Wisconsin Conrad 30 Waiver Program: Application Information

• Conrad 30 Waiver Program
• General Information
• Program Description
• Application Information
• Other State Letters of Support
• Conrad 30 Resource Links
• Frequently Asked Questions

Applications must be submitted directly to the Division of Public Health (DPH) by the health care employer or the employer’s agent by October 1 each year. Applications will be scored using criteria listed below. DPH will notify employers of its decision to proceed or not with the waiver recommendation by October 30 each year. If all slots for that fiscal year are not filled by October 30, applications may continue to be submitted, and will receive a decision within 60 working days after receipt of the application. Applications will be retained until the end of each federal fiscal year, September 30, and only returned upon request.

Physicians from areas not federally designated as underserved may be considered if slots remain (Flex slots). These applications will be considered only after those from federally underserved areas are filled. Federal law limits each state to 10 flex applications per year.

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. 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.

Review criteria for applications

• DPH will strive to recommend waiver applicants in each of Wisconsin’s five public health regions (PDF), depending on applications received.
  • Employers submitting multiple applications will need to identify the public health region in which each individual intends to practice.
• Waiver applications will be ranked according to community need, as evidenced by Health Professional Shortage Area (HPSA)/Medically Underserved Area (MUA)/ Medically Underserved Population (MUP) scores.
• Waiver applications from employers who have experienced lengthy or multiple unsuccessful prior recruitments for the specialty identified will be prioritized.
• Alignment of country of origin and language(s) spoken by applicants to major community needs will be considered (e.g., Spanish-speaking physicians for a community area with a large number of Spanish-speakers; Somali nationals for a community area with a large number of Somali immigrants, etc.).

Submit the application

You must submit the application via SharePoint site. No paper copies will be accepted.

Before submitting the application via the SharePoint site, you should register for a WILMS-ID. To register:

1. Visit this Department of Administration webpage (Note: This is NOT the same as a WAMS ID)
2. Click "Self Registration"
3. Click "Accept"
4. Enter the details as requested in the form
5. Ensure to select “SharePoint” from the list of systems
6. Create an Account ID and Password
7. Email the DHS Program staff member at Jaime.Olson@dhs.wisconsin.gov with your logon ID, password, and email address that you registered with.

Once you have the WILMS-ID and approval from DHS, submit the application to the SharePoint site:

1. Visit J-1Visa - Home (wisconsin.gov)
2. Click "State of WI Users Sign in Here" and log in using your WILMS-ID and password
3. Click "your Law Firm"
4. Click "New" then click "New Folder" and enter the applicant's name
5. Click the Applicant’s Folder and Click "Upload" to submit the application. Each document should be uploaded separately in the order mentioned below.
6. Complete the Supplemental Information Form and save to the applicant's folder
7. Complete the J-1 Applicant Checklist and save to the applicant's folder

The application should include the following in this order:

• Cover letter stating physician’s name, date of birth, employer, employer address/service location, type of physician, and specify if the service location is in a HPSA/MUA/MUP designation or if the application a flex request. (Visit this Health Resources & Services Administration (HRSA) webpage for more information.)
• Copy of the USDOS J-1 visa waiver application, USDOS case number, and the USDOS bar code.
• Community Information 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. Please include:
  • 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.
  • Any existing community connections such as family, schooling, volunteer commitments, etc.
• 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.
• Copies of all DS-2019 forms.
• 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, will this be the first specialist of this type for the service area etc.)
  • An impact statement explaining how a denial will negatively affect healthcare in the community.
  • 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.). Please indicate if the applicant has applied previously and been denied due to a limited amount of slots.
  • 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.
  • 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.
  • If the employer is submitting multiple waiver applications, the employer must provide a priority ranking for each individual application.

1. A copy of the applicant physician’s curriculum vitae.
2. A signed copy of the Applicant Physician Assurances Form, F-43005 (PDF).
3. Explanation of any time “out of status” if applicable
4. Copies of all G-28 forms.
5. Copy of the I-94 departure record.
6. No objection statement from foreign government if applicable.
7. 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.
8. Evidence of the applicant physician’s completion of a U.S. residency or fellowship, or a letter from the residency director indicating the applicant’s current status in a residency and/or fellowship program.
9. Three letters of recommendation for the applicant physician from professionals in health care.
10. A signed Health Care Employer Assurances Form, F-43006 (PDF).
11. Retention plan specifying the following:
    • Monetary and non-monetary compensation
    • Work environment
    • Organizational culture
    • Community acclimation for the physician and physician’s family, etc.

For questions on the Wisconsin Conrad 30 application process, email: Jaime Olson at Jaime.Olson@dhs.wisconsin.gov, Primary Care Program Coordinator.

Failure to comply with requirements

Per section 214(k) of the Immigration Nationality Act (INA), if the J-1 Visa Waiver recipient fails to fulfill the terms of his or her employment contract with the health care facility named in the waiver application, then he or she becomes ineligible to apply for an immigrant visa, permanent residence, or any other change of nonimmigrant status until the two-year foreign residence requirement has been met.

If an employer fails to make reasonable effort to retain the J-1 visa waiver physician for at least three years, DPH reserves the right to deny future requests from the employer for state recommendations for J-1 visa waiver physicians.