N-565 E-file Copy Deck

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Overview

Copy Deck Version Info
Application Overview
Getting Started
Your Request
Evidence
Additional Information
Review & Submit
Warnings

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Sheet 1: Copy Deck Version Info

myUSCIS copy deck

N-565 Application for Replacement Naturalization/Citizenship Document

OMB control number 1615-0087

Baseline version: concluded 10/21/2019

Edits in support of: Final Fee Rule

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Sheet 2: Application Overview

Final Fee Rule - edits made
N565 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY
Step	Section	Current Instructional Text	Revised Instructional Text	Current CTA	Revised CTA	Notes
Application for Replacement Naturalization/Citizenship Document	Application for Replacement Naturalization/Citizenship Document	The Application for Replacement Naturalization/Citizenship Document (N-565) is used to apply to U.S. Citizenship and Immigration Services (USCIS) for a replacement of a Certificate of Naturalization, Certificate of Citizenship, Declaration of Intention, Repatriation Certificate, or to apply for a special certificate of naturalization to be recognized as a U.S. citizen by a foreign country.		Learn more about <a href="https://www.uscis.gov/n-565">applying for a replacement document</a>
Before you start your application	Eligibility	Your eligibility to apply for a replacement document depends on the reason for your request. You may apply for a replacement if: • You were issued a Certificate of Naturalization, Certificate of Citizenship, Declaration of Intention, or Repatriation Certificate which was lost, stolen, destroyed, or mutilated • You were issued a Certificate of Naturalization, Certificate of Citizenship, Declaration or Repatriation Certificate which is incorrect due to a typographical/clerical error by USCIS • Your name was changed by marriage or by court order after the document was issued and you seek a document in your new name • 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 • 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 • 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. 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 on a Naturalization Certificate if you reported an incorrect date on your Application for Naturalization (N-400), 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.
	Fee	Fee: $545 If your current document is incorrect due to a typographical or clerical error caused by USCIS, there is no fee. If you are applying for a fee waiver, you cannot submit your request online and will need to file a paper form instead. Refund Policy: USCIS does not refund fees, regardless of any action we take on your application, petition, or request. By continuing this transaction, you acknowledge that you must submit fees in the exact amount and that you are paying the fees for a government service.	Fee: $535 If your current document is incorrect due to a typographical or clerical error caused by USCIS, there is no fee. Refund Policy: USCIS does not refund fees, regardless of any action we take on your application, petition or request, or how long USCIS takes to reach a decision. By continuing this transaction, you acknowledge that you must submit fees in the exact amount and that you are paying the fees for a government service. Please refer to the instructions for the form(s) you are filing for additional information or you may call the USCIS Contact Center at 800-375-5283. For TTY (deaf or hard of hearing) 800-767-1833.	Learn more about <a href="https://www.uscis.gov/feewaiver">filing a fee waiver</a>	[deleted]
	Submitting online	Submitting your application online is the same as mailing in a completed paper form. They both gather the same information and cost the same.
	Documents you may need	Before starting the Application for Replacement Naturalization/Citizenship Document (N-565), you may want to gather the documents you will need to support your application. These include your original document, if you still have it, and a recent color photograph of yourself. The other documents you need will depend on the information you provide in the application, such as the reason you are requesting the replacement document. We will tell you which documents you need to submit in the Evidence section of the application.
After you submit your application	Track your application status	After you submit your application, you can track its status through your USCIS account. Sign in to your account often to check on your case status and read any important messages from USCIS.		<a href="link">Go to my USCIS account</a>
	Mail in your original document	USCIS may require you to mail your original document. This is required if you are applying for a new document for one of the reasons below. • Current document is mutilated • Current document has a typographical/clerical error caused by USCIS • Name changed • Date of birth changed • Gender changed You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
	Respond to requests for evidence	If we need more information from you, we will send you a Request for Evidence (RFE) or Request for Information (RFI). You can respond to our request and upload your documents through your USCIS account.
Completing your form online	Complete the Getting Started section first	You should answer all questions in the Getting Started section first so we can best customize the rest of your online application experience.
	Provide as many responses as you can	You should provide as many responses as you can, to the best of your knowledge, throughout the application. Incomplete fields or sections and missing information can slow down the process after you submit your application.
	Saving your responses will be done automatically	We will automatically save your information when you select "next" to go to a new page or navigate to another section of the application. We will save your information for 30 days from today, or from the last time you worked on your application.
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 provideto 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.	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 a rejection or 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, 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 Do not mail your completed Form N-565 to this address. OMB No. 1615-0091 Expires: 10/31/2021	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 55 minutes per response, 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 Do not mail your completed Form N-565 to this address. OMB No. 1615-0091 Expires: 10/31/2021
	Security Reminder	If you do not work on your application for more than 30 days, we will delete your data in order to prevent storing personal information indefinitely.

