Self help - J1 waiver process


Registered Users (C)

I'm starting few new threads to document the whole process. This should include a detailed process A to Z with all the form numbers and expected time frame for each step. From sumbmitting initial application to the State till getting H1 visa in hand to getting the stamp on the passport.

This should also include the web site address, phone number for different agencies for follow-up/status information etc.

How the information flows, i.e. J1 candidate to different agencies/lawyer. Which information goes directly to the lawyer? Is J1 applicant copied on all the corresponding sent the lawyer? If J1 applicant is not copied on the information, then how to find out what was sent to lawyer. I know the lawyer is supposed to keep J1 applicant upto date. But you know, in real life, he/she might sit on in the information for days or weeks, and I heard sometimes they totally forget and poor applicant is nervously waiting for the information. You got the picture...

Current costs for each step. Estimated lawyer cost.

Any other tips to expedite the case.

I think if someone could take a first shot at this. Then get some response/add ons to it.

At the end of this thread, I could incorporate all the responses and make it a post for final review. Then, someone could make it a sticky (I donot know how).

I think this would be a great addition and have all the answers at one place.

Thank you for your time and effort. You guys have been great.
My five cents on stages #1 and #2 of the process

Ok, here are my five cents on the first two steps in the process: Maybe the moderator can make this a 'sticky' so that it can grow to something useful.

As for the nittty-gritty of what to file, when and where, there is a series of pretty good articles on the website of Siskind&Susser

Look in the 'non immigrant visa' section under 'J-1 Flowchart Part VIII: J-1 IGA physician waivers'


IMHO, the first two steps are:

#1 Make sure that the Conrad30 program stays with us

And here is how you can help with that:

- Go to a friend who is a US citizen or permanent resident
- have them take out their checkbook
- write on a check:
1st line: Friends of Kent Conrad $100
2nd line: one hundred
3rd line: Campaign 2006 *their signature*
- write a note with their name, employer, address and nationality or immigration status
- put both in an envelope with a 37c stamp
- mail to:
Friends of Kent Conrad
Attn: Pat Ness, Treasurer
P.O. Box 812
Bismarck, ND 58502

- Send your friends to dinner to a good restaurant and pick up their check. Of course, there can be NO causal connection between dinner and check ;-) because this would violate the federal election commission rules...

The continuation of the Conrad30 progam depdends on one thing: Sen Kent Conrad to stay in the Senate. He is a democratic senator from a state that voted with 60+% for George Bush in the last election. Now, he is sort of a conservative on many issues and therefore less likely to be targeted by the Karl Roves right wing associates, but still, he is potentially vulnerable. He is up for reelection in 2006.
(As you all might have realized by now, elections in the US are not decided on the base of issues, but rather on the base of $$$$. In South Dakota, s^)$loads of money from the national republican party (GOP) managed to unseat Tom Daschle, the local democratic senator in the 2004 election. So, lets make sure that this doesn't happen 200miles further north, in ND. )

In the past, some of our specialty colleges have contributed to his campaigns($1000 each).

Individual contributions are key, look at the Dean campaign. He was swimming in cash until he killed his campaign in Iowa..

I am thinking about 'inspiring' some citizen friends to register a 'political action committee' with the Secretary of States office in Bismark and the FEC for this purpose. It allows to collect and funnel contributions with a particular agenda in hand. And money opens doors in US politics.


#2 Find a 'Waiver' Job

These are some of the things I have assembled on this. Part of it is out of my own quest, part of it is stuff I gleaned from talking to: other residents, my attorney, friends, colleagues....
I posted this in another thread before, so bear with me. I will try to add links and websites over time to make it a bit more authoritative.

