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TABLE OF CHANGES – INSTRUCTIONS

Form N-648, Medical Certification for Disability Exceptions

OMB Number: 1615-0060

11/30/2021

Reason for Revision: Revision

Project Phase: 30 Day

Legend for Proposed Text:

• Black font = Current text

• Red font = Changes

Expires 12/31/2021

Edition Date 07/23/2020

Current Page Number and Section	Current Text	Proposed Text
Page 1, What is the purpose of Form N-648?	[Page 1] What is the purpose of Form N-648? In general, applicants for naturalization must demonstrate that they understand the English language, including the ability to read, write, and speak words in ordinary usage. They must also demonstrate knowledge and understanding of the fundamentals of the history, principles, and form of government of the United States. Together, these are the English and civics requirements for naturalization. This form is intended for applicants who seek an exception to the English and/or civics requirements due to a physical or developmental disability or mental impairment that has lasted, or is expected to last, 12 months or more. [new]	[Page 1] What is the purpose of Form N-648? [deleted] This form is filled out and certified by certain medical professionals on behalf of applicants who are requesting an exception from the English and/or civics requirements for naturalization because of a disability and/or impairment. Definition of Disability and/or Impairment(s) for Exception from Literacy Requirements An applicant is eligible for this exception if they are unable to learn and/or demonstrate knowledge of English and/or U.S. history and civics because of a physical or developmental disability, or mental impairment (or a combination of impairments). The disability and/or impairment must result from anatomical, physiological, or psychological abnormalities, which can be shown by medically acceptable clinical and laboratory diagnostic techniques. The disability and/or impairment must result in functioning so impaired that the applicant is unable to demonstrate the required knowledge. NOTE: The definition of disability used for this exception may be different from the definition used for other purposes (for example, for Social Security Administration programs, Department of Veterans Affairs programs, and state worker's compensation programs). If your responses do not address how the applicant’s disability affects their ability to learn English and civics, we will request that the applicant submit a revised or second Form N-648 with the required information.
Page 1, Who should submit Form N-648 and when?	[Page 1] Who should submit Form N-648 and when? Applicants for naturalization seeking an exception to the English and/or civics requirements for naturalization because of a physical or developmental disability or mental impairment must submit this form when they file Form N-400 Application for Naturalization, with U.S. Citizenship and Immigration Services (USCIS). USCIS generally only considers a Form N-648 that is concurrently submitted with a Form N-400 to be filed timely, but later-submitted or multiple Forms N-648 may be accepted in certain circumstances. Applicants do not have to fulfill the English and/or civics requirements if they cannot do so because of a physical or developmental disability or mental impairment. (See Immigration and Nationality Act (INA) section 312(b)(1)). A certifying medical professional must complete this form within six months of submission of Form N-400 to USCIS.	[Page 1] Who should submit Form N-648 and when? Applicants for naturalization seeking an exception to the English and/or civics requirements for naturalization because of a physical or developmental disability or mental impairment should submit this form when they file Form N-400, Application for Naturalization, with U.S. Citizenship and Immigration Services (USCIS). Applicants whose N-648 has been found sufficient do not have to fulfill the English and/or civics requirements if they cannot do so because of a physical or developmental disability or mental impairment. (See Immigration and Nationality Act (INA) section 312(b)(1)). USCIS may not consider a Form N-648 if the certifying medical professional completed this form more than 180 days before the submission of Form N-400 to USCIS.
Page 1, Who should not submit this Form N-648?	[Page 1] Who should not submit Form N-648? Applicants who can satisfy the English and civics requirements for naturalization with reasonable accommodations provided under the Rehabilitation Act of 1973 do not need to submit this form. Reasonable accommodations include, but are not limited to, sign language interpreters, extended time for testing, and off-site testing. Applicants requesting an accommodation should indicate that on Part 3. of their completed Form N-400. However, if you are unable to complete the English and/or civics requirements even with an accommodation, you must file Form N-648. Illiteracy alone is not a valid reason to seek an exception to the English and civics requirement by submitting this form.	[Page 1] Who should not submit Form N-648? Applicants who can satisfy the English and civics requirements for naturalization with reasonable accommodations provided under the Rehabilitation Act of 1973 do not need to submit this form. Reasonable accommodations include, but are not limited to, sign language interpreters, extended time for testing, and off-site examination. Applicants may request a disability accommodation online at uscis.gov/accommodations or by calling the USCIS Contact Center at 800-375-5283 (TTY 800-767-1833). However, if you are unable to complete the English and/or civics requirements even with an accommodation, you must file Form N-648 to request an exception from these requirements. Illiteracy and advanced age alone are not valid reasons to seek an exception from the English and/or civics requirements. For additional information, go to www.uscis.gov/about-us/disability-accommodations-for-the-public.
