Nov 1, 2026 Pendency Rule: Civil Surgeon Signature Rules, U.S. Filers

The civil surgeon must sign Form I-693 in original ink, not a stamp, not a photocopy, except for narrow health department or military exceptions and only after your exam and any required treatments are finished. If your form was signed on or after November 1, 2023, it stays valid only while the green card application it was filed with remains pending, a policy USCIS confirmed on June 11, 2025. Get any part of that sequence wrong and you are looking at a rejection or a request for evidence.

TL;DR:

• A civil surgeon’s signature must be an original, handwritten ink mark applied in front of the applicant during the exam, not a stamp or photocopy, with exceptions for health departments and military facilities under strict conditions.
• The validity of the signed Form I-693 now depends on case pendency; it remains valid as long as the underlying application is pending, but becomes invalid if the application is denied or withdrawn.
• Proper signing sequence is critical: the applicant signs first in front of the surgeon, the surgeon verifies ID, completes examination and treatments, then signs last with a wet ink signature sealed in an envelope.
• Stamped signatures are only acceptable from blanket-designated health departments or military physicians, and only if accompanied by an official seal and proper documentation, not from private clinics.
• Common signature errors include missing applicant signatures, use of stamps instead of ink, signing before completing the exam, and using outdated forms, all of which can cause rejection or delays.

Table of Contents

• What are the civil surgeon signature rules under USCIS policy?
• When can a civil surgeon use a stamp instead of a signature?
• How long is a signed I-693 valid?
• What is the correct signing sequence for Form I-693?
• How does the sealed envelope requirement work for I-693?
• What signature errors get an I-693 rejected?
• What happens if USCIS rejects or invalidates your I-693?
• How does a specialized clinic prevent these signature errors?
• Why the pendency rule changes filing strategy more than the 60-day rule ever did
• Ready to schedule an I-693 exam that meets every signature requirement?
• Sources
• FAQ

What are the civil surgeon signature rules under USCIS policy?

USCIS treats the civil surgeon’s signature as a sworn legal certification, not a formality. The USCIS Policy Manual and the official Form I-693 instructions both require an original, wet ink signature from the civil surgeon performing the exam. There is no substitute for that ink on paper, and USCIS officers are trained to spot the difference between a genuine signature and a reproduction.

A valid signature has more flexibility in form than most applicants expect. Under the Policy Manual’s chapter on signatures, it does not need to be legible, does not need to be in English, and can even be abbreviated or reduced to a mark like an “X” in some circumstances. What matters is that a real hand made real contact with the page at the time of signing.

Here is what typically passes and what does not:

• Acceptable: a handwritten signature in any legible or illegible cursive, an abbreviated version of the civil surgeon’s name, or a signature mark, as long as it was physically applied by the person signing.
• Acceptable in narrow cases: stamped signatures paired with an official seal, but only from blanket-designated health departments or qualifying military physicians (covered in the next section).
• Not acceptable: a rubber stamp of a private civil surgeon’s name, a typed or computer-generated signature block, a photocopy of a signature, or a scanned image pasted onto the form.
• Not the same thing: electronic signatures used inside a USCIS online account. Those are governed by separate rules that apply only where specific form instructions permit them, and they do not extend to the civil surgeon’s certification on a paper I-693. A tool like FlowPDF’s e-signature feature can be useful for other document workflows, but it has no role in completing a civil surgeon’s I-693 certification.

Because Form I-693 is signed under penalty of perjury, USCIS enforces signature integrity strictly. Officers reviewing your file are not just checking that a signature exists. They compare ink texture, check whether the civil surgeon identification number lines up with the name on the form, and look for the telltale flatness of a photocopied or stamped signature where one should not appear. Even a signature that looks legitimate can trigger scrutiny if it does not match the surgeon’s designation status on file.

When can a civil surgeon use a stamp instead of a signature?

Two categories of practitioners get an exception to the wet ink rule, and both come with strict conditions attached. Understanding these exceptions matters if you were examined through a public health clinic or a military facility, because a stamped form that would be rejected from a private civil surgeon can be entirely valid here.

Blanket-designated health departments. Some state and local health departments hold a blanket civil surgeon designation, most commonly used for refugee vaccination assessments and related public health screenings. Physicians working under that designation may use a stamped signature, but the attending physician’s name must still appear, and the department’s official stamp or seal must accompany it. The exception covers the format of the signature, not the requirement that a real, identifiable physician stands behind the certification.