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Sheet 3: Getting Started

Final Fee Rule - edits made

N565 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

Instructional text: Text that appears directly below a question and provides instructions for answering the question.

Help text: Text that appears below or next to an input field, partially hidden. Users can click to expand. Provides additional contextual or clarifying information about a question.

Question grouping page breaks are indicated by a horizontal line

Conditional question logic is indicated in ( ) before question

Personalized copy is indicated in [ ]

Step

Section

Paper Form Question #

Question

Sub-Question

Revised Sub-Question

Field Type

Instructional Text

Help Text

Getting Started

Preparer and interpreter information

Is someone assisting you with completing this application?

Yes/No

Radio

(IF YES) Is a preparer assisting you with completing this application?

Yes/No

Radio

A preparer is anyone who completes or helps you complete all or part of your application using information and answers that you provide.

(IF YES) Is an interpreter assisting you with completing this application?

Yes/No

Radio

Preparer information

12.1

What is your preparer's full name?

Given name (first name)

Text

Family name (last name)

Text

12.2

What is your preparer's business or organization name?

Text

My preparer is not part of a business or organization.

Checkbox

12.3

What is your preparer's mailing address?

Country

Dropdown

Address line 1

Text

Address line 2

Text

City or town

Text

State/Province

Text

ZIP code/Postal code

Text

12.4

What is your preparer's contact information?

Daytime telephone number

Text

12.5

Mobile telephone number

Text

My preparer does not have a mobile telephone number.

Checkbox

12.6

Email address

Text

My preparer does not have an email address.

Checkbox

Interpreter information

11.1

What is your interpreter's full name?

Given name (first name)

Text

Family name (last name)

Text

11.2

What is your interpreter's business or organization name?

Text

My interpreter is not part of a business or organization.

Checkbox

11.3

What is your interpreter's mailing address?

Country

Dropdown

Address line 1

Text

Address line 2

Text

City or town

Text

State/Province

Text

ZIP code/Postal code

Text

11.4

What is your interpreter's contact information?

Daytime telephone number

Text

11.5

Mobile telephone number

Text

My interpreter does not have a mobile telephone number.

Checkbox

11.6

Email address

Text

My interpreter does not have an email address.

Checkbox

10.2.b

What language is your interpreter using to interpret this application for you?

Text

About you

2.1

What is your current legal name?

Given name (first name)

Text

Your current legal name is the name on your birth certificate, unless it changed after birth by a legal action such as marriage or court order. Do not provide any nicknames here.

Middle name (if applicable)

Text

Family name (last name)

Text

Have you used any other names since birth?

Yes/No

Radio

2.2

(IF YES)

Given name (first name)

Text

Provide the other names you have used.

Middle name (if applicable)

Text

Family name (last name)

Text

1.2

What is your country of former citizenship or nationality?

Country

Dropdown

10.4

How can we contact you?

Mobile telephone number

Text

10.3

Daytime telephone number

Text

This is the same as my mobile telephone number.

Checkbox

10.5

Email address

Text

2.3

What is your current mailing address?

In care of name (if any)

In care of name

Text

We will use your current mailing address to contact you throughout the application process. We may not be able to contact you if you do not provide a complete and valid address.

