N-565 Online Filing Copy Deck

N565-011-Online Filing Copy Deck.pdf

Application for Replacement Naturalization/Citizenship Document

N-565 Online Filing 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⚠️ Notice: This form may be outdated.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: Revision of currently approved
collection
Baseline Form Edition: 10/21/2019

COPY DECK VERSION INFO

Revision of currently approved collection - edits made

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

Section

Revised

Instructional Text

Revised

Application for Replacement Application for
Replacement
Naturalization/Citizenship
Naturalization/Citizens
Document
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:

You may apply for a replacement document 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

• You were issued a Certificate of Naturalization, Certificate of Citizenship, Declaration or Repatriation Certificate which is incorrect due to a typographical or 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

• Your name was changed by marriage, divorce, annulment, or 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 received your Certificate of Citizenship and afterwards you obtained a court order or a document issued by the U.S. government or the government of any
U.S. state that changes your date of birth and you seek a certificate with the new date of birth

Eligibility

CTA
Learn more about applying for a replacement
document

• 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- • You were issued a Certificate of Citizenship, a Certificate of Naturalization, Declaration of Intention, or Repatriation Certificate and your change of gender is legally
recognized through a court order, a government-issued document, or a letter from a licensed health care professional.
issued document, or a medical certification

Fee

• 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.

USCIS cannot make any changes to an incorrect date of birth or name on a Certificate of Naturalization if you provided an incorrect date or name 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: $555

Fee: $555
Learn more about filing a fee waiver
your request online and will need to file a paper form instead.
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, 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.

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 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.
application. These include your original document, if you still have it.
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.

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.

Go to my USCIS
account

Application Overview

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Section

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Instructional Text

Biometric services
appointment

Revised

CTA

If you reside in the United States, USCIS may request that you attend an appointment at an ASC to have your photograph taken.
USCIS may require that you appear for an interview or provide biometrics (fingerprints, photograph, and/or signature) at any time to verify your identity, obtain
additional information, and conduct background and security checks, including a check of criminal history records maintained by the Federal Bureau of Investigation
(FBI), before making a decision on your application or petition. After USCIS receives your application and ensures it is complete, we will inform you if you need to
attend a biometric services appointment. If an appointment is necessary, the notice will provide you the location of your local or designated USCIS application
support center (ASC) and the date and time of your appointment or, if you are currently outside the United States, instruct you to contact a U.S. Embassy, U.S.
Consulate, or USCIS office outside the United States to set up an appointment.
If you are required to provide biometrics, at your appointment you must sign an oath reaffirming that:
1. You provided or authorized all information in the application;
2. You reviewed and understood all of the information contained in, and submitted with, your application; and
3. All of this information was complete, true, and correct at the time of filing.

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

Completing your form online Complete the Getting
Started section first
Provide as many
responses as you can
Saving your responses
will be done
automatically
DHS Privacy Notice

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.

You should answer all questions in the Getting Started section first so we can best customize the rest of your online application experience.
Completely fill out this 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 Once USCIS accepts your application, we will check it for completeness. If you do not completely fill out this application, you will not establish a basis for your
application
can slow down the process after you submit your application.
eligibility and USCIS may reject or deny 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.

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.

Application Overview

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

Paperwork Reduction Act

Security Reminder

Revised

Instructional Text

Revised

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

U.S. Citizenship and Immigration Services
Office of Policy and Strategy, Regulatory Coordination Division
5900 Capital Gateway Drive, Mail Stop #2140
Camp Springs, MD 20588-0009

Do not mail your completed Form N-565 to this address.

OMB No. 1615-0091
Expires: mm/dd/yyyy

CTA

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

Revision of currently approved collection - 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

Revised

Paper Form
Question #

Revised

Getting Started Preparer and interpreter
information

Preparer information

Interpreter information

About you

Question

Yes/No

Radio

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

Yes/No

Radio

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

Text
Text
Text

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

Checkbox

Mobile telephone number
My preparer does not have a mobile
telephone number.
Email address
My preparer does not have an email address.

