Form I-602 - Application By Refugee For Waiver Of Grounds Of Excludability Page 3
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4C. Endorsement by Local or State Health Officer
Endorsement signifies recognition of the physician or facility for the purpose of providing care for tuberculosis. If the facility or
physician who signed in Section B is not in your health jurisdiction and is not familiar to you, you may wish to contact the health
officer responsible for the jurisdiction of the facility or physician prior to endorsing.
Signature:
Date:
Enter name and address of the local health department to which Form CDC 75.18, Notice of Arrival of Alien With Tuberculosis
Waiver, will be sent when the applicant arrives in the United States.
Local Health Department Address:
Form I-602 (Rev. 12/19/16) Y Page 3
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