Step 1 registration for IMGs does not happen in MyIntealth anymore.
It moved to the FSMB USMLE portal on January 12, 2026. Every guide written before that date describes buttons that no longer exist.
If a senior, a YouTube video or a Telegram group told you to register for Step 1 inside MyIntealth, that advice is now wrong.
This guide gives you every verified fee, every step in the correct order, and the exact mistakes that delay scheduling permits this cycle.
All fees and policies verified June 2026 against ECFMG and USMLE official sources.
Quick Answer: In 2026, IMGs complete ECFMG certification tasks in MyIntealth and register for USMLE Step 1 in the FSMB USMLE portal at usmle.fsmb.org. An IMG testing outside the US and Canada pays $905 in Step 1 exam fees, a $695 exam fee plus a $210 international surcharge. Starting from zero, the total to reach test day is $1,890. Allow at least two weeks for registration approval, and 2 to 4 months from first account to exam.
On January 12, 2026, all USMLE services for IMGs moved from the Educational Commission for Foreign Medical Graduates (ECFMG) to the Federation of State Medical Boards (FSMB). This is called the USMLE Service Transition, and it splits the process you knew into two portals.
Your senior who took Step 1 in 2024 or 2025 did everything in one place. You will not. Here is the before and after.
| Task | Before January 12, 2026 | From January 12, 2026 |
|---|---|---|
| ECFMG certification application | MyIntealth | MyIntealth (unchanged) |
| Identity verification | MyIntealth | MyIntealth (unchanged) |
| Credential verification | MyIntealth | MyIntealth (unchanged) |
| Step 1 and Step 2 CK registration | MyIntealth | FSMB USMLE portal |
| Score report delivery | ECFMG | FSMB USMLE portal |
| Eligibility period extensions | ECFMG | FSMB USMLE portal |
| Testing region changes | ECFMG | FSMB USMLE portal |
| Score rechecks | ECFMG | FSMB USMLE portal |
| USMLE customer service for IMGs | ECFMG | FSMB at usmle@fsmb.org |
Two things did not change. The exam itself is identical in content, format and scoring. ECFMG certification requirements are also identical. Your school must still be listed in the World Directory of Medical Schools with the appropriate Sponsor Note.
One thing was added. The FSMB USMLE portal account costs $75 to create. That fee is new in 2026, it is paid one time, and it is not credited toward any exam fee.
We see the confusion every single week. Applicants log into MyIntealth, look for the exam application section, and conclude their account is broken. It is not broken. The function moved to usmle.fsmb.org.
The single most important thing to understand in 2026 is which portal owns which task. MyIntealth, run by Intealth, handles everything about ECFMG certification. The FSMB USMLE portal handles everything about the exams themselves.
Print this table. It answers most of the questions we get.
| Task | Portal | Owner |
|---|---|---|
| Create your applicant account and get your MyIntealth ID | MyIntealth | Intealth / ECFMG |
| Identity verification through NotaryCam | MyIntealth | Intealth / ECFMG |
| Application for ECFMG Certification ($580) | MyIntealth | ECFMG |
| Credential verification, diploma and transcript ($220) | MyIntealth | ECFMG |
| ECFMG certification status tracking | MyIntealth | ECFMG |
| Name of record changes (My Profile, then Identity Information) | MyIntealth | Intealth / ECFMG |
| Create FSMB USMLE account ($75) | FSMB USMLE portal | FSMB |
| Apply for Step 1 ($695 plus surcharge) | FSMB USMLE portal | FSMB |
| Apply for Step 2 CK | FSMB USMLE portal | FSMB |
| Receive scheduling permit by email | FSMB USMLE portal | FSMB |
| Eligibility period extension (one time only) | FSMB USMLE portal | FSMB |
| Testing region change | FSMB USMLE portal | FSMB |
| Score reports (365 days of access) | FSMB USMLE portal | FSMB |
| Score rechecks | FSMB USMLE portal | FSMB |
| Book, reschedule or cancel the test appointment | Prometric | Prometric |
| Test accommodations (allow at least 60 business days) | NBME Disability Services | NBME |
The sequence between the portals is fixed. MyIntealth comes first, FSMB comes second. You cannot apply for Step 1 until your Application for ECFMG Certification is accepted, because FSMB confirms your eligibility with ECFMG behind the scenes for every Step application.
IMG Helping Hands – Step 1 Registration Support
From MyIntealth setup and NotaryCam to your FSMB Step 1 application, we guide you step by step so a wrong sequence never costs you weeks.