Country

Dropdown

Address line 1

Text

Address line 2

Text

City or town

Text

State/Province

Text

ZIP code/Postal code

Text

Additional information

3.1

What is your ethnicity?

Hispanic or Latino Not Hispanic or Latino

Radio

Hispanic or Latino refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

3.2

What is your race?

White

Checkbox

Select all that apply. Your race is different from your ethnicity and should reflect your geographical origins.

White A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Asian

Checkbox

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.

Black or African American

Checkbox

Black or African American A person having origins in any of the black racial groups of Africa.

American Indian or Alaska Native

Checkbox

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.

Native Hawaiian or Other Pacific Islander

Checkbox

Native Hawaiian or Other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

3.3

What is your height?

Feet/Inches

Text

3.4

What is your weight?

Pounds

Text

3.5

What is the color of your eyes?

Black/Blue/Brown/Gray/Green/Hazel/Maroon/Pink/ Unknown/other

Dropdown

3.6

What is the color of your hair?

Bald (no hair)/Black/Blonde/Brown/Gray/Red/Sandy/White/ Unknown/other

Dropdown

2.5

What is your current marital status?

Single/Married/Divorced/Widowed/Marriage Annulled

Radio

If your marital status has changed since you received your original document, we may request evidence of this change. Sign in to your USCIS account often to check for any Requests for Evidence.

2.4

Has your marital status changed since your last document was issued?

Yes/No

Radio

1.4

What is your A-Number?

Text

I do not have or know my A-Number.

Checkbox

2.6

Since becoming a U.S. citizen, have you lost or renounced your citizenship in any manner?

Yes/No

Radio

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test

test

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Sheet 4: Your Request

Final Fee Rule - no edits
N565 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY
Instructional text: Text that appears directly below a question and provides instructions for answering the question.
Help text: Text that appears below or next to an input field, partially hidden. Users can click to expand. Provides additional contextual or clarifying information about a question.
Question grouping page breaks are indicated by a horizontal line
Conditional question logic is indicated in ( ) before question
Personalized copy is indicated in [ ]
Step	Section	Paper Form Question #	Question	Sub-Question	Field Type	Instructional Text	Help Text
Your Request	Current document	1.3	What is the certificate number on your current document?		Text
		1.5.b	When did USCIS issue this document?	Month/Day/Year	Date
		1.5.a	Which court or USCIS office issued your document?		Text
		1.1	In which name was your current document issued?	The name on my current document matches my current legal name.	Checkbox
				Given name (first name)	Text
				Middle name (if applicable)	Text
				Family name (last name)	Text
	New document	4.1A	Which document are you requesting?	New Certificate of Citizenship	Radio
		4.1B		New Certificate of Naturalization	Radio
		4.1C		New Certificate of Repatriation	Radio
		4.1D		New Declaration of Intention	Radio
		4.1E		Special Certificate of Naturalization to obtain recognition of my U.S. citizenship by a foreign country	Radio
		9.1	(IF 4.1E) What is the name of the foreign country?		Dropdown
		9.2	(IF 4.1E) What is the name of the foreign official who is requesting this certificate?	Given name (first name)	Text
				Middle name (if applicable)	Text
				Family name (last name)	Text
		9.2	(IF 4.1E) What is the foreign official's title?		Text
		9.2	(IF 4.1E) What is the foreign official's government agency?		Text
		9.3	(IF 4.1E) What is the foreign official's address?	Country	Dropdown
				Address line 1	Text
				Address line 2	Text
				City or town	Text
				State/Province	Text
				Zip code/Postal code	Text
	Reason for new document	4.2A	Why are you requesting a new document?	My certificate or declaration was lost, stolen, or destroyed.	Checkbox	Select all that apply
		4.3		My certificate or declaration is mutilated.	Checkbox
		4.4		My certification or declaration is incorrect due to typographical/clerical error by USCIS.	Checkbox
		4.5		My name has legally changed	Checkbox
		4.6		My date of birth has legally changed through a court order or U.S. government-issued document.	Checkbox
		4.7		I am seeking to change the gender listed on my document.	Checkbox
		4.8A		My reason for applying for a new document is not listed above.	Checkbox
		4.2B	(IF LOST STOLEN OR DESTROYED) When, where, and how was your document lost, stolen, or destroyed?		Text
		4.1	(IF CLERICAL ERROR) What was the typographical or clerical error in your document?	Name/Date of Birth/Gender/Other	Radio
		5.2	Provide an explanation of what is incorrect on your current certificate or declaration.		Text
		6.1A	(IF NAME CHANGED) Why has your name changed?	Marriage or divorce	Radio
		6.1B		Court order	Radio
				On what date did your name change?
				Month/Day/Year	Date
		6.2	What is your new legal name?	Given name (first name)
				Family name (last name)
				Middle name (if applicable)
		7.1.A	(IF BIRTHDAY CHANGED) How was your date of birth changed?	Court order	Checkbox
		7.1.B		State-issued document	Checkbox		A state-issued document could be a birth certificate, certificate recognizing the foreign birth, certificate of birth abroad, or other similar records issued by the child's state of residence.
				On what date did your date of birth change?
				Month/Day/Year	Date
		7.2	(IF BIRTHDAY CHANGED) What is your new date of birth?	Month/Day/Year	Date
		8.1A	(IF GENDER CHANGED) How has your gender change been legally recognized?	Court order	Checkbox
		8.1B		Other official documentation recognizing the new gender by a U.S. state, local jurisdiction, or foreign state, such as an amended birth certificate, passport or driver's license	Checkbox
		8.1C		Certification of Gender issued by a licensed physician (Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.))	Checkbox
		8.2	(IF GENDER CHANGED) What is your current gender designation?	Male/Female	Radio
		4.8B	(IF MY REASON FOR APPLYING FOR A NEW DOCUMENT IS NOT LISTED ABOVE") Why are you requesting a new document?		Text

