1. A physician must agree to work full-time (40 hours a week) in a clinical practice for a total of five years;
2. The clinic must be located within an area that is designated as a Medically Underserved Area (MUA), a Primary Medical Health Professional Shortage Area (HPSA), a Mental Health Professional Shortage Area (MHPSA), or within a Veterans Affairs (VA) facility;
3. A physician serving in a MUA, MHPSA, or HPSA must provide services in a medical specialty for which the area is designated. For example, a physician who received a J waiver through the VA based on specialty practice likely could not leave the VA system after the initial three-year service obligation to work in a HPSA, since HPSAs are designated for primary care.
4. A physician must accumulate the required five-years (5) of medical service within the six-year period beginning on the date the NIW is approved. If a physician has obtained a J-1 waiver and changed to H-1B nonimmigrant status from J-1, the physician will begin accumulating the required five-years (5) of service on the date the physician changes from J-1 to H-1B status, not on the date of I-140 approval. No time spent in J-1 classification counts towards meeting the five-year requirement.

In a 1/29/07 Interoffice Memorandum, Michael Aytes, Associate Director, Domestic Operations, USCIS, notified officers of the two-year extension of the Conrad State 30 program until 6/1/08.

To file NIW Application, a physician normally needs to provide the following:

a)  An employment contract for the five-year period of clinical medical practice, or an employment commitment letter from a VA facility or reliable evidence of self-employment. CIS requires the employment agreement to be dated within the six months before the date the NIW petition is filed. (This requirement means that the employment agreement used for J-1 waiver purposes cannot be used.) If the physician will start his own full-time practice, the physician must submit a sworn statement committing to the full-time practice of clinical medicine and describe the steps the physician has taken or intends to take to establish the practice, including a business plan, office lease and proof of financing for self-employed NIW practitioners;

b)  Evidence that the physician will provide full-time clinical medical service in the geographical area and medical specialty designated by the Secretary of the Health and Human Services (HHS). Alternatively, evidence of the physician's facility being under the jurisdiction of the VA must be provided if a physician is employed by the VA;

c)  A letter from a federal agency or state department of public health asserting that the physician's work is in the public interest. The letter must be dated within six months before the date the NIW petition is filed. A government attestation must be submitted reflecting the agency's knowledge of the alien's qualifications and the agency's background in making determinations on matters involving medical affairs so as to substantiate the finding that the physician's work is or will be in the public interest. An attestation from a state public health department must reflect that the agency has jurisdiction over the practice area. Please note that many J-1 waiver recommendations will not satisfy these requirements, and a new letter from a state public health official may be required.