How do I apply for a waiver based on a request from a State health agency?
• A: The applicant is responsible for gathering the following: • A data sheet • A Processing fee: cashier’s check or money order for $136 • IAP-66 forms • Your Curriculum vitae • A “No objection” statement from the visitor’s government in cases in which foreign government funding is involved • A Form G-28 or letter from a law office if applicant has an attorney • Two self-addressed stamped, legal-size envelopes The State health agency must gather and send directly to the Waiver Review Division the following: • A letter from the State health department’s designated official (designated by the state governor) which states it is in the “public interest” that the exchange visitor physician remain in the U.S. and includes the following: • Exchange visitor’s name • Country of last legal permanent residence • Name of medical facility • Address of facility • U.S. Department of Health and Human Services designated Health Professional Shortage Area (HPSA) ID number of medical shortage area • A l
