N-565 E-file Copy Deck

N565-006-Copy Deck-Biometrics Rule NPRM.pdf

Application for Replacement Naturalization/Citizenship Document

N-565 E-file Copy Deck

OMB: 1615-0091

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1615-0091 can be found here:

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myUSCIS copy deck
N-565 Application for Replacement
Naturalization/Citizenship Document
OMB control number 1615-0091
Edits in support of: Biometrics Rule NPRM

Biometrics Rule NPRM - edits made

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

Step

Current Section

Revised Section

Current Instructional Text

Application for Replacement Application for
Naturalization/Citizenship
Replacement
Document
Naturalization/Citizens
hip 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.

Before you start your
application

Your eligibility to apply for a replacement document depends on the reason for your request. You may apply for a replacement if:

Eligibility

Revised Instructional Text

CTA
Learn more about applying for a replacement
document

• 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: $555

The application fee is $640. This includes the $555 filing fee plus an $85 biometric services fee.

If your current document is incorrect due to a typographical or clerical error caused by USCIS, there is no fee. If you are applying 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.
for a fee waiver, you cannot submit your request online and will need to file a paper form instead.

After you submit your
application

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.

Track your application
status

Biometrics
appointment

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 few weeks after you submit your application, we will contact you to schedule an appointment at an Application Support Center
near you. At the appointment, we will get your biometrics.

Learn more about filing a fee waiver

Go to my USCIS
account

If you are currently outside the United States, you must submit two properly completed Form FD-258 fingerprint cards with your
Form N-400. The FD-258 cards must be completed at an authorized site such as a U.S. Embassy, U.S. Consulate, or U.S. military
installation.
Every individual who is an applicant, petitioner, derivative, beneficiary, or sponsor of an immigration benefit request or other
request submitted to USCIS is required to submit biometrics unless USCIS waives or exempts the requirement. You will be notified
of the time and place of your appointment if you must appear and you will be provided requirements for rescheduling if necessary.
If you fail to submit any biometrics as required, USCIS may deny your application, petition, or request.

Application Overview

Biometrics Rule NPRM - edits made

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Current Section

Revised Section

Current Instructional Text

Revised Instructional Text

CTA

DHS may store the biometrics submitted by an individual and use or reuse biometrics to conduct background and security checks,
including a check of criminal history records maintained by the Federal Bureau of Investigation (FBI), verify identity, produce
documents, determine eligibility for immigration and naturalization benefits, or to perform any other functions necessary for
administering and enforcing immigration and naturalization laws, and any other law within DHS authority.
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
Provide as many
responses as you can
Saving your responses
will be done
automatically

You should answer all questions in the Getting Started section first so we can best customize the rest of your online application
experience.
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.
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 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

Security Reminder

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:

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 3 hours and 40 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

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.

Application Overview

Biometrics Rule NPRM - edits made
N565 INTERACTIVE FORM COPY: QUESTIONS, INSTRUCTIONAL AND HELP TEXT, AND OTHER COPY

Copy in gray boxes is approved copy from the N400 and should not be edited
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

Getting Started

Preparer and interpreter
information

Preparer information

Paper Form
Question #

Current Question

Revised Question

Current
Revised Instructional Text
Field Type Field Type
Radio

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

Yes/No

Radio

(IF YES) Is an interpreter assisting you with completing this
application?
What is your preparer's full name?

Yes/No

Radio

12.1
12.2

What is your preparer's business or organization name?

Given name (first name)
Family name (last name)

Text
Text
Text
Checkbox

12.3

What is your preparer's mailing address?

12.4
12.5

What is your preparer's contact information?

My preparer is not part of a business or
organization.
Country
Address line 1
Address line 2
City or town
State/Province
ZIP code/Postal code
Daytime telephone number
Mobile telephone number
My preparer does not have a mobile
telephone number.
Email address
My preparer does not have an email address.

11.1

What is your interpreter's full name?

11.2

What is your interpreter's business or organization name?

11.3

What is your interpreter's mailing address?

11.4
11.5

What is your interpreter's contact information?

Given name (first name)
Family name (last name)
My interpreter is not part of a business or
organization.
Country
Address line 1
Address line 2
City or town
State/Province
ZIP code/Postal code
Daytime telephone number
Mobile telephone number
My interpreter does not have a mobile
telephone number.
Email address
My interpreter does not have an email
address.

11.6

2.1

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

2.2

Have you used any other names since birth?
(IF YES)

10.2.b
About you

Revised Sub-Question

Yes/No

12.6

Interpreter information

Current Sub-Question

Is someone assisting you with completing this application?

1.2
10.4
10.3
10.5

What is your country of former citizenship or nationality?
How can we contact you?

What is your date of birth?

