Intealth ECFMG

Educational Commission for Foreign Medical Graduates

Pre-arrival Information

Welcome to ECFMG’s Exchange Visitor Sponsorship Program (EVSP)

ECFMG is authorized by the U.S. Department of State to sponsor foreign national physicians as J-1 exchange visitors. The objectives of ECFMG’s EVSP are to enhance international exchange in the field of medicine and to promote mutual understanding between the people of the United States and other countries through the interchange of persons, knowledge, and skills. It is ECFMG’s hope that your time in the United States will be educationally and professionally rewarding and include enriching cross-cultural experiences.

IMPORTANT NOTE: All prospective and current J-1 exchange visitor physicians are required to read the EVSP Reference Guide.

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ECFMG is authorized to sponsor the spouse and/or unmarried minor children under the age of 21 for J-2 status. The visa application procedure for J-2 dependents at U.S. Consulates is the same as for J-1 visa applicants. Once sponsorship is approved by ECFMG, the spouse and/or children are each issued their own Form DS-2019.

J-2 Work Authorization

J-2 dependent spouses and, in some cases, minor children under age 21 are eligible to apply for employment authorization from U.S. Citizenship and Immigration Services. The income derived from the spouse’s employment cannot, however, be used to support the J-1 physician and/or the family. Your spouse will be required to submit an estimate of the family’s monthly budget and proof of adequate financial resources with the application for employment authorization.

School for Minor Children

Public education is available free of charge in the United States to children for schooling in grades 1 through 12 (typically ages 6 to 18). All children are required to attend some type of schooling until age 16. Children generally attend public school in the district in which they live or are enrolled in a private school. If you choose to enroll your child in a private school, you will likely have to pay tuition. Whether in a public or private school, it is likely that you will have to purchase some supplies such as notebooks, folders, pencils, a backpack, etc.

If school-aged children will be accompanying you, it is important to make sure that all of their immunizations are up-to-date and documented. For each child, you will need to bring with you an official birth certificate, school records, complete medical history, and immunization records. Check with the district/school at which your child will enroll for specific immunization requirements.

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Responsibilities of J-1 Physicians and J-2 Dependents

J-1 Physicians

Each J-1 physician is required to obtain and remain in valid J-1 visa status throughout the duration of his/her stay in the United States. If a J-1 physician wishes to extend his/her stay in this country beyond the end date on the most recent Form DS-2019, he/she must file the appropriate application with ECFMG well in advance of the current sponsorship/program end form date. Each DS-2019 is issued to reflect specific training dates, training levels, and training programs. The DS-2019 is not transferable and is to be used exclusively for training at the institution indicated on the form. J-1 physicians are also responsible for:

  • Maintaining a valid passport
  • Securing and maintaining required health and accident insurance as detailed on the Mandatory Medical Insurance page
  • Reporting any address changes within ten days to ECFMG through ECFMG’s On-line Applicant Status and Information System (OASIS)
  • Engaging in full-time training at the host institution identified on Form DS-2019
  • Notifying ECFMG of any proposed changes to his/her training plan (e.g., training levels, training dates, resignation, etc.)
  • Reporting to ECFMG any serious matter involving you or your J-2 dependents; including any events impacting your health, safety, and welfare
  • Adhering to all U.S. laws

J-2 Dependents

ECFMG is authorized to sponsor the spouse and/or unmarried minor children of a J-1 physician for entry to the United States under J-2 visa status. A minor child is defined as one under the age of 21. Parents, brothers, sisters, other family members, and nannies are not eligible for sponsorship as J-2 dependents.

J-2 dependents must:

  • Maintain a valid passport
  • Secure and maintain required health and accident insurance as detailed on the Mandatory Medical Insurance page
  • Notify ECFMG of plans to permanently depart the United States prior to the J-1 spouse/parent or change U.S. visa status
  • Live with the J-1 physician (at the same U.S. residential address)
  • Adhere to all U.S. laws

Two-year Home Physical Presence Requirement

In accordance with Section 212(e) of the Immigration and Nationality Act, as amended, all physicians who enter the United States in the J-1 category of “alien physician” are subject to the two-year home physical presence requirement. Accordingly, all J-1 alien physicians must return to their home countries for a cumulative period of at least two years before being eligible to do any of the following:

  • Change status while in the United States to the nonimmigrant categories of temporary worker (H) or intracompany transferee (L);
  • Adjust status while in the United States to immigrant visa/lawful permanent resident status (LPR/Green Card);
  • Receive an immigrant visa at a U.S. Embassy or Consulate; and
  • Receive a temporary worker (H), intracompany transferee (L), or fiancé (K) visa at a U.S. Embassy or Consulate.

