Test Accommodations Common Questions


If you have a documented disability covered under the Americans with Disabilities Act (ADA) and require test accommodations, you must obtain information regarding procedures and documentation requirements from the Test Accommodations section of this website.

You must submit your application for the Step and your request for test accommodations with required documentation at the same time.

  • We recommend advanced planning to help ensure that you can test on a date and time of your choosing. Start by completing your exam registration and choosing a three-month eligibility window through your registration entity (NBME, ECFMG, or FSMB). Please note that this may be done approximately 1 year in advance of your anticipated testing window once the registration opens in mid-September for the following calendar year. You must have a current and completed exam registration at the time you submit a request for accommodations.
  • After you have completed your Step exam registration, submit your accommodation request form and supporting documents to Disability Services no later than the first three weeks of your three-month eligibility period. If your eligibility period expires before you have submitted your request form and supporting documentation, Disability Services will not be able to process your request. If your eligibility period has less than 60 days left at the time you submit your request to Disability Services you will need to update your eligibility period so there is sufficient time to review your completed request for test accommodations.
  • Next, we will review your submission for initial completeness and confirm receipt of your request within approximately 2 business days.  Once that request and all necessary supporting documentation have been submitted, please allow approximately 60-business days for the review process and to receive a decision letter.
  • For more information about the process, please visit the test accommodations site.

A scheduling permit is issued when an examinee has completed the registration process and is allowed to schedule their test date.  If you check the box for test accommodations on your exam application, a temporary hold will be placed on your scheduling permit. Checking the box does not initiate an accommodation request; you must still submit a request form and supporting documentation to Disability Services to initiate your request. Once a decision has been made, the hold will be released, and your scheduling permit will be issued to you several business days later.  Once you have received your scheduling permit you may schedule your exam at any time.

Please allow approximately 60 business days to process a request, starting from the time we receive your completed application and all supporting documentation and have confirmed that your registration is current and complete.

Your file is typically reviewed by one or more psychological or medical professionals, depending on the basis of your request.  Some requests are also reviewed, at NBME’s request, by external professionals.

  • We will begin processing your request once we have received your complete documentation, provided that your registration for the Step for which you are seeking accommodations is current, complete, and you have not tested with the related scheduling permit.
  • If we ask you for additional information regarding your request, the processing of your request will resume once we have received the requested information and/or we have received a communication from you that you do not intend to submit any additional documentation.  

If additional documentation is needed, you will be notified by email within approximately two weeks of submitting your request.

Examinees may submit a request for reconsideration of the original decision if the request for reconsideration is submitted within their current and active eligibility period window (the eligibility period for that step exam has not expired and the examinee has not taken the exam). Please see the Reconsideration page to find the Reconsideration Request Form and additional information. 

We recommend you address the reviewer in writing with your specific questions or concerns, and you will receive a response within approximately two business days.

Due to high volumes and time constraints, we do not speak to providers directly. If there are questions about our accommodation process, we recommend that your treatment provider review the General Guidelines to Request Test Accommodations as well as the additional Guidelines for Specific Impairments if needed.

Once you have been granted accommodations on a USMLE Step exam, simply submit to us the completed Subsequent Request for Test Accommodations form at the time you complete your Step exam registration. Please check the box for test accommodations on your exam application. The Subsequent Request form can be found on the Forms page.

Nursing/breastfeeding individuals may test under standard conditions and request to bring and use their breast pumps during standard breaks, or they may submit a request for additional break time to express milk

Please note that additional break time makes Step 2 CK a two-day exam and Step 3 a three-day exam.

  • Why do I need to request to bring/use my breast pump? Disability Services needs to let Prometric know in advance so that Prometric can ensure it has the appropriate space available.


Your scheduling permit will remain temporarily on hold for the duration of the accommodation review process, and you will not be able to schedule an exam. As soon as a decision has been reached, we will email you a copy of your decision letter and release the hold on your permit. You will generally be able to schedule your exam within a few days of receiving the email that notifies you that the hold has been released on your scheduling permit. Your scheduling permit will contain information about how to schedule your exam with Prometric. For more specific questions please contact your specialist.

