Application for Replacement Naturalization/Citizenship Document

Instructions for Application for
Replacement Naturalization/Citizenship Document
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form N-565

OMB No. 1615-0091
Expires 02/28/2015

What Is the Purpose of Form N-565?
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:
1. Certificate of Naturalization;
2. Certificate of Citizenship;

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3. Declaration of Intention;

4. Repatriation Certificate; or

5. To apply for a special certificate of naturalization to be recognized as a U.S. citizen by a foreign country.

Who May File Form N-565?

You may apply for a replacement if:

1. You were issued a Certificate of Naturalization, Certificate of Citizenship, Declaration of Intention, or Repatriation
Certificate which was lost, stolen, destroyed, or mutilated;
2. You were issued a Certificate of Naturalization, Certificate of Citizenship, Declaration or Repatriation Certificate
which is incorrect due to typographical/clerical error by USCIS;
3. Your name was changed by marriage or by court order after the document was issued and you seek a document in
your new name;
4. You received your Certificate of Citizenship and afterwards you obtained a court order or a state-issued document that
changes your date of birth and you seek a certificate with the new date of birth;
5. You were issued a Certificate of Citizenship or a Certificate of Naturalization and your change of gender is legally
recognized through a court order, a government-issued document, or a medical certification; or
6. You are a naturalized citizen seeking a special certificate of naturalization for the purpose of a foreign country
recognizing you as a citizen of the United States.
USCIS will not change a name without evidence such as a marriage certificate, divorce decree, or court order. We will
not change a date of birth on a Certificate of Citizenship without documentation such as a U.S. court order or state-issued
documents.
NOTE: USCIS cannot make any changes to an incorrect date of birth on a Naturalization Certificate if you reported an
incorrect date on your Form N-400, Application for Naturalization, and then later swore to the facts of your application by
signing Part 15. Signature at Interview.

General Instructions
USCIS provides forms free of charge through the USCIS Web site. In order to view, print, or fill out our forms, you
should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you
do not have Internet access, you may call the USCIS National Customer Service Center at 1-800-375-5283 and ask that
we mail a form to you. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

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Signature. Each application must be properly signed and filed. For all signatures on this application, USCIS will not
accept a stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal
guardian may sign the application on your behalf. A legal guardian may also sign for a mentally incompetent person.
Filing Fee. Each application must be accompanied by the appropriate filing fee. (See the What Is the Filing Fee
section of these Instructions.)
Evidence. At the time of filing, you must submit all evidence and supporting documentation listed in the Initial
Evidence section of these Instructions. For additional information, see the USCIS Policy Manual, Volume 12, Part K,
Certificates of Citizenship and Naturalization at www.uscis.gov/policymanual.
Biometric Services Fee. If you file this application with USCIS, you do not need to include a biometric services fee at
the time you submit it. If you are later notified that you must submit biometrics, you will receive a biometric services
appointment notice with instructions on how to submit the additional biometric services fee. If you file this application
with an agency other than USCIS, please check with that agency to determine if and when you must submit biometric
services fees.

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Acknowledgement of Appointment at USCIS Application Support Center (ASC). Review the ASC
Acknowledgement that appears in Part 9. of the application. The purpose of this ASC Acknowledgement is to confirm
that you have completed your application, reviewed your responses, and affirmed that the information was provided by
you and is complete, true, and correct. If someone helped you fill out your application, that person must review the ASC
Acknowledgement with you to make sure you understand it.
Copies. You may submit legible photocopies of documents requested, unless the instructions specifically state that you
must submit an original document. USCIS may request an original document at the time of filing or at any time during
processing of an application, petition, or request. If you submit original documents when not required, the documents
may remain a part of the record, and USCIS will not automatically return them to you.
Translations.  If you submit a document with information in a foreign language, you must also submit a full English
translation. The translator must sign a certification that the English language translation is complete and accurate, and
that he or she is competent to translate from the foreign language into English.
How to Fill Out Form N-565
1. Type or print legibly in black ink.
2. If you need extra space to complete any item within this application, attach a separate sheet of paper; type or print
your name and Alien Registration Number (A-Number) (if any) at the top of each sheet; indicate the Page Number,
Part Number, and Item Number to which your answer refers; and sign and date each sheet.
3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been
married and the question asks “Provide the name of your current spouse”), type or print “N/A,” unless otherwise
directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many
children do you have” or “How many times have you departed the United States”), type or print “None,” unless
otherwise directed.

Initial Evidence
1. Photographs. You must submit two identical color photographs of yourself taken within 30 days of filing 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 headwear as required by a religious denomination of which you are a member. Using a pencil or felt pen,
lightly print your name and A-Number (if any) on the back of the photo.
2. If you are applying for replacement of a mutilated document, you must attach the mutilated document.

