It even applies to people who switch from F-1 to H1b while in the US, but then go home to Nepal for vacation and get a new H1b visa stamp from the embassy before returning to the US. Last time I got my US visa at 2 pm on Tuesday, the Shram Karyalaya sticker by 4 pm, and the next day I was traveling. I was lucky though that the Shram Karyala folks were still around (apparently I should have arrived before 1 pm). The brokers outside arrange the "insurance" and "doctors report" for you and walk you through the steps. It's probably quickest and simplest to go through them. The officers will examine your H1b paperwork in rather great detail (and they seem to know what they are looking at). The board outside Sram Karyalaya says you need a letter from the employer stating that you'll be working no more than 40 hours a week, 6 days a week. Try to get that from your HR person before you leave for Nepal. Easier than trying to insert a line onto your letter. ALSO: once you have your sticker, make sure you take with you either the receipt or a photocopy of the receipt that you get at Shram Karyalaya. You will be asked for that again at the airport. At the airport: once you go upstairs from check-in, there is a counter at your left. Go there, and get a stamp on your sticker (and show whatever documents they ask for). AND THEN you'll be all set to proceed to immigration and your flight. A bit of a hassle for people on H1B visas... but really not too bad (and you'll be guided along the way)... and hey... you might even get this cosy feeling that the Nepali government is watching out for you as you go toil in foreign lands :P