N-565 Form Table of Changes

TABLE OF CHANGES – FORM

Form N-565, Application for Replacement Naturalization/Citizenship Document

OMB Number: 1615-0091

07/29/2021

Reason for Revision: Revision

Project Phase: 30-day FRN

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 10/31/2021

Edition Date 10/21/2019

Current Page Number and Section	Current Text	Proposed Text
Page 1, Part 1. Information From Current Certificate or Declaration	[Page 1] … Family Name (Last Name) Given Name (First Name) Middle Name [new] 2. Country of Former Citizenship or Nationality 3. Certificate or Declaration Number 4. Alien Registration Number (A-Number) 5. Certificate or Declaration Issuance Provide information about who issued your last certificate or declaration along with the date it was issued. …	[Page 1] … Family Name (Last Name) Given Name (First Name) Middle Name 2. Date of Birth on Certificate or Declaration (mm/dd/yyyy) 3. Country of Former Citizenship or Nationality 4. Certificate or Declaration Number 5. Alien Registration Number (A-Number) 6. Certificate or Declaration Issuance Provide information about who issued your last certificate or declaration along with the date it was issued. …
Pages 1-2, Part 2. Current Information About You	[Page 1] Part 2. Current Information About You 1. Your Full Legal Name Family Name (Last Name) Given Name (First Name) Middle Name 2. Other Names You Have Used Provide any other names you have used since birth, for any period of time, including aliases, maiden names, and nicknames. If your answer is “none,” type or print “None.” If you need extra space to complete this section, use the space provided in Part 13. Additional Information. … [Page 2] 3. Mailing Address In Care of Name Street Number and Name Apt./Ste./Flr. Number City or Town State ZIP Code Province Postal Code Country … NOTE: If you answered “Yes” to Item Number 6., provide an explanation in Part 13. Additional Information or attach a separate sheet of paper.	[Page 1] Part 2. Current Information About You 1. Your Full Legal Name (Do not provide a nickname) Family Name (Last Name) Given Name (First Name) Middle Name 2. Other Names Used Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 12. Additional Information. … [Page 2] 3. Current Mailing Address In Care of Name Street Number and Name Apt./Ste./Flr. Number City or Town State ZIP Code Province Postal Code Country … NOTE: If you answered “Yes” to Item Number 6., provide an explanation in Part 12. Additional Information or attach a separate sheet of paper.
Page 2, Part 3. Biographic Information	[Page 2] Part 3. Biographic Information 1.  Ethnicity (Select only one box) Hispanic or Latino Not Hispanic or Latino 2.  Race (Select all applicable boxes) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White 3.  Height  Feet__ Inches __ 4.  Weight    Pounds _ ­_ _ 5.  Eye Color (Select only one box) Black Blue Brown Gray Green Hazel Maroon Pink Unknown/Other 6.  Hair Color (Select only one box) Bald (No hair) Black Blond Brown Gray Red Sandy White Unknown/Other	[deleted]
Page 3, Part 4. Type of Application	[Page 3] Part 4. Type of Application … NOTE: If you selected Item E., skip the Basis for My Application section below and go to Part 9. … NOTE: If you selected Item A. in Item Number 2., go to Part 10. and attach a copy of the certificate or declaration (if available), police report, and/or sworn statement. … NOTE: If you selected Item Number 3., go to Part 10. and attach the original certificate or declaration. … NOTE: If you selected Item Number 4., go to Part 5. and attach the original certificate or declaration. … NOTE: If you selected Item Number 5., go to Part 6. and attach the original certificate or declaration and evidence of the name change. … NOTE: If you selected Item Number 6., go to Part 7. and attach the original certificate or declaration and evidence of the date of birth change. … NOTE: If you selected Item Number 7., go to Part 8. and attach the original certificate or declaration and evidence of the gender change. … NOTE: If you selected Item A in Item Number 8., go to Part 10. and attach the original certificate or declaration and any evidence documents.	[Page 3] Part 3. Type of Application … NOTE: If you selected Item E., skip the Basis for My Application section below and go to Part 8. … NOTE: If you selected Item A. in Item Number 2., go to Part 9. and attach a copy of the certificate or declaration (if available), police report, and/or sworn statement. … NOTE: If you selected Item Number 3., go to Part 9. and attach the original certificate or declaration. … NOTE: If you selected Item Number 4., go to Part 4. and attach the original certificate or declaration. … NOTE: If you selected Item Number 5., go to Part 5. and attach the original certificate or declaration and evidence of the name change. … NOTE: If you selected Item Number 6., go to Part 6. and attach the original certificate and evidence of the date of birth change. … NOTE: If you selected Item Number 7., go to Part 7. and attach the original certificate or declaration and evidence of the gender change. … NOTE: If you selected Item A. in Item Number 8., go to Part 9. and attach the original certificate or declaration and any evidence documents.
