Instructions For Application For Civil Surgeon Designation (Form I-910) (Page 3 of 10) in pdf

Can Civil Surgeon Designation Be Revoked?

USCIS may revoke a civil surgeon designation. Reasons for revocation include, but are not limited to: failure to continue

to meet the professional qualifications required for civil surgeon designation, failure to meet the responsibilities of a civil

surgeon (including failure to follow the CDC’s Technical Instructions), engaging in immigration fraud, or otherwise

engaging in activity that poses a risk to public health or safety.

General Instructions

USCIS provides forms free of charge through the USCIS website. In order to view, print, or fill out our forms, you should

use the latest version of Adobe Reader, which you can download for free at If you do not

have Internet access, you may call the USCIS National Customer Service Center at 1-800-375-5283 and ask that we mail

a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Signature. Each application must be properly signed and filed. For all signatures on this application, USCIS will not

accept a stamped or typewritten name in place of a signature.

Filing Fee. Each application must be accompanied by the appropriate filing fee. (See the What Is the Filing Fee section

of these Instructions.)

Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the Specific

Instructions section of these Instructions.

Copies. You should submit legible photocopies of documents requested, unless the Instructions specifically state that you

must submit an original document. USCIS may request an original document at the time of filing or at any time during

processing of an application, petition, or request. If USCIS requests an original document from you, it will be returned to

you after USCIS determines it no longer needs your original.

NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be

immediately destroyed upon receipt.

Translations. If you submit a document with information in a foreign language, you must also submit a full English

translation. The translator must sign a certification that the English language translation is complete and accurate, and that

he or she is competent to translate from the foreign language into English. The certification must include the translator’s

signature. The Department of Homeland Security (DHS) recommends the certification contain the translator’s printed

name and the date and the translator’s contact information.

How To Fill Out Form I-910

1. Type or print legibly in black ink.

2. If you need extra space to complete any item within this application, use the space provided in Part 9. Additional

Information or attach a separate sheet of paper; type or print your name and Civil Surgeon Identification (CSID)

Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your

answer refers; and sign and date each sheet.

3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been

married and the question asks “Provide the name of your current spouse”), type or print “N/A,” unless otherwise

directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many

children do you have” or “How many times have you departed the United States”), type or print “None,” unless

otherwise directed.

Specific Instructions

Part 1. Information About You

Complete Item Numbers 1.a. - 8. only if you were previously designated as a civil surgeon.

Form I-910 Instructions 12/23/16 N

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Instructions For Application For Civil Surgeon Designation (Form I-910) Page 3