USMLE Step 1 registration for IMGs in 2026 runs through two portals in a fixed sequence: MyIntealth first for ECFMG certification, then the FSMB USMLE portal for the exam application. Here is the complete walkthrough we run with clients, from zero to scheduling permit.
Before you spend a single dollar, search for your medical school in the World Directory of Medical Schools and confirm it carries the appropriate Sponsor Note. Without that note, you cannot pursue ECFMG certification and nothing else in this article applies to you yet.
The mistake at this step: assuming your school qualifies because seniors from your school have matched. Schools get added, and notes change. Check your own graduating year. Confirmation takes 10 minutes and costs nothing.
Go through ecfmg.org to reach MyIntealth and establish your account. The fee is $110 and it includes the $50 NotaryCam fee for online notarization of your identification form.
Enter your name exactly as it appears on your passport. This single decision will follow you through every later step, including the FSMB account. The mistake we see every single week: applicants use a shortened name, skip a middle name, or follow a different name order than their passport. Fix it now, not after it blocks your eligibility verification.
After payment, you complete identity verification through NotaryCam, a live online notarization session.
What you need ready: your valid government-issued ID, usually your passport, your completed identification form, a device with a working camera and microphone, and a quiet, well lit room. Hold the ID steady when asked, and make sure the photo page is legible on camera.
The mistake at this step: joining with a weak connection or a blurry camera. A failed session means rebooking and lost days. Realistic time for this step: a few days from account creation to completed notarization, depending on appointment availability.
Once identity verification clears, you receive your MyIntealth ID. This is your applicant identifier with Intealth and ECFMG. It is the number ECFMG uses to track your certification, and FSMB will check against this record later.
You can confirm your name or record at any time under My Profile, then Identity Information, in MyIntealth. Screenshot it. You will compare it against your FSMB account in Step 7.
Inside MyIntealth, submit the Application for ECFMG Certification and pay $580. This application confirms you meet the requirements to enter the certification process. It asks for your school details, your graduation status and your attestation.
The mistake at this step: believing this application registers you for Step 1. It does not. It is the gate before exam registration, not the registration itself. Roughly half the cost questions we get come from people who paid $580 and expected a test date to follow automatically.
ECFMG verifies your final medical diploma ($110) and your final medical school transcript ($110) directly with your medical school. Final-year students verify enrollment status instead, with final documents verified after graduation.
This is the step with the least predictable timeline, because it depends entirely on how fast your medical school responds to ECFMG. We have seen schools respond in 2 weeks and schools take several months. If your documents are not in English, add translation costs at $52 per page and extra days.
The mistake at this step: waiting passively. Contact your registrar, tell them an ECFMG verification request is coming, and follow up weekly. The applicants who chase their schools get verified faster. That is not policy, it is just what happens.
Your Application for ECFMG Certification must be accepted before you can move to FSMB. Track the status inside MyIntealth.
Do not create the FSMB account before this acceptance. The sequence is fixed: MyIntealth account and identity verification first, then acceptance of the Application for ECFMG Certification, then the FSMB account, then the Step 1 application. Paying FSMB early buys you nothing, because FSMB confirms eligibility with ECFMG for every Step application.
Go to usmle.fsmb.org and create your account. The fee is $75, it is paid one time, it is new in 2026, and it cannot be credited toward anything else.
Now the warning that matters more than any other in this article. The name on the government ID you use to open the FSMB account must exactly match your Intealth name of record. Exactly. Not close, not reordered, not abbreviated. A mismatch blocks eligibility verification and your Step 1 application stalls until it is fixed through usmle@fsmb.org.
Name matching is the silent killer of this cycle. Before you create the account, open MyIntealth, go to My Profile, then Identity Information, and copy the name character by character.
Inside the FSMB USMLE portal, apply for Step 1. You select a three month eligibility period and a testing region, then pay the $695 exam fee. If your testing region is outside the US and Canada, the $210 international test delivery surcharge is added, for a total of $905. If you test in India, 18% GST is added on top.
The mistake at this step: choosing an eligibility period based on hope instead of readiness. You get one extension, ever, and it must be contiguous. Pick a window you can realistically hit. The next section covers how to choose.
Allow at least two weeks for exam registration approval and issuance of your scheduling permit. During this window, FSMB verifies your eligibility with ECFMG behind the scenes.
The mistake at this step: emailing support on day 3. Two weeks is the floor, not the ceiling. If your names match and your certification application is accepted, the permit comes. If there is a name mismatch, this is where it surfaces, and that is a usmle@fsmb.org conversation.