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Cross-cultural Experiences

The J‐1 exchange visitor visa was created to facilitate educational and cultural exchange between the United States and other countries. Therefore, in addition to being educationally and professionally rewarding, it is the U.S. Department of State’s expectation that each ECFMG‐sponsored J‐1 physician’s stay in the United States includes enriching cross-cultural experiences. Through such cross‐cultural experiences, J‐1 physicians are able to gain insight into U.S. customs, communities, and people while participating in rewarding educational programs.

Most residency programs provide multiple opportunities for cultural exchange throughout the course of a training year. You are encouraged to take advantage of any/all opportunities offered by your host teaching institution to share your culture, learn from others with different backgrounds, and explore your community.

Examples of cross‐cultural experiences might include:

  • Family picnics
  • Excursions to local amusement parks, sporting events, concerts, museums, or community events
  • Celebrations for U.S. holidays (i.e., Thanksgiving, Fourth of July)
  • Gatherings for physicians / families to share and compare their cultures
  • Outings to local restaurants or potluck dinners featuring foods from different cultures
  • Departmental luncheons, happy hours, or other social events
  • Academic conferences

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Mandatory Medical Insurance

General Requirements

The U.S. Code of Federal Regulations (22 CFR § 62.14) mandates that all J-1 exchange visitors and accompanying J-2 dependents secure comprehensive health insurance effective on the program start date indicated on Form DS-2019 and maintain coverage, without interruption, for the full duration of stay in the United States in J-1 status. Any J-1 exchange visitor who willfully refuses to comply with insurance requirements will be considered in violation of his/her status and subject to termination from the J-1 program.

See the Mandatory Medical Insurance webpage for additional details about this requirement.

The full text of 22 CFR § 62.14 outlining J visa insurance requirements can be found at .

Important Insurance Terms

  • Premium - A premium is the amount that must be paid to a health insurance company for a health insurance plan. Consumers and/or their employers usually pay it bi-weekly, monthly, quarterly, or yearly.
  • Copayment (or “Copay”) - Copayment is a fixed amount (e.g., $20) consumers pay for a covered health care service, usually at the time of service. The amount can vary by the type of covered service, such as seeing a doctor, filling a prescription, or going to the emergency room. Copays are generally lower for services delivered by primary care doctors than by specialists. Copays for in-network providers are typically lower than for out-of-network providers.
  • Deductible - The deductible is the amount a consumer owes for health care services before his or her health insurance plan begins to pay. For example, if a consumer’s deductible is $1,000, the plan won’t pay anything until the consumer has met/paid his or her $1,000 deductible for covered health care services. Some health care services may be covered by the health plan even if the consumer hasn’t met the deductible. Premiums and copays don’t count toward the deductible.
  • Coinsurance - Coinsurance is a consumer’s share of the cost of a covered health care service, calculated as a percent of the amount allowed by the health plan for that service. A consumer pays coinsurance plus any deductibles that are owed. For example, if the health insurance plan's allowed amount for an office visit is $100 and a consumer has met his or her deductible, the coinsurance payment of 20% would be $20. The Health Insurance Plan pays the rest of the amount owed.
  • The Patient Protection and Affordable Care Act, or Affordable Care Act (ACA) - The ACA is a part of federal legislation that made changes to how health insurance is procured and paid for. Signed into law in 2010, the ACA requires individuals who don’t receive health insurance benefits through their employers to purchase coverage or pay a penalty. The law sets minimum standards for health insurance policies and puts certain limits on what insurers may or may not do with respect to eligibility and coverage. The ACA seeks to lower health care costs by making sure more people participate and receive preventive care, while prohibiting some of the insurance industry’s more restrictive practices such as cancelling policies when policy holders become sick or denying coverage to individuals for pre-existing conditions.
  • COBRA - If consumers lose or quit their jobs, they may extend the job-based health insurance through a program called Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows consumers to continue their existing health coverage for a limited period of time, typically at a higher rate than when they were employed.

