Vaccination RFE; source of requirement for two MMR vaccinations?

[RobertonVJ 0]

Almost a year after filing the I-485 (and over six months after a NPIW), we received an RFE stating that "The vaccination report you submitted is incomplete." There was no detail on what was missing and when I called USCIS to try to find out what might be wrong, the Tier 2 said "you'll have to go back to your civil surgeon to complete it."

I have reviewed materials on VJ trying to figure out what is missing, including Nich-Nick's very useful "Immunizations" post from May 31, 2015. One likely problem is that the civil surgeon did not check the "Insufficient Time Interval" box for the MMR vaccination, the first of which was administered on the date the I-693 was filled in.

(There are some other possible flaws, including missing A-numbers on the pages of the Civil Surgeon Worksheet, a not-very-legible rubber stamp for the doctor's name and address in the Civil Surgeon's Certificate block, and the use of a rubber stamp signature, instead of an original signature as the instructions say are required.)

When I contacted the doctor's office, the nurse who originally filled out the form on behalf of the civil surgeon denied that it was necessary to check the "Insufficient Time Interval" box and also denied that two MMRs are required for an adult. (The "Completed Series" box is not checked either.)

We have an appointment next week to try to sort it out with the doctor. I would like to be able to show them a USCIS document that sets forth the requirement for more than one MMR. Can anyone point me to an official source?

Also, I suppose that at this point a second vaccination will be necessary, since more than the 30 day time interval for the vaccination has gone by?

Finally, we are planning to re-do Part 1 of I-693 (the version of which has changed since we originally submitted it with the I-485), and I presume that the civil surgeon should do the same for his parts.

Thanks,

Robert and Carlos

[RobertonVJ 0]

I think I have answered my own question concerning the source of the requirement. I found this "ACIP" recommendation:

http://www.cdc.gov/m...ml/rr6204a1.htm

It includes the following:

Two doses are recommended for adults at high risk for exposure and transmission (e.g., students attending colleges or other post-high school educational institutions, health-care personnel, and international travelers) and 1 dose for other adults aged ≥18 years.

Since international travel is a given, I can now see why USCIS would require two doses and will point this out to the very stubborn nurse at the civil surgeon's office.

If anyone sees any other problems on my vaccination record (thumbnail attached to original post), I would appreciate your pointing them out!

Robert

[Nich-Nick 3,354]

It could be any of the things you mentioned. A series of two MMR shots is generally accepted as full immunity in the U.S. I can't find the document I was looking for saying a small percentage are not immune after one dose, so two are recommended. There's some of that in this document. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm

But there are plenty of references saying at least one of a series of the required shots must be on your record, so not necessarily the MMR.

The insufficient time interval not marked...their policy manual says if it's not completely correctly, they can still accept the shots as done. The policy manual says to generally accept the Panel Physician recommendation which does say "Complete".

Signature? I can't see one at all. Could be it.

I think you got RFEed by somebody who could have just as easily passed you. There's too many adjudicators to expect they all read all the references in the policy manual. So I think you will just have to go to a civil surgeon and let him do your form. Maybe he will give you a MMR and maybe not. I don't really know how you could fight this RFE effectively or if anybody would take time out to read references cited from all over the place.

[RobertonVJ 0]

Thanks. Nice to know we got an especially diligent review.

I think that we will:

1) Submit a fresh I-693, using the latest version of the form;

2) Insist that the civil surgeon administer a second MMR, state the dates of both, and mark the Completed Series column with an X for the MMR row;

3) Make sure that the name and address information in the Civil Surgeon's Certification Block is legible (see attached thumbnail for how it looks on original);

4) Make sure that the civil surgeon's signature is original, not a rubber stamp (I can't be sure from our photocopy, but it looks like a rubber stamp); and

5) Make sure that the A- number is on every page of the civil surgeon's part. (I think that autofill in the latest version of the I-693 will take care of that.)

Don't know what else to do!!

If this is still deemed incomplete, would it result in a further RFE or a denial?

Thanks,

Robert

[KayDeeCee 4,896]

I agree with Nich-Nick. Hard to determine exactly what they found insufficient. There tends to be a lot of inconsistency in the adjudication process/policies.

To answer your question of a source from USCIS, I can point out the fact that only one in a series is required >

https://www.uscis.gov/news/questions-and-answers/vaccination-requirements

Q. Certain vaccine series can only be completed with multiple visits to the civil surgeon. Am I required to complete the entire series before the civil surgeon can sign the Form I-693?
A. You are only required to receive a single dose of each vaccine when you visit the civil surgeon. You are encouraged to follow up with your private health care provider to complete the series. Once you have received the single dose appropriate at the time, the civil surgeon can sign and certify the Form I-693.