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

Dropdown
Text
Text
Text
Text
Text
Text
Text
Checkbox
Text
Checkbox
Text
Text
Text
Checkbox
Dropdown
Text
Text
Text
Text
Text
Text
Text
Checkbox
Text
Checkbox
Text

Given name (first name)

Text

Middle name (if applicable)
Family name (last name)
Yes/No
Given name (first name)

Text
Text
Radio
Text

Middle name (if applicable)
Family name (last name)

Text
Text

Month/Day/Year
Country
Mobile telephone number
Daytime telephone number
This is the same as my mobile telephone number.
Email address

Help Text

Dropdown
Text
Text
Checkbox
Text

Your current legal name is
the name on your birth
certificate, unless it
changed after birth by a
legal action such as

Provide the other names
you have used.

Date

Getting Started

Biometrics Rule NPRM - edits made
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Step

Section

Additional information

Paper Form
Question #

Current Question

2.3

What is your current mailing address?

Revised Question

Current Sub-Question

Revised Sub-Question

Current
Revised Instructional Text
Field Type Field Type

In care of name (if any)

Text

Country
Address line 1
Address line 2
City or town
State/Province
ZIP code/Postal code

Dropdown
Text
Text
Text
Text
Text

3.1

What is your ethnicity?

Hispanic or Latino
Not Hispanic or Latino

Radio

3.2

What is your race?

White

Checkbox

Asian

Checkbox

Help 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.

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.
Select all that apply. Your White
race is different from your
ethnicity and should reflect A person having origins in any of
your geographical origins. the original peoples of Europe,
the Middle East, or North Africa.
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

3.3
3.4
3.5

What is your height?
What is your weight?
What is the color of your eyes?

3.6

What is the color of your hair?

Feet/Inches
Pounds
Black/Blue/Brown/Gray/Green/Hazel/Maroo
n/Pink/ Unknown/other
Bald (no
hair)/Black/Blonde/Brown/Gray/Red/Sandy/
White/ Unknown/other

Checkbox

Text
Text
Dropdown

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

Dropdown

Getting Started

Biometrics Rule NPRM - edits made
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Step

Section

Paper Form
Question #

Current Question

2.5

What is your current marital status?

Single/Married/Divorced/Widowed/Marriage Annulled

Radio

2.4

Has your marital status changed since your last document was
issued?
What is your A-Number?

Yes/No

Radio

I do not have or know my A-Number.
Yes/No

Text
Checkbox
Radio

1.4
2.6

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

Revised Question

Current Sub-Question

Revised Sub-Question

Current
Revised Instructional Text
Field Type Field Type

Help Text

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.

Getting Started

Biometrics Rule NPRM - no edits

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

Step

Section

Your Request

Current document

New document

Paper Form
Question #
1.3
1.5.b
1.5.a
1.1

Question
What is the certificate number on your current document?
When did USCIS issue this document?
Which court or USCIS office issued your document?
In which name was your current document issued?

4.1A Which document are you requesting?
4.1B
4.1C
4.1D
4.1E

9.1 (IF 4.1E) What is the name of the foreign country?
9.2 (IF 4.1E) What is the name of the foreign official who is
requesting this certificate?

9.2 (IF 4.1E) What is the foreign official's title?
9.2 (IF 4.1E) What is the foreign official's government agency?
9.3 (IF 4.1E) What is the foreign official's address?

Reason for new document

4.2A Why are you requesting a new document?
4.3

Sub-Question

Month/Day/Year
The name on my current document matches my
current legal name.
Given name (first name)
Middle name (if applicable)
Family name (last name)
New Certificate of Citizenship
New Certificate of Naturalization
New Certificate of Repatriation
New Declaration of Intention
Special Certificate of Naturalization to obtain
recognition of my U.S. citizenship by a foreign
country
Given name (first name)
Middle name (if applicable)
Family name (last name)

Country
Address line 1
Address line 2
City or town
State/Province
Zip code/Postal code
My certificate or declaration was lost, stolen, or
destroyed.
My certificate or declaration is mutilated.

Field Type

Text
Text
Text
Radio
Radio
Radio
Radio
Radio

Dropdown
Text
Text
Text
Text
Text
Dropdown
Text
Text
Text
Text
Text
Checkbox

Checkbox

4.5
4.6

My name has legally changed
My date of birth has legally changed through a court
order or U.S. government-issued document.
I am seeking to change the gender listed on my
document.
My reason for applying for a new document is not
listed above.

Checkbox
Checkbox

Name/Date of Birth/Gender/Other

Radio

4.2B (IF LOST STOLEN OR DESTROYED) When, where, and how was
your document lost, stolen, or destroyed?

4.1 (IF CLERICAL ERROR) What was the typographical or clerical
error in your document?
5.2 Provide an explanation of what is incorrect on your current
certificate or declaration.
6.1A (IF NAME CHANGED) Why has your name changed?
6.1B

Select all that apply

Checkbox

My certification or declaration is incorrect due to
typographical/clerical error by USCIS.

