Form N-648 TOC

TABLE OF CHANGES – FORM

Form N-648, Medical Certification for Disability Exceptions

OMB Number: 1615-0060

01/13/2017

Reason for Revision: Extension of currently approved form and Instructions; minimal edits by POC

Current Page Number and Section	Current Text	Proposed Text
Page 2, Part 111. INFORMATION ABOUT DISABILITY and/or IMPAIRMENT(S)	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. Provide a basic description of the disability and/or impairment(s), e.g., “Down syndrome is a genetic disorder that causes lifelong intellectual disability (also referred to as mental retardation), developmental delays, and other problems.”	Part 3. INFORMATION ABOUT DISABILITY and/or IMPAIRMENT(S) 1. Provide the clinical diagnosis of the applicant’s disability and/or impairment, that form the basis for seeking an exception to the English and/or civics requirements. If applicable, please provide the relevant medical code as accepted by the Department of Health and Human Services (HHS). This includes the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). For example, DSM-V 318.1 Intellectual Disability (Severe) or 2015/16 ICD-10-CM F72 Severe intellectual disabilities. 2. Provide a basic description of the disability and/or impairment(s), for example, Intellectual Disability (Severe) is a genetic disorder that causes lifelong intellectual disability, developmental delays, and other problems.

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