Ok, step #2 has a couple of substeps which you will have to repeat multiple times
2.1. find some leads towards potential job opportunities
2.2 check whether they might qualify for a waiver based on location (HPSA/MUA)
2.3 check which programs might apply for this location (state/ARC/DRA)

A couple of warnings right at the beginning:

-- Be very careful that you don't get taken advantage of. There are a couple of unscrupulous agencies charging residents 25k for getting a waiver job. Anytime, somebody makes you put down money before they can look for a job for you it is a fraud (I am not talking about legit lawyers fees once you have a job offer, I am talking about agencies 'guaranteeing' a waiver job if you pay them a 5k deposit.)


2.1 let's get started. Finding 'leads'

-- Look for job postings on the websites of large multispecialty practices in the midwest. They frequently have clinics in rural areas they need to staff, many rural locations are also MUA/HPSA.

-- Look for 'community health centers' or 'CHC look-alikes'. Most of them are in underserved locations or qualify for waiver physicians even if they are not in a HPSA.

-- Check out Many of the job postings are hopelessly out of date, but it can give you contacts to CHC's and rural practices that have looked for docs in the past.

-- DON'T look in JAMA or NEJM. Practices who post jobs there are innundated with CV's from J1 docs and run them through the shredder the moment they get the impression that you need a waiver.

-- Commercial recruiters are usually a dead end. They are in for the quick money, hassles such as a J1 waiver don't fit into their plan. The moment they find out that you need a waiver, they will shun you like you have leprosy. The few recruiters specializing (-->preying) on J1 docs, are for the greater part crooks.

-- Try to look for clinics/hospitals with 'in house' employed recruiters. They actually have a long-term perspective and far more accessible for you purposes.

2.2 Checking the location for HPSA/MUA status

Once you have located a potential job go through the following steps:

-- try to find the EXACT location of the practice. Not the address of the recruiter, not the address of the hospital, no the EXACT geographic location of the office in which you would be working.

-- then go to the website of the US census website
click on the 'census2000' logo
smack in the middle, click on 'enter a street address to find census2000 data'
enter the street address with town and state
click on the 'go' button

It will spit out a table/list out of which you can extract the following geographic information:
the 'county subdivision' or 'MCD' (minor civil division),
'census tract' (most important)

-- now, go to the website of the 'bureau for primary health care ' of the department of health and human services.

go to their 'databases' section
go to the 'HPSA database'
enter the state and county and put the filters on 'designated'
run a query
check whether the geography (county, MCD, census tract) for the job you are looking at is considered a HPSA
If yes: BINGO, you found a potential waiver job.
If no:

go back to the databases screen
now go to the 'MUA/MUP' database
enter state and county
check the geography
If yes: BINGO
If no: move on

2.3 What program does apply

State Conrad30 programs (your best bet)

Check on the website of the department of health for that state what their policy for waiver jobs is. Some are pretty lenient, others are outright bizarre. As a rule of thumb:
- Stay away from FL, NY, CA, IL, TX (the equation 30/population=X is the worst there)
- the south and the coasts seem to be more difficult than the midwest and plains.
- Look at places like ME, ND, SD, RI, NE.

Appalachian Regional commission
for parts of the states that have the Appalachian mountains runnign through them.
(only primary care, very restrictive)

Delta Regional Authority
for parts of the states that the Missisipi river runs through.
The DRA program was drafted with the input of attorney Siskind. As a result it is a bit less restrictive than the ARC for example. On Siskinds website there is a little article with an outline on the program.

After you have run through 2.1-2.3 successfully you are approximately already 1% of the way there :)))

The tricky part is to convince a practice that wasn't looking for a waiver job to go through the hassles of sponsoring you. But once you explain to them that by sponsoring you they are assured that you will stay for 3-5 years, they usually warm up.

to be continued..
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i think it is a great idea to put in the details of the entire process. i have a couple of questions.

1.most poeple go through conrad 30, DRA or ARC. i am wondering if someone can shed light on the experience of getting HHS and VA waivers. HHS has tough rules of minimum score=14, < 1 year from residency training. once that has been met, is it a better option than conrad 30? advantage is that there is no limit on the number of waivers offered so there is no competition. lawyers seem reluctant to talk about HHS waivers. does anybody know why?