Military treatment facilities. Qualifying military physicians examining service members or their dependents may also use a stamped signature accompanied by an official seal, under the same Form I-693 instructions that govern the health department exception. This accommodates the volume and structure of military medical processing without loosening the underlying accountability standard.

Before accepting a stamped I-693 from either category, verify the following:

• Confirm the health department or military facility actually holds active blanket designation status, rather than assuming any government clinic qualifies.
• Check that the stamp includes the physician’s name and an official seal, not just a generic department stamp.
• Ask whether a Civil Surgeon Identification Number (CSID) is required on the form. Blanket-designated providers are typically exempt from entering a CSID, while private civil surgeons are not, according to USCIS Policy Manual guidance.
• If you have any doubt about a facility’s designation, ask the clinic directly for documentation before you rely on the form for filing.

If your exam happened outside one of these two categories and the form shows anything other than a wet ink signature, treat it as a red flag. That includes forms from private clinics that got the memo wrong.

How long is a signed I-693 valid?

USCIS overhauled this rule twice in recent years, and the current version catches a lot of applicants and attorneys off guard. Understanding the shift matters more than memorizing the current rule in isolation, because it explains why timing strategy has changed so much since 2023.

Older filers may remember the “60-day rule,” which required a civil surgeon’s signature to be dated no more than 60 days before the underlying benefit application was filed. USCIS eliminated that requirement in a policy update effective March 31, 2023, partly because the tight window generated confusion and a steady stream of avoidable RFEs. Applicants who completed their exam slightly too early, or whose attorney needed extra time to assemble the rest of the filing, kept getting penalized for a timing technicality rather than anything wrong with the medical findings themselves. COVID era policy had already forced USCIS to issue temporary waivers extending validity, which showed the agency that rigid day counting created more problems than it solved.

Then, in a newsroom alert dated June 11, 2025, USCIS replaced the old system with a pendency-based rule. For any Form I-693 signed on or after November 1, 2023, the validity period is now tied directly to the immigration application it was filed with. As long as that application remains pending, the I-693 stays valid, no matter how much calendar time has passed since the civil surgeon signed it.

That sounds like a relief, and in one sense it is. You no longer have to sprint to file within a fixed window after your exam. But the pendency structure creates a different risk that catches people off guard: if your I-485 or other underlying application is denied, withdrawn, or otherwise stops being pending, your existing I-693 becomes invalid for any future filing. You cannot simply reuse it when you refile. That means:

• A denial forces a brand new medical exam and a brand new I-693, even if your last one was completed a matter of weeks earlier.
• Withdrawing an application to refile under different circumstances carries the same consequence.
• Coordinating exam timing with your attorney’s filing strategy still matters, just for a different reason than before. You want the exam close enough to your actual filing that you are not gambling on an application’s outcome before you have a signed form in hand.

If you are working with counsel, ask directly how your firm sequences medical exams relative to filing dates under the current rule. Our guide on scheduling the medical exam relative to your interview walks through the practical coordination points in more detail, and our page on how long Form I-693 stays valid breaks down the pendency rule with more filing scenarios.

What is the correct signing sequence for Form I-693?

Signature timing is not just about the calendar. It is also about the exact order in which two specific signatures get applied to the form, and USCIS checks this sequence closely.

1. You sign Part 2 first, in the civil surgeon’s presence, at the start of your appointment. This is not a formality you complete at home ahead of time. The Form I-693 instructions require that your signature happen in front of the civil surgeon, tied to identity verification with a government-issued photo ID.
2. The civil surgeon verifies your identity against that ID before proceeding. This step confirms the person being examined matches the person named on the form, closing off a documented source of fraud in the medical exam process.
3. The exam, lab work, vaccination review, and any required treatments happen next. Nothing about the civil surgeon’s certification can be finalized until this phase is genuinely complete, not scheduled or in progress.
4. The civil surgeon completes Parts 5 and 7 only after everything above is finished, entering a Civil Surgeon Identification Number unless working under a blanket designation. This is also where any outstanding referrals or follow-up treatments need to be resolved or properly annotated on the form.
5. The civil surgeon signs last, applying the wet ink signature that certifies the results.

A common mistake practitioners see: staff or applicants trying to have the civil surgeon pre-sign forms, or having the applicant sign before identity verification happens, treating both signatures as paperwork to knock out quickly. Neither shortcut holds up. USCIS Policy Manual guidance on medical examination documentation is built around the idea that the civil surgeon’s signature reflects a completed, verified exam, not an administrative placeholder.