Page 1-3, Who is authorized to certify Form N-648?	[Page 1] Who is authorized to certify Form N-648? Only medical doctors, doctors of osteopathy, or clinical psychologists licensed to practice in the United States (including the U.S. territories of the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the Virgin Islands) may certify this form. While staff of the medical practice associated with the medical professional certifying the form may assist in completing it, the medical professional is responsible for the accuracy of the form’s content. How to Complete This Form All parts of Form N-648, except Part 4. Interpreter’s Certification and Part 5. Applicant’s (Patient’s) Attestation/Release of Information, must be certified by a licensed medical professional. Before certifying Form N-648, the medical professional must have conducted an in-person examination of the applicant. [Page 2] The medical professional must answer all questions and items fully and accurately. USCIS will not accept an incomplete Form N-648. Responses should use common terminology, without abbreviations, that a person without medical training can understand. If completed in writing, all responses must be legible and written in black ink. USCIS recommends that the certifying medical professional use the electronic Form N-648 located in the “FORMS” section at www.uscis.gov. Failure to provide all information requested on the form may result in USCIS determining that the form is insufficient. In addition to providing a detailed assessment of any of the applicant’s physical or developmental disabilities or mental impairments that may affect the applicant’s ability to successfully complete the English and/or civics requirements, a medical professional completing the form may attach supporting medical diagnostic reports or records. However, these attachments may not take the place of written responses to each question or item on Form N-648. Information the medical professional (you) should include in Part 3., Information about Disability and/or Impairment: Information Needed for Item Number 1. You should provide the clinical diagnosis of the applicant's medical disability and/or impairment that forms the basis for seeking an exception to the English and/or civics requirements. If applicable, please provide the relevant medical code as accepted by the Department of Health and Human Services. This includes the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). For example, you could provide a diagnosis of DSM-V 318.1 Intellectual Disability (Severe) or 2015/16 ICD-10-CM F72 Severe intellectual disabilities. [new] If applicable, please provide the relevant medical code as accepted by the Department of Health and Human Services. This includes the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). For example, you could provide a diagnosis of DSM-V 318.1 Intellectual Disability (Severe) or 2015/16 ICD-10-CM F72 Severe intellectual disabilities. Information Needed for Item Number 2. You should provide a basic description of the disabilities and/or impairment(s). For example: “Severe intellectual disability is a genetic disorder that causes lifelong intellectual disability, developmental delays, and other problems.” Information Needed for Item Number 5. Please explain what caused the applicant's medical disabilities and/or impairment(s). For example: “Severe intellectual disability is usually caused by an error in cell division occurring in utero. The cause of such errors in cell division is currently unknown.” Information Needed for Item Number 6. Explain which clinical methods you used to diagnose the applicant's medical disability and/or impairment. For example: “The patient was diagnosed in utero through a Chorionic Villus Sampling (CVS). CVS is a test done during early pregnancy that can identify certain genetic disorders or chromosomal birth defects, such as ‘Severe intellectual disabilities.’ I confirmed this by reviewing medical records provided by the patient.” [new] Information Needed for Item Number 7. You should explain the extent of the disabilities and/or impairment(s) as it specifically relates to the applicant. For example: “The applicant’s severe intellectual disability causes very limited communication skills. He requires family supervision even in simply daily routine activities.” Information Needed for Item Number 8. You should also include an explanation of how the disabilities and/or impairment(s) affects specific functions of the applicant’s life. For example: “Severe intellectual disability prevents the applicant from obtaining employment. The applicant is also unable to drive a car. The applicant requires routine assistance in daily activities, such as preparing meals and maintaining hygiene.” Information Needed for Item Number 13. [Page 3] You must clearly establish a causal connection that explains how the applicant's disability and/or impairment(s) affects his or her ability to demonstrate a knowledge and understanding of English and/or civics. For example: “The patient's condition is a global, lifelong impairment that severely affects cognition, language, and motor skills. Because of this impairment, his memory is deficient, he cannot