Text
Checkbox

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

Text
Text
Text

My interpreter is not part of a business or
organization.
Country

Checkbox

Address line 1
Address line 2
City or town
State/Province
ZIP code/Postal code
Daytime telephone number

Text
Text
Text
Text
Text
Text

Mobile telephone number
My interpreter does not have a mobile
telephone number.
Email address
My interpreter does not have an email
address.

Text
Checkbox

11.1

What is your preparer's full name?
What is your preparer's business or
organization name?

12.3

11.3

What is your preparer's mailing address?

12.4

11.4

What is your preparer's contact
information?

12.5

11.5

12.6

11.6

11.1

10.1

What is your interpreter's full name?

11.2

10.2

What is your interpreter's business or
organization name?

11.3

10.3

What is your interpreter's mailing address?

10.5

11.6

10.6

10.2.b

9.2.b

2.1

2.2

Field Type Revised

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

11.2

10.4

Revised

Radio

12.2

11.5

Sub-Question
Yes/No

12.1

11.4

Revised

Is someone assisting you with completing
this application?

What is your interpreter's contact
information?

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

(IF YES)

Given name (first name)

Text

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

Text
Text
Dropdown

How can we contact you?

10.5
2.3

9.5

What is your current mailing address?

An interpreter is someone who
reads the instructions and
questions on this application to you
in a language in which you are
fluent.

Text

Text
Text
Radio

What is your country of former citizenship or [moved to Your Request]
nationality?

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

Text
Checkbox

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

9.4
9.3

Revised

Dropdown

Have you used any other names since birth?

1.3

Help Text

Text
Checkbox

Text

10.4
10.3

Revised

Dropdown
Text
Text
Text
Text
Text
Text

Given name (first name)

1.2

Instructional Text

[moved to Your Request]

Mobile telephone number
Daytime telephone number
This is the same as my mobile telephone
number.
Email address
In care of name (if any)

Text
Text
Checkbox

Country
Address line 1
Address line 2
City or town
State/Province

Dropdown
Text
Text
Text
Text

Text
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.

Other names used may include
nicknames, aliases, and maiden
names.
Provide the other names you have
used.

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.

Getting Started

Revision of currently approved collection - 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

Step

Section

Additional information

Revised

(delete)

Paper Form
Question #

Revised

Question

Revised

Sub-Question

Revised

Field Type Revised

(delete)

Text
Radio

(delete)

Checkbox

(delete)

3.1

(delete)

What is your ethnicity?

(delete)

ZIP code/Postal code
Hispanic or Latino
Not Hispanic or Latino

3.2

(delete)

What is your race?

(delete)

White

Asian

(delete)

Checkbox

Instructional Text

Revised

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 race is
different from your ethnicity and
should reflect your geographical
origins.

(delete)

Help Text

Revised

White

(delete)

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

(delete)

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

(delete)

Checkbox

Black or African American

(delete)

A person having origins in any of
the black racial groups of Africa.
American Indian or Alaska Native

(delete)

Checkbox

American Indian or Alaska
Native

(delete)

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

(delete)

Checkbox

Native Hawaiian or Other
Pacific Islander

(delete)

A person having origins in any of
the original peoples of Hawaii,
Guam, Samoa, or other Pacific
Islands.
3.3
3.4
3.5

(delete)
(delete)
(delete)

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

(delete)
(delete)
(delete)

3.6

(delete)

What is the color of your hair?

(delete)

Has your marital status changed since your
last document was issued?
What is your current marital status?

2.4
2.5

1.4
2.6

1.5

What is your A-Number?
Since becoming a U.S. citizen, have you lost
or renounced your citizenship in any
manner?

(If Yes to changed marital status)
What is your current marital status?

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
Yes/No

(delete)
(delete)
(delete)

Text
(delete)
(delete)
Text
Dropdown (delete)

(delete)

Dropdown (delete)

Radio

Single/Married/Divorced/Widowed/Marriage
Annulled

Radio

If your marital status has changed (delete)
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.