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Sheet 5: Evidence

Final Fee Rule - no edits
N565 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY
Instructional text: Text that appears directly below a question and provides instructions for answering the question.
Help text: Text that appears below or next to an input field, partially hidden. Users can click to expand. Provides additional contextual or clarifying information about a question.
Question grouping page breaks are indicated by a horizontal line
Conditional question logic is indicated in ( ) before question
Personalized copy is indicated in [ ]
Step	Section	Evidence Title	Field Type	Instructional Text	Notes
Evidence	Evidence to support your application			As part of the application process, you will need to provide evidence to support your application. These documents help us evaluate your application and verify your answers are true. You are required to provide images or copies of several documents now as part of submitting your application. You may also need to provide additional evidence, depending on how you answered certain questions in the application. You also must mail your original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
			[Upload tool]	Drag files here or choose a file Maximum size: 6MB per file Accepted formats: JPG, JPEG, PDF, TIF, or TIFF No encrypted or password-protected files Attaching your files Use a scanner or take pictures of each document. Make sure each image you attach is clear and that all text is readable. Translations If your documents are in a foreign language, upload an English translation along with the original.
		2" x 2" photo of you	Upload	Upload a recent color photograph of yourself that measures 2 inches by 2 inches, with your face measuring 1 inch to 1 3/8 inch from your chin to the top of your head. Your eyes should be between 1 1/8 inch and 1 3/8 inch from the bottom of the photo. Make sure your whole face is visible, you are facing the camera directly, and the background is white or off-white. Your head must be bare, unless contrary to your religious beliefs. Also, include an image of the back of the photograph with your name and A-Number written in pen or pencil. If you need help understanding the photo requirements or want to resize, rotate, or crop your photo, you can use to the Department of State's <a href="https://travel.state.gov/content/passports/en/passports/photos/photo-composition-template.html">photo composition tools</a>.
		(IF TYPOGRAPHICAL/CLERICAL ERROR, NAME CHANGE, DOB CHANGE, GENDER CHANGE) Original document from USCIS	Upload	Upload an image or copy of your original document. You also must mail your original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF MUTILATED) Evidence of your mutilated document	Upload	Upload an image or copy of your damaged document. You also must mail your damaged original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF LOST, STOLEN, OR DESTROYED) Evidence of your lost, stolen, or destroyed document	Upload	Upload an image or copy of your original document if you have one. You can also upload a copy of a police report or a sworn statement that explains how your original document was lost, stolen, or destroyed. You do not have to upload a copy of your police report if you do not have one.
		(IF CLERICAL/TYPO ERROR) Evidence of clerical or typographical error	Upload	Upload images or copies of documents supporting your explanation of the error and request for a new document. You also must mail your incorrect original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF NAME CHANGE BY MARRIAGE) Evidence of your name change	Upload	Upload an image or copy of the marriage certificate or divorce certificate that shows your legally changed name. You also must mail your original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF NAME CHANGE BY COURT ORDER) Evidence of your name change	Upload	Upload an image or copy of the certified court order, amended birth certificate, or amended passport that shows your legally changed name. You also must mail your original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF DOB CHANGE) Evidence of your date of birth change	Upload	Upload an image or copy of the state-issued document or a certified copy of the complete document (court order) showing the date of birth change. A state-issued document may include: • Birth certificate • Certificate recognizing foreign birth • Certificate of birth abroad • Other record issued by the child's state of residence You also must mail your original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF GENDER CHANGE BY COURT ORDER) Court order showing legally changed gender	Upload	Upload an image or certified copy of the court order that shows your legally changed gender. You also must mail your original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF GENDER CHANGED BY BIRTH CERT.) Birth certificate showing legally changed gender	Upload	Upload an image or certified copy of your amended birth certified certificate that shows your legally changed gender. You also must mail your original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF GENDER CHANGED BY OTHER OFFICIAL DOC) Official document showing legally changed gender	Upload	Upload an image or certified copy of the official document that shows your legally changed gender. An official document may include: • Amended birth certificate • Passport recognizing the gender change • Driver's license recognizing the gender change You also must mail your original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF GENDER CHANGED BY MED. CERT.) Medical evidence of legally changed gender	Upload	Upload an image or copy of the medical certification that documents your legally recognized gender change. A medical certification must come from a licensed physician (Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.)) and must include the following: • Physician's full name, address, and telephone number • Physician's medical license or certificate (including number and issuing state) • Physician's Drug Enforcement Administration registration number or comparable foreign number (if applicable) • Language stating that you have received the appropriate treatment for gender transition to the new gender (male or female) • Language stating that 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 and has reviewed and evaluated your medical history in relation to your change in gender. You also must mail your original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF OTHER) Evidence of incorrect document	Upload	Upload images or copies of any documents supporting your explanation of the error and request for a replacement document. You also must mail your incorrect original document to USCIS to complete your application. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
		(IF LOSS OF CITIZENSHIP) Loss of citizenship	Upload	Upload a document explaining how and why you lost or renounced your United States citizenship.
		Additional evidence you want to provide	Upload	Upload any additional documents that support your application and help explain any of your answers on the application.
		Evidence of change in marital status	Upload	If your marital status has changed since you were last issued a document, you must upload an image or copy of your most recent marriage certificate, divorce decree, or spouse's death certificate. You do not have to upload a copy of your marriage certificate, divorce decree, or spouse's death certificate if your marital status has not changed.

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Sheet 6: Additional Information

Final Fee Rule - no edits

N565 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

Instructional text: Text that appears directly below a question and provides instructions for answering the question.

Help text: Text that appears below or next to an input field, partially hidden. Users can click to expand. Provides additional contextual or clarifying information about a question.

Question grouping page breaks are indicated by a horizontal line

Conditional question logic is indicated in ( ) before question

Personalized copy is indicated in [ ]

Step

Section

Paper Form Question #

Question

Sub-Question

Field Type

Not Required

Instructional Text

Help Text

Notes

Additional Information

Optional explanation

13

You may provide additional information for your request

Additional information

Textbox

If you need to provide any additional information for any of your answers to the questions in this form, enter it into the space below. You should include the questions that you are referencing. If you do not need to provide any additional information, you may leave this section blank.

