USMLE Testing Accommodations: Eligibility and How to Apply

USMLE offers test accommodations to people with documented disabilities, and each request is reviewed individually, so approval depends on your documentation and cannot be promised. The most important practical point is timing: USMLE states that decisions take about 60 business days and cannot be rushed.

This page explains the process in general terms. The rules are on usmle.org, and that page, not this one, controls what you must submit.

Who may qualify #

USMLE provides accommodations under the Americans with Disabilities Act (ADA), including the ADA Amendments Act of 2008. Whether you qualify is decided by an individualized assessment of how an impairment currently affects you compared with most people.

• The condition must be documented.
• The accommodation must relate to the exam setting.
• USMLE says accommodations provide access to the exam. They do not guarantee better performance or completion.

This page is not a diagnosis tool or legal advice. If you are unsure whether your situation counts, ask a clinician who knows you and consider contacting NBME Disability Services directly.

What documentation is expected #

According to USMLE, supporting documentation should:

• clearly describe the functional impairment and explain why each requested accommodation matters for the exam;
• come from a qualified professional and be comprehensive;
• be recent enough to reflect your current level of impairment.

The request form also asks for a personal statement about your condition and its effect on daily life, and for an evaluation report or treatment records. Scan digital copies before you start. Where appropriate, your medical school completes a certification form (the CPTA) that you upload.

How to apply #

1. Read the current request guidelines on the USMLE accommodations page.
2. Create or log in to your MyUSMLE Portal account.
3. Complete your Step exam application. Processing does not begin until it is complete.
4. Upload the request form and documentation through the portal.
5. Watch your email for follow-up requests for more documents.

Selecting an accommodations option when you register does not start a request. You must submit the request and documentation.

Request types #

Timing #

USMLE says a decision takes about 60 business days from the moment it has complete documentation and a complete exam application. Requests are handled in the order received. For a June to August eligibility period, USMLE suggests submitting by early March.

Who handles what after January 2026 #

In plain terms: NBME Disability Services reviews requests, while your registration entity issues your scheduling permit. IMGs should confirm which office issues the accommodated permit and how to re-register if you already hold a standard one. ECFMG still decides your eligibility for ECFMG certification, which is separate from accommodations. Contact details are on the USMLE page, and ECFMG-specific questions should be confirmed on ECFMG's current pages.

Items you can bring without a request #

USMLE lists many pre-approved items, such as basic eyeglasses, an inhaler, an insulin pen, glucose monitor supplies, braces, medical alert jewelry, and some mobility devices. Show them at check-in. Devices with wireless or Bluetooth capability, or that make sound or vibrate, require review and may not be permitted. Anything not listed needs a request. See the exam day checklist.

After a decision #

If you are approved, the accommodations apply to the exam named in the decision, so check that your permit matches the letter. If you are denied, reconsideration needs new objective evidence. A letter restating earlier information is generally not enough.

The exam software also changed in 2026. USMLE says examinees with approved extra time or break time receive an updated decision letter, so read yours carefully (see the policy tracker).

Confidentiality #

USMLE states that disability documentation is kept confidential and shared only with the staff and expert reviewers who process requests, with limited legal exceptions.