Text
Checkbox
Radio

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

(If Yes to lost/renounced) provide an
explanation. [Fillable text]

Getting Started

Revision of currently approved collection - edits made

N565

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

Step

Section

Revised

Your Request

Current document

Current certificate or declaration

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

Revised Question

1.2

New document

4.1A
4.1B
4.1C
4.1D
4.1E

1.2

Reason for new document

What is the date of birth on your current document?

3.1.A Which document are you requesting?
3.1.B
3.1.C
3.1.D
3.1.E

1.3 What is your country of former citizenship or nationality?

9.1

(If 3.1.E) 8.1 What is the name of the foreign country?

9.2

(If 3.1.E) 8.2 What is the name of the foreign official who is requesting
this certificate?

9.2

(If 3.1.E) 8.2 What is the foreign official's title?

9.2

(If 3.1.E) 8.2 What is the foreign official's government agency?

9.3

(If 3.1.E) 8.3 What is the foreign official's address?

4.2A

Revised

1.4 What is the certificate number on your current document? What is the certificate or declaration number on your
current document?
When was this document issued?

1.6.b When did USCIS issue this document?
1.6.a Which court or USCIS office issued your document?
In which name was your current document issued?

3.2A Why are you requesting a new document?

(If New Cit/Natz/Repat/Special Cert) What is your country
of former citizenship or nationality?

Sub-Question

Revised

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
Country

Text
Text
Text
The date of birth on my current document matches
my current date of birth

Dropdown

I do not know their name.
I do not know their title.

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.

I do not know their agency.

I do not know their address.

Text
Text
Text
Text
Dropdown
Text
Text
Text
Text
Text
Checkbox

3.4

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

Checkbox

4.5

3.5

My name has legally changed

Checkbox

4.6

3.6

My date of birth has legally changed through a
court order or U.S. government-issued document.

Checkbox

I am seeking to change the gender listed on my
document.
My reason for applying for a new document is not
listed above.

Checkbox

3.7
3.8A
3.2B (IF LOST STOLEN OR DESTROYED) When, where, and how
was your document lost, stolen, or destroyed?

4.1

5.2

6.1B

5.1B

6.2

5.2 What is your new legal name?

Marriage or divorce

Marriage, divorce, annulment

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

6.1B

State-issued document

Only applicants applying for a new Certificate of Citizenship may select
this option.

If you select Court order, we will request a copy of either the original or
certified court document.

Date

Checkbox
U.S. Government-issued document

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

Checkbox

Date
Date
Court order granting change of sex or gender.

Checkbox

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

Government-issued document reflecting the
gender change.

Checkbox

8.1C

7.1C

Certification of Gender issued by a licensed
physician (Doctor of Medicine (M.D.) or Doctor of
Osteopathy (D.O.))

Certification of gender issued by a licensed health
care professional

Checkbox

7.2 (IF GENDER CHANGED) What is your current gender
designation?

Select all that apply

If you select marriage, divorce or annulment, we will request a copy of
your marriage certificate, annulment decree, or divorce decree.

Court order

3.8B (IF MY REASON FOR APPLYING FOR A NEW DOCUMENT IS
NOT LISTED ABOVE") Why are you requesting a new
document?

Checkbox

Radio

8.1B

8.2

Checkbox

Radio

7.1A (IF GENDER CHANGED) How has your gender change been
legally recognized?
7.1B

4.8B

Checkbox

Radio

Court order

7.1.B

6.2 (IF BIRTHDAY CHANGED) What is your new date of birth?

Checkbox

Text
(IF NAME CHANGED) How did your name change?

6.1A (IF BIRTHDAY CHANGED) How was your date of birth
changed?

7.2

(delete)

Radio

Text

7.1.A

8.1A

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.

Date
Checkbox

Checkbox

(IF CLERICAL ERROR) What was the typographical or clerical (IF CLERICAL ERROR) What was the typographical or clerical Name/Date of Birth/Gender/Other
error in your document?
error in your document that needs to be corrected?

5.1A (IF NAME CHANGED) Why has your name changed?

