VisaScreen certificate: who needs it, English scores, fees and timeline

VisaScreen is the federal health care worker certificate that most foreign nurses and certain allied health professionals need before the United States will issue them a work visa or green card in their profession. It is issued by TruMerit, the organization formerly called CGFNS International, which says it is the only credentials evaluation company authorized by USCIS to certify all nine covered occupations: registered nurses, licensed practical and vocational nurses, physical therapists, occupational therapists, physician assistants, audiologists, speech-language pathologists, clinical laboratory technicians and clinical laboratory scientists.

VisaScreen checks four things: that your education is comparable to a US graduate's, that every professional license you have ever held is valid and unrestricted, that you meet the federal English requirement, and, for registered nurses only, that you have passed the NCLEX-RN or the TruMerit Nurse Qualifying Exam. The application costs $740. TruMerit says 90% of certificates are issued within 3.5 business days once your documents have been received and validated. The certificate must be used within five years of the date it is issued.

VisaScreen is not a license and does not decide your visa. It is one of the documents the consulate or USCIS needs. For the full picture of how licensing and immigration fit together, see our guide to working in US healthcare and our page on TruMerit (CGFNS) services.

The rule is in section 212(a)(5)(C) of the Immigration and Nationality Act, added by section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, and implemented by the regulation at 8 CFR 212.15. It makes a foreign health care worker in a covered occupation inadmissible unless they present a certificate from an approved credentialing organization.

The regulation says the certificate must be used for any admission into the United States, change of status within the United States, or adjustment of status within five years of the date it is issued. Nonimmigrants present it when the visa is issued and at the port of entry; immigrants present it with the immigrant visa or with the adjustment of status application.

The regulation also sets out who it does not apply to. Under 8 CFR 212.15(b), it does not apply to:

• Physicians. Doctors follow the ECFMG route instead, described in our USMLE guide for international medical graduates.
• Non-clinical roles, meaning jobs that do not involve direct or indirect patient care, such as teaching, research or management.
• Trainees coming as H-3 nonimmigrants or for training as part of an F or J program.
• Spouses and dependent children of an immigrant or nonimmigrant.
• Certain adjustment applicants whose petition is not based on work in a covered occupation.

So a nurse who immigrates as the spouse of another worker and is not coming to work in nursing on that basis does not need VisaScreen for that admission. A nurse coming on an employer's EB-3 petition does. If you are unsure which applies to you, ask an immigration attorney; TruMerit itself says it does not advise on which visa to apply for.

8 CFR 212.15 lists the covered occupations, and TruMerit groups them into nine:

TruMerit says it is the only organization authorized for all nine occupations and the only one authorized to validate seven of them. Physical and occupational therapists can choose: our pages on physical therapy in the USA and occupational therapy in the USA compare VisaScreen with the FCCPT and NBCOT certificates. Lab professionals and speech-language pathologists use VisaScreen; see lab scientists in the USA and speech-language pathology in the USA.

If your profession is not on the list, such as psychologists or dietitians, there is no VisaScreen step, though you still need a work visa and a state license.

1. Education. TruMerit checks that your professional education is comparable to that of a US graduate in the same profession. Your school sends official transcripts directly to TruMerit, using TruMerit's request forms. Copies you send yourself are not accepted as primary-source evidence. TruMerit also asks for your secondary school diploma, but says it waives that if you completed secondary school more than 10 years ago.

2. Licensure. Every current and past professional license, in every jurisdiction where you have held one, must be validated as valid and unrestricted. This includes expired licenses and licenses from countries where you no longer work. The licensing authority sends the validation directly to TruMerit. This is the step that most often holds applications up, because some regulators are slow or charge their own fees.

3. English. You must pass an approved English test at the score set for your occupation level, unless you are exempt. The scores are in the next section.

4. Nursing exam (registered nurses only). TruMerit requires verification that you passed the NCLEX-RN, from a US state board of nursing, or that you passed the TruMerit Nurse Qualifying Exam through its Certification Program. Most nurses use their NCLEX pass; our NCLEX-RN guide explains how to get one. TruMerit notes that the Canadian CNATS exam alone does not meet this requirement.

You also need a recent passport-style photograph: TruMerit asks for a color JPG, square, 51 mm by 51 mm.

TruMerit publishes the approved tests and scores in a table effective May 12, 2026, which follows an update from HRSA in the Department of Health and Human Services. There are three columns: occupational and physical therapists, registered nurses and other bachelor's-level health care workers, and health care workers below bachelor's level (such as licensed practical and vocational nurses and clinical laboratory technicians).

Points to note:

• Speaking is the hard part. The speaking minimum is the same at every level, and it is higher than the overall score for IELTS and PTE.
• The TOEFL iBT figures use the 2026 score scale, not the older 0 to 120 scale.
• At-home tests are not accepted. Book a test center sitting. TOEIC is no longer on the list.
• Older tests. TruMerit says tests taken before May 12, 2026 are assessed against its previous score requirements.
• Exemption. You do not need a test if your entry-level professional education was in Australia, Canada (except Quebec), Ireland, New Zealand, the United Kingdom or the United States, with English as the language of instruction and textbooks. An English-taught program anywhere else, including the Gulf, India or the Philippines, does not exempt you.

State boards set their own English rules. For registered nurses, the Texas Board of Nursing uses the same scores as the bachelor's-level column, so one test can often satisfy both. Check your own board before you book.

Some registered nurses can use a 212(r) Certified Statement instead of a full VisaScreen certificate. TruMerit says you qualify if you:

• hold a registered nurse license in Florida, Georgia, Illinois, Michigan or New York,
• have passed the NCLEX-RN, and
• were educated in Australia, Barbados, Canada (only certain approved Quebec schools for Quebec), Ireland, Jamaica, New Zealand, South Africa, Trinidad and Tobago, the United Kingdom or the United States, with English as the language of instruction and textbooks.

