IMLC Letter of Qualification: Eligibility, Fees, and Validity

The IMLC Letter of Qualification is a verified credential confirming that a physician meets every eligibility standard the Interstate Medical Licensure Compact sets for expedited multi-state licensing. Once you hold one, you can request a full medical license in any participating Compact state through a single online portal, and those licenses typically arrive within 7 to 10 days. More than 40 jurisdictions participate, which makes this the fastest route for physicians practicing across state lines or treating telemedicine patients outside their home state.

The Letter itself is not a license to practice medicine. It is the credential that unlocks the expedited licensing process in member states.

Which States You Can Use It In

Compact membership comes in two tiers. Full-participation states both evaluate applications as a State of Principal License and issue expedited licenses. Partial-participation states only issue licenses.

As of 2026, the full-participation jurisdictions are Alabama, Arizona, Colorado, Delaware, Florida, Georgia, Guam, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, Wyoming, and Washington, D.C. Connecticut, Hawaii, and Vermont participate on a partial basis. Arkansas, North Carolina, New Mexico, and Rhode Island have enacted the Compact but are still implementing it.

If your home state is not a member, the Compact pathway is not available to you, and each out-of-state license has to be pursued through the traditional application process.

Who Qualifies

Every requirement must be satisfied at the time the application is reviewed. Falling short on one item disqualifies you from the expedited process, though you can still pursue licenses state by state through traditional channels.

A Qualifying State of Principal License

Your State of Principal License is the member state whose medical board evaluates your application and issues the Letter. You must hold a full, unrestricted license there, and you must demonstrate a real connection to it through at least one of four criteria: your primary residence is in that state, at least 25 percent of your medical practice occurred there in the preceding six months, your employer is located there, or you use it as your state of residence for federal income tax purposes.¹ The tax criterion is a fallback used only when none of the first three apply.

“Employer” means a person, business, or organization located in your designated state that employs or contracts with you to practice medicine. A registered agent in the state is not enough. Primary residence means the dwelling where you usually live, and you can claim only one.¹

Education, Training, and Board Certification

You must have graduated from a medical school accredited by the Liaison Committee on Medical Education or the Commission on Osteopathic College Accreditation. International graduates qualify if their school appears in the International Medical Education Directory or its equivalent.²

Your graduate medical education must be accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association. If you completed residency outside the United States, confirm the program holds ACGME or AOA accreditation before applying. Programs without it will not meet the standard, regardless of their reputation.³

You must also have passed every component of the USMLE or COMLEX-USA in no more than three attempts per component. And you need current specialty certification, or a time-unlimited specialty certificate, recognized by the American Board of Medical Specialties or the American Osteopathic Association’s Bureau of Osteopathic Specialists.³

Criminal and Disciplinary History

The Compact draws a hard line on criminal history. If you have ever been convicted of, received adjudication for, or received deferred adjudication, community supervision, or deferred disposition for a qualifying offense, you are ineligible.⁴ Plea deals, deferred sentences, and first-offender probation all count. A charge “dismissed” after a diversion program may still disqualify you if the program involved deferred adjudication.

Qualifying offenses are felonies, gross misdemeanors (offenses punishable by at least six months of incarceration), and crimes of moral turpitude. A routine traffic ticket is not a disqualifier, but anything carrying potential jail time likely is.⁴

On the professional side, you cannot have any history of actions against your medical license, any history of controlled substance actions, or any active investigation pending against you.³

How to Apply

Applications go through the online portal at imlcc.com. You submit the application, pay the fee, and then complete fingerprinting once your State of Principal License contacts you with instructions.

Fees

The Letter of Qualification application fee is $700, non-refundable regardless of the outcome.⁵ Of that, $300 goes to your State of Principal License for its verification work and $400 goes to the Commission. The State of Principal License charges nothing beyond its share.

