the official source — verify on Form G-1055
- Mailing address — Not stated in the official source — verify on the USCIS website at www.uscis.gov/I-910
- Signature — Confirm handwritten ink signature; scanned copies of the original signature are accepted per Instructions p.3
Quick Facts
Downloads
After you file
- 1Keep a copy of the submitted Form I-910 and all attachments.
- 2Store the copy for at least 5 years in case USCIS requests it.
- 3Monitor your USCIS online account for the OAN receipt notice.
- 4If you receive a rejection notice, correct the deficiency and refile.
- 5Update USCIS of any address change within 10 days if you are not a U.S. citizen.
- 6Retain the receipt notice as proof of filing.
Sources
- SRCInstructions p.1 — purpose: Form I-910 is used by physicians seeking civil surgeon designation.
- SRCInstructions p.1 — who should use: physicians seeking civil surgeon designation to perform immigration medical examinations and complete Form I-693.
- SRCInstructions p.1 — do not use: military or public health department physicians who qualify for blanket civil surgeon designation.
- SRCInstructions p.3 — signature requirements and acceptance of scanned copies.
- SRCInstructions p.3 — filing fee reference to Form G-1055.
- SRCInstructions p.8 — filing address must be checked on www.uscis.gov/I-910.
- SRCInstructions p.1 — revision date 01/20/25 and expiration 03/31/2027.
- SRCForm p.7 — preparer contact information section exists.
Common confusion points
Do I need to pay a fee with this form?
The fee amount is not listed on the form itself.
→ Check Form G-1055 for the current fee.
Can I use a typed signature?
USCIS requires a handwritten ink signature.
→ Verify your signature is handwritten ink.
Where do I mail the form?
No address is printed on the form.
→ Visit www.uscis.gov/I-910 for the current filing address.
Do I need to include my A-Number?
You may not have an A-Number.
→ Enter “N/A” if you do not have one.
Is a public health department physician eligible?
Blanket designation rules differ for public health physicians.
→ Confirm you are not eligible for blanket designation before filing.
Can I submit a scanned copy instead of the original?
USCIS accepts scanned copies of the original signed form.
→ Ensure the scan is of the original handwritten signature.
Workflow map
Related forms and next steps
Current
⚠ If something goes wrong
Questions about USCIS Form I-910
What is USCIS Form I-910 used for?
This form lets a doctor apply to become a civil surgeon so they can conduct immigration medical exams and complete Form I-693. You list your clinic locations, contact details, and sign the application. Any foreign‑language documents must include a certified English translation.
Who must file USCIS Form I-910?
Physicians seeking civil surgeon designation to perform immigration medical examinations for benefit applications in the United States must file USCIS Form I-910.
What information does USCIS Form I-910 require?
The form collects the physician’s clinic physical and mailing addresses, contact information, the applicant’s Alien Registration Number (Item 13), and requires a handwritten signature; see Part 2 and Part 9.
Where do I file USCIS Form I-910?
See the USCIS website at www.uscis.gov/I-910 for the most current filing address; do not mail the form to the address printed on the form.
How do I complete USCIS Form I-910?
Complete Part 2 with the physical U.S. address of each clinic where immigration exams will be performed, then list any different mailing address in Item 11. Enter your A‑Number in Item 13 or write “N/A” if you have none. Attach certified English translations for any foreign‑language documents, sign each page, and include any required separate sheets with page, part, and item references. Submit the package to the filing address listed on the USCIS website.
What happens if USCIS Form I-910 is filed incorrectly?
Providing false information or engaging in immigration fraud, as prohibited by the instructions, can result in denial of the designation and possible enforcement actions.
Do I need to pay a fee with this form?
The fee amount is not listed on the form itself. Check Form G-1055 for the current fee.
Can I use a typed signature?
USCIS requires a handwritten ink signature. Verify your signature is handwritten ink.
Source transparency
Copyright & Licensing - US Government Forms
BrieflyGo links to and explains official public form sources. We are not a government agency, and this page is for general form guidance, not legal advice.
Understand the agreement before you sign it.
Review risky clauses in plain English, fix the document, and keep it moving toward signature.