Application for Replacement Naturalization/Citizenship Document

OMB No. 1615-0091; Expires 04/30/2010

Department of Homeland Security
U.S. Citizenship and Immigration Services

Instructions for Form N-565, Application for
Replacement Naturalization/Citizenship Document
Instructions

Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet(s) of paper. Write your name and Alien Registration Number (A #), if any, at the top of each sheet of paper and
indicate the section and number of the item to which the answer refers.

What Is the Purpose of This Form?
Form N-565, Application for Replacement Naturalization/
Citizenship Document, is used to apply to U.S. Citizenship
and Immigration Services (USCIS) for a replacement of:
1. Declaration of Intention;
2. Certificate of Naturalization;
3. Certificate of Citizenship;
4. Repatriation Certificate; or
5. To apply for a special certificate of naturalization as a
U.S. citizen to be recognized by a foreign country.

Who May File Form N-565?
You may apply for a replacement:
1. If you have been issued a Certificate of Naturalization,
Certificate of Citizenship, Declaration of Intention or
Repatriation Certificate which has been lost, mutilated,
or destroyed;
2. If your name has been changed by marriage or by court
order after the document was issued and you seek a
document in the new name; or
3. If you are a naturalized citizen desiring to obtain
recognition as a citizen of the United States by a foreign
country, you may apply for a special certificate for that
purpose.

General Instructions.
Step 1. Fill Out the Form N-565.

3. If you are applying for a special certificate of
naturalization, you must attach a copy of your
naturalization certificate.

Copies. Unless specifically required that an original

document be filed with an application or petition, an ordinary
legible photocopy may be submitted. Original documents
submitted when not required will remain a part of the record,
even if the submission was not required.
Translations. Any document containing a foreign language
submitted toUSCIS shall be accompanied by a full English
language translation which the translator has certified as
complete and accurate, and by the translator's certification that
he or she is competent to translate from the foreign language
into English.

Photographs.
You must submit two identical color photographs of yourself
taken within 30 days of the filing of this application. The
photos must have a white to off-white background, be printed
on thin paper with a glossy finish, and be unmounted and
unretouched.
Passport-style photos must be 2" x 2." The photos must be in
color with full face, frontal view on a white to off-white
background. Head height should measure 1" to 1 3/8" from
top of hair to bottom of chin, and eye height is between 1 1/8"
to 1 3/8" from bottom of photo. Your head must be bare
unless you are wearing a headdress as required by a religious
order of which you are a member. Using pencil or felt pen,
lightly print your name and Alien Registration Number on the
back of the photo.

1. Type or print legibly in black ink.
2. If extra space is needed to complete any item, attach a
continuation sheet, indicate the item number, and date and
sign each sheet.
3. Answer all questions fully and accurately. State that an
item is not applicable with "N/A." If the answer is none,
write "none."

Step 2. Initial Evidence Requirements.

1. If you are applying for replacement of a mutilated
document, you must attach the mutilated document.
2. If you are applying for a new document because your name
has been changed, you must submit the original USCIS (or
former INS) document and a copy of the marriage certificate
or court order showing the name change.

Where to File?
If you reside in AL, AR, CT, DE, DC, FL, GA, KY, LA,
MS, ME, MD, MA, NH, NJ, NM, NY, NC, SC, OK, PA,
PR, RI, TN, TX, VA, VI, VT, WV
Submit your N-565 to the Texas Service Center at:
DHS/USCIS
Texas Service Center
PO Box 851182
Mesquite, TX 75185-1182
Form N-565 Instructions (Rev. 02/18/2010)Y

If you reside in AK, AZ, CA, CO, GU, HI, ID, IL, IN, IA,
KS, MI, MN, MO, MT, NE, NV, ND, OH, OR, SD, UT,
WA, WI, WY
submit your N-565 to the Nebraska Service Center at:
DHS/USCIS
Nebraska Service Center
PO Box 87565
Lincoln, NE 68501-7565