Each state you later select for licensure charges its own licensing fee, paid through the portal. If you return during the 365-day window to add states, you pay a $100 processing fee on top of each new state’s licensing fee.⁶

Fingerprints and Background Check

After your State of Principal License receives the application, it contacts you with fingerprinting instructions for the FBI national criminal background check. You have 60 days from that point to submit prints.³

Fingerprint quality matters more than most applicants expect. The FBI’s Criminal Justice Information Services Division rejects submissions that fall below its image quality standards.⁷ If your prints are rejected twice, the agency must switch to an FBI Name Check, a backup process that adds time. Using a facility experienced with federal submissions, such as a law enforcement office or a commercial fingerprinting service that handles these routinely, lowers the risk of a rejection that threatens your 60-day deadline.

Processing Timeline

Once your application, fingerprints, and fee are in, your State of Principal License conducts primary source verification by contacting your medical school, residency program, and previous licensing authorities directly. That stage typically takes 20 to 30 days. After the Letter is issued and you select states, the individual state licenses usually arrive within 7 to 10 days because the vetting is already complete.

Using the Letter to Get State Licenses

Once you hold the Letter, you return to the Commission’s portal and select the member states where you want licenses. You pay each state’s licensing fee through the portal, the Commission notifies those boards, and each board issues a full, unrestricted medical license in your name. These licenses are identical in scope to licenses obtained through traditional applications and carry the same obligations, including each state’s continuing education and practice requirements.

You can select states at any time during the 365-day validity window. Adding a state later costs the $100 processing fee plus that state’s licensing fee.⁶

Validity and Reapplication

A Letter of Qualification is valid for exactly 365 days from its issuance date. No waivers, no extensions.⁶ After expiration, you can no longer use it to request new state licenses, but any licenses you already obtained through it remain active and follow their own state renewal cycles.

To request licenses in additional states after the 365 days pass, you apply for a new Letter. The Commission describes reapplication as relatively simple, and you will not be asked to demonstrate current specialty board certification again.⁸ You will pay the $700 fee again and complete a new background check.⁶

Renewing Licenses Obtained Through the Compact

Licenses obtained through the Compact are renewed through the Compact’s portal, not through each state’s traditional renewal system. You do not need an active Letter of Qualification to renew. Each renewal costs a $25 processing fee per license plus whatever renewal fee the state charges.⁹

Tracking renewal dates and fees for each license is your responsibility. Cycles vary. Some states renew annually, others biennially, and due dates follow each state’s own schedule. After you submit a renewal through the portal, the issuing board verifies your information and decides whether you qualify. Some states add a second step. Ohio and Florida both require you to finish the renewal through their own online licensing systems after the Compact submission.⁹

One limit: you can only renew licenses through the Compact that were originally obtained through the Compact. A traditional license in one state and a Compact license in another means each follows its own renewal process.⁹

Common Causes of Delay or Denial

Fingerprint problems are the single most frequent delay. Rejected prints push you toward the FBI Name Check backup, and with only 60 days to submit after your State of Principal License sends instructions, a double rejection creates real pressure.⁷

Physicians are often caught off guard by the breadth of the criminal history rule. Deferred adjudications and first-offender dispositions count the same as formal convictions.⁴

Lapsed board certification is another common issue. If your ABMS or AOABOS certification expired before you applied, you do not meet the eligibility criteria. The same applies to residency training at international programs lacking ACGME or AOA accreditation.

If your application is denied, you can appeal through your State of Principal License’s existing appeal process. A successful appeal makes you eligible to continue through the Compact. Denial through the Compact does not stop you from applying for individual state licenses the traditional way, which may use different eligibility standards.

1
Interstate Medical Licensure Compact. IMLCC Rule Chapter 4 – State of Principal License
2
Interstate Medical Licensure Compact. IMLC Compact Law
3
Interstate Medical Licensure Compact. Information For Physicians
4
Interstate Medical Licensure Compact. IMLCC Rule Chapter 5 – Expedited Licensure
5
Interstate Medical Licensure Compact. IMLCC Rule Chapter 3 – Administrative Rule on Fees
6
Interstate Medical Licensure Compact. General FAQs
7
Federal Bureau of Investigation (FBI). FBI Name Checks for Fingerprint Submissions Rejected Twice Due to Image Quality
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Interstate Medical Licensure Compact. LOQ Re-Apply
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Interstate Medical Licensure Compact. License Renewal