N-336 Form TOC

TABLE OF CHANGES – FORM

Form N-336, Request for a Hearing on a Decision in Naturalization

OMB Number: 1615-0050

04/20/2016

Reason for Revision: Updates to standard language, update to ELIS collection field

Current Page Number and Section	Current Text	Proposed Text
	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.	[Page 1] START HERE - Type or print in black ink. NOTE: Type or Print "N/A" if an item is not applicable. Type or Print "None" if the answer is none. Failure to answer all of the questions may delay your Form N-336.
Page 1, Part 1. Information About You, the Naturalization Applicant	Part 1. Information About You, the Naturalization Applicant 1. Current Legal Name (do not provide a nickname) Family Name (Last Name) Given Name (First Name) Middle Name 2. Date of Birth (mm/dd/yyyy) 3. Home Address Street Number and Name (do not provide a P.O. Box in this space unless it is your only address) Apartment Number City State ZIP Code Province (foreign address only) Postal Code (foreign address only) Country (foreign address only) 4. Mailing Address C/O (in care of name) Street Number and Name Apartment Number City State ZIP Code Province (foreign address only) Postal Code (foreign address only) Country (foreign address only)	[Page 1] Part 1. Information About You, the Naturalization Applicant Enter Your 9 Digit A-Number: 1. Current Legal Name (do not provide a nickname) Family Name (Last Name) Given Name (First Name) Middle Name 2. Other Names Used (if any) List all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 9. Additional Information. Family Name (Last Name) Given Name (First Name) Middle Name 3. Date of Birth (mm/dd/yyyy) 4. USCIS Online Account Number (if any) 5. Physical Address (do not provide a PO Box in this space unless it is your only address) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code + 4 Province (foreign address only) Postal Code (foreign address only) Country (foreign address only) [Page 2] 6. Mailing Address In Care Of Name (if any) Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code + 4 Province (foreign address only) Postal Code (foreign address only) Country (foreign address only) 7. Contact Information A. Daytime Telephone Number B. Work Telephone Number (if any) C. Evening Telephone Number D. Mobile Telephone Number (if any) E. Email Address (if any)
Page 2, Part 2. Information About Form N-400 (Application for Naturalization) Denial On Which You Are Requesting a Hearing	Part 2. Information About Form N-400 (Application for Naturalization) Denial On Which You Are Requesting a Hearing 1. Form N-400 Receipt Number 2. Date of Form N-400 Denial Notice (mm/dd/yyyy) 3. USCIS Office That Issued Form N-400 Denial Notice	[Page 2] Part 2. Information About Form N-400 Denial On Which You (the Naturalization Applicant) Are Requesting a Hearing [No Change]
[NEW]		[Page 2] Part 3. Biographic Information 1. Ethnicity (Select only one box) Hispanic or Latino Not Hispanic or Latino 2. Race (Select all applicable boxes) White Asian Black or African American American Indian or Alaska Native Native Hawaiian or Other Pacific Islander 3. Height Feet Inches 4. Weight Pounds 5. Eye Color (Select only one box) Black Blue Brown Gray Green Hazel Maroon Pink Unknown/Other 6. Hair Color (Select only one box) Bald (No hair) Black Blond Brown Gray Red Sandy White Unknown/Other
Page 2, Part 3. Reason You Are Requesting a Hearing	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, the date, the question number, and sign the top of each additional sheet(s). NOTE: Refer to Form N-336 Instructions, Page 1, Document Submission, for documents to submit with your Form N-336.	[Page 3] Part 4. Reason You Are Requesting a Hearing Provide the reasons you are requesting a hearing on your denied Form N-400. If you need extra space to complete this section, use the space provided in Part 9. Additional Information. NOTE: Refer to the What Evidence Must You Submit section of Form N-336 Instructions for documents to submit with your Form N-336.
Page 3, Part 4. Accommodations for Individuals With Disabilities and/or Impairments	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) If you checked "Yes," check the box(es) below that apply: I am deaf or hearing impaired and need a sign language interpreter who uses the following language (e.g., American Sign Language (ASL)): I use a wheelchair. I am blind or sight-impaired. I will need another type of accommodation. Explain:	[Page 4] Part 5.  Accommodations for Individuals With Disabilities and/or Impairments NOTE: Read the information in the Form N-336 Instructions before completing this part. Are you requesting an accommodation because of your disabilities and/or impairments? If you answered "Yes" to Item Number 1., select any applicable box. A. I am deaf or hard of hearing and request the following accommodation. (If you are requesting a sign-language interpreter, indicate for which language (for example, American Sign Language).) [Deleted] B. I am blind or have low vision and request the following accommodation: C. I have another type of disability and/or impairment. (Describe the nature of your disability and/or impairment and the accommodation you are requesting.)