Revised Help Text

Checkbox

4.2 Provide an explanation of what is incorrect on your current
certificate or declaration.

6.1A

Help Text

Text

4.4

4.7

Revised Instructional Text

Dropdown

3.3

4.2B

Instructional Text

Radio
Radio
Radio
Radio
Radio

4.3

4.8A

Revised

Date
Text
Checkbox

The name on my current document matches my
current legal name.
Given name (first name)
Middle name (if applicable)
Family name (last name)

Provide the following information about the foreign official
who has requested this certificate.
(If Yes to name of foreign official) What is the name of the Given name (first name)
foreign official who is requesting this certificate?
Middle name (if applicable)
Family name (last name)

(If 3.1.A, 3.1.B, 3.1.C, or 3.1.D) Why are you requesting a
new document?

Field Type
Text

Month/Day/Year

Male/Female

Radio

Text

Your Request

Revision of currently approved collection - 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

Step

Section

Evidence

Evidence to support your
application

Evidence Title

Revised

Field Type

Revised

Instructional Text

Revised

As part of the application process, you will need to provide evidence to support your
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 application. These documents help us evaluate your application and verify your answers
are true.
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 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.

[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

U.S. Government-issued photo identification

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.

Upload an image of your U.S. Government-issued photo identification.
(If applicant provided a foreign address) 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
your photo, you can use to the Department of State's photo composition tools.
href="https://travel.state.gov/content/passports/en/passports/photos/photocomposition-template.html">photo composition tools.

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.

(IF TYPOGRAPHICAL/CLERICAL ERROR, NAME
CHANGE, DOB CHANGE, GENDER CHANGE)
Original document from USCIS

Upload

Upload an image or copy of your original document.

If your marital status has changed since your original document was issued, you must
upload an image or copy of the document establishing your change in marital staus. Such
documents may include your most recent marriage certificate, divorce decree,
annulment decree, or spouse's death certificate.

(IF MUTILATED)
Evidence of your mutilated document

(IF LOST, STOLEN, OR DESTROYED)
Evidence of your lost, stolen, or destroyed
document

Upload

Upload an image or copy of your damaged document.

Upload an image or copy of your mutilated 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.

You also must mail your mutilated 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

Mail your original document to:
USCIS Nebraska Service Center
850 S. Street
Lincoln, NE 68509

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
You must also upload a copy of a police report and/or a sworn statement explaining what
your original document was lost, stolen, or destroyed. You do not have to upload a copy happened to the document and any attempts to retrieve the document.
of your police report if you do not have one.

Evidence

Revision of currently approved collection - edits made

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Step

Section

Evidence Title

Revised

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

Field Type

Revised

Upload

Instructional Text

Revised

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.

[deleted]

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.

Upload an image or copy of the marriage certificate, annulment decree, or divorce
decree 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.

[deleted]

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.

Upload an image or copy of the original or certified court order 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.

[deleted]

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.

Upload an image or copy of the original or certified U.S. Government-issued document
or court document 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

A U.S. Government document may include:
• Birth certificate
• Certificate recognizing foreign birth
• Certificate of birth abroad
• Other similar vital records issued by the U.S. state where you resided when the
document was issued

You also must mail your original document to USCIS to complete your application. You
should include your A-Number with your original document.

[deleted]

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

(IF GENDER CHANGE BY COURT ORDER)
Court order granting change of sex or gender

Upload

Upload an image or certified copy of the court order that shows your legally changed
gender.

Upload an image or certified copy of the court order granting your change of sex or
gender.

You also must mail your original document to USCIS to complete your application. You
should include your A-Number with your original document.

[delete]

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

[delete]

Upload

[delete]

Upload an image or certified copy of your amended birth certified certificate that shows
your legally changed gender.

[delete]

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) (IF GENDER CHANGED BY GOV-ISSUED DOC)
Official document showing legally changed gender Government-issued document reflecting the
requested gender designation.

