Form N-648, Medical Certification for Disability Exceptions
Form Table of Change
OMB RIN 1615-0060
April 15, 2011
Page Number |
Current Version |
Proposed Version |
Page 2, Part III, INFORMATION ABOUT DISABILITY and/or IMPAIRMENT(S) |
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; e.g., “DSM-IV 318.0 Down syndrome.” |
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; e.g., “DSM-IV 318.0 Down syndrome”. If you cannot provide a DSM IV code, write “N/A” and explain why you cannot provide a DSM IV code. |
Page 5, Medical Professional’s Certification
|
[new language] |
All medical professionals must complete the certifications below.
[place above I certify that this applicant’s identity and below the solid line] |
| File Type | application/msword |
| File Title | Form N-648, Medical Certification for Disability Exceptions |
| Author | Gina Short |
| Last Modified By | Evadne Hagigal |
| File Modified | 2011-04-15 |
| File Created | 2011-04-15 |