2. when does a lawyer come into the process? once you have an idea that someone might hire you and sponsor you for a waiver, is that when you consult a lawyer and have them negotiate the contract?

3. i've heard that you can apply for a case number even before you have a job. apparently, that saves time in the process.

4. in terms of timing, how does it work for FY2006? do they start accepting applications only on oct 1, 2005? NY state has a different process for conrad 30. they make their decisions only in june. will that be june 2006 for 2006 waivers? a lawyer randomly told me that won't accept a 2006 application in june 2005. that almost makes it impossible to apply for a conrad 30 waiver in new york state unless you have plans to switch to an 0-1 or extend your DS2019.

5 fyi, you can extend your DS2019 to take your boards following completion of residency training.

6. any tips on writing a good CV for a J1 waiver? how do u convince someone to hire you almost a year in advance?

7. is it better to go out there and find ur own job or rely on physician recruiters?

since i am applying for a J1 waiver in 2006, i am just starting the process so can put it down as it happens for the benefit of others. i will appreciate if someone can answer my initial questions.

thank you
Step #3 Get a case # from DOS

The next step in the process is to obtain a case# from the department of state.

Opinions are split as to when it is safe to do that. If you are in your last year of residency or fellowship and you plan to leave the country, you might want to be careful. When you apply for the DS2019 and your visa, they will ask you somewhere on the forms: 'have you taken any steps to obtain a waiver of your HRR'. Now, I don't think it will be held against you if you answer yes, but you never know.

Here is the process how to get the #. No need to go through a lawyer for that (who will charge you), it is just some forms you send to DOS.
(Bad enough that the federal goverment that stands to get the most benefit out of you staying is charging you $230 for a simple act like this.)
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step #4 Lawyer, no lawyer ? If yes, which one.

A J1 waiver is kind of a complex process. You CAN probably do it yourself, but considering what is at stake you might want to think twice about cheaping out here.

Now, there are three kinds of immigration attorneys:

1. ) The imbeciles. They have realized that immigration law is the only area of law they can survive in. All they do is family based cases and H1b's, and they are bad at that. Their victims (oh, I am sorry, clients) are foreigners they can get away with their crimes with impunity. If you ask them whether they can do a J1 waiver they will answer 'sure no problem, I have done dozends of them' !

2. ) The bigmouth 'prominent' types. Everyone knows their name, they have expensive websites and give brilliant testimony in congressional hearings. The principals name draws the clients, but once you retain them you get handed off to some fresh lawschool graduate 'associate' who often knows less about immigration law than you. If you call, you end up talking to a paralegal and your attorney is not available, nevertheless, on your bill you will see that as 'phone consultation' (comes right after 'email consultation'-->$32) In the end things work out bc the 'workerbee' associates are supervised by the big-whigs and before any significant paperwork goes out the experience folks will sign off on it.
The plus is the level of experience they have as a company. There are some quirks with the process in various states, someone in the company might have dealt with that aspect before and you can avoid trouble.

3. ) The 'pearls'. Small companies specialized on one area of immigration law. e.g. extraordinary ability petitions for university professors. They come at a premium, don't advertise and work on 'word of mouth' propaganda. An attorney you can get hold of on the phone if you have to can be worth a lot. Talk to everyone and their brother in your program whether they have an attorney they are happy with.

For your J1 waiver, you definitely want to stay away from group #1 (actually, I think they should be shot in the backyard anyway).
With #2 you know that things will work out, but it will cost you and dealing with the companies can be very frustrating.
If you find a one from the #3 group, I personally think it is the best solution.
individual reply

> lawyers seem reluctant to talk about HHS waivers.
> does anybody know why?

