Wisconsin Conrad 30 Waiver Program: Application Information

Starting October 1 of each year, the Division of Public Health (DPH) Conrad 30 Waiver Program will accept applications for the federal cycle (October 1 - September 30). Requests for a state recommendation must be submitted by the health care employer or its attorney. All application materials for state recommendations (except the USDOS application and "user fee") must be submitted directly to DPH. See below to view and print a copy of the complete Wisconsin Guidelines for State Recommendations for J-1 visa waivers.

U.S. Department of State (USDOS) "user fee" and "J-1 Visa Waiver Review Application"

J-1 visa physicians or their attorneys are responsible for submitting the USDOS "user fee" and the "J-1 Visa Waiver Review Application" directly to the U.S. Department of State. This must be done before the rest of the application is submitted to DPH. Please note: a Wisconsin "slot" will not be assigned until DPH has received, reviewed and approved a complete application from the employer, including the physician’s USDOS case file number. DPH cannot submit a J-1 visa waiver application to the USDOS until a federal case file number is available.

A list of immigration attorneys who have successfully worked with DPH on J-1 visa waivers is available upon request by contacting DPH staff.

Due to COVID-19, only emailed applications will be accepted. Please email the following documentation in this order to the Primary Care Program:

  1. Copy of the USDOS J-1 visa waiver application, USDOS case number, and the USDOS bar code.

  2. Statement by applicant physician explaining why they want to stay in US, and how they will contribute to their employer’s community during their waiver period. Also include in this statement that the applicant physician agrees to begin working for the employer within 90 days of the effective date of the J-1 visa waiver (after completion of training program), and the applicant physician agrees to the contractual requirements for J-1 visa waivers set forth in federal immigration law.

  3. Signed employment agreement that includes:

    • Street address for the applicant physician’s practice location or locations.

    • Term of agreement, which must be valid for at least three years.

    • Agreement must specify full time employment (40 hours per week, with at least 32 hours in direct patient care).

    • Wage & benefit offer designed to retain applicant physician (competitive for service area and can be based on prevailing wage or other information). Wisconsin requires at least a higher wage rate then Level 2, or the Mean Wage, from the Foreign Labor Certification Data Center Online Wage Library.

  4. Copies of all DS-2019 forms.

  5. Employer application letter with documentation of need and recruitment efforts:

    • Describe the need for additional primary care providers or subspecialty provider in the community (e.g., loss of physicians due to retirement or relocation, an increased demand in community, an increased wait time for appointments, etc.).

    • How this physician’s qualifications and future responsibilities will help satisfy the healthcare needs and improve access to care for the under-served population of the service area.

    • Describe efforts to recruit a U.S. physician in past 6 months (e.g., ads with dates posted, contract with recruiter, signed affidavit stating your efforts, etc.).

    • If the employer is submitting multiple waiver applications, the employer must provide a priority ranking for each individual application.

  6. A copy of the applicant physician’s curriculum vitae.

  7. A signed copy of the Applicant Physician Assurances Form F-43005.

  8. Explanation of any time “out of status” if applicable.

  9. Copies of all G-28 forms.

  10. Copy of the I-94 departure record.

  11. No objection statement from foreign government if applicable.

  12. Evidence of a valid professional license to practice medicine in Wisconsin, or a copy of the physician’s application to the Wisconsin Department of Safety and Professional Services.

  13. Evidence of the applicant physician’s completion of a U.S. residency, or a letter from the residency director indicating the applicant’s current status in a residency or fellowship program.

  14. Three letters of recommendation for the applicant physician from professionals in health care.

  15. A signed Health Care Employer Assurances Form F-43006.

  16. Retention plan specifying the following:

    • Monetary and non-monetary compensation

    • Work environment

    • Organizational culture

    • Community acclimation for the physician and physician’s family, etc.

  17. Community Information Statement:

    • A description of the location and characteristics of the area served by the healthcare facility.

    • A statement detailing the current healthcare resources of the area and how they are over-utilized, excessively distant, or otherwise inaccessible to the population served by the healthcare facility.

    • An impact statement explaining how a denial will negatively affect healthcare in the community.

    • The Health Professional Shortage Area (HPSA) or Medically Underserved Area or Population (MUA/P) ID number (please reference the HRSA website to find shortage areas by address)

    • A payor mix statement of percentage of medically underserved patients (Medicaid, Medicare, and uninsured) the practice has provided care to over the last six months.

Other questions on the Wisconsin Conrad 30 application process should be directed to:

Mailing Address:

Jaime Olson
Primary Care Program
Division of Public Health
PO Box 2659
Madison, WI 53701-2659

Fax: 608-267-2832
Telephone: 608-267-1440
Email the DHS Primary Care Office

Street Address:

Jaime Olson
Primary Care Program
Division of Public Health
1 W. Wilson St., Room 250
Madison, WI 53703

Last Revised: August 6, 2020