Added new section

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Sheet 7: Review & Submit

Final Fee Rule - edits made

N565 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

Instructional text: Text that appears directly below a question and provides instructions for answering the question.

Help text: Text that appears below or next to an input field, partially hidden. Users can click to expand. Provides additional contextual or clarifying information about a question.

Question grouping page breaks are indicated by a horizontal line

Conditional question logic is indicated in ( ) before question

Personalized copy is indicated in [ ]

Step

Section

Paper Form Question #

Question

Sub-Question

Revised Sub-Question

Field Type

Instructional Text

Revised Instructional Text

Help Text

Review and Submit

Review your application

Check your application before you submit

We will review your application to check for accuracy and completeness before you submit it. We encourage you to provide as many responses as you can throughout the application. Missing information can slow down the review process after you submit your application. You can return to this page to review your application as many times as you want before you submit it.

Your fee

Refund Policy: USCIS does not refund fees, regardless of any action we take on your application, petition, or request. By continuing this transaction, you acknowledge that you must submit fees in the exact amount and that you are paying the fees for a government service.

Refund Policy: USCIS does not refund fees, regardless of any action we take on your application, petition or request, or how long USCIS takes to reach a decision. By continuing this transaction, you acknowledge that you must submit fees in the exact amount and that you are paying the fees for a government service.

Alerts and warnings

You have one or more alerts and warnings based on the information you provided in your application. A red alert means you have incomplete or incorrect responses to certain questions. You ​cannot​ submit your application with any alerts. A yellow warning means you may be missing information or may need to follow-up with us about your responses. You can still submit your application, but some warnings may slow down the review process after you submit your application.

Your application summary

Here is a summary of all the information you provided in your application. Make sure you have provided responses for everything that applies to you before you submit your application. You can edit your responses by going to each application section using the site navigation. We also prepared a draft case snapshot with your responses, which you can download below.

Preparer signature

12.7A

Preparer's statement

I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent

Radio

Your preparer must read the statements below and select the statement that applies to him or her. If your preparer is an attorney or accredited representative whose representation extends beyond preparation of this application, he or she may be obliged to submit a completed Notice of Entry of Appearance as Attorney or Accredited Representative (G-28) with your application.

12.7B

I am an attorney or accredited representative and my representation of the applicant in this case does not extend beyond the preparation of this application

Radio

12.7B

I am an attorney or accredited representative and my representation of the applicant in this case extends beyond the preparation of this application

Radio

12

Preparer's certification

By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted with, his or her application, including the Applicant's Certification, and that all of this information is complete, true, and correct. I completed this application based only on information that the applicant provided to me or authorized me to obtain or use.

Your preparer must read and agree to the certification below.

As the applicant's preparer, you must sign on paper and provide your signature page to the applicant. Follow these steps: 1. Download the Preparer Signature page 2. Print the Preparer Signature page 3. Read and sign the Preparer Signature page 4. Give the signed Preparer Signature page to the applicant The applicant will need to scan and upload your completed signature page on the next screen.

12.8

Preparer's signature upload

Upload

Scan and upload your preparer's completed signature page below.

Interpreter signature

11

Interpreter's certification

I certify, under penalty of perjury that: I am fluent in English and the language provided in the Getting Started section of this application, and I have read to this applicant every question and instruction on this application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question, and answer on the application, including the Applicant's Certification, and has verified the accuracy of every answer.

Your interpreter must read and agree to the certification below.

As the applicant's interpreter, you must sign on paper and provide your signature page to the applicant. Follow these steps: 1. Download the Interpreter Signature page 2. Print the Interpreter Signature page 3. Read and sign the Interpreter Signature page 4. Give the signed Interpreter Signature page to the applicant The applicant will need to scan and upload your completed signature page on the next screen.

11.7

Interpreter's signature upload

Upload

Scan and upload your interpreter's completed signature page below.

Your signature

NOTE: Read the Penalties section of the Form N-565 Instructions before completing this section. By signing this 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.