[Nich-Nick 3,354]

Okay, I am revising my comments a little. I was thinking this was a DS-3025 from a K1 entrant. It is actually an I-693 done by a civil surgeon. There is a lot more written directly about that situation. It's more difficult probably to make a strict adjudicator accept something from a visa medical overseass, but this is from a civil surgeon. He marked you complete. They should have accepted that.

From the policy manual https://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB-Chapter9.html

Generally, all age appropriate vaccine rows of the vaccination assessment must have at least one entry before the assessment can be considered to have been properly completed.​ CHECK

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As indicated in the previous section, generally all age appropriate vaccine rows of the vaccination assessment must have at least one entry before the assessment can be considered to have been properly completed. However, if the officer can see from the record that the age appropriate vaccine was not required because, for instance, it is not the flu season but the civil surgeon failed to mark this on the vaccination assessment, then the officer may grant a blanket waiver despite the omission. In such cases, the officer should annotate in the For USCIS Use Only Remarks box in the vaccination record that a blanket waiver was granted. ​ An example showing the officer may use his discretion , even if the form was not completed perfectly

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Vaccine history complete for each vaccine, all requirements met ​

If the applicant has met the vaccination requirements, i.e., completed the series for all required vaccines, the "Vaccine history complete for each vaccine, all requirements met" box must be checked.​ CHECK

---

And finally, the reason I think it was rejected. Policy Manual https://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB-Chapter4.html

Under 4. Validity ​Period ​of ​Form I-693​ ​(Including Use of Prior Versions)​

Generally, the only ​acceptable ​version of ​Form I-693​ is the version in use at the time of the medical examination.​ Prior versions of ​Form I-693​ are generally not acceptable because they may lack necessary information.​ [27]

The date of the medical exam was May 11. 2015 and reported on I-693 version date 1/15/13

However there was a new form https://www.uscis.gov/sites/default/files/files/form/i-693.pdf dated March 30, 2015. If you look at the form, the date 3/30/2015 is followed by a letter N. The dates on forms will have the letter Y or N. That means Yes previous forms are acceptable or No previous forms are not acceptable.

The OP had a an exam May 2015 using a form that was replaced March 2015.

He could go back to the civil surgeon and request that the form be done over on the current version completing only the pages required for the vaccination section. Parts 1, 2, 4, 7. Seal and mark envelope DO NOT OPEN.

But isn't it rather weird that only the vaccinations were rejected and not the entire medical report?

Edited April 24, 2016 by Nich-Nick

[RobertonVJ 0]

Thanks for the additional reply. I definitely intend to submit the new version of the I-693 and correct everything else I can think of, as noted in my list.

It's been awhile, but I believe that we downloaded the I-693 from the USCIS website immediately before going to the civil surgeon and saw a note that the old form could be used past its end date -- I don't think the new one was available yet. But I don't have a record of that.

It does seem to me that they ought to have let us know in what way the vaccination record was incomplete. It would be more efficient for them as well as for us. Why make an applicant engage in a guessing game????

[RobertonVJ 0]

KayDeeCee -- neglected earlier to thank you for your reply. Thanks!

The ACIP states that a second MMR is suggested because of international travel. As I understand it, since you have to wait a month before the second one and USCIS doesn't make you wait to get the second of that or any vaccine, the civil surgeon can check the "insufficient time interval" box for that vaccine and then check the "may be eligible for blanket waiver" box in the results section. Our civil surgeon had marked MMR as complete. And, despite having marked a number of vaccines as not age appropriate, he marked the "all vaccinations complete" box in results instead of the blanket waiver box.

We asked the civil surgeon to administer another MMR which he did, but he insisted on charging for it. I don't think that was fair because the second MMR was necessitated by his having checked the wrong box, but we weren't in a position to argue. He was quite annoyed that I pointed out about a half dozen errors in the I-693 he prepared and said "I have been doing this for 15 years and you are coming into MY office and questioning ME?"

I also asked him if it would be prudent to administer Hep A and B vaccines because of similar international travel wording in the ACIP. But he breezily said it was not necessary for an adult and wasn't interested in reading the ACIP footnotes. I am not so sure if that is true since it appears we have a picky adjudicator.

Finally, even after the civil surgeon re-did the I-693, we discovered yet another error -- they mistranscribed the historic TD vaccination that was recorded in the panel physician's report as Tdap. That might be enough for a technical ding.

We haven't submitted the response to the RFE yet. Since we have some time, we are thinking of going to another civil surgeon and have the whole thing re-done. I will get my fired civil surgeon to send a record of the MMRs that he completed to the new civil surgeon, who can then transcribe them in the "Transferred from a written record" column.

[KayDeeCee 4,896]

Hep A and B not needed for adults > http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/vaccination-civil-technical-instructions.html#tbl1