Your scheduling permit arrives by email from FSMB. Permits are never sent more than six months before your selected eligibility period begins, so if you choose a far future window, do not panic at the silence.
Check every detail on the permit immediately, especially your name. If you need a name change, FSMB must process it no later than 7 business days before your test date, and you will need a revised permit.
With permit in hand, book your test date and test center at prometric.com. Popular centers in high volume countries fill early, especially in peak months. Book as soon as your permit arrives, even if you might adjust later.
Remember the 45 day rule: rescheduling, canceling or changing test centers within 45 days of the appointment carries a Prometric fee that varies by region and notice window. Changes made earlier than 45 days out are the cheapest changes you will ever make.
Your eligibility period is the three month window during which you must take Step 1. Choose it as carefully as you choose your test date, because the rules around it are rigid.
When you apply for Step 1 in the FSMB portal, you select a three month eligibility period. Your scheduling permit is valid only inside that window. You can take the exam on any available Prometric date within those three months, but not a day outside them.
Permits are never issued more than six months before the eligibility period begins. Apply 8 months ahead and you will wait 2 months before anything arrives. That is normal, not a problem.
If you cannot test inside your window, FSMB allows one extension. The rules are strict: it is available one time only, the new period must be contiguous with the original one, and you request it through the FSMB portal.
One time only means exactly that. If you extend and miss the extended window too, you reapply and pay the exam fee again. We tell every client the same thing: treat the extension as an emergency tool, not a planning tool.
These are different decisions made in different systems. The testing region is the geographic area you select in your FSMB application, and it determines whether the $210 international surcharge applies. The test center is the specific Prometric location you book inside that region after your permit arrives.
You can switch test centers within your region through Prometric, subject to the 45 day fee rule. Changing the region itself is an FSMB portal request and takes processing time. Pick the region where you will actually be living during your eligibility period, not where you are today.
Do not apply for Step 1 until your practice scores say you are 3 to 4 months from ready. The time lost to a missed window costs more than the money. Anchor the decision to data: consistent practice exam performance at your target level, then apply, then book.
From a standing start, most IMGs need 2 to 4 months from creating a MyIntealth account to sitting Step 1, and the single biggest variable is how fast your medical school answers ECFMG. Here is what the calendar actually looks like, based on the cases we handle.
| Week | What Happens |
|---|---|
| Week 1 | Create MyIntealth account ($110), complete NotaryCam verification, receive MyIntealth ID |
| Week 2 | Submit Application for ECFMG Certification ($580) and credential verification requests ($220) |
| Weeks 3 to 4 | School responds quickly, credentials verified, application accepted |
| Week 5 | Create FSMB account ($75), apply for Step 1 ($695 plus $210) |
| Weeks 6 to 7 | FSMB processing, two weeks minimum |
| Week 7 | Scheduling permit arrives by email, book Prometric immediately |
| Weeks 8 to 12 | Test on your chosen date inside the eligibility period |
Best case, you hold a scheduling permit about 7 weeks after starting. That requires a school registrar who replies to ECFMG within days, which is rare.
| Phase | Duration | Notes |
|---|---|---|
| MyIntealth account plus NotaryCam | 1 to 2 weeks | Appointment availability varies |
| ECFMG application plus credential verification | 4 to 10 weeks | Entirely school dependent, chase your registrar weekly |
| FSMB account plus Step 1 application | A few days | Name match is the only common blocker |
| FSMB processing to permit | 2 to 3 weeks | Two weeks is the stated minimum |
| Permit to preferred test date | 2 to 8 weeks | Popular centers fill early |
Typical case, plan for 3 to 4 months from first login to test day. Students at schools with slow registrars should start the MyIntealth and credential process 6 months before their target test month. The exam preparation timeline runs in parallel and is usually the longer track anyway.
One more timing rule that surprises people: test accommodations through NBME Disability Services need at least 60 business days, which is roughly 3 months of calendar time. If you need accommodations, that request defines your timeline, so file it early.
As of the 2026 cycle, an IMG starting from zero and testing outside the US and Canada pays $1,890 to reach Step 1 test day. Here is every dollar, itemized and verified.
| Item | Paid To | Fee |
|---|---|---|
| MyIntealth account establishment (includes the $50 NotaryCam notarization fee) | Intealth | $110 |
| Application for ECFMG Certification | ECFMG | $580 |
| Credential verification, final medical diploma | ECFMG | $110 |
| Credential verification, final medical school transcript | ECFMG | $110 |
| FSMB USMLE portal account creation (new in 2026, one time) | FSMB | $75 |
| Step 1 exam fee | USMLE program via FSMB | $695 |
| Step 1 international test delivery surcharge (testing outside the US and Canada) | USMLE program via FSMB | $210 |
| Total through Step 1 | $1,890 |
If you test inside the US or Canada, drop the $210 surcharge and the total falls to $1,680.
