Comment on DOS-2026-0694-0008

I submit this comment as a USCIS-designated civil surgeon and physician with direct experience conducting immigration medical examinations and serving immigrant patients in clinical and legal settings. I. The Data-Sharing Language Represents a Dangerous Departure from Public Health Principles The notice states that medical information collected through this process will be shared with "any other U.S. government agencies with statutory or lawful authority to use such information, including for law enforcement and immigration enforcement purposes." This language - particularly the explicit reference to immigration enforcement - fundamentally reframes the immigration medical examination from a public health tool into a surveillance mechanism. As a civil surgeon, I conduct examinations that require patients to disclose sensitive health information: communicable disease history, mental health conditions, substance use, and vaccination records. This disclosure is only possible when patients trust that the purpose of the examination is their health and their immigration case - not to generate a data trail that could be used against them or their families by enforcement agencies. II. The Chilling Effect Is Real and Measurable I have witnessed firsthand how fear of government data-sharing deters immigrant patients from seeking medical care. When patients believe that health information may reach immigration enforcement, they delay or avoid examinations entirely - including for conditions that pose genuine public health risks. Broad data-sharing authority, especially when framed to include enforcement uses, will predictably reduce examination completion rates and undermine the very public health goals this collection purports to serve. III. The Language Is Impermissibly Vague The phrase "any other U.S. government agencies with statutory or lawful authority" provides no meaningful limit on who may access sensitive medical information. Patients - and civil surgeons - have no way to know which agencies may receive this data, for what purposes, or under what retention and use restrictions. This lack of specificity is inconsistent with basic privacy principles and with the informed consent obligations civil surgeons owe to their patients. IV. The Burden Estimate Is Inaccurate The notice estimates an average burden of 2 hours per response. This significantly underestimates the actual time civil surgeons spend on each examination, including chart review, vaccination history reconciliation, coordination with specialists for required follow-up, completion of required CDC-mandated forms, and documentation review. A more accurate estimate is 3–5 hours per examination for complex cases, which are common in underserved immigrant communities. The Department should revise its burden estimate to reflect actual practice. V. Recommendations 1. Remove or substantially narrow the data-sharing language to exclude immigration enforcement use of medical examination records. 2. Require explicit patient notification - in plain language and the patient's primary language - of any agency with whom their medical data may be shared. 3. Prohibit use of medical examination information for purposes other than adjudication of the underlying immigration benefit. 4. Revise the burden estimate to reflect the actual time required of civil surgeons, particularly for complex cases. 4. Require a privacy impact assessment before finalizing any revision that expands data-sharing authority. The immigration medical examination serves a legitimate and important public health function. That function is undermined - not strengthened - when patients cannot trust that participating in a medical examination is safe. I urge the Department to revise this collection accordingly.