learn new skills, and he is not capable of reasoning but only of performing simple daily activities. The patient's severe intellectual disability makes him incapable of learning a new language (even basic words) and demonstrating the required knowledge of U.S. history and government.” Information Needed for Item Numbers 15. and 16. Provide the first and last dates you examined the applicant. Information Needed for Item Number 22. If you are not the medical professional who regularly treats the applicant, please explain in detail why that professional was unable or unwilling to complete this form. [moved up from General Instructions]	[Page 2] Who is authorized to certify Form N-648? [deleted] How to Complete This Form The certifying medical professional must have conducted an examination of the applicant before certifying Form N-648. Parts 1. - 3. must be completed and certified by a licensed medical professional. If a telephonic or video facilitated interpreter was used, the certifying medical professional must also complete Part 5. Interpreter Information and Certification. USCIS may accept a Form N-648 certified by an authorized medical professional who completed the applicant’s medical examination through telehealth. The medical professional should be licensed, and telehealth examinations should be synchronous, real-time interactions between the medical professional and the applicant. The applicant for naturalization must complete Part 6. Applicant’s (Patient’s) Attestation/Release of Information. The certifying medical professional must answer all questions and items fully and accurately. USCIS will not accept an incomplete Form N-648. If handwritten, all responses must be legible and written in black ink. USCIS recommends that the certifying medical professional use the electronic Form N-648 located in the “FORMS” section at www.uscis.gov/n-648. The certifying medical professional must provide the completed form to the applicant for submission to USCIS. For electronic filing of naturalization applications, the N-648 may be uploaded as additional evidence. Failure to provide all information requested on the form may result in USCIS determining that the form is insufficient. In addition to providing a detailed assessment of any of the applicant’s physical or developmental disabilities or mental impairments that may affect the applicant’s ability to successfully complete the English and/or civics requirements, the certifying medical professional completing the form may attach supporting medical diagnostic reports or records. However, these attachments may not take the place of written responses to each question or item on Form N-648. Information the certifying medical professional (you) should include in Part 3. Information about Disabilities and/or Impairments: Information Needed for Item Number 1. You should provide the clinical diagnosis of the applicant's medical disability and/or impairment that forms the basis for seeking an exception to the English and/or civics requirements. Also, in Item Number 1., the certifying medical professional needs to explain, in as much detail as possible, how each disability and/or impairment prevents the applicant from learning English and/or civics. In other words, you should explain how the disability and/or impairment causes the applicant’s inability to learn English and/or civics. Responses should use clear and common terminology, without abbreviations, that a person without medical training can understand. For example: “The patient’s condition is a global, lifelong impairment that severely affects cognition, language, and motor skills. Because of this impairment, the patient's memory is deficient, the patient cannot learn new skills, and the patient is not capable of reasoning. The patient is only able to perform simple daily activities. The patient’s severe intellectual disability makes the patient incapable of learning a new language (even basic words) and demonstrating the required knowledge of U.S. history and government.” [deleted] [deleted] Information Needed for Item Number 2. Explain which clinical methods or laboratory diagnostic techniques you used to diagnose each of the applicant's medical disability and/or impairments. For example: “The patient was diagnosed in utero through a Chorionic Villus Sampling (CVS). CVS is a test done during early pregnancy that can identify certain genetic disorders or chromosomal birth defects, such as ‘Severe intellectual disabilities.’ I confirmed this by reviewing medical records provided by the patient.” [Page 3] Part 4. Ability to Understand Oath of Allegiance Information Needed for Item Number 1. In order to obtain an oath waiver because of a medical disability, an applicant must have a legal guardian, surrogate, or designated representative to complete the naturalization process. In the absence of a legal guardian or surrogate, a U.S. citizen spouse, parent, adult son or daughter, or adult brother or sister who is the primary custodial caregiver and who takes responsibility for the applicant can serve as the designated representative. [deleted] Part 5. Interpreter Information and Certification. If in-person interpretation services were used during the medical examination, the interpreter must fill out this section and sign and date the certification. If telephonic interpretation services were used during the medical examination, the certifying medical professional must complete all items in this section, except Item Number 6.
