The third and most common J-1 waiver is the Interested Government Agency (IGA) waiver.  If a government agency requests a waiver of the foreign residency requirement for you, then it is almost always granted.  Currently, there are five IGAs who consistently request waivers for foreign medical graduates:

1. Appalachian Regional Commission (ARC) waiver (federal agency);
2. Department of Veterans Affairs (VA) (federal agency);
3. United States Department of Health and Human Services (HHS) (federal agency);
4. Delta Regional Authority
5. State Health Agencies under the Conrad 30 program.

In this article we will be discussing the ARC waiver and the VA waiver.

Appalachian Regional Commission (ARC) Waiver

Although Congress passed legislation in late 2004 which allows federal agencies to sponsor waivers for specialists, the ARC waiver requires you to practice at least 40 hours per week as a primary care physician for a minimum period of three years at a health professional shortage area (HPSA)  facility located in the Appalachian region.  The Appalachian region includes Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia and West Virginia.  The ARC defines “primary care” as internal medicine, family practice, pediatrics, obstetrics and gynecology, and general psychiatry.

You will be required to sign a three-year employment contract that includes a $250,000 liquidated damages clause.  This means that you will be required to pay a $250,000 penalty if you quit the job before the end of the term.

Your employer sponsor must also submit documentation of recruitment efforts for the six months immediately preceding the date of the employment contract.  These recruitment efforts must include notification of the job opening to all the medical schools/residency programs located in the state where the job is located.  Finally, the waiver request must be accompanied with a letter from the governor of the state in question.

Department of Veterans Affairs (VA) Waiver

The VA waiver is available to physicians coming to work in facilities run by the Veterans Administration.  Unlike most of the other IGA waivers, the VA waiver is not restricted to primary care physicians nor must the facility be located in a HPSA. However, the VA will only sponsor you for a J-1 waiver if your services are necessary for the continuation of a specific program and the VA's efforts to fill the position with a U.S. physician have failed.  In that vein, the sponsoring VA facility must submit extensive documentation of national recruitment efforts for the 12 months prior to submission of the waiver application.  In addition, you must sign a minimum one-year employment contract.

Please note that although the VA waiver only requires a one-year contract, you must practice with the VA for at least three years to comply with the USCIS waiver requirement.