CDC Domestic TB Screening Requirements for Refugees

The Centers for Disease Control and Prevention (CDC) requires that all refugees with TB-related findings from their overseas medical examination complete domestic TB follow-up within 90 days of arrival in the United States. This requirement is separate from the USCIS adjustment of status process but is directly relevant to it.

State and local health departments are responsible for ensuring that refugees complete required TB follow-up. Refugees are typically notified of their TB follow-up requirements upon arrival and are referred to local health departments or TB clinics.

Class A and Class B TB Conditions

TB conditions identified during overseas exams are classified as Class A or Class B. Class A TB (active TB disease) is a ground of inadmissibility and must be treated before the individual can be admitted to the United States. Class B TB conditions are those that do not make the individual inadmissible but require domestic follow-up.

Class B1 TB refers to individuals with TB infection (latent TB) who require evaluation and possible treatment. Class B2 TB refers to individuals who have completed TB treatment overseas but require domestic follow-up to confirm treatment completion. Both Class B1 and B2 conditions require domestic follow-up before I-485 can be approved.

• Class A TB: active disease — must be treated before admission
• Class B1 TB: latent TB infection — requires domestic evaluation and possible treatment
• Class B2 TB: completed overseas treatment — requires domestic follow-up confirmation
• All Class B conditions require documentation of follow-up for I-485 approval

The Civil Surgeon's Role in TB Follow-Up

When a refugee files I-485 and a civil surgeon examination is required, the civil surgeon will review the refugee's overseas exam results and domestic TB follow-up documentation. The civil surgeon documents TB follow-up status on Form I-693.

If TB follow-up has been completed, the civil surgeon will note this on I-693 and the form can be submitted to USCIS. If TB follow-up has not been completed, the civil surgeon cannot certify that the applicant meets the health-related admissibility requirements, and USCIS will not approve the I-485.

What to Bring to Your Civil Surgeon Appointment

Refugees should bring all documentation of their overseas medical exam, TB follow-up records from their state or local health department, any TB treatment records, and their vaccination records. The more complete your documentation, the more efficiently the civil surgeon can complete Form I-693. If you are unsure whether your TB follow-up is complete, contact your local health department before your civil surgeon appointment.