The Cost of Becoming a U.S. Permanent Resident, Part I

by Anonymous

A Visit to the Civil Surgeon

Two close friends are getting married in July, and they recently sent around the link to their wedding website. It’s helpfully organized into who-what-when-etc. sections; the “why” page has a picture of their dog pooping and the text “because we really want the government to play a larger role in our relationship.”

I love these friends and their sense of what a marriage is for, but I do not have the luxury of snark. I am actually inviting the government to play a larger role in my relationship, and giving them the power to asses it and its bona fides. I just got legally wed at New York City Hall (actually the Office of the City Clerk) and am in the process of applying for family-based permanent residency. That is, a spousal green card. I’ve been in the U.S. in student status (not a visa! Canadians don’t need visas!) since 2008, and since I’m graduating in May, now is the time to make some moves.

In the fall, I went to a “visa options after graduation” event at Columbia, and when the lawyer running the workshop said that she offered free initial consults for Columbia students, I made an appointment. My feller and I went to see her and she very helpfully walked us through the application timeline and confirmed that we should get married and file for permanent residency soon if I want to a) work when I graduate and b) be able to travel internationally for some weddings in May and June. (She was great and I’ll give her a plug here: Suzanne Seltzer at The Seltzer Firm.)

There are two main components of the permanent residency application. My husband (!!!!) files a petition for an alien relative (form I-130), and I file a adjustment of status application (1–485) to switch myself from being a nonimmigrant student to a permanent resident. These forms require a host of supplementary materials, but the one that I was the most concerned about getting done in time was form I-693, the “report of medical examination and vaccination record.”

Form I-693 cannot be filled out by just any doctor, it must be completed by a U.S. “Civil Surgeon.” None of the doctors at Columbia Health Services have this designation, and I didn’t know how long it would take to get an appointment. The United States Citizen and Immigration Services (USCIS) provides a list of Civil Surgeons and the book I took out of the library suggested that I call a few, because there is no standard pricing. I went through the list and copied the info of all the ones nearby, and then started making calls asking how much it would cost and how soon I could have an appointment.

The least expensive immigration medical exams are $129, offered by a walk-in-clinic company called StatCare that has one of their four locations in Brooklyn, four blocks from me — but that location is “opening soon.” (I found them Googling “U.S. Civil Surgeon Brooklyn.”) Other doctors charge between $200 and $400, some with vaccinations and lab work fees included, some without. One of the first places I called was down the street from my apartment — they quoted $350, but “$200 and up” without immunizations. As I made these phone calls I realized that I had no idea what the exam really consisted of — I kept telling the women who answered the phone that I was certain that I didn’t need any extra immunizations, but I wasn’t even sure if that was really true.

Then, I got on the phone with Dr. Earl A. Ellis, whose office in Prospect Lefferts Gardens seemed close enough to be worth investigating. When I asked his receptionist how getting form I-693 filled out would cost, she paused, said “let me put the doctor on the phone,” and then did just that! Dr. Ellis told me that he charged $140, as low as he could, because he knows that the immigration process is expensive. The blood work (which mostly checks for syphilis) and the TB test are done at a nearby-ish lab, which was the most inexpensive place he could partner with, and that would cost an additional $60. And for immunizations, he sends people to the Department of Health, because they’re all free. We talked about what immunizations were required, and confirmed that I was up to date. He asked if I had insurance — I told him I did, through Columbia — and he said he could give me a list of all the things the lab would do, because I could get it done for free if my insurance covered it, and that I could bring all the documentation to him and he would do the forms. Dr. Ellis was so straightforward and kind that I almost made an appointment on the spot; instead, I thanked him and told him I’d call him back.

Armed with this information about what the test actually entailed, I called the place near me again, confirmed that the price would be $250 (I did need another tetanus shot), and made an appointment for the next day. Even though I felt instantly loyal to Dr. Ellis, his $140 plus the $60 lab fee wasn’t cheaper enough to be worth the travel. I called him back, thanked him again, and apologized for not coming to see him. He wished me luck.

Spending the extra $50 to stay local was the right answer because I had to go to the office — which was in the basement of a large apartment building on Eastern Parkway, with no sign on the outside — three times: First for the checkup and to have blood drawn, second to get the TB test fluid inserted in my arm (they were out of it the first day I went), and third to confirm no reaction to the TB fluid, get the tetanus shot, and to complete the form. I could possibly even count the first visit twice, because I had to leave in the middle of the appointment to run to the ATM — they only accepted cash and no one had told me on the phone.

I wasn’t nervous about the medical exam showing anything problematic, and in fact, there is no hard-and-fast medical conditions that precludes entry into the United States. I was only nervous that someone would fill out the form wrong and my whole application would be send back to me. I asked the nurse who stuck all the needles in my arm how often people came through with form I-693. She said three or four times a week, this is Brooklyn after all. I was reassured.

Costs to permanent residency so far:
Meeting with immigration lawyer: Free!
Civil Surgeon: $250
Total: $250

The writer lives in New York.

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