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PRINTED: 08/01/2023 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION
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The 1115 form, also known as the 'Application for Waiver of the Two-Year Foreign Residency Requirement,' is a form that allows certain individuals with J-1 visa status to request a waiver of the two-year home-country physical presence requirement.
Individuals who have J-1 visa status and are subject to the two-year home residency requirement are required to file the 1115 form if they seek a waiver of this requirement.
To fill out the 1115 form, applicants must provide personal identification information, details about their J-1 status, the reasons for requesting a waiver, and any supporting documents that justify their request.
The purpose of the 1115 form is to allow eligible J-1 visa holders to apply for a waiver of the two-year residency requirement, enabling them to remain in the United States or change their immigration status.
The 1115 form requires information such as personal details (name, address), J-1 program details, reasons for requesting a waiver, and any relevant supporting documentation.
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