N-336 Form TOC

N-336_Form_TOC_07-21-2011.doc

Request for Hearing on a Decision in Naturalization Proceedings Under Section 336

N-336 Form TOC

OMB: 1615-0050

Document [doc]
Download: doc | pdf

FORM N-336

FORM TABLE OF CHANGES

OMB RIN 1615-0050

07-21-2011


LOCATION

CURRENT VERSION

PROPOSED VERSION

Top of the Form


Print or type all your answers fully and accurately in black ink. Write “N/A” if an item is not applicable. Write “None” if the answer is none. Failure to answer all of the questions may delay your Form N-336.

For USCIS Only

For USCIS Only


Decision:


Grant

[text box]


Denial

[text box]


Fee:

[text box]

For USCIS Only


DELETE


DELETE



DELETE



DELETE

First Page (similar to N-400)

[new section]

Bar Code

[text box]

First Page (similar to N-400)

[new section]

Date Stamp

[text box]

First Page (similar to N-400)

[new section]

Remarks

[text box]

For USCIS Only

First Page


[new section]

[inside Remarks Block]


Concur with Form N-400 Denial.


Do Not Concur with Form N-400 Denial.


1. In the Matter of:

1. In the Matter of:


(Name of Naturalization Applicant)

DELETE

File Number:

File Number:


A-

Your A-Number: [box next to Part 1. box]

A _ _ _-_ _ _-_ _ _

2. I am filing a request for hearing on the decision date:

2. I am filing a request for hearing on the decision date:

DELETE

3. Please check the one block that applies:

3. Please check the one block that applies:


a. I am not submitting a separate brief, statement, or evidence.

[text box]


b. I am submitting a separate brief, statement, and/or evidence with this form.

[text box]


c. I need _________days to submit a brief, statement, and/or evidence to the USCIS. (May be granted only for good cause show. Explain in a separate letter.)

[text box]


DELETE

4. Person filing request

4. Person filing request:


Name (Type or print in black ink.)


Address (Street Number and Name)


(Apt. Number)


(City)


(State)


(Zip Code)


Signature


Date (mm/dd/yyyy)


I am an attorney or representative and I represent the applicant requesting a hearing on a naturalization proceeding. [You must attach Form G-28, Notice of Entry of Appearance as Attorney or Representative, if you are an attorney or representative and did not previously submit such a form.]


(Person for whom you are appearing)

Part 1. Information About You, the Naturalization Applicant


1. Current Legal Name (do not provide a nickname)


Family Name (last name)

[text box]


Given Name (first name)

[text box]


Middle Name (if applicable)

[text box]


2. Date of Birth (mm/dd/yyyy)

[text box]


3. Home Address


Street Number and Name (do not write a P.O. Box in this space unless it is your ONLY address.)

[text box]


Apartment Number

[text box]


City

[text box]


County

[text box]


State

[text box]


ZIP Code

[text box]


Province (foreign address only)

[text box]


Country (foreign address only)

[text box]


Postal Code (foreign address only)

[text box]


4. Mailing Address


C/O (in care of name)

[text box]


Street Number and Name

[text box]


Apartment Number

[text box]


City

[text box]


State

[text box]


ZIP Code

[text box]


Province (foreign address only)

[text box]


Country (foreign address only)

[text box]


Postal Code (foreign address only)

[text box]


5. Daytime Phone Number [text box]


Work Phone Number (if any)

[text box]


Evening Phone Number

[text box]


Mobile Phone Number (if any)

[text box]


6. E-Mail Address (if any)

[text box]



[new section]

[new section]

Part 2. Information About Form N-400 (Application for Naturalization) for Which You Are Requesting a Hearing


1. Form N-400 Receipt Number

[text box]


2. Date of Form N-400 Denial Notice (mm/dd/yyyy)

[text box]


3. USCIS Office That Issued Form N-400 Denial Notice

[text box]



5. Briefly state the reason(s) for this request for a hearing:

5. Briefly state the reason(s) for this request for a hearing:


[text box]

Part 3. Reason You Are Requesting a Hearing


Provide the reason(s) you are requesting a hearing on your denied Form N-400. If extra space is needed to provide an explanation, attach an additional sheet(s) of paper. You must write your A-Number, date, the question number, and sign the top of each additional sheet(s).


NOTE: Refer to the Form N-336 Instructions, Page 1, Document Submission, for documents to submit with your Form N-336.


[large text box]


[new section]

Part 4. Accommodations for Individuals With Disabilities and/or Impairments


Are you requesting an accommodation for the Form N-336 hearing because of a disability and/or impairment? (see Part 4, Specific Form Instructions, in the Form N-336 instructions for some examples of accommodations)


[text box]

Yes

[text box]

No


If you checked “Yes,” check the box(es) below that applies:


[text box]

I am deaf or hearing impaired and need a sign language interpreter who uses the following language (e.g., American Sign Language (ASL)): ____________


[text box]

I use a wheelchair.


[text box]

I am blind or sight impaired.


[text box]

I will need another type of accommodation.

Explain: ___________

[new section]

[new section]

Part 5. Your Signature (USCIS will reject your Form N-336 if it is not signed.)


I certify, under penalty of perjury under the laws of the United States, that this request, and the evidence submitted with it, is all true and correct. I authorize the release of any information that U.S. Citizenship and Immigration Services needs to determine eligibility for naturalization.


Your Signature

[text box]


Date (mm/dd/yyyy)

[text box]


[new section]

[new section]

Part 6. Signature of Person Who Prepared This Form N-336 For You (if applicable)


I declare that I prepared Form N-336 at the request of the above person. The answers provided are based on information of which I have personal knowledge or were provided to me by the above-named person in response to the questions contained on this form.


Preparer’s Printed Name

[text box]


Preparer’s Signature

[text box]


Date (mm/dd/yyyy)

[text box]


Preparer’s Firm or Organization Name (if applicable)

[text box]


Preparer’s Daytime Phone Number

[text box]


Preparer’s Address


Street Number and Name

[text box]


City

[text box]


State

[text box]


ZIP Code

[text box]


Province (foreign address only)

[text box]


Country (foreign address only)

[text box]


Postal Code (foreign address only)

[text box]


Preparer’s E-Mail Address

[text box]


Preparer’s Fax Number

[text box]




7


File Typeapplication/msword
File TitleFORM N-336
Authoruser_template
Last Modified ByEvadne Hagigal
File Modified2011-12-09
File Created2011-12-09

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