General Insurance Information Links

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Applying for a J-1 Visa / Change in Visa Classification

How to Apply for a Visa from Outside of the United States

To apply for a J-1 visa, you will need a Form DS-2019, “Certificate of Eligibility,” issued by ECFMG. This document is sent to the Training Program Liaison (TPL) at your host institution after all necessary application materials have been received, reviewed, and approved. The TPL will, in turn, forward Form DS-2019 to you. Once received, carefully read the instructions on the back of Form DS-2019 and sign where instructed. You will then use Form DS-2019 along with the following documentation to apply for a J visa at a U.S. Embassy or Consulate:

  • Passport valid for at least six months past the end date on Form DS-2019
  • Appropriate financial documentation (hospital contact or letter of offer, funding letter from home government or institution, and/or a personal bank statement)
  • Proof of required Student and Exchange Visitor Information System (SEVIS) fee payment (see below)
  • One (1) 2 in. x 2 in. photograph

U.S. Embassies and Consulates vary in their application procedures. Most require personal interviews. In all cases, you will be required to complete Form DS-160, Nonimmigrant Visa Application . All applicants must also pay a non-refundable, nonimmigrant visa application processing fee. The type of visa for which you apply determines the fee amount. The current fee for J visa applicants is $185. See how to apply for a U.S. nonimmigrant visa for additional information.

A listing of U.S. Embassies and Consulates around the world is available at . It is recommended that you visit the website of the embassy or consulate at which you plan to apply for your visa to familiarize yourself with its visa application procedures and requirements in advance of your planned interview.


In addition to the nonimmigrant visa application fee, there is also an additional $220 Student and Exchange Visitor Information System (SEVIS) fee for J visa applicants that must be paid before the visa application. J-2 dependents are not charged a separate SEVIS fee. Information on current SEVIS fee payment procedures can be found at .

Canadian Citizens

Although you are not required to hold a visa (stamp) in your passport, you must hold a valid passport and submit your Form DS-2019 and supporting documentation, including proof of SEVIS fee payment, to an immigration officer at the U.S. border or other port of entry. It is imperative that you secure Form I-94 at the border/port of entry to document that you have entered the U.S. legally and in J-1 status. In most cases, a paper Form I-94 is still issued at border ports of entry.

Visa Interview Tips

The J-1 visa carries with it “nonimmigrant intent.” For this reason, the burden of proof will be on you to convince the U.S. Consular Officer when applying for a visa that you have close ties to your home country and plan to return. Therefore, it is recommended that you be ready to provide proof of the following at the time of your visa interview:

  • Proof of a permanent residence abroad (i.e., in your home country) that you have no intention of abandoning;
  • Strong economic, social, and family ties to your home country; and
  • The usefulness of your experience in the United States to your home country.

For additional information about applying for your visa, visit the Department of State website .

Applying for a Change in Visa Classification from within the United States

Some visa applications require further administrative processing, which takes additional time after the visa applicant’s interview by a consular officer. See the U.S. Department of State’s Administrative Processing Information webpage for more information.

If you are in the United States in a visa status other than “J-1,” you may be eligible to process Form DS-2019 by filing an Application to Extend/Change Nonimmigrant Status (Form I-539) with a Regional Service Center of the United States Citizenship and Immigration Services (USCIS) .

It is important to verify USCIS current filing requirements and processing times, which may be several weeks to months. During this time you must maintain your current visa status. Physicians are not permitted to train until the change of status has been approved by USCIS. Approved applications result in the Department of Homeland Security (DHS)/USCIS issuing a “Notice of Action, Form I-797” which will include a new Form I-94 granting status change to “J-1/D/S.” Change of status applicants are strongly advised not to depart the United States while awaiting a decision on a change of status application to avoid potential problems with their SEVIS records. Once USCIS approves a change of status application and confers J-1 status, travel outside of the United States is not required. However, any subsequent travel outside of the United States will require that you secure a J-1 stamp in your passport.

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Please see the Fees page for a list of U.S. government and ECFMG fees that may be required for participants in ECFMG’s J-1 program.

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Arrival in the United States

Form I-94

Unless you are a citizen of Canada, you cannot enter the United States as an exchange visitor unless you have a J-1 visa in your passport. You can enter the United States no more than 30 days before the beginning of your program as shown on your Form DS-2019 and you can remain in the United States no more than 30 days after the end date. You cannot participate in a training program during the 30-day “grace periods” before commencing and after completing your training program.

