Application for Replacement Naturalization/Citizenship Document - Paper

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 06/30/2019

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:

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1. Certificate of Naturalization;
2. Certificate of Citizenship;

3. Declaration of Intention; or
4. Repatriation Certificate.

You can also use this application to apply for a special certificate of naturalization to have a foreign country recognize you
as a U.S. citizen.

Who May File Form N-565?

You may apply for a replacement document if you were issued a Certificate of Naturalization, Certificate of Citizenship,
Declaration of Intention, or Repatriation Certificate, and at least one of the following applies:
1. The document was lost, stolen, destroyed, or mutilated;

2. The document is incorrect due to a typographical or clerical error by USCIS;

3. Your name was changed by marriage, divorce, annulment, or court order, and you seek a document in your new name;
or
4. You obtained a court order, a U.S. Government-issued document, or a letter from a licensed health care professional
recognizing that your gender is different from the gender listed on your current document, and you seek a document
reflecting the recognized gender.
In addition, you may apply for a replacement of your Certificate of Citizenship if you obtained a court order or a
document issued by the U.S. government or the government of any U.S. state that changes your date of birth, and you seek
a document with the new date of birth.
You may also file this application if you are a naturalized citizen seeking a special certificate of naturalization for the
purpose of a foreign country recognizing you as a U.S. citizen.
NOTE: USCIS will not change your name without evidence such as a marriage certificate, divorce decree, or court order.
We will not change the date of birth on a Certificate of Citizenship without documentation such as a U.S. court order or
state-issued documents.
USCIS cannot make any changes to an incorrect date of birth or name on a Naturalization Certificate if you provided
an incorrect date or name on your Form N-400, Application for Naturalization, and then later swore to the facts of
your application by signing Part 16. Signature at Interview. We can only change the name on your Certificate of
Naturalization if you changed your name after you naturalized.

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General Instructions
USCIS provides forms free of charge through the USCIS website. 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/.
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.
Validity of Signatures. USCIS will consider a photocopied, faxed, or scanned copy of the original, handwritten signature
valid for filing purposes. The photocopy, fax, or scan must be of the original document containing the handwritten, ink
signature.

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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 Appointment. USCIS may require that you appear for an interview or provide biometrics at any
time to verify your identity, obtain additional information, and conduct background and security checks, including a check
of criminal history records maintained by the Federal Bureau of Investigation (FBI), before making a decision on your
application or petition. After USCIS receives your application and ensures it is complete, we will inform you in writing
if you need to attend a biometric services appointment. If an appointment is necessary, the notice will provide you the
location of your local or designated USCIS Application Support Center (ASC) and the date and time of your appointment.
If you are required to provide biometrics, at your appointment you must sign an oath reaffirming that:
1. You provided or authorized all information in the application;

2. You reviewed and understood all of the information contained in, and submitted with, your application; and
3. All of this information was complete, true, and correct at the time of filing.

If you fail to attend your biometric services appointment, USCIS may deny your application.

Copies. You should 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 or petition. If USCIS requests an original document from you, it will be returned to you after
USCIS determines it no longer needs your original.
NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be
immediately destroyed upon receipt.
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. The certification must include the
translator’s signature. The certification must contain the translator’s printed name and the date and the translator’s contact
information.

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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, use the space provided in Part 13. Additional
Information or 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.

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4. USCIS Online Account Number (if any). If you have previously filed an application or petition using the USCIS
online filing system (previously called USCIS Electronic Immigration System (USCIS ELIS)), provide the USCIS
Online Account Number you were issued by the system. You can find your USCIS Online Account Number by
logging in to your account and going to the profile page. If you previously filed certain applications or petitions on a
paper form via a USCIS Lockbox facility, you may have received a USCIS Online Account Access Notice issuing you
a USCIS Online Account Number. You may find your USCIS Online Account Number at the top of the notice. If you
were issued a USCIS Online Account Number, enter it in the space provided. The USCIS Online Account Number is
not the same as an A-Number.
5. Part 3. Biographic Information. Provide the biographic information requested. Providing this information as part
of your application may reduce the time you spend at your USCIS ASC appointment as described in the Biometric
Services Appointment section of these Instructions.
A. Ethnicity and Race. Select the boxes that best describe your ethnicity and race.
B. Categories and Definitions for Ethnicity and Race

(1) Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race. (NOTE: This category is only included under Ethnicity in
Part 3., Item Number 1.)
(2) American Indian or Alaska Native. A person having origins in any of the original peoples of North and
South America (including Central America), and who maintains tribal affiliation or community attachment.
(3) Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the
Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam.
(4) Black or African American. A person having origins in any of the black racial groups of Africa.
(5) Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands.
(6) White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
C. Height. Select the values that best match your height in feet and inches. For example, if you are five feet and
nine inches, select “5” for feet and “09” for inches. Do not enter your height in meters or centimeters.
D. Weight. Enter your weight in pounds. If you do not know your weight or need to enter a weight under 30 pounds
or over 699 pounds, enter “000.” Do not enter your weight in kilograms.
E. Eye Color. Select the box that best describes the color of your eyes.
F. Hair Color. Select the box that best describes the color of your hair.