4.8A

Help Text

Text
Date
Text
Checkbox

4.4

4.7

Instructional Text

Checkbox
Checkbox
Text

Text
Marriage or divorce
Court order

Radio
Radio

Your Request

Biometrics Rule NPRM - no edits

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Step

Section

Paper Form Question
Question #

6.2 What is your new legal name?

7.1.A (IF BIRTHDAY CHANGED) How was your date of birth
changed?
7.1.B

7.2 (IF BIRTHDAY CHANGED) What is your new date of birth?
8.1A (IF GENDER CHANGED) How has your gender change been
legally recognized?
8.1B

8.1C

8.2 (IF GENDER CHANGED) What is your current gender
designation?
4.8B (IF MY REASON FOR APPLYING FOR A NEW DOCUMENT IS
NOT LISTED ABOVE") Why are you requesting a new
document?

Sub-Question
On what date did your name change?
Month/Day/Year
Given name (first name)
Family name (last name)
Middle name (if applicable)
Court order

Field Type

Instructional Text

Help Text

Date

Checkbox

State-issued document

Checkbox

On what date did your date of birth change?
Month/Day/Year
Month/Day/Year
Court order

Date
Date
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.

Other official documentation recognizing the new
Checkbox
gender by a U.S. state, local jurisdiction, or foreign
state, such as an amended birth certificate, passport
or driver's license
Certification of Gender issued by a licensed physician Checkbox
(Doctor of Medicine (M.D.) or Doctor of Osteopathy
(D.O.))
Male/Female
Radio
Text

Your Request

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Step

Section

Evidence

Evidence to support your
application

Evidence Title

Field Type

Instructional Text

Revised Instructional Text

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 reside outside the United States, 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
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 photo composition tools.
composition-template.html">photo composition tools.

(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

Evidence

Biometrics Rule NPRM - edits

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

Step

Section

Evidence Title

Field Type

Instructional Text

(IF MUTILATED)
Evidence of your mutilated document

Upload

Upload an image or copy of your damaged document.

Revised Instructional Text

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

(IF CLERICAL/TYPO ERROR)
Evidence of clerical or typographical error

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.

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

Evidence

Biometrics Rule NPRM - edits

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Step

Section

Evidence Title

Field Type

Instructional Text

(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.

Revised Instructional Text

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.

(IF GENDER CHANGED BY BIRTH CERT.)
Birth certificate showing legally changed gender

Upload

Mail your original document to:
USCIS Nebraska Service Center
850 S. Street
Lincoln, NE 68508
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)
Upload
Official document showing legally changed gender

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

Evidence

Biometrics Rule NPRM - edits

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

Step

Section

Evidence Title

Field Type

Instructional Text

(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:

Revised Instructional Text

• 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
Additional evidence you want to provide

Upload

Evidence of change in marital status

Upload

Upload a document explaining how and why you lost or renounced your United States
citizenship.
Upload any additional documents that support your application and help explain any of
your answers on the application.
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.

Evidence

Biometrics Rule NPRM - no edits

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

Step

Section

Additional
Information

Optional explanation

Paper Form Question
Question #

Sub-Question

13 You may provide additional information for Additional information
your request

Field Type Not Required

Instructional Text

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.

Additional Information

Biometrics Rule NPRM - edits made

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

Step

Section

Review and Submit

Review your application

Paper Form Question
Question #

Current Sub-Question

Revised Sub-Question

Field
Type

Check your application before
you submit

Instructional Text

Revised Instructional Text

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.

You have one or more alerts and warnings based on the information you provided in
your application.

Alerts and warnings

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
12.7B
12

Preparer's certification

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

Radio
Radio
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.

Interpreter signature

12.8
11

Preparer's signature upload
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.

Upload

Scan and upload your preparer's completed signature page below.
Your interpreter must read and agree to the certification below.

Review & Submit

Biometrics Rule NPRM - edits made

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

Step

Section

Paper Form Question
Question #

Current Sub-Question

Revised Sub-Question

Field
Type

Instructional Text

Upload

Scan and upload your interpreter's completed signature page below.
NOTE: Read the Penalties section of the Form N-565 Instructions before completing
this section.

Revised Instructional Text

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.

Your signature

11.7

Interpreter's signature upload

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.
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.
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.

Checkbox You must read and agree to the statement below.

10.1.A
10

Applicant's declaration and
certification

You must read and agree to the statement below.
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.

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.

If you are required to provide biometrics, at the 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.

I furthermore authorize release of information contained in this application, in supporting [deleted]
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.

Pay and submit

10.6

Your signature

10.6

Date of signature

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.
Text

Month/Day/Year
The final step to submit your Application for Replacement Naturalization/Citizenship
Document is to pay the required fee.

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.

Date

Your application fee is: [$XXX.00]
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.

Review & Submit

Biometrics Rule NPRM - 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
Warning

Logic
applying because:
- mutilated
- typo/clerical error
- name change
- DOB change
- gender change

Message
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

h5. You cannot request a Special Certificate of Naturalization online yet

If 2.1E (requesting Special Certificate)

You should file the paper version of the Application for Replacement Naturalization/Citizenship Document (N565).

Warnings

File Type	application/pdf
Author	Microsoft Office User
File Modified	2020-08-27
File Created	2020-08-27