Upon arrival to the United States, you must apply for admission via U.S. Customs and Border Protection (CBP). A CBP immigration officer will inspect your documents. Present your passport, visa, and Form DS-2019 to the immigration officer. If all of your documentation is found to be in order, you will be admitted to the United States in J-1 status. You will be issued Form I-94, Arrival/Departure Record. Form I-94 serves to document the date/place of admission to the United States as well as your status. As a J-1 physician, your Form I-94 should be notated with J-1 “Duration of Status (D/S).” If you are issued Form I-94 indicating a status other than J-1 or notating a specific end date, it is important that you contact ECFMG immediately.

NOTE: If arriving at a U.S. air or sea port-of-entry, the CBP immigration officer will scan your passport, generating an electronic arrival record and creating an electronic Form I-94. In this case, you should visit the CBP website to print a copy of your electronic Form I-94. Physicians entering through a land port-of-entry will typically have a paper Form I-94 issued to them, although some ports-of-entry are now issuing them electronically.

Validation of Initial Arrival

ECFMG, as J-1 program sponsor, must confirm the arrival of all newly sponsored J-1 exchange visitors in the SEVIS, a U.S. government database. Specific documents evidencing arrival in J-1 visa status are required before your SEVIS record can be validated. Upon arrival to the United States, you must report to your training program as soon as possible and present the ECFMG-recognized Training Program Liaison (TPL) with evidence of your J-1 visa status.

Evidence of J-1 status includes:

  • Copy of J-1 visa stamp in passport issued by U.S. Consulate (Canadian citizens are not required to have a visa stamp)
  • Copy of Form I-94 (or Form I-797) reflecting your status “J-1, D/S

Your TPL is then required to complete a Validation of Initial Arrival of ECFMG-Sponsored J-1 Physicians for SEVIS Reporting form and upload it with required supporting documentation to your ECFMG sponsorship application record. Once received, ECFMG will validate your arrival to the United States in SEVIS. Upon validation in SEVIS, your program start date cannot be amended.

NOTE: SEVIS validation is required to apply for a U.S. Social Security Number (SSN); J-1 physicians must wait 11 business days after being validated in SEVIS before applying for an SSN. Validation status can be confirmed in OASIS. Validated records are marked “active.” On the Social Security Card application, at the question about “citizenship,” J-1 physicians should select “other.”

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Weather / Clothing

Temperatures vary considerably across the United States and from month-to-month, and year-to-year. The National Oceanic and Atmospheric Association provides information on current as well as past weather for specific cities. Information can be accessed by entering the mailing zip code or city and state names into its search engine and choosing “Forecast” or “Past Weather.”

Colder U.S. climates, generally occurring in the winter months, require heavy jackets, hats, scarves, gloves, and boots. A jacket and/or raincoat, sweater(s), and long-sleeved clothing is recommended even in the warmer states (i.e., Florida, California) as autumn and spring days and evenings can become chilly. You will also likely be required to wear “scrubs” and/or a lab coat while on duty in the hospital. Check with your TPL for additional information on required hospital clothing and recommendations for dressing for the weather in your region.

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Opening a U.S. Bank Account

It is recommended that you open a bank account soon after arrival. You should do some research prior to opening an account to compare services offered, fees, and interest rates to choose a bank that fits your needs best. The information about terms and policies can be found on each bank’s website. Most banks require an initial deposit to be made to open a bank account.

You should take the following documents with you to open a bank account:

  • Unexpired passport
  • Form I-94 or Form I-797 approval notice
  • Form DS-2019
  • A secondary form of identification
  • U.S. Social Security Number (SSN) card, if available

Additional documentation may be needed; contact the specific bank for details prior to going in person.

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Paying Taxes

It is very important for J-1 exchange visitors and J-2 dependents to understand their U.S. tax responsibilities. Any foreign national present in the United States for any part of the calendar year must file a “tax return” with the Internal Revenue Service (IRS) by the following April.

Overview of the U.S. Tax System

In the United States, federal and state income taxes are generally withheld from each paycheck by employers based on information provided by the employee on Form W-4 at the time of hire. Since the withholding is only an estimate, employees must reconcile the amount taken out with how much was owed annually.

Employers provide form W-2 to all employees at the end of each calendar year. This form gives a summary of the total amount of wages earned during the year and the amount of money withheld for any taxes. The form W-2 is then used by the employee to file a tax return with the U.S. government. If too much was withheld, an employee will receive a refund. If not enough was withheld, an employee will need to pay the government the additional amount. If the amount withheld matches the amount due, no money is owed by the employee to the government or by the government to the employee.