You mean the HHS primary care waiver ?
Probably bc the HHS program is 'on hold'. They took peoples filing fees two years ago but never delivered on the waiver.
Unless it eluded my attention, the program is I think still on hold.

> 2. when does a lawyer come into the process? once
> you have an idea that someone might hire you and

Two kinds of lawyers involved when you are looking for a waiver job.
1. Your contract attorney whoose job is to look out for you that you don't get screwed financially. That is the person you send out to negotiate over the terms of the contract with the practices attorney and owner.
2. Your immigration attorney.

> 3. i've heard that you can apply for a case number
> even before you have a job. apparently, that saves
> time in the process.

Yes, it saves 2-4 weeks.

> 4. in terms of timing, how does it work for FY2006? do

As you have realized in NYS it doesn't. The reason for that is that the SUNY system has tons of people in the O1 pipeline on faculty positions that need to be taken care of. By making the process inaccessible for everybody else, it is easier for the SUNY crowd.

Most states accept applications starting oct1st once they have a new quota. Others take your application any time bc they never run out of slots in the first place.

> 6. any tips on writing a good CV for a J1 waiver? how
> do u convince someone to hire you almost a year
> in advance?

A year in advance is pretty much normal for physician jobs. It takes 3-6 months to get ready to practice in a given state anyway (if you care to get paid for your services).

> 7. is it better to go out there and find ur own job or
> rely on physician recruiters?

As I commented above: The regular commercial recruiters are not interested in you bc you can't guarantee the easy 20k they are in for. The handful of crooks that prey on the J1 crowd you want to stay away from anyway. Places like community health centers don't go through recruiters anyway. Use your network. Around here, one of our IM residents got his waiver job through some help from one of the surgical residency program directors (who had a buddy from medschool who was married to the person....) Take advantage of any nepotic structure you have access to.
Try to stay away from people who specifically recruit saying something 'J1 is ok'. I have the feeling that these are the slavedrivers that need a new sucker every 3 years and 1 day.
thanks for the reply hadron.
i have been communicating with mr.berry of HHS for primary care waiver and he hasn't mentioned anything about it being 'on hold'. he told me they accept applications as long as the criteria are met. could someone share their experience with HHS clinical waivers? previously, they came under the h1B cap.
> i have been communicating with mr.berry of HHS for primary care
> waiver and he hasn't mentioned anything about it being 'on hold'.

Great ! So I guess it DID escape my very divided attention.

The program was initially administered by USDA who after 9/11 found this event a reason to drop it like a hot potato. They saw it as a clear loophole for hordes of terroristic foreign looking physicians to sneak into the country !
A year later or so, Tommy Thompson had a bit press junket and announced the rebirth of the program under HHS tutelage. He acted as if he was personally bringing doctors to the underserved masses of the US.
Next thing I heard was that they accepted applications but strung people along for a couple of months. Only after all other filing deadlines were blown they sent out a memo that the program is 'on hold', leaving a number of people out in the cold.
step #5 Power to the state !

Once you have lined up a job, made your contribution to the continuation of the Conrad30 program and hired an attorney, you are ready for the next step: Finding out what program can get you a waiver and then hit them right between the eyes.

Statistically, most people end up getting their waiver through the Conrad30 program, so most of this collection will apply to this program. If you are either in one of the 'big states' or in one of the 'xenophobic states', you might have to look at other alternatives such as the ARC, DRA or HHS.

So, lets start alphabetically. Some of the stuff is basic 'google', others is ripped of the 3rnet website and some 5.7mb pdf tomb that I downloaded years ago.
Some of these things change. States that didn't do specialists suddenly do, others who only accepted specialist applications on june15 now accept them in october etc. Only by directly contacting the state offices you will be able to get the pertinent information.

You can find similar lists at various places in the web:
(plenty of outdated information)


Why would you want to go THERE ?