ECFMG certification requires passing Step 1, passing Step 2 CK, and meeting the clinical and communication skills requirement through a Pathway. Here is the full stack for an IMG testing internationally.
| Item | Fee |
|---|---|
| Everything in Table 1 | $1,890 |
| Step 2 CK exam fee | $695 |
| Step 2 CK international test delivery surcharge | $235 |
| Application to a Pathway for ECFMG Certification | $945 |
| OET Medicine (required alongside Pathways) | Verify current fee at occupationalenglishtest.org |
| Total through full ECFMG certification | $3,765 plus OET |
As of June 2026, the verified total from zero to full ECFMG certification for an internationally testing IMG is $3,765 plus the OET Medicine fee.
These costs come later, during residency application season and beyond. Verified fees are marked. Everything else is an estimate that varies by person.
| Item | Fee | Status |
|---|---|---|
| ERAS Token via ECFMG | $185 | Verified |
| AAMC ERAS application fees (scale with number of programs) | Verify at aamc.org | Estimate, varies |
| NRMP Match registration | Verify at nrmp.org | Estimate, varies |
| Step 3 exam fee (usually during or before residency, US territory testing only) | $955 | Verified |
| Travel for interviews or US testing | Varies widely | Estimate |
| Visa costs for US clinical experience or residency | Varies by country and visa type | Estimate |
These are the charges nobody budgets for. We see each of them surprise clients every cycle.
India GST: The USMLE program collects 18% goods and services tax on Steps 1 and 2 taken in India, effective December 4, 2024. On a $905 Step 1 total, that is roughly $163 added at payment. Budget for it if you select India as your testing region.
Prometric change fees: Rescheduling, canceling or changing test centers within 45 days of your appointment carries a Prometric fee. The amount varies by region and by how much notice you give. Check prometric.com for your region before you book a date you are not sure about.
Document translations: If your diploma or transcript is not in English, ECFMG requires translations at $52 per page.
Credit card foreign transaction fees: Every fee in this article is charged in US dollars. Most non US cards add 2% to 4% per transaction. Across $1,890 in payments, that is $38 to $76 in silent extra cost. A card with no foreign transaction fee saves real money here.
Notarization: The $50 NotaryCam fee is already inside the $110 MyIntealth account fee, so do not budget it twice. You only pay extra if a failed session forces a repeat.
IMG Helping Hands – Plan Your Step 1 Budget
Missed windows, name mismatches, and reapplications quietly inflate the real cost. We help you time eligibility, protect your one-time extension, and avoid the repeat fees.
Your MyIntealth ID is your Intealth and ECFMG applicant identifier. Your USMLE identification number is associated with your exam record. They identify you in different systems, and the FSMB portal links to your ECFMG record during eligibility verification. Keep both numbers saved in one place.
No. The $580 application enters you into the certification process. Step 1 registration is a separate application, made later, in the FSMB portal, for a separate $695 fee plus surcharge. Two applications, two portals, two payments.
No. It is a new fee in 2026, paid one time to create your FSMB USMLE portal account. It is not credited toward exam fees and was not part of any pre 2026 fee structure.
Eligibility verification fails and your Step 1 application stalls. The name on the government ID used for your FSMB account must exactly match your Intealth name of record. The fix runs through usmle@fsmb.org, and it costs you weeks. Check the name first at My Profile, then Identity Information, in MyIntealth.
For ECFMG certification steps, mostly yes. For Step 1 registration, no. Any guide showing exam registration inside MyIntealth describes a workflow that ended January 12, 2026.
No. The exam is identical, and ECFMG certification requirements are identical. Your school must still be listed in the World Directory of Medical Schools with the appropriate Sponsor Note. Only the service provider for exam administration changed, from ECFMG to FSMB.
Applications in process during the January 2026 cutover were handled under transition procedures published by the USMLE program. If yours was affected and something looks wrong, contact usmle@fsmb.org with your identifiers rather than reapplying.
Score reports are delivered through the FSMB portal and stay available for 365 days from the notification email. After that, your score is available only through an official transcript. Download the PDF the day it arrives.
Withdrawal and refund terms depend on the USMLE program’s current policy and the timing of your request. What is certain: Prometric changes within 45 days of the appointment carry their own fee regardless of any exam fee refund.