What Is the Filing Fee?
The filing fee Form N-565 is $380.00, except there is no fee if
you check block 2 (d) of Part 2 of the form.
You may submit one check or money order for both the
application and other documents you are applying for.
Use the following guidelines when you prepare your check or
money order for the Form N-565 fee:
1. The check or money order must be drawn on a bank or
other financial institution located in the United States
and must be payable in U.S. currency; and
2. Make the check or money order payable to U.S.
Department of Homeland Security, unless:
A. If you live in Guam and are filing your application
there, make it payable to Treasurer, Guam.
B. If you live in the U.S. Virgin Islands and are filing
your application there, make it payable to
Commissioner of Finance of the Virgin Islands.
C. If you live outside the United States, Guam, or the
U.S. Virgin Islands, contact the nearest U.S.
consulate or embassy for instructions on the
method of payment.
NOTE: Please spell out U.S. Department of Homeland
Security; do not use the initials "USDHS" or "DHS."

How to Check If the Fees Are Correct.
The form fee for this form is current as of the edition date
appearing in the lower right corner of this page. However,
because USCIS fees change periodically, you can verify if the
fees are correct by following one of the steps below:
1. Visit our Web site at www.uscis.gov, select "Check
Filing Fees" to check the appropriate fee;
2. Review the Fee Schedule included in your form
package, if you called us to request the form; or
3. Telephone our National Customer Service Center at
1-800-375-5283 and ask for the fee information.

NOTE: If your Form N-565 requires payment of a biometric
service fee for USCIS to take your fingerprints, photograph
or signature, you can use the same procedure to obtain the
correct biometric fee.

Processing Information.
Rejection. Any application that is not signed or not
accompanied by the correct fee will be rejected with a notice
that the application is deficient. You may correct the
deficiency and resubmit the application. However, an
application is not considered properly filed until accepted by
USCIS.
Initial processing. Once the application has been accepted, it
will be checked for completeness, including submission of
the required initial evidence. If you do not completely fill out
the form, or file it without required initial evidence, you will
not establish a basis for eligibility and we may deny your
application.
Requests for more information or interview. We may
request more information or evidence or we may request that
you appear at a USCIS office for an interview. We may also
request that you submit the originals of any document. We
will return these originals when they are no longer required.
Decision. If you establish eligibility for the document, your
application will be approved and the document issued. Where
appropriate, a special certificate of naturalization will be
forwarded to the U.S. Department of State for delivery to a
foreign government official. If your application is denied, you
will be notified in writing of the reasons for the denial.

USCIS Forms and Information.
To order USCIS forms, call our toll-free number at
1-800-870-3676. You can also get USCIS forms and
information on immigration laws, regulations and procedures
by telephoning our National Customer Service Center at
1-800-375-5283 or visiting our internet Web site at www.
uscis.gov.
As an altenative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
our internet-based system, InfoPass. To access the system,
visit our website. Use the InfoPass appointment scheduler
and follow the screen prompts to set up your appointment.
InfoPass generates an electronic appointment notice that
appears on the screen.

Penalties.
If you knowingly and willfully falsify or conceal a material
fact or submit a false document with this request, we will
deny the benefit you are filing for, and may deny any other
immigration benefit.
Form N-565 Instructions (Rev. 02/18/2010)Y Page 2

In addition, you will face severe penalties provided by law,
and may be subject to criminal prosecution.

Privacy Act Notice.
We ask for the information on Form N-565, and associated
evidence, to determine if you have established eligibility for
the immigration benefit for which you are filing. Our legal
right to ask for this information can be found in the
Immigration and Nationality Act, as amended. We may
provide this information to other government agencies. Failure
to provide this information, and any requested evidence, may
delay a final decision or result in denial of your Form N-565.

Paperwork Reduction Act.
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a currently valid
OMB control number. The public reporting burden for this
collection of information is estimated at 55 minutes per
response, including the time for reviewing instructions,
completing and submitting the form. Send comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing
this burden, to: U.S. Citizenship and Immigration Services,
Regulatory Products Division, 111 Massachusetts Avenue, N.
W., 3rd Floor, Suite 3008, Washington, DC 20529. OMB No.
1615-0091. Do not mail your application to this address.

Form N-565 Instructions (Rev. 02/18/2010)Y Page 3