Page 3, Part 5. Your Signature (USCIS will reject your Form N-336 if it is not signed.)	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 Date (mm/dd/yyyy)	[Page 4] Part 6. Naturalization Applicant's Statement, Contact Information, Certification, and Signature NOTE: Read the Penalties section of the Form N-336 Instructions before completing this part. Naturalization Applicant's Statement NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. 1. Naturalization Applicant's Statement Regarding the Interpreter A. I can read and understand English, and I have read and understand every question and instruction on this request and my answer to every question. B. The interpreter named in Part 7. read to me every question and instruction on this request and my answer to every question in ___________________________________, a language in which I am fluent, and I understood everything. 2. Naturalization Applicant's Statement Regarding the Preparer [] At my request, the preparer named in Part 8., [Fillable Filed], prepared this request for me based only upon information I provided or authorized. Naturalization Applicant's Contact Information 3. Naturalization Applicant's Daytime Telephone Number 4. Naturalization Applicant's Mobile Telephone Number (if any) 5. Naturalization Applicant's Email Address (if any) [page 5] Naturalization Applicant's Certification Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS may need to determine my eligibility for the immigration benefit I seek. I further authorize release of information contained in this request, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws. I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that: 1) I reviewed and provided or authorized all of the information in my request; 2) I understood all of the information contained in, and submitted with, my request; and 3) All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury, that I provided or authorized all of the information in my request, I understand all of the information contained in, and submitted with, my request, and that all of this information is complete, true, and correct. Naturalization Applicant's Signature 6. Naturalization Applicant's Signature Date of Signature (mm/dd/yyyy) NOTE TO ALL NATURALIZATION APPLICANTS: If you do not completely fill out this request or fail to submit required documents listed in the Instructions, USCIS may deny your request.
[NEW]		[Page 5] Part 7. Interpreter's Contact Information, Certification, and Signature Provide the following information about the interpreter. Interpreter's Full Name 1. Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name) 2. Interpreter's Business or Organization Name (if any) Interpreter's Mailing Address 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code + 4 Province Postal Code Country [page 6] Interpreter's Contact Information 4. Interpreter's Daytime Telephone Number 5. Interpreter’s Mobile Telephone Number (if any) 6. Interpreter's Email Address (if any) Interpreter's Certification I certify, under penalty of perjury, that: I am fluent in English and [ ], which is the same language specified in Part 6., Item B., in Item Number 1.; and I have read to this naturalization applicant in the identified language every question and instruction on this request and his or her answer to every question. The naturalization applicant informed me that he or she understands every instruction, question, and answer on the request, including the Naturalization Applicant’s Certification, and has verified the accuracy of every answer. Interpreter's Signature 7. Interpreter's Signature Date of Signature (mm/dd/yyyy)
Page 3, Part 6. Signature of Person Who Prepared This Form N-336 For You (if applicable)	Part 6. Signature of Person Who Prepared This Form N-336 For You (if applicable) Preparer's Printed Name Preparer's Firm or Organization Name (if applicable) Preparer's Address Street Number and Name City State ZIP Code Province (foreign address only) Postal Code (foreign address only) Country (foreign address only) Preparer's Daytime Phone Number Preparer's Fax Number Preparer's E-Mail Address (if any) Preparer's Signature Date (mm/dd/yyyy)	[Page 6] Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Request, if Other Than the Naturalization Applicant Provide the following information about the preparer. Preparer's Full Name 1. Preparer's Family Name (Last Name) Preparer's Given Name (First Name) 2. Preparer's Business or Organization Name (if any) Preparer's Mailing Address 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code + 4 Province Postal Code Country [Page 7] Preparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Mobile Telephone Number (if any) 6. Preparer's Email Address (if any) Preparer's Statement 7. A. [] I am not an attorney or accredited representative but have prepared this request on behalf of the naturalization applicant and with the naturalization applicant's consent. B. [] I am an attorney or accredited representative and my representation of the naturalization applicant in this case [] extends [] does not extend beyond the preparation of this request. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this request, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this request. Preparer's Certification By my signature, I certify, under penalty of perjury, that I prepared this request at the request of the naturalization applicant. The naturalization applicant then reviewed this completed request and informed me that he or she understands all of the information contained in, and submitted with, his or her request, including the Naturalization Applicant’s Certification, and that all of this information is complete, true, and correct. I completed this request based only on information that the naturalization applicant provided to me or authorized me to obtain or use. Preparer's Signature 8. Preparer's Signature Date of Signature (mm/dd/yyyy)
[NEW]		[Page 8] Part 9. Additional Information If you need extra space to provide any additional information within this request, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this request or attach a separate sheet of paper. Type or print your name and 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. 1. Family Name (Last Name) Given Name (First Name) Middle Name 2. A-Number (if any) 3. A. Page Number B. Part Number C. Item Number D. ___________ 4. A. Page Number B. Part Number C. Item Number D. ___________ 5. A. Page Number B. Part Number C. Item Number D. ___________ 6. A. Page Number B. Part Number C. Item Number D. ___________

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