F-4 Preference Category for Siblings

Siblings (brothers and sisters) of U.S. citizens are classified in the F-4 (fourth preference) family-based immigration category. Unlike immediate relatives (spouses, children, and parents of U.S. citizens), F-4 siblings are subject to annual visa quotas, which means there can be very long waits — often many years or even decades — before a visa number becomes available.

Once a visa number becomes available and the sibling is eligible to file Form I-485, the immigration medical exam requirement is the same as for all other adjustment of status applicants.

Timing the Medical Exam for F-4 Siblings

Because F-4 siblings often wait many years for their priority date to become current, it is critical not to complete the medical exam too far in advance of the I-485 filing date. Form I-693 is only valid for two years from the civil surgeon's signature date.

Monitor the USCIS Visa Bulletin monthly to track your priority date. Schedule your medical exam when your priority date is current or within a few months of becoming current. If you complete the exam and then experience unexpected delays, you may need to repeat the exam if I-693 expires.

• F-4 siblings often wait many years for visa availability
• Do not complete the exam until your priority date is current or nearly current
• I-693 must be signed no more than 60 days before submission to USCIS
• I-693 is valid for two years from the civil surgeon's signature date
• Monitor the USCIS Visa Bulletin monthly

What the Exam Includes

The civil surgeon exam for F-4 siblings is identical to the exam for other adjustment of status applicants. It includes a complete physical examination, TB testing, required laboratory tests (syphilis and gonorrhea serology for applicants aged 15 and older), and a vaccination review.

The civil surgeon will administer any missing required vaccines and complete Form I-693, which is then sealed and submitted to USCIS with the I-485 application.

Consular Processing as an Alternative

Some F-4 siblings may choose to go through consular processing at a U.S. embassy or consulate rather than adjusting status inside the United States. Consular processing applicants complete a panel physician exam overseas, not a civil surgeon exam. The panel physician completes Form DS-2053 for the embassy or consulate. If you are considering consular processing, consult an immigration attorney to determine which pathway is best for your situation.