Page 4, Part 5. Complete If Applying to Correct Your Document Due to a USCIS Typographical or Clerical Error	[Page 4] Part 5. Complete If Applying to Correct Your Document Due to a USCIS Typographical or Clerical Error NOTE: After completing this section, go to Part 10. 1. Which information needs correcting? (select all applicable boxes) …	[Page 4] Part 4. Complete If Applying to Correct Your Document Due to a USCIS Typographical or Clerical Error NOTE: After completing this section, go to Part 9. 1. What was the typographical or clerical error in your document that needs to be corrected? (select all applicable boxes) …
Page 4, Part 6. Complete If Applying for a New Document Because of a Name Change	[Page 4] Part 6. Complete If Applying for a New Document Because of a Name Change NOTE: After completing this section, go to Part 10. If you are applying to correct your document due to a USCIS error, use Part 5. …	[Page 4] Part 5. Complete If Applying for a New Document Because of a Name Change NOTE: After completing this section, go to Part 9. If you are applying to correct your document due to a USCIS error, use Part 4. …
Page 4, Part 7. Complete If Applying for a New Certificate of Citizenship Because of an Official Date of Birth Change	[Page 4] Part 7. Complete If Applying for a New Certificate of Citizenship Because of an Official Date of Birth Change NOTE: After completing this section, go to Part 10. If you are applying to correct your document due to a USCIS error, use Part 5. …	[Page 4] Part 6. Complete If Applying for a New Certificate of Citizenship Because of an Official Date of Birth Change NOTE: After completing this section, go to Part 9. If you are applying to correct your document due to a USCIS error, use Part 4. …
Page 5, Part 8. Complete If Applying for a New Document Because of an Official Change in Gender	[Page 5] Part 8. Complete If Applying for a New Document Because of an Official Change in Gender NOTE: After completing this section, go to Part 10. If you are applying to correct your document due to a USCIS error, use Part 5. …	[Page 5] Part 7. Complete If Applying for a New Document Because of an Official Change in Gender NOTE: After completing this section, go to Part 9. If you are applying to correct your document due to a USCIS error, use Part 4. …
Page 5, 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	[Page 5] 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 …	[Page 5] Part 8. Complete If Applying for a Special Certificate of Recognition as a Citizen of the United States to the Government of a Foreign Country …
Pages 6-7, Part 10. Applicant’s Statement, Contact Information, Certification, and Signature	[Page 6] Part 10. Applicant’s Statement, Contact Information, Certification, and Signature … B. The interpreter named in Part 11. read to me every question and instruction on this application and my answer to every question in [Fillable Field], a language in which I am fluent, and I understood everything. … At my request, the preparer named in Part 12., [Fillable Filed], prepared this application for me based only upon information I provided or authorized. … Applicant’s Declaration and Certification … 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. …	[Page 6] Part 9. Applicant’s Statement, Contact Information, Certification, and Signature … B. The interpreter named in Part 10. read to me every question and instruction on this application and my answer to every question in [Fillable Field], a language in which I am fluent, and I understood everything. … At my request, the preparer named in Part 11., [Fillable Filed], prepared this application for me based only upon information I provided or authorized. … Applicant’s Certification … 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 may require me to appear for an appointment to take my biometrics and, if I am required to appear, 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 I provided or authorized all of the information in my application, I understand all of the information contained in, and submitted with, my application, and that all of this information is complete, true, and correct. …
Page 7, Part 11. Interpreter’s Contact Information, Certification, and Signature	[Page 7] Part 11. Interpreter’s Contact Information, Certification, and Signature … I am fluent in English and [Fillable Field], which is the same language specified in Part 10., Item B. in Item Number 1., and I have read to this applicant in the identified language 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. …	[Page 7] Part 10. Interpreter’s Contact Information, Certification, and Signature … I am fluent in English and [Fillable Field], which is the same language specified in Part 9., Item B. in Item Number 1., and I have read to this applicant in the identified language 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. …
Page 8, Part 12. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant	[Page 8] Part 12. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant …	[Page 8] Part 11. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant …
Page 9, Part 13. Additional Information	[Page 9] Part 13. Additional Information …	[Page 9] Part 12. Additional Information …

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