Becoming a U.S. citizen is a multi-year process that begins long before you ever fill out the citizenship application. Most guides jump straight to Form N-400 and the naturalization interview, but the path to citizenship actually starts earlier, with getting a green card, and that step includes a mandatory medical exam that often catches applicants off guard. If you’re in the Tampa Bay area and need to complete your immigration medical exam in Tampa, understanding where that exam fits in the full process will save you time and confusion.
Here is the complete picture, from the first step to the oath ceremony.
Who can apply for U.S. citizenship?
U.S. citizenship through naturalization is available to lawful permanent residents, meaning green card holders, who meet specific requirements. The standard criteria are:
- Be at least 18 years old
- Have held a green card for at least 5 years (or 3 years if married to a U.S. citizen)
- Have lived continuously in the United States during that period
- Have been physically present in the U.S. for at least 30 months out of the last 5 years
- Have good moral character
- Be able to read, write, and speak basic English
- Pass a civics test on U.S. history and government
- Be willing to take the Oath of Allegiance
If you don’t have a green card yet, that is your first step, and it comes with its own set of requirements, including the medical exam.
Step 1: get your green card first
Citizenship through naturalization requires being a lawful permanent resident before you apply. If you are still in the process of adjusting your status, you must complete that process, including obtaining your green card, before you can begin the naturalization process.
To apply for a green card from within the United States, most applicants file Form I-485, Application to Register Permanent Residence or Adjust Status. This is where the immigration medical exam enters the picture.
Step 2: complete the immigration medical exam (Form I-693)
This is the step that virtually every citizenship guide skips over, yet it is mandatory and cannot be overlooked.
When you file Form I-485, you must submit Form I-693, the Report of Immigration Medical Examination and Vaccination Record, completed and sealed by a USCIS-designated civil surgeon. Your regular doctor cannot perform this exam. Only a physician specifically authorized by USCIS can complete it.
The exam covers your medical history, a physical examination, blood tests for tuberculosis and syphilis, a vaccination review, and a mental health and substance use screening. The civil surgeon seals the completed form in an envelope that you submit directly to USCIS with your green card application.
Under current USCIS rules, your I-693 is valid while your application remains pending. If your application is denied or withdrawn, the form becomes invalid and you would need a new exam before reapplying. For a full breakdown of the timing rules, read our guide on how long your immigration medical exam stays valid.
Step 3: wait for green card approval
Once USCIS receives your I-485 and I-693, your case enters processing. USCIS will schedule a biometrics appointment to collect your fingerprints and photo for a background check. Depending on your situation, you may also be called for an in-person interview at your local USCIS office.
Processing times for adjustment of status vary significantly, ranging from several months to over two years depending on your visa category, country of birth, and the USCIS field office handling your case.
Step 4: file Form N-400, Application for Naturalization
Once you have held your green card for the required period (3 or 5 years depending on your situation), you can file Form N-400, the Application for Naturalization. This is the official citizenship application.
You can file online through your USCIS account or by mail. Along with the form, you will submit supporting documents that demonstrate you meet all eligibility requirements, and pay the current filing fee.
One important note: naturalization itself does not require a new immigration medical exam. The I-693 was part of your green card process. The N-400 process involves a different type of interview and a civics and English test, not a physical.
Step 5: attend your biometrics and naturalization interview
After USCIS accepts your N-400, they will schedule a biometrics appointment and then a naturalization interview. At the interview, a USCIS officer reviews your application, verifies your eligibility, and administers the English and civics tests.
The civics test consists of 10 questions drawn from a list of 100 possible questions about U.S. history and government. You need to answer at least 6 correctly. If you are 65 or older and have been a permanent resident for at least 20 years, a shorter list of questions applies.
If you pass, USCIS may approve your application on the spot or notify you by mail.
Step 6: take the Oath of Allegiance
The final step is the naturalization ceremony, where you take the Oath of Allegiance and officially become a U.S. citizen. USCIS schedules these ceremonies at federal courthouses and USCIS offices. Some ceremonies happen the same day as your interview; others are scheduled separately.
After the ceremony, you receive your Certificate of Naturalization, which is your proof of citizenship.
Start with the medical exam if you haven’t yet
If you are still in the green card phase and need to complete your immigration medical exam, Medical Exams of Tampa has a USCIS-designated civil surgeon on staff, bilingual service in English and Spanish, flat-rate pricing, and Saturday appointments available. Schedule your immigration medical exam in Tampa and get your sealed I-693 form ready to file with your I-485.