Anyone graduating from a Canadian medical school on or after July 1, 2025 is treated as an IMG for USMLE purposes and registers through FSMB. Earlier Canadian graduates follow the prior rules. This catches Canadian students off guard every week.
As of the 2026 cycle, an IMG testing outside the US and Canada pays $905 for Step 1, made up of a $695 exam fee and a $210 international test delivery surcharge. Starting from zero, including ECFMG and FSMB account and application fees, the total is $1,890.
IMGs register for Step 1 in the FSMB USMLE portal at usmle.fsmb.org. Since January 12, 2026, the Federation of State Medical Boards handles exam registration, scheduling permits, score reports and eligibility extensions for IMGs. MyIntealth now handles only ECFMG certification tasks.
As of June 2026, full ECFMG certification costs $3,765 plus the OET Medicine fee for an IMG testing internationally. That covers the MyIntealth account, the certification application, credential verification, the FSMB account, Step 1, Step 2 CK with surcharges, and the $945 Pathways application.
Allow at least two weeks for exam registration approval and the scheduling permit. FSMB verifies your eligibility with ECFMG during this window. Permits arrive by email and are never sent more than six months before your selected eligibility period begins.
Yes, one time only. The extension must be contiguous with your original three month eligibility period and is requested through the FSMB USMLE portal. If you miss the extended window as well, you must reapply and pay the exam fee again.
Yes. You need a MyIntealth account ($110, includes NotaryCam notarization) for ECFMG certification and a separate FSMB USMLE portal account ($75) for exam registration. The MyIntealth account comes first, and the name on both must match exactly.
Yes. The USMLE program collects 18% goods and services tax on Steps 1 and 2 taken in India, effective December 4, 2024. On a $905 Step 1 fee total, the GST adds roughly $163. Budget for it when selecting India as your testing region.
Prometric charges a fee for rescheduling, canceling or changing test centers within 45 days of your appointment. The amount varies by region and by how much notice you give. Changes made more than 45 days before the appointment avoid the fee tier entirely.
Score reports are delivered through the FSMB USMLE portal and remain available for 365 days from the date of the notification email. After 365 days, scores are available only by ordering an official transcript. Download and save your report immediately.
Graduates of Canadian medical schools who graduate on or after July 1, 2025 are treated as IMGs for USMLE purposes. They register through the FSMB USMLE portal and follow the same two portal process as other IMGs, including ECFMG certification requirements.
You need a valid government issued photo ID, normally your passport, your completed identification form, and a device with a working camera and microphone. The $50 NotaryCam fee is already included in the $110 MyIntealth account establishment fee.
No, The sequence is fixed. Your Application for ECFMG Certification must be accepted in MyIntealth before you create the FSMB account and apply for Step 1. FSMB confirms eligibility with ECFMG for every Step application, so applying early only stalls.
Three numbers matter most this cycle. $905 is what an IMG pays in Step 1 exam fees when testing internationally. $1,890 is the verified all in total from zero to test day. Two weeks is the minimum wait between applying and holding a scheduling permit.
Three rules prevent almost every delay we fix for clients. ECFMG certification application first, FSMB second, always in that order. The name on your FSMB government ID must exactly match your Intealth name of record. And the eligibility extension exists once, so pick a window your practice scores support.
Everything else in this article is detailed in service of those six facts. Verify fees at ecfmg.org and usmle.org before you pay, because fees change every April.
IMG Helping Hands walks IMGs through every screen described in this article, from MyIntealth setup and NotaryCam verification to the FSMB portal and the Match. If you want it handled right the first time, with no lost weeks to avoidable errors, reach out to us. We do this every day.
IMG Helping Hands – USMLE Step 1 Registration Support
Three rules prevent almost every delay: ECFMG application first, FSMB second, always in that order; the name on your FSMB ID must match your Intealth record exactly; and the eligibility extension exists only once, so the window has to match your prep.
We run this every day, MyIntealth setup, NotaryCam verification, the $580 ECFMG application, credential verification, and the FSMB Step 1 application, taking IMGs from a zero account to a scheduling permit under the 2026 process.
Correct portal order. Matched names. A window your scores can hit. Handled once, properly.
MyIntealth first. FSMB second. From zero to scheduling permit, without the avoidable delays.
Articles published by IMG Helping Hands are prepared by our team using information from direct experience, publicly available resources, and educational references. AI tools may be used to assist with drafting, proofreading, and formatting; however, all content undergoes review and approval before publication.
The information provided is intended for educational purposes only. Requirements, policies, and processes may change over time. Readers should consult official sources for the most current information.
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