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

An official document may include:
• Amended birth certificate
• Passport recognizing the gender change
• Driver's license recognizing the gender change
• Other official document showing identity issued by the U.S. Government, a state or
local government in the United States, or a foreign government

[deleted]

Evidence

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Step

Section

Evidence Title

Revised

Field Type

(IF GENDER CHANGED BY MED. CERT.)
Medical evidence of legally changed gender

(IF GENDER CHANGED BY LIC. HEALTH CARE
PROF.)
Letter from licensed health care professional

Upload

Revised

Instructional Text

Revised

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:

Upload an image or copy of a letter from a licensed health care professional certifying
the requested gender designation is consistent with your gender identity. Licensed
health care professionals include licensed counselors, nurse practitioners, physicians
(Medical Doctors or Doctors of Osteopathy), physician assistants, psychologists, social
workers, and therapists. The health care certification must include the following
information:

• 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.

• The health care professional’s full name, address, and phone number;
• The health care professional’s license number and issuing state, country, or other
jurisdiction of the professional license;
• Language stating the health care professional has treated or evaluated you in relation
to your gender identity; and
• The health care professional’s assessment of your gender identity.

[delete]

Mail your original document to:
USCIS Nebraska Service Center
850 S. Street
Lincoln, NE 68508

(IF OTHER)
Evidence of incorrect document

(IF OTHER)
Evidence supporting your request

Upload

Upload images or copies of any documents supporting your explanation of the error and Upload images or copies of any documents supporting your request for a replacement
request for a replacement document.
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.

[deleted]

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
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.

Upload any additional documents explaining how and why you lost or renounced your
United States citizenship.

Evidence

Revision of currently approved collection - no edits made

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

Step

Section

Additional
Information

Optional explanation

Paper
Form

Question

Sub-Question

Field
Type

13 You may provide additional information for Additional information Textbox
your request

Not Required

Instructional Text
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

Revision of currently approved collection - edits made

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

Step

Section

Review and
Submit

Review your application

Paper Form
Question #

Revised

Question

Revised

Sub-Question

Revised

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 We will review your application to check for accuracy and completeness before you
submit it.
submit it.
If you do not completely fill out this application, you will not establish a basis for
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 eligibility and USCIS may reject or deny your application.
your application.
You can return to this page to review your application as many times as you want
before you submit it.
You can return to this page to review your application as many times as you want
before you submit it.

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

11.7A

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

11.7B

12.7B

11.7B

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

11.8
10

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.

Upload

Scan and upload your interpreter's completed signature page 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

10.7

Interpreter's signature upload

Review & Submit

Revision of currently approved collection - 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

Step

Section

Paper Form
Question #

Revised

Question

Revised

Sub-Question

Revised

Field
Type

Your signature

Instructional Text

Revised Instructional Text

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

(IF PREPARER) Applicant's statement
9.2
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

(IF
Applicant's statement
INTERPRETER) regarding the interpreter
9.1B

Checkbox You must read and agree to the statement below.

10.1.A

(IF NO
INTERPRETER)
9.1A
9
Applicant's declaration and
certification

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.

Applicant's statement

Applicant's certification

Copies of any documents I have submitted are exact photocopies of unaltered, original
documents, and I understand that USCIS may require that I submit original documents to
USCIS at a later date. 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 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 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

9.6

Your signature

10.6

9.6

Date of signature

You must read and agree to the statement below.

Applicant's signature

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 criminal prosecution and penalties provided by law.

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.

Text

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

If you knowingly and willfully falsify or conceal a material fact or submit a false
document with your Form N-565, we will deny your Form N-565 and may deny any
other immigration benefit. In addition, you will face severe penalties provided by
law and may be subject to criminal prosecution.

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: $555
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

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

Revised

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

Revised

Message
h5. You must mail your original document to USCIS

Revised

Notes

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

(delete)

If 2.1E (requesting Special Certificate)

(delete)

You should file the paper version of the Application for Replacement Naturalization/Citizenship Document (N(delete)
565).

Warnings

File Type	application/pdf
Author	Microsoft Office User
File Modified	2021-04-16
File Created	2021-04-16