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3. If you are applying for replacement of a document that is incorrect due to typographical/clerical errors by USCIS, you
must attach the incorrect document, complete Part 4.
4. If you are applying for a new document because your name was changed, you must submit the original USCIS
document and a copy of the marriage certificate or a certified copy of the complete document (such as a marriage
certificate or certified copy of a court order, amended birth certificate, or amended passport) showing the name change,
complete Part 5.

5. If you are applying for a new Certificate of Citizenship because your date of birth has legally changed, you must
submit the original USCIS document and the state-issued document or a certified copy of the complete document
(court order) showing the date of birth change, complete Part 6. State-issued documents may include birth certificate,
certificate recognizing the foreign birth, certificate of birth abroad, or other similar state vital record issued by the
child’s state of residence. Only applicants applying for a new Certificate of Citizenship may select this option.

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6. If you are applying for a new document because your gender has legally changed, you must submit the original
USCIS document and a certified copy of the complete document (court order, government-issued document, or a
medical certification) recognizing the gender change, complete Part 7. Government documentation may include
an amended birth certificate, or foreign, state, or local justification documentation recognizing the gender such as a
passport or driver’s license. A licensed physician (Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) must
provide the certification and the certificate must include the following information:
A. Physician’s full name, address, and phone number;

B. Physician’s medical license or certificate (including number and issuing state);

C. Physician’s Drug Enforcement Administration registration number or comparable foreign registration number (if
applicable);
D. Language stating that the individual has had appropriate clinical treatment for gender transition to the new gender
(male or female); and
E. Language stating you have a doctor-patient relationship with the certifying physician and that he or she has treated
you in relation to your change in gender or has reviewed and evaluated your medical history in relation to your
change in gender.
NOTE: Statements from persons who are not licensed physicians, such as psychologists, physician assistants, nurse
practitioners, social workers, health practitioners, chiropractors, are not acceptable. Visit www.uscis.gov/N-565 for
additional information.
7. If you are applying for a special certificate of naturalization to obtain recognition as a citizen of the United States by a
foreign country, you must attach a copy of your naturalization certificate.
NOTE: USCIS regulations require this special certificate when a foreign state requires proof of your citizenship for
any legitimate purpose, except for admission to the foreign country or in processing their own immigration benefit
requests. (Regulation is 8 CFR 343b.2.)
8. If your marital status has changed since you were last issued a document, you must submit your most recent marriage
certificate, divorce decree, or spouse’s death certificate.

Specific Instructions
Part 9. Applicant’s Statement, Contact Information, Acknowledgement of Appointment at USCIS Application
Support Center, Certification, and Signature
Item Numbers 1. - 6. Select the appropriate box to indicate that you either read this application yourself or someone
interpreted this application for you from English to a language in which you are fluent. If applicable, select the box to
indicate if someone prepared this application for you. You must also affirm that you have read and understand or that an
interpreter or preparer read to you, and you understand the Acknowledgement of Appointment at USCIS Application
Support Center in Part 9. Further, you must sign and date your application and provide your daytime telephone
number, mobile telephone number (if any), and email address (if any). Every application MUST contain the signature
of the applicant (or parent or legal guardian, if applicable). A stamped or typewritten name in place of a signature is not
acceptable.
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Part 10. Interpreter’s Contact Information, Certification, and Signature
Item Numbers 1. - 6. If you used anyone as an interpreter to read the Instructions and questions on this application to
you in a language in which you are fluent, the interpreter must fill out this section, provide his or her name, the name and
address of his or her business or organization (if any), his or her daytime telephone number, and his or her email address
(if any). The interpreter must also certify that he or she has read the Acknowledgement of Appointment at USCIS
Application Support Center in Part 9. to you in the same language in which you are fluent. The interpreter must sign
and date the application.
Part 11. Contact Information, Statement, Certification, and Signature of the Person Preparing this Application, If
Other Than the Applicant
Item Numbers 1. - 8. This section must contain the signature of the person who completed your application, if other than
you, the applicant. If the same individual acted as your interpreter and your preparer, that person should complete both
Part 10. and Part 11. If the person who completed this application is associated with a business or organization, that
person should complete the business or organization name and address information. Anyone who helped you prepare this
application MUST sign and date the application. A stamped or typewritten name in place of a signature is not acceptable.
Anyone who helped you prepare your application must also certify that he or she has read the Acknowledgement
of Appointment at USCIS Application Support Center in Part 9. to you, and that you informed him or her that
you understood the ASC Acknowledgement. If the person who helped you prepare your application is an attorney or
accredited representative, he or she must also submit a completed Form G-28, Notice of Entry of Appearance as Attorney
or Accredited Representative, along with your application.

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We recommend that you print or save a copy of your completed application to review in the future and for
your records. We recommend that you review your copy of you completed application before you come to
your biometric services appointment at a USCIS ASC. At your appointment, USCIS will permit you to complete
the application process only if you are able to confirm, under penalty of perjury, that all of the information in your
application is complete, true, and correct. If you are not able to make that attestation in good faith at that time,
USCIS will require you to return for another appointment.

