N-336 Form TOC

TABLE OF CHANGES – FORM

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

OMB Number: 1615-0050

12/20/2018

Reason for Revision: Revision

Legend for Proposed Text:

• Black font = Current text

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Expires 5/31/2019

Edition Date 12/23/2016

Current Page Number and Section	Current Text	Proposed Text
Page 1	[Page 1]    To be completed by an attorney or accredited representative (if any).  Select this box if Form G-28 is attached.  Attorney State Bar Number (if applicable)  Attorney or Accredited Representative USCIS Online Account Number (if any)	[Page 1]    To be completed by an Attorney or Accredited Representative (if any).  Select this box if Form G-28 is attached.  Attorney State Bar Number (if applicable)  Attorney or Accredited Representative USCIS Online Account Number (if any)
Pages 1-2, Part 1. Information About You, the Naturalization Applicant	[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.    Enter Your 9 Digit A-Number:      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. 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  County State  ZIP Code + 4  Province or Region (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  County[Soft Break]State  ZIP Code + 4  Province or Region (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 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.    Enter Your 9 Digit A-Number:      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. Other Names Used (if any)    Provide 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 8. 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  County State  ZIP Code Province or Region Postal Code  Country     [Page 2]    6. Mailing Address  In Care Of Name (if any)  Street Number and Name  Apt. Ste. Flr. Number  City or Town  County[Soft Break]State  ZIP Code Province or Region Postal Code  Country   7. Contact Information    [delete]   A.  Work Telephone Number (if any)    B.  Evening Telephone Number    [delete]   [delete]
Page 2, Part 2. Information About Form N-400 Denial On Which You (the Naturalization Applicant) Are Requesting a Hearing	[Page 2]  Part 2.  Information About Form N-400 Denial On Which You (the Naturalization Applicant) 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    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    4. Did you file your Form N-400 on the basis of qualifying military service? Yes No
Page 2, Part 3. Biographic Information	[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.  Biographic Information    1. Ethnicity (Select only one box)  Hispanic or Latino  Not Hispanic or Latino    2. Race (Select all applicable boxes)  American Indian or Alaska Native  Asian  Black or African American  Native Hawaiian or Other Pacific Islander  White   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 3, Part 4. Reason You are Requesting a Hearing	[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. 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 8. Additional Information. [deleted]
Page 4, Part 5. Accommodations for Individuals With Disabilities and/or Impairments	[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.    1. Are you requesting an accommodation because of your disabilities and/or impairments? Y/N    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).)    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 4]    [deleted]
Pages 4-5, Part 6. Naturalization Applicant’s Statement, Contact Information, Certification, and Signature	[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 [Fillable Field], 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 Field], 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.	[Page 4]  Part 5. Naturalization Applicant’s Statement, Contact Information, Certification, and Signature   NOTE:  Read the Penalties section of the Form N-336 Instructions before completing this section.    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 6. read to me every question and instruction on this request and my answer to every question in [Fillable Field], 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 7., [Fillable Field], 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 and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.    I furthermore 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 law.    I understand that USCIS may require me to appear for an appointment to take my biometrics 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, USCIS may deny your request.
Pages 5-6, Part 7. Interpreter’s Contact Information, Certification, and Signature	[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 [Fillable Field], 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 5] Part 6.  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 Province or Region 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 [Fillable Field], which is the same language specified in Part 5., 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)
Pages 6-7, Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Request, if Other Than the Naturalization Applicant	[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)	[Page 6] Part 7.  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  Province or Region  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, you may need 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)
Page 8, Part 9. Additional Information	[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.	Part 8.  Additional Information  [no change]

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