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6. Part 9. Complete If Applying for a Special Certificate of Recognition as a Citizen of the United States to the
Government of a Foreign Country. Provide the information requested in Item Numbers 1. - 3. about the official of
a foreign country who has requested this certificate, if you know it.
NOTE: You do not need to complete Item Number 4. before you file Form N-565. The USCIS or consular official’s
certification will be completed after USCIS adjudicates your Form N-565, if it is approved.
7. Part 10. Applicant’s Statement, Contact Information, Certification, and Signature. Select the appropriate box to
indicate whether you read this application yourself or whether you had an interpreter assist you. If someone assisted
you in completing the application, select the box indicating that you used a preparer. 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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8. Part 11. Interpreter’s Contact Information, Certification, and Signature. 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, his or her mobile telephone number (if any), and his or her email address (if
any). The interpreter must sign and date the application.
9. Part 12. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other
Than the Applicant. 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 11. and Part 12. 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 complete this application MUST sign and date the application. A stamped or typewritten name in place
of a signature is not acceptable. If the person who helped you prepare your application is an attorney or accredited
representative, he or she may also need to submit a completed Form G-28, Notice of Entry of Appearance as Attorney
or Accredited Representative, along with your application.
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 your completed application before you go 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.

Initial Evidence
1. Photographs. Only applicants who reside outside the United States must submit two identical color passport-style
photographs of yourself taken recently. The photos must have a white to off-white background, be printed on thin
paper with a glossy finish, and be unmounted and unretouched.
The two identical color passport-style photos must be 2 by 2 inches. 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 inches from top of hair to
bottom of chin, and eye height should measure between 1 1/8 to 1 3/8 inches 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 Alien Registration Number (A-Number) (if any) on the back of the
photo.
2. You must submit a copy of your U.S. Government-issued photo identification.

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3. If your marital status has changed since your original document was issued, you must submit a copy of the document
establishing your change in marital status (such as your marriage certificate, divorce decree, annulment decree, or
spouse’s death certificate).
4. If your document was lost, stolen, or destroyed, you must attach a copy of the document (if available), a police report,
and/or a sworn statement explaining what happened to the document and any attempts to retrieve the document.
5. If you are applying for replacement of a mutilated document, you must attach the mutilated document.
6. If you are applying for replacement of a document that is incorrect due to a typographical or clerical error by USCIS,
you must attach the original incorrect document and complete Part 5. of Form N-565.
7. If you are applying for a new document because your name was changed, you must submit the original USCIS
document and a copy of either the original or certified document establishing the name change (such as a marriage
certificate, divorce decree, annulment decree, or court order), and complete Part 6. of Form N-565.

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8. 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 you are seeking to replace. You must also submit a copy of either the original
or certified document establishing the date of birth change (for example, a court order or vital record document issued
by the U.S. Government or the government of any U.S. state (“U.S. Government documents”)) and complete Part 7.
of Form N-565. U.S. Government documents may include a birth certificate, a certificate recognizing foreign birth, a
certificate of birth abroad, or other similar vital records issued by the U.S. state where you resided when the document
was issued. Only applicants applying for a new Certificate of Citizenship may select this option.
9. If you are applying for a new document that reflects a different gender than is shown on your current document,
you must submit the original USCIS document along with one of the forms of evidence listed below supporting the
requested official change in gender designation and complete Part 8. of Form N-565.
Submit one of the following forms of evidence supporting your requested official change in gender designation:
A. A court order granting change of sex or gender;

B. A U.S. Government-issued document reflecting the requested gender designation. Acceptable U.S. Governmentissued documents include an amended birth certificate, a passport, a driver’s license, or other official document
showing identity issued by the U.S. Government, a state or local government in the United States, or a foreign
government;
C. A letter from a licensed health care professional certifying the requested gender designation is consistent with
your gender identity. Licensed health care professionals include licensed counselors, nurse practitioners,
physicians (Medical Doctors or Doctors of Osteopathy), physician assistants, psychologists, social workers, and
therapists. The health care certification must include the following information:
(1) The health care professional’s full name, address, and phone number;
(2) The health care professional’s license number and issuing state, country, or other jurisdiction of the
professional license;
(3) Language stating the health care professional has treated or evaluated you in relation to your gender identity;
and
(4) The health care professional’s assessment of your gender identity.
10. 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 (8 CFR 343b.2).