Yes. You may withdraw your request at any time by providing an email or dated and signed letter stating your desire to withdraw your request. We will then release any hold that may be on your scheduling permit so that you may schedule to test under standard conditions at your convenience.

You can view available test dates and centers for standard appointments by navigating through the Prometric website to the USMLE section (https://www.prometric.com/test-takers/search/usmle) and selecting "Locate" on the left-hand side of the page. All questions regarding test centers and scheduling should be directed to Prometric (https://www.prometric.com/contact-us). If you are granted test accommodations, you may contact Prometric at the phone number listed on your scheduling permit with any questions about scheduling with your accommodations.

If your eligibility period has begun while your accommodation request is being processed and you have questions or concerns about whether you will be able to test within your eligibility period, please contact your Disability Services Specialist for more specific information regarding your eligibility period.

  • To confirm, cancel, or reschedule your testing appointment(s), please follow the instructions on your scheduling permit.
  • If you had a standard exam appointment and were later approved for test accommodations and a new accommodated scheduling permit was issued to you, your previous exam appointment will automatically be canceled, please destroy your original scheduling permit as it is no longer valid. You may use your new accommodated scheduling permit to schedule a new appointment with the approved accommodations.

  • If you are taking Steps 1 & 2 and your medical school is in the US or Canada, you should contact Customer Operations Management. Telephone: (215) 590-9700, Fax: (215) 590-9460, or E-mail: usmlereg@nbme.org.
  • If you are taking Steps 1 & 2 and your medical school is outside of the US or Canada, you should contact ECFMG. Telephone: (215) 386-5900, or E-mail: info@ecfmg.org.
  • If you are taking Step 3 and you are a graduate with an MD or DO degree, you should contact the FSMB. Telephone (817) 868-4041, or E-mail: usmle@fsmb.org 

For more information about applying for and scheduling your exam, please refer to the Bulletin of Information.


You should submit documentation which confirms that you have a physical or mental impairment that substantially limits your ability to perform one or more major life activities that are relevant when taking an examination like the Step examinations, as compared to most people in the general population. The documentation should be sufficiently up to date to reflect your current level of functional impairment, which generally means that it was prepared within the past three years.  For detailed information regarding documentation, please refer to the Guidelines for Requesting Test Accommodations and Additional Guidelines for Specific Impairments.

We certainly understand that historical records may not always be obtainable. We recommend you submit whatever historical documentation you can reasonably obtain and provide as that will help us determine what accommodations, if any would be appropriate.

While specific categories of information are requested (for example, documentation of your impairment from a qualified professional, and information on your use of accommodations on the MCAT), there is no specific amount of documentation required, and there is no specific piece of documentation that will guarantee an accommodationWe will review all the documentation you choose to submit. Keep in mind, however, that the documentation must be sufficient to demonstrate the existence of your impairment(s) and whether accommodations are warranted considering the functional limitations that you experience because of your impairment(s).  For additional information on documentation guidelines, please see the Guidelines page. 

A personal statement is your opportunity to describe your impairment and accommodation needs in your own words. There is no length requirement, but you should provide a clear rationale for the requested accommodation(s). For more information on Personal Statements, please see the Guidelines page.

Supporting documentation is currently submitted to NBME electronicallyThe maximum email file size is 15 MB (including text in body of email, headers, and all attachments). Files larger than 15 MB may require separate emails. All attachments should be in PDF, Word, or JPEG format. Please scan your documents into as few attachments as possible. Photographs of Personal Items may be in digital format such as JPEGs/JPGs. We are not able to access embedded or encrypted links.

Separate Testing Rooms

Please note that the separate testing rooms at Prometric test centers are not guaranteed to be “distraction-free” or any quieter than the standard Prometric testing area, which is designed to provide a reasonably quiet environment that is conducive to high-stakes, standardized test administrations. The separate room is typically located next to the check-in or proctors’ station, which can be busy. A window between the separate room and the check-in or proctors’ station is there for security measures.

Soft foam earplugs (without cords) are permitted in all testing rooms, and sound-reduction headphones are also available for all test-takers to minimize the distraction of ambient noises. Additionally, individual workstation carrels are provided in the general testing area to shield test-takers from visual distractions.