Medical Certification for Disability Exceptions

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

OMB No. 1615-0060; Expires 10/31/10

DRAFT

Instructions for Form N-648, Medical
Certification for Disability Exceptions

Instructions

Please read these instructions carefully to properly complete this form. If you need more space to complete an answer, use a
separate sheet of paper. Write the applicant's name and Alien Registration Number (A-Number), at the top of each sheet of
paper and indicate the part and number of the item to which the answer refers. You must sign and date each continuation
sheet.

What Is the Purpose of This Form?
In general, applicants for naturalization must demonstrate an
understanding of the English language, including an ability to
read, write, and speak words in ordinary usage. They must
also demonstrate a knowledge and understanding of the
fundamentals of the history and principles and form of
government of the United States. Together, these are known
as the English and civics requirements for naturalization.
This form is intended for applicants who seek an exception to
the English and civics requirements due to a physical or
developmental disability or mental impairment that has
lasted, or is expected to last, 12 months or more.

Who Should Submit This Form and When?
An applicant for naturalization seeking an exception to the
English and civics requirements because of a physical or
developmental disability or mental impairment(s) should
submit this form at the time he or she files an N-400,
Application for Naturalization, with USCIS. Per Immigration
and Nationality Act (INA) 312(b)(1), applicants are not
required to fulfill the English and civics requirements if the
person is unable to do so because of physical or
developmental disability or mental impairment(s).
Note: Failure to submit Form N-648 with Form N-400
may delay the time for the adjudication of Form N-400.

Who Should Not Submit This Form?
An applicant who can satisfy the English and civics
requirements with reasonable accommodations provided
under the Rehabilitation Act of 1973 does not need to submit
this form. Reasonable accommodations include, but are not
limited to, sign language interpreters, extended time for
testing and off-site testing. An applicant requesting an
accommodation should so indicate on Part 3 of his or her
completed Form N-400. Illiteracy alone is not a valid reason
to seek an exception to the English and civics requirement
by submitting this form.

Who Is Authorized to Certify This Form?
Only medical doctors, doctors of osteopathy, or clinical
psychologists licensed to practice in the United States
(including the U.S. territories of Guam, Puerto Rico, and the
Virgin Islands) are authorized to certify the form. While staff
of the medical practice associated with the medical
professional certifying the form may assist in its completion,
the medical professional is responsible for the accuracy of the
form's content.

How to Complete This Form?
All parts of Form N-648 except the "Applicant Attestation"
and "INTERPRETER'S CERTIFICATION", must be certified
by a licensed medical professional. Before certifying Form
N-648, the medical professional must have conducted an inperson examination of the applicant.
All questions or items must be answered fully and accurately.
USCIS will not accept an incomplete Form N-648. Responses
should use common terminology, without abbreviations, that a
person without medical training can understand. If completed
in writing, all responses must be legible and appear in blue or
black ink. USCIS recommends that the certifying medical
professional use the electronic Form N-648 located in the
"FORMS" section at www.uscis.gov.
Failure to provide all information requested on the form may
result in USCIS determination that the form is insufficient. In
addition to providing a detailed assessment of the applicant's
physical or developmental disability or mental impairment as
requested on the form, a medical professional completing the
form may attach supporting medical diagnostic reports or
records. However, these attachments may not take the place
of written responses to each question or item on Form N-648.
The following are examples of sufficient responses to some of
the items on Part III of Form N-648:
1. Provide the clinical diagnosis, and DSM IV code (If
applicable) of the applicant's disability and/or
impairment(s), that form the basis for seeking an
exception to the English and/or civics requirements.
"DSM-IV 318.0, Down syndrome."

Form N-648 Instructions (Rev. 04/16/10) Y

2. Provide a basic description of the disability and/or
impairment(s).
"Down syndrome is a genetic disorder that causes lifelong
intellectual disability (also referred to as mental
retardation), developmental delays, and other problems."
8. What caused the applicant's medical disability and/or
impairment(s) listed in number 3?
"Down syndrome is usually caused by an error in cell
division occurring in utero. The cause of such errors in cell
division is currently unknown."
9. What clinical methods did you use to diagnose the
applicant's medical disability and/or impairment(s)
listed in number 3?
"The patient was diagnosed in utero through a Chorionic
Villus Sampling (CVS). CVS is a test done during early
pregnancy that can identify certain genetic disorders or
chromosomal birth defects, such as Down syndrome."
10. Clearly describe how the applicant's disability and/or
impairment(s), affect his or her ability to demonstrate
a knowledge and understanding of English and/or
civics.
"The patient's condition is a global, lifelong impairment that
severely affects cognition, language, and motor skills. While
many individuals with mild to moderate forms of Down
syndrome are capable of daily tasks and working in the
community, this patient suffers from a particularly severe
form. Because of this impairment, his memory is deficient, he
cannot learn new skills, and he is not capable of reasoning but
only of performing simple daily activities. The patient's severe
intellectual disability (mental retardation) makes him incapable
of learning a new language (even basic words) and
demonstrating the required knowledge of U.S. history and
government."

What Are the Penalties for Making False
Representations?
Both the applicant and the medical professional are required to
attest to the contents of this form under penalty of perjury.
Title 18, United States Code, Section 1546, provides that:

Whoever knowingly makes under oath, or as permitted under
penalty of perjury under Section 1746 of Title 28, United
States Code, knowingly subscribes as true, any false statement
with respect to a material fact in any application, affidavit, or
other document required by the immigration laws or
regulations prescribed thereunder, or knowingly presents any
such application, affidavit, or other document containing any
such false statement, shall be fined in accordance with this
title or imprisoned not more than 10 years, or both.
If either the applicant or the medical professional includes in
this form any information that the party knows to be false, that
person may be liable for criminal prosecution under U.S. laws.
In addition to the criminal penalties under Title 18 of the
United States Code, Section 274C of the Immigration and
Nationality Act and 8 U.S.C. 1324c provides for civil
penalties.

General Instructions
USCIS recommends that the certifying medical
professional complete and print the fillable electronic
Form N-648 located in the "FORMS" section at www.
uscis.gov.
1. Type or print clearly using blue or black ink. Keep all
information within the area provided. If you require
additional space to complete the answer to any item, the
information fields in the fillable electronic form will
expand to accommodate the additional information. If you
are not completing an electronic version of the form and
you continue to need extra space to complete any item,
write the applicant's name and Alien Registration
Number (A-Number) at the top of each continuation sheet
and indicate the part and number of the item to which the
answer refers. You must sign and date each continuation
sheet.
2. All questions must be answered fully and accurately. If an
item is not applicable, indicate it with "N/A." If the
answer is none, write "None."
3. The medical professional must provide the completed form
to the applicant.

Form N-648 Instructions (Rev. 04/16/10) Y Page 2

DRAFT
Privacy Act Notice
Authority for the collection of the information requested on
this form is contained in 8 U.S.C. 1103, 1423, and 1427.
USCIS will use the information principally to support an
individual's application for naturalization. Submission of the
information is voluntary. However, failure to provide the
necessary information may result in the denial of a request for
a waiver of the English language and U.S. history and civic
requirements for naturalization. USCIS may also, as a matter
of routine use, set forth in USCIS System of Records Notices
published in the Federal Register, disclose the information
collected on this form, to other Federal, State, local, and
foreign law enforcement and regulatory agencies.

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 alternative 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 Web site. 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.

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 120 minutes per
response, including the time for reviewing instructions and
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 20529-2210.
OMB No. 1615-0060. Do not mail your application to this
address.

Form N-648 Instructions (Rev. 04/16/10) Y Page 3