Office of Rural Health

J-1 Visa Waiver Program — National Interest Waiver
State Letter of Attestation Guidelines

The following documentation must be submitted to the South Dakota Department of Health when requesting a letter of attestation in support of a National Interest Waiver request. The request must contain all of the following information and documentation and must be submitted in a single package with the documents presented in the order in which they are listed.

1. A letter from the J1 Waiver physician requesting that the South Dakota Department of Health provide a letter of attestation for the National Interest Waiver which includes the following:
   

   Physician’s full name, home address, home phone number, email address, country of birth, date of birth, specialty area, and the U.S. Department of State case number. Description of prior service in the HPSA or MUA for a minimum of 2 years of the J-1 obligation period. Description of how the approval of the waiver is in the national interest. Verification that the physician is in good standing. Documentation of need for the physician’s services. The effects of denial of the National Interest Waiver to the facility and to the HPSA/MUA. Affirmation that the physician will practice in a HPSA or MUA. Affirmation that the physician will practice full-time — see ARSD 44:63:01:01 (4). Practice location under the National Interest Waiver. Include facility name, address, and phone number.

   
   
2. A copy of the physician’s current South Dakota medical license.
3. A current copy of the three-year J-1 employment contract.
4. A copy of the proposed five-year National Interest Waiver contract.

Submit the letter of attestation request in the proper order to:

Josie Petersen
South Dakota Department of Health

Office of Rural Health
600 E. Capitol Ave.
Pierre, SD 57501
Phone: (605) 773-3517
Email: josie.petersen@state.sd.us

If a favorable response is indicated, a letter of attestation from the Secretary of the South Dakota Department of Health will be sent to the applicant.

In those instances when application materials do not support a letter of attestation, the Secretary shall notify the applicant in writing as to the reasons for the determination.

If an application is incomplete, one written request to the applicant will be made for any materials not included in the request. If the requested materials are not received within 30 days of the date of the written request, the request will be rejected.