Application for Replacement Naturalization/Citizenship Document

OMB No. 1615-0091
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 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?

General Instructions

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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 a:

Step 1. Fill Out the Form N-565.

1. Declaration of Intention;

2. If extra space is needed to complete any item, attach a
continuation sheet, indicate the item number, and date and
sign each sheet.

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.
NOTE: USCIS has no legal basis to change a name absent a
legal document such as a marriage certificate, divorce decree,
or a court ordered name change. In addition, USCIS is
prohibited from making any changes to an incorrect date of
birth if one has completed the naturalization/citizenship
process and sworn to the facts, including the wrong date of
birth.

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.

1. Type or print legibly in black ink.

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
document and a copy of the marriage certificate or court
order showing the name change.
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 to USCIS 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.

Form N-565 Instructions (Rev. 06/09/11) Y

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
denomination of which you are a member. However, your face
must be visible. Using pencil or felt pen, lightly print your
name and Alien Registration Number on the back of the photo.

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.
3. 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.

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Where to File?

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:

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

1. Visit our Web site at www.uscis.gov, select "Check Filing
Fees" to check the appropriate fee;

Submit your N-565 to the USCIS Texas Service Center at:

2. Review the Fee Schedule included in your form package, if
you called us to request the form; or

DHS/USCIS
Texas Service Center
PO Box 851182
Mesquite, TX 75185-1182

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 USCIS 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 $345, 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 the application
and other documents for which you are applying.

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 biometrics
services fee for USCIS to take your fingerprints, photograph
or signature, you can use the same procedure to obtain the
correct biometrics 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.

Form N-565 Instructions (Rev. 06/09/11) Y Page 2

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.

DISCLOSURE: The information you provide is voluntary.
However, failure to provide the requested information, and
any requested evidence, may delay a final decision or result in
denial of your form.
ROUTINE USES: The information you provide on this form
may be shared with other Federal, State, local, and foreign
government agencies and authorized organizations following
approved routine uses described in the associated published
system of records notices [DHS-USCIS-007 - Benefits
Information System and DHS-USCIS-001 - Alien File (AFile) and Central Index System (CIS), which can be found at
www.dhs.gov/privacy]. The information may also be made
available, as appropriate, for law enforcement purposes or in
the interest of national security.

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USCIS Forms and Information

You can get USCIS forms and immigration-related
information on the USCIS Web site at www.uscis.gov. You
may order USCIS forms by calling the USCIS toll-free
number at 1-800-870-3676. You may also obtain forms and
information by telephoning the USCIS National Customer
Service Center at 1-800-375-5283.

As an alternative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
the USCIS Internet-based system, InfoPass. To access the
system, visit the USCIS 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.

Penalties

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, Office of the Executive
Secretariat, 20 Massachusetts Avenue, N.W., Washington, DC
20529-2020. OMB No. 1615-0091. The form expires May 31,
2011. Do not mail your application to this address.

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

USCIS Privacy Act Statement
AUTHORITIES: The information requested on this form,
and the associated evidence, is collected under the
Immigration and Nationality Act, section 101, et seq.
PURPOSE: The primary purpose for providing the requested
information on this form is to determine if you have
established eligibility for the immigration benefit for which
you are filing. The information you provide will be used to
grant or deny the benefit sought.
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