Instructions For Form I-693 - Instructions For Report Of Medical Examination And Vaccination Record Page 3


Extra Space. If you (the applicant or the civil surgeon) need extra space to complete any item within this form, use the
space provided in Part 10. Additional Information or attach a separate sheet of paper; type or print the applicant’s name
and Alien Registration Number (A-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.
Specific Instructions
How To Fill Out My (the Applicant’s) Portion of Form I-693
Form I-693 is divided into 10 parts. These instructions will help you and the civil surgeon complete Form I-693.
Only complete Part 1. of Form I-693 and the identifying information at the top of each page. The civil surgeon and any
other doctors, clinics, or health departments that you are referred to will complete the remaining parts of Form I-693.
Part 1. Information About You
Complete this part before your medical examination appointment. Fill out your name and A-Number (if any) at the top of
each page of Form I-693. The civil surgeon will check that this information matches Part 1.
Item Number 1. Your Full Name. Use your legal name, which is the name that appears on your birth certificate, unless
it was changed after birth by a legal action such as marriage or a court order. If you do not have and cannot obtain your
birth certificate, use your full legal name as it appears on government issued identity documents such as a passport,
refugee travel document, or similar official record. Do not provide a nickname. If you have two last names, include both
and use a hyphen (-) between the names, if appropriate.
Item Number 2. Physical Address. Provide your physical street address. This must include a street number and name
or a rural route number. Do not provide a post office box (PO Box) number here.
Item Number 3.A. Sex. Select the box that indicates whether you are male or female.
Item Number 3.B. Date of Birth. Use eight numbers to show your date of birth in mm/dd/yyyy format (for example,
type or print May 1, 1979 as 05/01/1979).
Item Number 3.C. City/Town/Village of Birth. Provide the name of the city, town, or village where you were born.
Item Number 3.D. Country of Birth. Provide the name of the country where you were born.
Item Number 3.E. Alien Registration Number (A-Number) (if any). This is your alien registration file number. If
you are not sure if you have one, look at any letters or notices that you have received from the Department of Homeland
Security (DHS). Look for a number that begins with a letter “A” followed by 8 or 9 digits (for example: A 000 000 000).
If you do not have one, or if you cannot remember what it is, leave this space blank.
Item Number 3.F. USCIS Online Account Number (if any). If you have previously filed an application, petition, or
request using the USCIS online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)),
provide the USCIS Online Account Number you were issued by the system. You can find your USCIS Online Account
Number by logging in to your account and going to the profile page. If you previously filed certain applications, petitions,
or requests on a paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice
issuing you a USCIS Online Account Number. If you received such a notice, your USCIS Online Account Number can be
found at the top of the notice. If you were issued a USCIS Online Account Number, enter it in the space provided. The
USCIS Online Account Number is not the same as an A-Number.
Form I-693 Instructions 10/19/17 N
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Parent category: Medical