TruMerit says the advantages are fewer license validations (only from the 212(r) state and the state that authorized your NCLEX), no English test, and education deemed comparable without a transcript review. TruMerit's page does not list the fee or the visa categories it can be used with, so contact TruMerit or your attorney before choosing it.

The certificate follows you into whichever immigration process brings you to the US to work in a covered occupation. The regulation ties it to three events: admission into the United States, change of status inside the US, and adjustment of status to permanent residence. In practice it comes up in these routes:

• EB-3 immigrant visas for nurses and physical therapists. USCIS treats professional nurses and physical therapists as Schedule A occupations, so the employer files Form I-140 with an uncertified labor certification. When your priority date is current, you present the certificate at your immigrant visa interview or with your adjustment of status application.
• Temporary work visas such as the H-1B, for roles that normally need a specific bachelor's degree or higher. Many speech-language pathologist and some therapist roles use this route. The certificate is presented when the visa is issued and at the port of entry.
• Trade NAFTA (TN) status for eligible Canadian and Mexican professionals. TruMerit lists TN among the occupational visa types that need VisaScreen.

Because the five-year clock starts when the certificate is issued, not when you file, timing matters. If you apply too early in a long immigrant visa queue, the certificate may lapse before your interview. If you apply too late, it can hold up a consular appointment. Your employer's attorney normally tells you when to order it. VisaScreen does not decide your eligibility for any visa, and TruMerit says it is separate from that process.

TruMerit runs several services, and people often order the wrong one. The CES Professional Report ($485) is an education and license comparability report that state boards of nursing use to decide whether you can sit the NCLEX. VisaScreen ($740) is the federal immigration certificate. The Certification Program ($495) is a credentials review, Nurse Qualifying Exam and English test that some boards require before the NCLEX. The fees are not interchangeable, so a CES report does not count as VisaScreen.

A state license is also separate. Having a license does not replace VisaScreen, and VisaScreen does not license you to practice in any state. Plan both tracks together so that one English test, one set of transcripts and one round of license validations serve both where TruMerit allows.

1. Confirm you need it. Check that your occupation is covered and that your visa route requires it. Your employer's immigration attorney usually tells you when.
2. Create a TruMerit Connect account and order VisaScreen for the right occupation. Enter your name exactly as on your passport, and list every license you have ever held, including expired ones.
3. Request transcripts from every school on your professional education, sent directly to TruMerit.
4. Request license validations from every licensing authority, sent directly to TruMerit. If you work in the Gulf, ask DHA, DOH, MOHAP, SCFHS, QCHP or your regulator while your license is active.
5. Send English scores from the testing organization, unless you are exempt. TruMerit charges $25 to forward English test results.
6. RNs: arrange NCLEX-RN verification from your state board, or complete the Nurse Qualifying Exam through the Certification Program.
7. Track and respond. TruMerit asks for missing items through your account. If your application expires before it is complete, reprocessing within 12 months of expiry costs $250 and gives you another 12 months.
8. Receive your certificate. It is issued digitally; a paper certificate costs $195. Give it to your attorney for the visa or adjustment of status filing.

If you have already used TruMerit for a CES report for your state board, ask whether documents it already holds can be used, so you do not request the same validations twice.

From TruMerit's fee schedule:

Your English test, any fees your school or regulator charges to send documents, and the NCLEX are separate. Some US employers pay VisaScreen as part of a recruitment package; whether they do, and whether you repay it if you leave early, varies by employer and should be in your contract.

• Collecting documents usually takes longest: schools and regulators, not TruMerit, set the pace. Start license validations early.
• Processing: TruMerit says 90% of VisaScreen certificates are issued within 3.5 business days once documents are received and validated, and 50% of those the same day.
• Expedited review ($650) means processing within 10 business days of documents arriving, and is not available to physical therapists.
• Validity: under 8 CFR 212.15 the certificate must be used for admission, change of status or adjustment of status within five years of issue.
• Renewal: TruMerit says to renew within six months of expiry. A renewal is dated five years from the previous expiry date. You need new license validations (including for expired licenses and for validations older than three years) and updated English evidence, but no new academic documents. Miss the window and you file a full new application at the higher fee.

The English exemption on renewal applies if you have at least 27 months of US employment in your profession, including at least nine months in the year before you apply, confirmed by your employer on signed company letterhead. This matters for nurses waiting in a long EB-3 queue: if your priority date takes years to become current, your certificate may need renewing before you use it.

For a registered nurse, the usual order is: credentials evaluation for your state board, English test, NCLEX-RN, state license, VisaScreen, then the employer's EB-3 petition and the wait for a visa number. Many nurses apply for VisaScreen soon after passing the NCLEX, because the NCLEX pass is one of its requirements. Our US nursing route covers the green card steps, and our NCSBN page covers the state board side.

Three mistakes come up again and again:

• Assuming the NCLEX replaces VisaScreen. It does not; it is one of its inputs.
• Taking an at-home English test or a test your state board accepts but VisaScreen does not. Pick one center-based test that meets both.
• Leaving out an old license. Every license you have held must be validated. An undeclared license found later delays or blocks the certificate.

If you work in the Gulf: your DHA, DOH, MOHAP, SCFHS or QCHP license counts as one of the licenses TruMerit must validate, as does your home country license. Gulf practice and an English-taught degree do not exempt you from the English test. If you are also weighing the UK, our Health and Care Worker visa guide explains how the UK handles the same stage.