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11. If you are filing from overseas and provide a foreign mailing address, USCIS will send your new document (if
approved) to the nearest U.S. Embassy, U.S. Consulate, or USCIS field office. You will receive notification by mail
where to pick up your new document.

What Is the Filing Fee?
The filing fee for Form N-565 is $555. A biometric services fee of $85 is also required for applicants.
EXCEPTION: There is no fee required if you select Part 4., Item Number 4. on Form N-565. However, you must still
pay the $85 biometric services fee.

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NOTE: The filing fee and biometric services fee are not refundable, regardless of any action USCIS takes on this
application. DO NOT MAIL CASH. You must submit all fees in the exact amounts.
Payments by Checks or Money Orders

Use the following guidelines when you prepare your checks or money orders for the Form N-565 filing fee and biometric
services fee:
1. The checks or money orders 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 Paying by Check. If you send USCIS a check, we 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
your check is returned as unpayable, we will re-submit the payment to the financial institution one time. If the check is
returned as unpayable a second time, we will reject your application and charge you a returned check fee.
Payments by Credit Card

If you are filing your application at a USCIS Lockbox facility, you can pay your filing fee and biometric services fee using
a credit card. Please see Form G-1450, Authorization for Credit Card Transactions, at www.uscis.gov/G-1450 for more
information.
How To Check If the Fees Are Correct
Form N-565’s filing fee and biometric services fee are current as of the edition date in the lower left 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 website at www.uscis.gov, select “FORMS,” and check the appropriate fee; or
2. Visit the USCIS Contact Center at www.uscis.gov/contactcenter to get answers to your questions and connect with a
live USCIS representative. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf
or hard of hearing) call: 1-800-767-1833.

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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.

Where to File?
Please see our website at www.uscis.gov/N-565 or visit the USCIS Contact Center at www.uscis.gov/contactcenter
to connect with a USCIS representative for the most current information about where to file this application.
The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing)
call: 1-800-767-1833.

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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. If USCIS requests an original
document from you, it will be returned to you after USCIS determines it no longer needs your original.
Decision. The decision on Form N-565 involves a determination of whether you have established eligibility for the
document you are requesting. If you establish eligibility for the document, USCIS will approve your application and issue
the document. Where appropriate, USCIS will forward a special Certificate of Naturalization to the U.S. Department of
State for delivery to a foreign government official. If your application is denied, USCIS will notify you of the decision in
writing.

USCIS Forms and Information
To ensure you are using the latest version of this application, visit the USCIS website at www.uscis.gov where you can
obtain the latest USCIS forms and immigration-related information.
Instead of waiting in line for assistance at your local USCIS office, you can schedule an appointment online at
www.uscis.gov. Select “Tools,” then under “Self Service Tools,” select “Appointments” and follow the screen prompts to
set up your appointment. Once you finish scheduling an appointment, the system will generate an appointment notice for
you.

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.

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By signing your application, you state under penalty of perjury (28 U.S.C. section 1746) that all information and
documentation submitted with this application is complete, true, and correct. You also authorize the release of any
information from your records that USCIS may need to determine your eligibility for the immigration benefit you are
seeking and consent to USCIS verifying such information.
The Department of Homeland Security (DHS) has the authority to verify any information you submit to establish
eligibility for the immigration benefit you are seeking at any time. USCIS’ legal authority to verify this information is in
8 U.S.C. sections 1103 and 1454 and 8 CFR parts 103 and 338. To ensure compliance with applicable laws and
authorities, USCIS may verify information before or after your case is decided.

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DHS Privacy Notice

AUTHORITIES: The information requested on this application, and the associated evidence, is collected pursuant to
Immigration and Nationality Act Section 343(a).
PURPOSE: The primary purpose for providing the 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 to be recognized by a foreign country. DHS will use the information
you provide to grant or deny the replacement document you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information,
including your Social Security number (if applicable), and any requested evidence, may delay a final decision or result in
denial of your application.
ROUTINE USES: DHS may share the information you provide on this application and any additional requested
evidence 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/ICE/CBP-001 Alien
File, Index, and National File Tracking System, DHS/USCIS-007 Benefits Information System, and DHS/USCIS-018
Immigration Biometric and Background Check] and published privacy impact assessments [DHS/USCIS/PIA-016(a)
Computer Linked Application Information Management System and Associated Systems, and DHS/USCIS/PIA-056
USCIS Electronic Information System, and DHS/USCIS/PIA-071 myUSCIS Account Experience], which can be found
at www.dhs.gov/privacy. DHS may also share this 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 Office of Management and Budget (OMB) control number. The public
reporting burden for this collection of information is estimated at 1 hour and 20 minutes per response, including the time
for reviewing instructions, gathering the required documentation and information, completing the application, preparing
statements, attaching necessary documentation, and submitting the application. The collection of biometrics is estimated
to require 1 hour and 10 minutes. 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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