USCIS Risk Assessment & Management 5 — Questions and Answers
Question 1: A civil surgeon is uncertain whether an applicant's chest X-ray abnormality represents active TB or an old healed lesion. What is the safest risk management approach?
- Classify as Class B and complete the form without further workup
- Order sputum AFB smear and culture to rule out active disease before completing the form (Correct answer)
- Repeat the chest X-ray in 3 months and defer classification
- Accept the applicant's report of no symptoms and classify as healthy
Correct answer: Order sputum AFB smear and culture to rule out active disease before completing the form
Ambiguous radiographic findings require microbiologic confirmation to rule out active infectious TB before the civil surgeon can complete Form I-693.
Question 2: How long is a completed Form I-693 valid for submission to USCIS after the civil surgeon signs and dates it?
- 6 months
- 2 years (Correct answer)
- 1 year
- Indefinitely if no medical changes occur
Correct answer: 2 years
Form I-693 is generally valid for 2 years from the date the civil surgeon signs it, provided it is submitted to USCIS within that period.
Question 3: An applicant is a known contact of a person with active pulmonary TB but has a negative IGRA and no symptoms. What is the correct risk management action?
- Treat with isoniazid preventive therapy and classify as Class A
- Document the exposure, repeat IGRA testing in 8–10 weeks to rule out recent infection, and defer final classification (Correct answer)
- Complete the exam with no notation since the applicant is currently negative
- Refer the applicant to the health department and suspend the immigration exam indefinitely
Correct answer: Document the exposure, repeat IGRA testing in 8–10 weeks to rule out recent infection, and defer final classification
A negative IGRA immediately after TB exposure may represent a window period before seroconversion; a repeat test 8–10 weeks after last exposure is needed to rule out recent infection.
Question 4: Which of the following best describes the civil surgeon's obligation when documenting a Class B condition on Form I-693?
- Recommend inadmissibility and request a waiver on behalf of the applicant
- Describe the condition, note its clinical status, and indicate whether follow-up is needed after admission (Correct answer)
- Withhold the information from USCIS to protect patient confidentiality
- Refer the applicant to a subspecialist before any documentation is made
Correct answer: Describe the condition, note its clinical status, and indicate whether follow-up is needed after admission
Class B conditions must be accurately described on Form I-693 with clinical details and an indication of whether the condition requires follow-up care after the applicant arrives in the US.
Question 5: A civil surgeon determines that an applicant has a communicable disease of public health significance. Who is responsible for notifying the local health department?
- USCIS automatically notifies all health departments upon receiving Form I-693
- The civil surgeon, following applicable state and local mandatory reporting laws (Correct answer)
- The applicant must self-report to the health department within 72 hours
- Notification is not required since Form I-693 is confidential federal documentation
Correct answer: The civil surgeon, following applicable state and local mandatory reporting laws
Civil surgeons are licensed physicians bound by state and local mandatory disease reporting laws; they must report notifiable conditions to the health department independent of the immigration process.
Question 6: An applicant with a history of alcohol use disorder reports 18 months of complete abstinence, supported by documentation from a treatment program. How should the civil surgeon classify this finding?
- Class A — alcohol use disorder is permanently inadmissible
- Class B — alcohol use disorder, in sustained full remission (Correct answer)
- No notation — 18 months abstinence is sufficient for full clearance
- Class A until 5 years of continuous sobriety are documented
Correct answer: Class B — alcohol use disorder, in sustained full remission
Alcohol use disorder in sustained full remission (typically 12+ months per DSM-5) is classified as a Class B condition, not Class A, reflecting its reduced public health risk.
Question 7: When evaluating an applicant for risk of drug abuse, which tool does the USCIS Technical Instructions recommend civil surgeons use as a clinical framework?
- The ICD-10 clinical diagnostic criteria exclusively
- The DSM-5 criteria for substance use disorders (Correct answer)
- A self-administered CAGE questionnaire without clinical interview
- The WHO AUDIT scoring system
Correct answer: The DSM-5 criteria for substance use disorders
USCIS Technical Instructions direct civil surgeons to use DSM-5 criteria when evaluating and classifying substance use disorders for immigration medical purposes.
USCIS Risk Assessment & Management 5
A civil surgeon is uncertain whether an applicant's chest X-ray abnormality represents active TB or an old healed lesion.
What is the safest risk management approach?