What to Include in Your Physician NIW Attestation Letter Request

Since 1999, foreign national physicians seeking green cards through the EB-2 second-preference employment category have this avenue paved for them via the Nursing Relief for Disadvantaged Areas Act. This piece of legislation allows physicians who agree to work full-time in areas deemed medically underserved to skip the EB-2 job offer and labor certification requirements. 

Part of qualifying for the waiver through the United States Citizenship and Immigration Services includes a written attestation letter, and we’ll cover the important information you need to know before you write yours here.

Understanding the Requirements of the Waiver

When you submit a request for a physician’s national interest waiver, you agree to work for five years performing full-time service in one of the following:

●     Health Professional Shortage Area (HPSA),

●     Mental Health Professional Area (MHPSA for psychiatrists)

●     A medically Underserved Population (MUP) or 

●     A Medically Underserved Area (MUA).

The state in which you’re planning to work must provide USCIS with a Letter of Attestation that supports your skills and knowledge in the medical field. This letter verifies that the area in which you intend to serve has been officially designated as one that has a shortage of healthcare providers and that your aid there is in the public interest.

These requests must come from the healthcare facility or an immigration attorney on your behalf. The letter of attestation is then submitted to the facility or attorney that requested it. A letter request is not guaranteed approval, as each request is reviewed to verify the physician is in compliance with federal and state guidelines for a National Interest Waiver. Provided all materials submitted are correct and comprehensive, the review process takes 3-5 weeks.

What You Must Include 

Each request for a Letter of Attestation is carefully reviewed for completion. Those evaluating the request ensure that placing a physician in a certain position will not adversely affect or in any way compromise the delivery of healthcare in that medically underserved area and that the physician and employer meet all federal and state guidelines for participation in the National Interest Waiver program. They also review any past or current disciplinary actions.

Submitting your request correctly the first time reduces potential delays for missing information. Your request must include the following documentation, filed in a single package in the specific order on this list (without any extra documents, staples, binders, paper that isn’t the standard size of 8.5” x 11”, or two-sided copies):

1. A written request from the employer or attorney, including the employer/attorney, address, contact info, physician’s name, home address, contact info, specialty, and a current H-1B, along with the DOS waiver case file number of the J-1 visa waiver,
2. Table of contents
3. Physician’s affidavit and agreement for the NIW, signed and dated
4. Letter from the employer that describes the service area, demographics, and facility the physician will serve
5. A copy of the sliding fee schedule
6. A copy of the HRSA Shortage Designation for the practice site’s location
7. The payor mix for the previous six months of revenue, such as Medicare, Medicaid, commercial, and uninsured payments
8. The physician’s info, including an up-to-date CV, medical license in the state of intended employment, a letter of good standing from the state’s Board of Medicine, a copy of any current visa with photo or the visa approval notice, a letter of recommendation that states the services would be in the community’s interest, a written statement from the malpractice carrier, a letter from any Medical Director where the physician has hospital privileges, a copy of the employment contract stating a five-year term and a 40-hour/week minimum and salary.

If the current J-1 waiver was sponsored by an outside state, the documentation will need to include further evidence from that state. Your attorney can guide you and ensure everything is included in your single packet.

What’s Next?

Completing a petition for a National Interest Waiver is always a comprehensive endeavor. As a physician, this goal is extremely rewarding but also extra challenging, as you must provide substantial evidence to obtain the Letter of Attestation before you can petition for the National Interest Waiver itself. Let our experts at Visa2US guide your steps and optimize your chances of success. The medically underserved community needs you!