Pro Tip: If your exam requires a follow-up test, like a chest X-ray reading or a TB treatment course, ask the clinic directly how they document that on the form if it is not finished before your appointment ends. A properly annotated form with pending results noted is very different from a form the civil surgeon simply signed too early to avoid a second visit.

How does the sealed envelope requirement work for I-693?

Once the civil surgeon signs, the form does not go straight into your hands as a loose document. USCIS requires the civil surgeon to place the completed Form I-693 into a sealed envelope, and you should never accept it any other way.

• Never accept an unsealed I-693. If a clinic hands you the form open or loose, ask them to reseal it properly before you leave. An unsealed form can raise questions about whether it was altered after signing.
• Keep the sealed envelope intact until you actually need to file it. Per the official Form I-693 page, you retain the sealed original and submit it together with Form I-485.
• If you are filing I-485 online, you are permitted to open the sealed envelope specifically to upload a copy of the completed form, but you must hold onto the original paperwork until USCIS reaches a final decision on your case.
• Bring the sealed original to your interview, or be ready to produce it if USCIS requests it directly. Officers sometimes ask to see the original sealed form even after a copy has already been submitted or uploaded.

Losing or damaging the sealed envelope before filing creates a genuinely difficult situation, since a resealed or reopened form does not carry the same evidentiary weight. Treat that envelope with the same care you would a passport, not a routine piece of mail.

What signature errors get an I-693 rejected?

Most I-693 signature problems fall into a short, predictable list. Attorneys who review immigration medical exam packets before filing tend to check these same few points every time, because they account for the overwhelming majority of avoidable rejections.

1. The applicant signature is missing from Part 2, often because the applicant assumed the civil surgeon’s office would handle it, or signed the wrong section entirely.
2. A private civil surgeon used a stamp instead of a wet ink signature, mistakenly assuming the health department or military exception applied to their practice.
3. The civil surgeon signed before the exam, labs, or required treatment were actually finished, leaving Part 7 certifying results that were not yet available.
4. The form is an outdated edition that USCIS no longer accepts, a surprisingly common error when applicants pull a blank form from an old download rather than the current version on the official I-693 page.
5. Names or A-numbers do not match across every page, including small discrepancies like a missing middle name or a transposed digit.
6. The sealed envelope was opened, damaged, or never provided, undermining the chain of custody USCIS expects for the completed form.

For attorneys building a final compliance check before filing, the short version is this: confirm the edition date, confirm the signing sequence matches the instructions, confirm the CSID or blanket designation is documented correctly, and confirm the sealed envelope is genuinely sealed. Those four checks catch nearly everything.

What happens if USCIS rejects or invalidates your I-693?

A rejection is frustrating, but it is rarely the end of the road if you understand what triggered it and respond correctly.

• Read the RFE or rejection notice carefully before doing anything else. USCIS typically states exactly which requirement was not met, and following those instructions precisely matters more than guessing at a broader fix.
• If the issue is a signature or documentation defect, you generally need a corrected I-693 signed properly, not just a note explaining the original error. That usually means returning to a civil surgeon, sometimes the original one, sometimes a new one if the original made a compliance mistake.
• If your underlying application (like Form I-485) was denied or withdrawn, your existing I-693 is no longer valid for a future filing, even if the medical findings themselves would still be accurate. You will need a new exam and a new signed form before you refile.
• Coordinate timing carefully to avoid paying for a second exam unnecessarily. If your attorney anticipates a gap between your current filing status and a future refiling, ask directly whether it makes sense to wait on scheduling a new exam until the refiling is imminent, given the current pendency-based validity rule.

Our detailed breakdown of what happens if your I-693 is rejected walks through the specific remedy paths depending on which requirement triggered the rejection.

How does a specialized clinic prevent these signature errors?

Immigrationmedicalexams has focused exclusively on immigration medical exams and Form I-693 since 2007. No primary care, no urgent care, no sick visits, just the exam, the labs, the vaccination review, and the paperwork that has to hold up under USCIS review.

That focus shapes how the clinic handles the exact problems covered above. Every I-693 is checked against the current accepted edition before the appointment even begins, so applicants are not handed an outdated form by mistake. Names and A-numbers get verified across every page, and the CSID entry is checked against the surgeon’s actual designation status rather than left blank. The sealed envelope is handled the way USCIS expects, meaning it leaves the clinic sealed and stays that way until the applicant is ready to file.