What Is the Filing Fee?

The filing fee for Form N-565 is $345.

NOTE: There is no fee required if you select Item C. in Item Number 1. of Part 2. of the application.
Visit www.uscis.gov/N-565 for current and additional filing fee information.
NOTE: The filing fee is not refundable, regardless of any action USCIS takes on this application. DO NOT MAIL
CASH. You must submit all fees in the exact amounts.
Use the following guidelines when you prepare your check or money order for the Form N-565 filing 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.
NOTE: Spell out U.S. Department of Homeland Security; do not use the initials “USDHS” or “DHS.”
Notice to Those Making Payment by Check. If you send us a check, USCIS will convert it into an electronic funds
transfer (EFT). This means we will copy your check and use the account information on it to electronically debit your
account for the amount of the check. The debit from your account will usually take 24 hours and your bank will show it
on your regular account statement.
You will not receive your original check back. We will destroy your original check, but will keep a copy of it. If USCIS
cannot process the EFT for technical reasons, you authorize us to process the copy in place of your original check. If
USCIS cannot complete the EFT because of insufficient funds, we may try to make the transfer two additional times.

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How to Check If the Fees Are Correct
Form N-565 fee is current as of edition date in the lower right corner of this page. However, because USCIS fees change
periodically, you can verify that the fees are correct by following one of the steps below.
1. Visit the USCIS Web site at www.uscis.gov, select “FORMS,” and check the appropriate fee; or
2. Call the USCIS National Customer Service Center at 1-800-375-5283 and ask for fee information. For TTY (deaf or
hard of hearing) call: 1-800-767-1833.
Fee Waiver
You may be eligible for a fee waiver under 8 CFR 103.7(c). If you believe you are eligible for a fee waiver, complete
Form I-912, Request for Fee Waiver (or a written request) and submit it and any required evidence of your inability to pay
the filing fee with this application. You can review the fee waiver guidance at www.uscis.gov/feewaiver.

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Where to File?

Please see our Web site at www.uscis.gov/N-565 or call our National Customer Service Center at 1-800-375-5283 for the
most current information about where to file this application. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Processing Information

Rejection. USCIS will reject any application that is not signed or accompanied by the correct fee and will send you a
notice that the application is deficient. You may correct the deficiency and resubmit the application. An application is not
considered properly filed until the date that USCIS accepts it.
Initial Processing. Once USCIS accepts your application, we will check it for completeness. If you do not completely
fill out this application, you will not establish a basis for your eligibility and USCIS may reject or deny your application.
Requests for More Information. We may request that you provide more information or evidence to support your
application. We may also request that you provide the originals of any copies you submit. USCIS will return any
requested originals when they are no longer needed.
Decision. If you establish eligibility for the document, USCIS will approve your application and issue the document.
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, USCIS will notify you in writing of the reasons for the denial.

USCIS Forms and Information
To ensure you are using the latest version of this application, visit the USCIS Web site at www.uscis.gov where you can
obtain the latest USCIS forms and immigration-related information. If you do not have Internet access, you may order
USCIS forms by calling our toll-free number at 1-800-870-3676.  You may also obtain forms and information by calling
the USCIS National Customer Service Center at 1-800-375-5283. For TTY (deaf or hard of hearing) call:
1-800-767-1833.
Instead of waiting in line for assistance at your local USCIS office, you can now schedule an appointment through our
online system, InfoPass, at infopass.uscis.gov. 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.

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Penalties
If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form N-565, we
will deny your Form N-565 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 application, and the associated evidence, is collected pursuant to
Immigration and Nationality Act sections 333, 341, 343 (codified as amended at 8 U.S.C. sections 1444, 1452, 1454) and
8 CFR sections 338.5, 343a.1.

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PURPOSE: The primary purpose for providing the requested information on this application is to request a replacement
of your Declaration of Intention, Certificate of Naturalization, Certificate of Citizenship, Repatriation Certificate, or to
apply for a special certificate of naturalization as a U.S. citizen for recognition by a foreign country. The information you
provide is used to provide a replacement certificate if you are determined eligible.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, and
any requested evidence, may delay a final decision in your case or result in denial of your application.
ROUTINE USES: The Department of Homeland Security (DHS) may share the information you provide on this
application with other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows
approved routine uses described in the associated published system of records notices [DHS-USCIS-007 - Benefits
Information System and DHS-USCIS-001 - Alien File, Index, and National File Tracking System of Records] which you
can find at www.dhs.gov/privacy. DHS may also share the information, as appropriate, for law enforcement purposes or
in the interest of national security.

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 in paper format, including the time for reviewing instructions,
gathering the required documentation and information, completing the application, attaching necessary documentation,
and submitting the application. 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
Coordination Division, Office of Policy and Strategy, 20 Massachusetts Ave NW, Washington, DC 20529-2140; OMB No.
1615-0091. Do not mail your completed Form N-565 to this address.

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