The mechanism for reconciliation of taxes with the U.S. government is called the “tax return.” The federal tax return is filed with the IRS, which is the U.S. government agency responsible for collecting federal taxes. The state tax return is filed with your state’s department of revenue, and your city/local tax return (if applicable) is filed with your municipal office.

J-1 exchange visitors and J-2 dependents must file tax returns regardless of whether they earned income while in the United States.

Alien Tax Status

For tax filing purposes, foreign nationals are considered either Non-resident Aliens or Resident Aliens depending on the duration of their presence in the United States. Determining “Alien Tax Status is important to ensure completion of correct tax forms. The Substantial Presence Test is used to determine an individual’s Alien Tax Status.

State Taxes

Information on tax regulations for a particular state can be found on the American Institute of CPAs website.

Important Tax Terms

  • Form 1099-INT
    A form issued by a U.S. bank that shows the interest received on deposits in bank savings accounts.
  • Form W-2 (Wage and Tax Statement)
    Form W-2 is a U.S. federal tax form issued by employers to all individuals who earned income from wages in the United States. It is a summary of the total amount of wages earned during the year and the amount of money withheld for any taxes (federal, state, and local).
  • Tax Deadline
    The deadline for federal tax returns is April 15 of each year. The deadline refers to the date the envelope is postmarked by the post office.
  • Tax Treaty
    A tax treaty is an agreement between certain countries and the United States which may allow residents of foreign countries to be taxed at a reduced rate, or to be exempt from U.S. income taxes on certain items of income they receive from sources within the United States. The IRS publishes information on its website on tax treaty agreements with various countries.

Additional Tax Resources

The content of the tax information provided is intended for general information purposes only and should not be used in place of a professional or legal tax advice. If you have any tax-related questions or concerns, please contact your local professional tax preparation service or the IRS directly.

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Housing costs vary from city-to-city, and state-to-state. You are encouraged to investigate average costs in the city where you will train well in advance of coming to the United States. The TPL at your host institution can likely provide you with general details on the average cost of housing close to your training site/hospital. Additionally, websites such as , and provide extensive information on neighborhoods, rental options, and costs.

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Obtaining a U.S. Driver's License / Public Transportation

Obtaining a Driver’s License

It is illegal to operate a motor vehicle (automobile, motorcycle, etc.) in the United States without a valid driver’s license. If you plan to drive while in the United States, you should check with the motor vehicle department in the state where you will train for details on the state’s requirements for obtaining a driver’s license, registering a car, automobile insurance requirements, etc.

Public Transportation

Many U.S. cities, particularly large metropolitan areas, have extensive public transportation systems. Public transportation may include buses, subways, trolleys, streetcars, ferries, trains, taxis, etc. The American Public Transportation Association’s website provides links to public transportation resources in all 50 U.S. states.

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U.S. Laws

It is important that J-1 physicians and J-2 dependents become familiar with United States federal laws, in addition to your state and local laws, which may vary. The following list is not comprehensive, but may act as a general primer for your reference.


  • Smoking: Many states have banned smoking in public places; most employers have banned smoking on premises.
  • Alcohol: U.S. legal drinking age is 21.
    • Driving under the influence (DUI/DWI) is a felony, and has serious repercussions for nonimmigrant visa holders. See the U.S. Department of State’s Guidance Directive on Visa Revocation for additional information.
    • While alcohol laws vary by state, most states prohibit drinking in public (e.g.; public parks), and/or public intoxication.
  • Drugs: It is the responsibility of those who prescribe controlled substances to fully comply with applicable federal and state laws and regulations. In addition:
    • Using or distributing drugs that are not prescribed to you is a felony offense.
    • Generally, employers may drug test and terminate employees based on usage.

Family and Relationships

  • Domestic Violence: Strict laws govern domestic relationships (husband/wives, boyfriend/girlfriend, etc.) to protect individuals from physical or mental harm; domestic offenses can include things such as spousal abuse or stalking.
  • Child Abuse or Neglect: If you have children, you are responsible for ensuring their health, safety, and well-being. The U.S. defines child abuse very broadly, perhaps more so than in your home country. If you have children, be mindful when:
    • Disciplining children with physical force; the legal line between discipline and abuse is very thin.
    • Leaving a child unattended, even for a few minutes. It is illegal to leave a child alone in a car while you “run a quick errand.”

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[Last update: November 2, 2023]

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