Applicants frequently come to Immigrationmedicalexams after running into delays, errors, or incomplete vaccination documentation from an exam performed elsewhere. Rebuilding a botched I-693 from scratch is common enough that the clinic’s workflow is built to catch the same mistakes that caused the original problem, particularly around signature timing and sequencing. Standard processing typically takes a few days, with an expedited option available for applicants working against tighter filing deadlines. Appointments can be scheduled online at any hour, which matters for applicants juggling work schedules or coordinating with an attorney’s own timeline.

Why the pendency rule changes filing strategy more than the 60-day rule ever did

The removal of the 60-day rule got treated as a straightforward win when it happened, and in terms of reducing filing pressure, it was. Applicants no longer had to treat a signed I-693 like a ticking clock. But the trade-off nobody discussed enough at the time is that pendency-based validity replaces a predictable countdown with a conditional one, and conditional risk is harder to plan around than a fixed deadline.

Here is the practical shift: under the old rule, your risk was entirely about calendar days. Under the current rule, your risk is tied to the outcome of your case, which you often cannot predict. A denial or a strategic withdrawal, something an attorney might recommend for legitimate reasons, now carries a hidden cost of invalidating a medical exam you already paid for and completed.

The applicants best positioned under this rule are the ones who treat the exam as one coordinated step in a broader filing strategy, not an isolated errand to knock out early. That means talking to your attorney about timing before you book the appointment, not after. It also means keeping your documentation, your sealed envelope, and your civil surgeon’s contact information organized in case a second exam becomes necessary. Waiting until a denial notice arrives to figure out your next step costs you both time and money that better sequencing would have avoided.

— ImmigrationMedicalExams Medical Team

Ready to schedule an I-693 exam that meets every signature requirement?

Immigrationmedicalexams is a straightforward alternative to piecing together an exam, lab work, and paperwork across multiple providers and hoping the signatures line up correctly. Everything happens under one flat-package appointment, built specifically around getting Form I-693 completed correctly the first time, with standard three-day processing or a two-day expedited option when your filing deadline is tight.

Bring a government-issued photo ID and your vaccination records if you have them, since incomplete vaccination documentation is one of the most common reasons applicants end up back at a clinic for a second visit. The exam follows the exact signing sequence outlined above: you sign in the civil surgeon’s presence at the start, and the civil surgeon signs only once your labs, vaccination review, and any required treatment are fully documented. Your completed form leaves in a properly sealed envelope, ready to file with your Form I-485. Spanish-language support is available, and you can book an appointment online at any hour through the clinic’s service page. If you want to see exactly how the sealed form process works before you book, review the sealed Form I-693 requirements page and schedule your exam when you’re ready.

This article is general information, not a substitute for advice from a qualified lawyer. Consult a qualified legal professional about your own circumstances before acting on anything here.

FAQ

What changed with the USCIS Form I-693 signature rule?

USCIS did not change the signature format rule itself. What changed, effective June 11, 2025, is validity: any I-693 signed on or after November 1, 2023 stays valid only while the application it was filed with remains pending.

Is a civil surgeon the same as a regular doctor?

Not quite. A civil surgeon is a licensed physician specifically authorized by USCIS to perform immigration medical exams and certify Form I-693, a designation separate from ordinary medical licensure.

What signatures does USCIS accept on Form I-693?

USCIS requires an original, wet ink signature from the civil surgeon, with legibility not required and abbreviated signatures permitted. Stamped signatures are accepted only from blanket-designated health departments or qualifying military physicians, always paired with an official seal.

Does USCIS require blue or black ink for signatures?

USCIS instructions do not specify a mandatory ink color for the civil surgeon’s signature on Form I-693. What matters is that the signature is original and applied by hand, not the color of the ink used to apply it.

Can I use an exam performed at a health department instead of a private civil surgeon?

Yes, and in that case a stamped signature with an official seal may be acceptable if the department holds blanket civil surgeon designation. Confirm that designation status directly with the department before relying on the form, since not every public clinic qualifies.

Recommended

• What Is the Sealed Envelope Rule for Form I-693?
• USCIS Accepts 01/20/25 I-693 in 2026: What U.S. Filers Must Do
• I-693 Exam Before Biometrics: 60-Day Rule (2026)
• Sealed I-693 Envelope: Mail vs Online Filing 2026