Page 3-4, General Instructions	[Page 3] General Instructions USCIS provides forms free of charge through the USCIS website. In order to view, print, or fill out our forms, you should use the latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you do not have internet access, you may call the USCIS Contact Center at 1-800-375-5283 and ask that we mail a form to you. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833. Signature. Each form must be properly signed and submitted. For all signatures on this form, USCIS will not accept a stamped or typewritten name in place of a signature. A legal guardian may also sign for a mentally incompetent person. If the request is not signed or if the requisite signature on the request is not valid, USCIS may reject or deny the request. See 8 CFR 103.2(a)(7)(ii)(A). Validity of Signatures. USCIS will consider a photocopied, faxed, or scanned copy of the original, handwritten signature valid for filing purposes. The photocopy, fax, or scan must be of the original document containing the handwritten, ink signature. Copies. You should submit legible photocopies of documents requested, unless the Instructions specifically state that you must submit an original document.  USCIS may request an original document at the time of filing or at any time during processing of an application or petition.  If USCIS requests an original document from you, it will be returned to you after USCIS determines it no longer needs your original. NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be immediately destroyed after we receive them. Translations. If you submit a document with information in a foreign language, you must also submit a full English translation. The translator must sign a certification that the English language translation is complete and accurate, and that he or she is competent to translate from the foreign language into English. The certification must include the translator’s signature, printed name, the signature date, and the translator’s contact information. How To Fill Out Form N-648 1. Type or print legibly in black ink. [Page 4] 2. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been married and the question asks, “Provide the name of your current spouse”), type or print “N/A” unless otherwise directed.  If your answer to a question which requires a numeric response is zero or none (for example, “How many children do you have” or “How many times have you departed the United States”), type or print “None” unless otherwise directed. 3. The medical professional must provide the completed form to the applicant. 4. Part 4. Interpreter’s Contact Information, Certification, and Signature. If an interpreter was used during the medical examination, the interpreter must fill out this section; provide his or her name, the name and address of his or her business or organization (if any), his or her daytime telephone number, his or her mobile telephone number (if any), and his or her email address (if any). The interpreter must sign and date the certification.	[Page 3] General Instructions [no change] Signature. Each form must be properly signed and submitted. USCIS will not accept a stamped or typewritten name in place of a signature. A legal guardian, surrogate or designated representative, may also sign for an applicant who has been deemed legally incompetent. If the request is not signed or if the requisite signature on the request is not valid, USCIS may reject the request. See 8 CFR 103.2(a)(7)(ii)(A). If USCIS accepts a request for adjudication and determines that it has a deficient signature, USCIS may deny the request. [no change] Copies. You should submit legible photocopies of documents requested unless the Instructions specifically state that you must submit an original document.  USCIS may request an original document at the time of filing or at any time during processing of an application or petition.  If USCIS requests an original document from you, it will be returned to you after USCIS determines it no longer needs your original. [no change] Translations. If you submit a document with information in a foreign language, you must also submit a full English translation. The translator must sign a certification that the English language translation is complete and accurate, and that they are competent to translate from the foreign language into English. The certification must include the translator’s signature, printed name, the signature date, and the translator’s contact information. [deleted]
		[Page 3] Filing Fee There is no filing fee for Form N-648.
		[Page 4] Address Change An applicant who is not a U.S. citizen must notify USCIS of his or her new address within 10 days of moving from his or her previous residence.  For information on filing a change of address, go to the USCIS website at www.uscis.gov/addresschange or reach out to the USCIS Contact Center at www.uscis.gov/contactcenter for help.  For TTY (deaf or hard of hearing) call:  1-800-767-1833. NOTE: Do not submit a change of address request to the USCIS Lockbox facilities because the Lockbox does not process change of address requests.