10.2

Applicant's statement regarding the preparer

At my request, the preparer named in the Getting Started section of this application, prepared this application for me based only upon information I provided or authorized.

Checkbox

You must read and agree to the statement below.

10.1.B

Applicant's statement regarding the interpreter

The interpreter named in the Getting Started section of this application read to me every questions and instruction on this application and my answer to every question in the language I specified in the Getting Started section, a language in which I am fluent, and I understood everything.

Checkbox

You must read and agree to the statement below.

10.1.A

I can read and understand English, and I have read and understand every question and instruction on this application and my answer to every question.

You must read and agree to the statement below.

10

Applicant's declaration and 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. Futhermore, 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 application, 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 will require me to appear for an appointment to take my biometrics and, at that time, I will be required to sign an oath reaffirming that: 1. I reviewed and provided or authorized all of the information in my application; 2. I understood all of the information contained in, and submitted with, my application; and 3. All of this information was complete, true, and correct at the time of filing. I certify, under penalty of perjury, that all of the information in my application and any document submitted with it were provided or authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my application, and that all of this information is complete, true and correct.

You must read and agree to the certification below. If you knowingly and willfully falsify or conceal a material fact or submit a false document with your application, we can deny your application and may deny any other immigration benefit. You may also face criminial prosecution and penalties provided by law.

10.6

Your signature

Text

You must provide your digital signature below by typing your full legal name. We may deny your application if you do not completely fill out this application or fail to submit required documents. We will record the date of your signature with your application.

10.6

Date of signature

Month/Day/Year

Date

Pay and submit

The final step to submit your Application for Replacement Naturalization/Citizenship Document is to pay the required fee. Your application fee is: $555 Refund Policy: USCIS does not refund fees, regardless of any action we take on your application, petition, or request. By continuing this transaction, you acknowledge that you must submit fees in the exact amount and that you are paying the fees for a government service.

The final step to submit your Application for Replacement Naturalization/Citizenship Document is to pay the required fee. Your application fee is: $535 Refund Policy: By continuing this transaction, you agree that you are paying for a government service and that the filing fee, biometric services fee and all related financial transactions are final and not refundable, regardless of any action USCIS takes on an application, petition or request, or how long USCIS takes to reach a decision. You must submit all fees in the exact amounts.

Pay for and submit your application

We will send you to Pay.gov — our safe, secure payment website — to pay your fees and submit your application online. Here are the steps in the payment and submission process: 1. Provide your billing information on Pay.gov 2. Provide your credit card or U.S. bank account information 3. Submit your payment When you have paid your fee, your application will be submitted. Pay.gov will redirect you to a uscis.gov confirmation screen, which will include your application receipt number. Please keep a copy of your receipt number for your records. You can track the status of your application through your USCIS online account.

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Sheet 8: Warnings

Final Fee Rule - no edits
N565 INTERACTIVE FORM COPY: WARNINGS, ALERTS, NOTICES, AND ERRORS
Copy in gray boxes is approved copy from the N400 and should not be edited
Alert: Appears in red box; indicates missing required information or lack of eligibility; user cannot submit application Warning: Appears in yellow box; indicates potential eligibility issue or follow-up step; user can submit application Notice: Appears in blue box; indicates potential exemptions or other useful information; user can submit application Error: Appears in red text below a form field; user can submit application
Number	Type	Logic	Message	Notes
1	Warning	applying because: - mutilated - typo/clerical error - name change - DOB change - gender change	h5. You must mail your original document to USCIS You must mail your original document to USCIS because of the reason you are requesting a new document. Review of your application may be delayed if you do not submit your original document. You should include your A-Number with your original document. Mail your original document to: USCIS Nebraska Service Center 850 S. Street Lincoln, NE 68508
2	Alert	If 2.1E (requesting Special Certificate)	h5. You cannot request a Special Certificate of Naturalization online yet You should file the paper version of the <a href="https://www.uscis.gov/n-565">Application for Replacement Naturalization/Citizenship Document (N-565)</a>.