I contacted them a while ago. They are basically very flexible: 'If it is HPSA or MUA and you can find a job, we'll sponsor you !'
- they do specialists
- they never use up their quota
- didn't mention advertisement requirment
- only few jobs opening up every year
- did I mention it is Alaska ?

I couldn't find their website, but there is a little synopsis of their program on the website of the Alaska Primary Care Association

The person I was talking to was:

Jean Findley, Health Program Manager
State of Alaska Division of Public Health
Primary Care & Rural Health Unit
P.O. Box 110616
Juneau AK 99811-0616




Well, good luck then. You have 35million people living there and plenty of folks who want to go there. 30 spots per year are the proverbial 'p*)( in the ocean'.
- PCP's only.
- very restrictive medical board (if you translate the latin motto on their insignia it reads 'making doctors commit suicide since 1867'). Better get started >9mo in advance. Bring some serious $$$ and good nerves. You need a transcript listing every hour you spend in medical school. If they think you are lacking lets say 2 hours of psychiatry training, they send you for 4 weeks of unpaid 'remedial training' in one of their state insane asylums.



Best kept secret on the east coast.
- they do specialists
- 'if it's HPSA/MUA, we sponsor it'
- city/rural doesn't matter
- no advertisement requirement
- first come first serve
- have your attorney at the state DPH, application in hand on oct1st and you are set

They have a website with the forms, I just can't find it and nobody references it.

Contact at DPH is:

Stephen B. Carragher
Health Program Supervisor
Connecticut Department of Public Health
Office of Practitioner Licensing and Certification


- does specialists
- small state
- few jobs
- if you have a job, good numeric chances for a waiver



- they can't fill out a ballot on election day, what did you expect
- allows fellowship training, but requires you to do primary care only (schizo!)
- has requirements regarding you %age of medicaid and no-pays


Lot's of protection for the 'old boys network'. Everything is rigged to minimize the influx of funny looking doctors who could reduce the shortages and worsen the negotiating position of the local old guard.

- has an advertisement requirement
- has some requirements regarding HPSA/MUA level
- 5 specialist slots for specialist practice
- 5 slots for part-time specialist practice
- mandates an INSANE liquidated damages clause $250k ! (after Lincoln took their slaves away, they needed to find another method of bonded servitude)


Yes, it is halfway home for most of you guys. In addition to the naval hospital, they have a little hospital for the locals. If you can find a job there, they can get you a waiver. I heard from someone who did peds there for three years.

- you are only 1100mi from Tokyo (good for shopping trips)
- if your patients crash, you can airlift them out to Hawaii (just a couple of 1000miles)
- very small medical sector. If things go bad, you have nowhere to go.
- Palm Trees can get boring after a while
- Oh, they have Typhoons there

Cynthia Naval
Department of Public Health and Social Services
123 Chalan Kareta, Route 10
Mangilao, Guam 96932
Phone: 671-735-7307


Aloha !








- don't let the alligators or the local racists get to you
- pre-approval for waiver jobs required


- small state, few jobs, but if you find one good chance for waiver
- frequently doesn't use all waivers
- sponsors specialists
- crappy payor mix, so don't bank on opening your own shop


- nice piece of real-estate
- they do specialists


- does specialists
- plenty of residency programs, people try to stick around hence tight jobmarket


- if you don't know the geography: UP means 'up there'. tons of snow and nothing much else.


- does specialists
- lots of paperwork but apparently easy to work with

Lorry Colaizy,Office of Rural Health & Primary Care,MN Dept of Health


WHY, WHY I ask would you want to go there ?
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can anyone share their experience at negotiating a contract for a j1 waiver postion? given the dependency that the waiver puts on us, i wonder how one communicates their needs effectively.
Negotiation of the contract for J1 waiver is like any other job. It depends on supply and demand. If there are more candidates applying for the same job, then it will be hard. If there are no other candidates available, then your chances are good.