Page 4, Processing Information for the Applicant	[Page 4] Processing Information for the Applicant Initial Processing. Once USCIS accepts your form, we will check it for completeness. Failure to provide all information requested on the form may result in USCIS determining that your Form N-648 is insufficient. Requests for More Information. USCIS may request that you provide more information or evidence to support your form. We may also request that you provide the originals of any copies you submit. If we request an original document from you, it will be returned to you after USCIS determines it no longer needs your original. Decision. The decision on Form N-648 involves determining whether you established eligibility for an exception to the English and/or civics requirements for naturalization. USCIS will notify you of the decision in writing.	[Page 4] Processing Information for the Applicant [no change] Requests for More Information. USCIS may request that you provide more information or evidence to support your form. We may also request that you provide the originals of any copies you submit. If USCIS requests an original document from you, we will return it to you after we determine we no longer need your original. Decision. The decision on Form N-648 involves determining whether you have established eligibility for an exception to the English and/or civics requirements for naturalization. USCIS will notify you of the decision in writing.
Page 4, USCIS Forms and Information	[Page 4] USCIS Forms and Information To ensure you are using the latest version of this form, visit the USCIS website at www.uscis.gov where you can obtain the latest USCIS forms and immigration-related information. If you do not have internet access, you may call the USCIS Contact Center at 1-800-375-5283 and ask that we mail a form to you. The USCIS Contact Center provides information in English and Spanish. For TTY (deaf or hard of hearing) call: 1-800-767-1833. [New]	[Page 4] USCIS Forms and Information [no change] Please visit us at www.uscis.gov/contactcenter to get basic information about immigration services and ask questions about a pending case. Through our digital self-help tools and live assistance, the USCIS Contact Center provides a pathway for you to get consistent, accurate information and answers to immigration case questions.
		[Page 4] Penalties If you knowingly and willfully falsify or conceal a material fact or submit a false document with your Form N-648, we will deny your Form N-648 and may deny any other immigration benefit. In addition, you will face severe penalties, including up to 10 years in prison, as provided by law and may be subject to criminal prosecution. You may also lose your medical license.
Page 5, DHS Privacy Notice	[Page 5] DHS Privacy Notice AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the Immigration and Nationality Act, 8 U.S.C. Section 1423 and 8 CFR Section 312.2. PURPOSE: The primary purpose for providing the requested information on this form is to determine whether the applicant has established eligibility for an exception to the English language and/or U.S. history and civic requirements due to a physical or developmental disability or mental impairment that has lasted, or is expected to last, 12 months or more. DHS uses the information provided to grant or deny the exception sought. 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 the denial of your request. ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you provide on this form 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-001 – Alien File, Index, and National File Tracking System and DHS-USCIS-007 - Benefits Information System] and the published privacy impact assessments [DHS/USCIS/PIA-015 Computer Linked Application Information Management System (CLAIMS 4) and DHS/USCIS/PIA-056 USCIS Electronic Immigration System] which you can find at www.dhs.gov/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the interest of national security.	[Page 4] DHS Privacy Notice [no change] [Page 5] PURPOSE: The primary purpose for providing the requested information on this form is to determine whether the applicant has established eligibility for an exception to the English language and/or civics requirements due to a physical or developmental disability or mental impairment that has lasted, or is expected to last, 12 months or more. DHS uses the information provided to grant or deny the exception sought. [no change]
Page 5, Paperwork Reduction Act	[Page 5] Paperwork Reduction Act An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection of information, unless it displays a currently valid Office of Management and Budget (OMB) control number. The public reporting burden for this collection of information is estimated at 2 hours and 25 minutes per response, including the time for reviewing instructions, gathering the required documentation and information, completing the form, preparing statements, attaching necessary documentation, and submitting the form. 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, Office of Policy and Strategy, Regulatory Coordination Division, 5900 Capital Gateway Drive, Mail Stop #2140, Camp Springs, MD 20588-0009; OMB No. 1615-0060. Do not mail your completed Form N-648 to this address.	[Page 5] Paperwork Reduction Act An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection of information, unless it displays a currently valid Office of Management and Budget (OMB) control number. The public reporting burden for this collection of information is estimated at 2 hours per response for the medical professional and 8 hours per response for the applicant, including the time for reviewing instructions, gathering the required documentation and information, completing the form, preparing statements, attaching necessary documentation, travel, appointments, and submitting the form. 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, Office of Policy and Strategy, Regulatory Coordination Division, 5900 Capital Gateway Drive, Mail Stop #2140, Camp Springs, MD 20588-0009; OMB No. 1615-0060. Do not mail your completed Form N-648 to this address.

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