1. J-1 Waivers for Clinicians and Researchers
H. Ronald Klasko, Esq.
Klasko, Rulon, Stock & Seltzer, LLP
Philadelphia New York
1800 JFK Blvd., 17th Floor 317 Madison Ave., Suite 1518
Philadelphia, PA New York, NY

2. H. Ronald Klasko, Esq.
Ron Klasko is the Managing Partner of Klasko, Rulon, Stock & Seltzer, LLP. Ron and his firm were chosen by clients and peers as one of the top five immigration firms in the country for five consecutive years and “the strongest in the country in representing clients in the university research and medical sectors.” (Chambers Global)
Ron is a former National President of the American Immigration Lawyers Association. He has been a featured invited speaker for the American Association of Medical Colleges (AAMC) and the Educational Commission for Foreign Medical Graduates (ECFMG). He has been Adjunct Professor of Immigration Law at Villanova University Law School and is a frequent author and lecturer on immigration law issues related to academic healthcare institutions.  
Ron is selected annually for inclusion in Best Lawyers in America. Mr. Klasko is the founder and co-chair of NAFSA’s Healthcare Interest Group. His practice emphasizes representation of universities, hospitals and research institutions and their students, scholars, staff and employees.

3. Avoiding Need for J-1 Waiver
Medical Researchers
Who decides if 2 year return requirement?
CIS – not DOS
Visa, DS 2019, advisory opinion not determinative
Only subject if
Skills list
Government financing
Graduate medical education or training

4. Avoiding Need for J-1 Waiver
(cont’d)
Skills list advocacy
Country of citizenship or country of last residence
Country of last residence vs. country of last permanent residence
Proving different skills list category
Effect of new country of citizenship
“Impossibility” of fulfillment argument

5. Avoiding Need for J-1 Waiver
(cont’d)
Government financing advocacy
Must be during J status
Indirect government financing
Funds earmarked for exchange program

6. Avoiding Need for J-1 Waiver
(cont’d)
Medical Doctors
Not subject if:
Not medical education or training
Observation, consultation, teaching or research with incidental patient care under direct supervision of U.S. doctor
ECFMG research fellowship

7. Visa Options Without Needing Waiver
Anything other than H or L visa or change of status
O-1, TN-1, E-3 ok
Canadian doctor H-1B visa-exempt entry ok?
Change of status from F-1 (or other) to H-1B ok
Labor certification and I-140 can be approved
DS230 can be filed
I-485 cannot be filed (except clinical NIW)

8. Fulfilling Two-Year Return Requirement
Return to country of nationality or last residence?
Can fulfill sequentially

9. J-1 Waiver Options No objection statement Exceptional hardship
Persecution
Interested government agency

10. No Objection Statement
Researchers only
Usually not helpful if U.S. or international organization funding
Quickest and easiest waiver
Attitudes of different countries

11. Exceptional Hardship Waiver
Hardship to U.S. citizen or LPR spouse or child
Hardship must be “exceptional”
Very difficult

12. Persecution Waiver
Individualized persecution
Similar to asylum

13. Interested Government Agency Waivers
General
Choosing between research track and clinical track
Research track
Usually through HHS
Peer review process – unlike CIS filings
Do not need 3 years in H-1B?

14. HHS Waivers Key Issues Importance of research program
Does not have to be NIH funded
Essentiality and uniqueness of foreign national
Recruitment (unavailability of U.S. researchers)
Future of program and future of foreign national
Bench research (at least 30 hours per week) vs. clinical research
Excellence of foreign national’s research

15. HHS Waivers Other Issues
(cont’d)
Other Issues
Involvement of NIH scientists familiar with the research
Reconsideration of denials
Impact of Fulbright funding
Timing

16. Other Medical Research Waivers
Usually limited to agency contracts, grants or research programs
Examples include DOD, NASA, DOE and DOI

17. Obtaining a J-1 Waiver Clinical Track
Choosing state vs. federal agency
Choosing between states
Cannot file more than one
HPSA or MUA or FLEX 10 or V.A.
Must be 3 years in H-1B
“Extraordinary circumstances” to change employers

18. Obtaining a J-1 Waiver Timing issues Vary by state
Vary by federal agency
3 steps
When to start
Options if J-1 expiring
O-1
J-1 extension?
Leave U.S.
(cont’d)

19. Conrad 30 Waivers Must be HPSA or MUA
Except FLEX 10
Agree to begin employment within 90 days of receiving waiver
Can delay if still in training program
Can expedite by filing H-1B before CIS approves waiver

20. Conrad 30 Waivers Differences between states Timing
(cont’d)
Differences between states
Timing
Recruitment required
When/how choose 30?
Primary care? Speciality? Subspecialty?
Use of FLEX 10

21. Federal Government Agency Waivers
Issues in common
40 hours in HPSA or MUA
Except VA
Primary care
General practice, family practice, internal medicine, psychiatry, pediatrics, OBGYN
Except VA and DRA

22. Federal Government Agency Waivers
(cont’d)
Recruitment
Facility must provide medical care to Medicaid/Medicare-eligible and indigent uninsured patients
No non-compete clauses

23. Federal Government Agency Waivers
(cont’d)
V.A. Waivers
3 levels of approvals
National and internal recruitment
At least 5/8 appointment
O-1 must wait 2 years

24. Federal Government Agency Waivers
(cont’d)
Appalachian Regional Commission Waivers
Rural counties in 13 states
File with state
Need state concurrence
Some states will transfer Conrad 30 to A.R.C.
Some states do not allow specialty training
Recruitment within last 6 months
Cannot be out of status more than 6 months
HPSA only

25. Delta Regional Authority Waivers
Part of 8 states
HPSA or MUA
No limitation to primary care
Specialty training allowed
Recruitment for 60 days, including national
Site surveys every 6 months

26. HHS Waivers HPSA of 7 or higher Need state DOH support letter
Must file within 12 months of completion of primary care residency
Limited to rural health clinics, certain native American facilities and HRSA-grant health centers
Very long process – not user friendly

27. Questions?

28. For Further Information
H. Ronald Klasko, Esq.
Klasko, Rulon, Stock & Seltzer, LLP
Telephone: (Philadelphia)
(New York)
Websites:
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