Remember, their are negatives and positives for J1 waiver jobs for employers. Good employers prefer J1 candidates not because they'll get them cheap.... but the j1 waiver doctor will stay at least 3 years at their site.... and may stick around long term if he/she likes the job and place.... and if employer is good and offering good pay/benefits, lots of J1 waiver candidates stay at their waiver location.
J 1 Waiver jobs for PM &R (PHYSIATRY)

I am a J 1 Physiatrist, have completed my residency & now complting my 1 year SCI med fellowship.
Pleaseguide how to go about the job offers, I obtained : should I tell the employers right away that I m J1 or wait till the contract is done.
Please reply,
Thanx :( :confused:
you have to tell your employer that you are applying for a J1 waiver position because the contract needs to be made in a certain way. besides, they have to request an agency to sponsor you for the waiver, process your H1B, etc.
Difficult question when to break it to them. If you put it on your CV or you bring it up too early, they might shy away.
When I was looking for a job, I waited to the point where they asked 'what would it take for you to come here'. I gave them a number as well as the information that I need some employer support regarding my immigration situation. It was hit or miss, a good number lost interest at that point. In the end I signed with the guys that said 'no problem, talk to our attorney'.
It is doable!!

I did the J-1 waiver myself . I think it is fairly simple and can be done. Having said that a lot depends on the state that you are dealing with as well. Most states do want to help and have clear instructions on what they want. I spent some of my own time and effort on it and saved myself couple of thousand dollars that i didnt have anyway. I compiled the whole package based on the web instructions and then got the packet reviewed by an attorney for 300dollars or so and then filed the waiver. It was approved in no time with no problems. Another friend of mine then used the same materials to file his waiver and his got approved too.
It is doable and we dont have to spend so much money talking to some paralegal. I also have filed my own H-1b's and NIW application.
So dont automatically believe that you have to have a lawyer file it and it is very complicated or something. It is not. Look at the state and then decide.
New York Waivers

hi hadron,

am wondering why you stopped with mississipi. can anyone share their experience with getting a waiver in NY city either through conrad, HHS or VA? since new york is so difficult and unique in its rules, i think it will be very helpful if we could shed some light on this. what does it take for one to be approved for a waiver in new york city given the tough competition?
Why I stopped with missisipi ? Because I DO have a day-job.

Seriously, there is about a 0% chance for a waiver in NYC. In Erie Co NY (they speak canadian there), you might have a chance, but in the city it is extremely tough.

I know of one guy, but he is the head of a department at an academic center and spent many years on O1. Officially he is located in some HIV sattelite clinic, but in reality he runs a hospital department. Without mob connections or some heavyweight political backing (which is one of the same in NYC) it will be hard to get a waiver.
j1 waiver

Dear all,
I am in research J1 visa now doing my MPH.I have just passed the USMLE steps and have the ECFMG certificate.Can I apply for a J1 wiaver or should I have the american board certificate.
J-1 Waiver in Oregon

I particularly liked the analysis Hadron gave on the states to get J-1 waiver from. I was eagerly waiting for Hadron's take on Oregon but thought I would share my first-hand experience in the forum until then.

I got a subspecialist waiver job in Southern Oregon. The state Conrad 30 program here offers 6 subspecialty positions per year. (I was one of them 2 years ago.) The quota rarely runs out in a fiscal year. The program coordinator is also very easy to work with. (Dia Shuhart, Voice: 503-945-9467, Fax: 503-731-4078) If you are looking to come to the west coast (or just to avoid the mid-west and the deep south) where the weather is not so severe, I highly recommend Oregon. Hope this helps.

Your comments coincide with what I heard about this state. Fairly specialist friendly but interested to get you out into central and eastern (empty) part of the state.

- has limited specialist slots
- has some sort of pre-approval process
- mostly interested to get people to the eastern part of the state, less so to Seattle.
- I received a contract from there once, they had this 250k liquidated damages if you leave crap in there. When I asked them, they said the state requires it.