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Information, Instructions & Forms
Instructions for submitting an application
Employer and Physician to submit Application Attestation form at time of application.
Physician to submit at time of application an Affidavit and Agreement Sponsorship and Eligibility Requirements agreement.
Employer/Sponsor to submit at time of application an Affidavit and Agreement Sponsorship and Eligibility Requirements agreement.
Complete a Verification of Status form upon start date.
Upon starting, both the Sponsors/Employers & Physicians participating in the Nevada Conrad 30 J-1 Visa Waiver Program are to read through the Rights and Responsibilities presentation, understand and acknowledge their Rights and Responsibilities.
Complete Physician and Employer Compliance Confirmation Verification form semi-annually. Each April and October for the prior six-month period all employers of physicians practicing medicine in the State of Nevada under a J-1 Visa Waiver supported by the Nevada Division of Public and Behavioral Health (DPBH) are required to confirm that the physician is providing a minimum of 40 hours a week of primary care in a practice site(s) located in an underserved area.
A change of status form to be completed and approved by DPBH when there would be a change in practice location, provider discipline or employer.
Application to request a variance with the Nevada State Board of Health for any person who, because of unique circumstances, is unduly burdened by a regulation of the State Board of Health and thereby suffers a hardship and the abridgement of a substantial property right may apply for a variance from a regulation. NAC 439.200(1).