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How to Register for USMLE Step 1 in 2026: A Step-by-Step Guide for IMGs

September 30, 2025

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Updated · Official USMLE & FSMB guidance

International medical students and graduates now register for USMLE Step 1 through FSMB. Here is the current pathway, from eligibility checks to booking your exam.

What changed in January 2026?

On January 12, 2026, FSMB took over IMG Step exam applications, score reports and exam customer support. ECFMG continues to handle certification eligibility. Read the official USMLE announcement.

Students and graduates of U.S. medical schools use the separate NBME pathway. Confirm your registration organization before applying.

Your registration pathway

Exam registration and ECFMG certification are separate processes.

How to register for Step 1

Follow these steps alongside FSMB’s getting-started instructions and application guidance.

  1. Confirm eligibility

    Read the current USMLE Bulletin and confirm that your medical school and student or graduate status meet ECFMG requirements.

    Eligibility must be met when applying and on exam day. Official eligibility rules

  2. Complete ECFMG prerequisites

    Before your first Step application, you need an accepted Application for ECFMG Certification through Intealth/ECFMG.

    Acceptance of this application is different from holding full ECFMG Certification.

  3. Create your FSMB account

    Go to FSMB’s USMLE portal and use “Sign up now” if you do not have an account. Verify your email.

    Use accurate personal details and your existing USMLE ID or MyIntealth ID when available.

  4. Complete identity checks

    Follow the portal’s identity-matching and Intealth eligibility-check instructions.

    Some applicants need ID and selfie verification or manual review. Do not create duplicate identities to bypass a mismatch.

  5. Start the Step 1 application

    Once the checks are complete, open the Step 1 application and review your details.

    Follow any outstanding verification instructions. Step 1 and Step 2 CK require separate applications and payments.

  6. Choose an eligibility period

    Select a three-month testing window that fits your preparation plans.

    An eligibility period is not a booked test appointment.

    You cannot change the window after you apply. For an earlier window, you cancel and reapply: before approval you get your fee back minus a $100 processing charge; after approval you lose the whole fee. For a later window, you can ask FSMB for an extension no later than 25 days after your window ends.

  7. Request accommodations if needed

    Indicate your request in the FSMB application. Submit the accommodation request and supporting documents separately through NBME’s MyUSMLE Portal.

    Follow the current USMLE accommodations instructions.

  8. Review fees and pay

    For eligibility periods ending in 2026 or 2027, the Step 1 base application fee is $695.

    Testing outside the U.S. and Canada adds a $210 region fee: $905 before applicable taxes or other charges.

  9. Track approval and permit

    Monitor your email and FSMB portal for application status and your scheduling permit.

    Resolve incomplete items promptly. Do not assume a fixed approval time.

    Scheduling permits, and booking with Prometric, are not available more than six months before your eligibility period starts.

  10. Schedule with Prometric

    After receiving your permit, book your date and test center through Prometric.

    Choose an available appointment within your eligibility period.

    Dates are first-come, first-served, and test center availability is not guaranteed. Book as soon as you have your permit; an early date leaves room to reschedule inside your window.

  11. Prepare for exam day

    Check your permit, appointment details, acceptable identification and current test-center rules.

    Your permit name must match your identification. Review changes or extensions before your window expires.

Before booking: wait for your scheduling permit and confirm that the name on it matches your identification.

What the Step 1 exam looks like now

Since May 14, 2026, Step 1 is given in fourteen 30-minute blocks of up to 20 questions each, in one 8-hour session, with at least 55 minutes of break time. The total (up to 280 questions) and the length of the day did not change. Practise with the new Step 1 interactive test. See every USMLE change in 2026.

After the exam: scores and ERAS

Results may be available two to four weeks after your test date, but USMLE advises allowing at least eight weeks. To send your USMLE transcript to residency programs, request it through FSMB’s USMLE portal: $70, once per application cycle (since June 4, 2026). ERAS 2027 dates and deadlines.

Coming in 2029: fixed testing dates

From January 2029, the three Step exams together will be given on only 45 days a year (Designated Testing Dates). Until then you can book any available date inside your eligibility period. If you plan to take Step 1 in 2029 or later, follow the Designated Testing Dates Information Hub.

Frequently asked questions

Where do IMGs register for Step 1 in 2026?

Use the FSMB USMLE portal. The January 12, 2026 transition moved IMG exam services, including registration and score reports, to FSMB. Read the official transition announcement.

Does ECFMG still have a role?

Yes. ECFMG continues to determine IMG certification eligibility. Follow the current Intealth/ECFMG requirements; an accepted certification application is required before your first Step application. Full certification is not a prerequisite for Step 1.

How much should I budget?

The base fee is $695 for 2026 and 2027 eligibility periods. Add $210 outside the U.S. and Canada. Applicable taxes, certification costs and other service charges are separate. Check USMLE’s fee information and FSMB’s fee schedule before paying.

Is identity verification always immediate?

No. The required checks depend on how your records match. Manual review can take several days. FSMB describes a conditional $75 nonrefundable identity-processing charge, credited toward a subsequent eligible FSMB service; it is not a universal exam surcharge. See FSMB’s account setup instructions.

When can I book my appointment?

Wait until your scheduling permit is issued. Approval depends on completing the required checks; a permit does not guarantee your preferred test-center date.

What if I need to reschedule or extend my window?

Appointment changes go through Prometric; eligibility-period extension requests go through FSMB. Deadlines and charges may apply. Check FSMB’s current FAQ before cancelling or reapplying.

How long is Step 1 now?

One 8-hour day: fourteen 30-minute blocks of up to 20 questions each, since May 14, 2026.

Is there extra tax if I test in India?

Yes. Steps 1 and 2 taken in India include an 18% GST, collected for the Indian government since December 4, 2024.

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Requirements and fees can change. Review the USMLE Bulletin of Information and current FSMB and ECFMG instructions before applying.