Can I get Form I-693 vaccines free at CVS or Costco before seeing a Civil Surgeon?

Yes. Insured applicants can receive routine ACIP shots (Tdap, MMR, HepB, Influenza) at $0 ACA preventive copay at DMV retail pharmacies, then bring stamped records to the USCIS Civil Surgeon.

Should I take QuantiFERON bloodwork instead of a skin PPD test?

Yes. CDC and USCIS Civil Surgeon technical instructions require Interferon-Gamma Release Assay (IGRA/QuantiFERON) blood testing for applicants aged 2 and older to prevent childhood BCG false positives.

USCIS Form I-693 Vaccines and Split Billing DMV Guide

Q: Is the COVID-19 vaccine still required for Form I-693 in 2026?

No. Effective January 22, 2025, USCIS waived any and all requirements that Adjustment of Status applicants present documentation of COVID-19 vaccination on Form I-693.

USCIS Form I-693 Billing Triage

Split-Billing Vaccination & Civil Surgeon Cost Estimator

USCIS Rule Active (Jan 22, 2025) COVID-19 Vaccine Waived ($0)

Applicant Age Bracket

Existing Vaccine Records

US Health Insurance

Recommended DMV Split Strategy Save ~$280

$295-$385 Est. combined DMV total

Route routine adult shots (Tdap, MMR, HepB, Flu) to an in-network MD/DC/VA retail pharmacy ($0 ACA copay) first, then carry stamped pharmacy VIS sheets to a USCIS Civil Surgeon for exam + QuantiFERON bloodwork only.

All-In-One Civil Surgeon Clinic No Pharmacy Split

$580-$840 Exam + cash markup shots

Paying USCIS Civil Surgeons directly for missing adult vaccines incurs per-antigen clinic markups ($85-$160/shot) plus lab fees, because most Civil Surgeon immigration exams cannot bill medical insurance preventively.

Required Form I-693 Antigen & Lab Routing

Profile: Age 18-49 | ACA Insured

I-693 Split-Save

20705 Baseline

Closest Pharmacy for Pre-Exam I-693 Shots

Costco Pharmacy #214 counseling counter in Beltsville, MD 20705.

Costco Pharmacy #214 -- mi

10925 Baltimore Ave, Beltsville

~$215-$255 +$35 admin

Mon-Fri 9 AM - 7 PM | Sat 9 AM - 6 PM

Google Route 301-902-2655

Compare all 16 DMV centers & Google Map ->

1. Retail Pharmacy vs Civil Surgeon Split Comparison

Most DMV USCIS Civil Surgeon offices treat immigration exams as non-covered administrative services, billing retail cash markups ($85-$160 per shot) if you lack documentation. Completing your immunization worksheet at a pharmacy beforehand protects your medical benefit.

Form I-693 Component	Best Execution Venue	Verified DMV Range
Routine Shots (Tdap, MMR, HepB, Flu)	Retail Pharmacy (CVS, Costco, Safeway) / County HD	$0 ACA / $35-$90 HD
COVID-19 Vaccine (2025-2026)	Optional (Waived by USCIS Jan 22, 2025 Policy)	$0 (Not Required)
IGRA QuantiFERON + RPR/NAAT + Seal	USCIS Designated Civil Surgeon Only	$280-$370 + Lab Fee

2. Verified 2025-2026 USCIS Policy Gates & Redlines

Filing Timing Gate Concurrent Form I-485 Submission

Since December 2, 2024, USCIS requires signed Form I-693 (or partial vaccination record when exempt) submitted together with Form I-485 rather than waiting for an RFE.

BCG False-Positive Trap IGRA Blood Test Over Skin PPD

Immigrants vaccinated with childhood BCG frequently test false-positive on skin PPD tests. CDC I-693 rules mandate QuantiFERON or T-Spot IGRA blood draws for age 2+.

Envelope Integrity Never Break the Civil Surgeon Seal

Request an unsealed patient photocopy for your personal records before departure, and submit the stamped, unbroken official envelope directly with your immigration petition.

Statutory Basis & Titers Workaround (Read Full Clinical Note)

Antibody Titers vs Revaccination: If you completed childhood MMR or Varicella overseas without translated paper certificates, ordering quantitative IgG antibody titers at LabCorp/Quest using primary-care insurance ($0-$40 copay) or re-taking a $0 retail booster are both accepted by Civil Surgeons on Form I-693 Part 10.

USCIS COVID-19 Rescission: USCIS formally announced on January 22, 2025 that it will no longer issue Requests for Evidence (RFEs) or Notices of Intent to Deny (NOIDs) based on missing COVID-19 documentation on Form I-693.

3. Form I-693 Operational FAQ

Is the COVID-19 vaccine still required for Form I-693 in 2026?

No. Effective January 22, 2025, USCIS permanently waived COVID-19 immunization documentation for all Adjustment of Status Form I-693 medical examinations.

Can a pharmacist sign USCIS Form I-693 directly?

No. Pharmacists legally administer and issue official IIS immunization receipts (used as proof), but only a USCIS-designated Civil Surgeon MD/DO may perform the exam and sign Form I-693.

Where do uninsured DMV applicants get cheap adult vaccines?

County Health Departments across Prince George's, Montgomery, and Fairfax charge flat low administrative fees ($20-$55), far below urgent care or Civil Surgeon cash markups.

Primary USCIS & CDC Technical References (3 Verified Sources)

USCIS Policy Alert (Jan 22, 2025). USCIS Waives COVID-19 Vaccination Requirement for Adjustment of Status Applicants. uscis.gov.
USCIS Form I-693 Filing Update (Dec 2, 2024). Concurrent Submission of Form I-693 with Form I-485. uscis.gov/i-693.
U.S. CDC Division of Global Migration Health. Technical Instructions for Civil Surgeons: Tuberculosis (IGRA) & Vaccination Schedules. cdc.gov.