Applicants preparing for Form I-693 often assume every vaccine on the CDC’s immunization schedule has to go into their arm before a civil surgeon will sign off. That is not how the exam works. USCIS builds its vaccination requirement around the Advisory Committee on Immunization Practices (ACIP), the CDC’s own advisory body, and a civil surgeon’s job is to apply that recommendation set to your specific age and history — not to check every box on a master list. Understanding which vaccines are genuinely mandatory for almost everyone, and which only apply depending on how old you are, makes the required vaccines for green card question much less intimidating.
How USCIS Decides What Counts as "Required"
Civil surgeons work from the CDC’s Technical Instructions for vaccination, which translate the ACIP’s general population recommendations into a specific checklist tied to the applicant’s date of birth. This is why two people applying for adjustment of status in the same week can walk out of the same clinic with different vaccination requirements: a 4-year-old and a 45-year-old are evaluated against completely different portions of the ACIP schedule. The civil surgeon documents each vaccine on Form I-693 as either already met (through vaccination records, a blood titer showing immunity, or a reliable documented history of the disease), administered at the visit, or waived because it genuinely does not apply to that applicant.
The Vaccines That Apply to Nearly Every Applicant
A core group of vaccines is treated as broadly mandatory across almost all age brackets once an applicant is past infancy, provided there is no medical contraindication. These are the ones a civil surgeon will look for on every I-693 regardless of the applicant’s particular profile:
| Vaccine | General rule |
|---|---|
| Measles, Mumps, Rubella (MMR) | Two doses, or documented immunity via titer or prior disease history. Adults born before 1957 are often presumed immune. |
| Polio (IPV) | At least one dose required for anyone not already up to date, applied broadly across adult age brackets, not just childhood. |
| Tetanus, Diphtheria, Pertussis (Tdap/Td) | A Tdap booster is expected, with Td boosters due roughly every ten years after. |
| Hepatitis B | A three-dose series, or lab evidence of immunity. |
| Varicella (Chickenpox) | Two doses, or documented immunity through a titer or a reliable history of having had chickenpox. |
| Seasonal Influenza | Required when the exam falls during flu season and the vaccine is currently available; the civil surgeon issues a blanket waiver when it falls outside that window. |
Vaccines That Depend on Your Age or Risk Profile
A second group is only mandatory for specific age brackets or documented risk factors, which is exactly why a "required vaccines" list that ignores age can be misleading. These are commonly waived for applicants outside the relevant group, not because the applicant is doing anything wrong, but because the vaccine was never meant for their age or situation in the first place:
- Haemophilus influenzae type B (Hib) — primarily a pediatric vaccine, rarely applicable to adult applicants.
- Pneumococcal (PCV13/PCV23) — expected for young children and for adults 65 and older, not for applicants in between.
- Rotavirus — applies only to infants within a narrow early-life window, roughly six to fourteen weeks old.
- Hepatitis A — generally expected for children and teens, or for adults with specific documented risk factors.
- Meningococcal ACWY — tied to adolescence, or to particular risk groups such as those with certain medical conditions or occupational exposure.
Why a Vaccine Being "Not Required for You" Isn’t a Loophole
It’s worth being precise about what a civil surgeon means when a vaccine is marked as not applicable rather than administered. This is not the applicant refusing a shot, and it is not the same process as the religious or moral exemption route that applies when someone declines a vaccine they are otherwise required to get. It simply reflects that the ACIP never recommended that particular vaccine for someone of the applicant’s age in the first place, so requiring it would go beyond what the underlying public health guidance actually calls for. The distinction matters for adjustment of status applicants because it explains why the exact list of shots you need can look different from a friend’s or family member’s, even if you’re applying through the same clinic in the same month.
What This Means When You Prepare for Your Exam
The most useful preparation is bringing complete, dated vaccination records, since a civil surgeon can only credit doses that are documented or confirmed by a lab titer. Applicants without records available should expect the civil surgeon to work through the age-based mandatory list first, then determine which additional shots, if any, need to be administered that day. Framing the required vaccines for green card question this way — core vaccines that apply broadly, plus a second tier that only applies if your age or risk profile calls for it — is a far more accurate way to walk into the exam than trying to match yourself against a single undifferentiated master list.