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If Im an exchange visitor physician and I plan to work in an underserved area in the U.S., what must be presented to obtain a waiver based on an interested U.S. government agency application?

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If Im an exchange visitor physician and I plan to work in an underserved area in the U.S., what must be presented to obtain a waiver based on an interested U.S. government agency application?

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• A: You will need to gather the following: • A Data sheet • A Processing fee – a cashier’s check or money order for $136 • IAP-66 forms • Your Curriculum vitae • A Physician statement – A statement signed by the physician that should read as follows: “I,__________(name of exchange visitor) hereby declare and certify, under penalty of the provisions of 18USC.1101, that: (1) I have sought or obtained the cooperation of_______(enter name of U.S. Government agency which will submit/is submitting an IGA request on behalf of the exchange visitor to obtain a waiver of the two-year home residence requirement); and (2) I do not now have pending nor will I submit during the pendency of this request, another request to any U.S. Government department or agency or any equivalent, to act on my behalf in any matter relating to a waiver of my two-year home residence requirement.” The statement must be signed and dated. • Form G-28 or letter from a law office if an attorney represents the applicant •

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