If the service site(s), named in the waiver, is due to close before the obligated three-year service, the J-1
Physician and immigration attorney must notify U.S. Citizenship and Immigration Service (USCIS) and receive
approval from this agency for the change. Depending on the circumstances, USCIS may consider the closure of the
healthcare facility named in the waiver application as an extenuating circumstance, excusing early termination
of employment. The J-1 Physician granted a J-1 Visa waiver and H-1B status must comply with the terms and
conditions of that non-immigration status. Such compliance includes notifying the USCIS of any material changes
in the terms & conditions of the H-1B employment. An example of an extenuating circumstance is the closure of a
healthcare facility or hardship to the J-1 Physician. In determining whether to excuse early termination of
employment, USCIS will base its decision on the specific facts of each case. In all cases, the burden to
establish eligibility rests with the physician. Contract changes which result in termination of a contract, a
change in practice scope, and/or relocation from a site approved in the application request must also be
presented in writing to the North Dakota Primary Care Office (NDPCO) at least thirty (30) days prior to the
North Dakota does not encourage the transfer of employment once a waiver has been approved. If unforeseen
circumstances cause the waiver recipient to transfer to or add a new practice site, notification must be made to
the USCIS immediately through an immigration attorney. Notification must be presented in writing to NDPCO at
least thirty (30) days prior to the change.
The decision on whether the transfer can take place rests solely with the USCIS. It is up to the J-1 Physician,
the new employer, and their representative (attorney) to make a case and submit the proper forms to the USCIS
including evidence of extenuating circumstances, proof of designation status for designated areas, and an
employment contract for remaining time of obligation.
Notify NDPCO, in writing, within ten (10) calendar days in the event of employment termination of the J-1
Physician by the employer and/or service site(s). Include the specific reason(s) for termination. NDPCO cannot
provide legal advice to the employer or J-1 Physician; both parties are encouraged to seek legal counsel to
assist with this issue.
Change in Practice Site Status
The change of status includes adding a new site location to the original practice site or transferring sites
while working with the same employer. It is important to note that the physician’s H-1B status is
address-specific. Therefore, the physician must inform USCIS of any new service site address to remain in
Adding a work location or transferring work locations under the same employer is acceptable as long as the
original conditions of the waiver application are met. Transferring from a designated to a non-designated
practice site is not acceptable. Adding a service site in a non-designated area while under a designated waiver
is not acceptable. If the physician is serving in a non-designated area and wishes to add a service site in a
designated area, please notify NDPCO so designation status can be verified. In all cases, notification to USCIS
must be provided by the physician or attorney.
The employer and J-1 Physician need to contact NDPCO and receive approval for any changes, in writing, at least
thirty (30) days in advance of any consideration of permanent changes in a service site(s) or circumstances of
the J-1 Physician under the agreement. If the J-1 Physician under a designated waiver adds a service site, or is
relocated to a service site that is in a non-designated HPSA, MUA, or MUP, termination of the J-1 waiver may
result in breach of contract and will be reported to U.S. Department of State and USCIS.