Medical Certification for Disability Exceptions

Instructions for
Medical Certification for Disability Exceptions
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form N-648

OMB No. 1615-0060
Expires 12/31/2021

What is the purpose of Form N-648?
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.

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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.

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.

Who should not submit this 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.

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Who is authorized to certify Form N-648?
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 authoized 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.

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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.”
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.”

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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.
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.

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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: 1-800-7671833.
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.
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 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.

Filing Fee
There is no filing fee for Form N-648.

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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.

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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 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.

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.
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.

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.

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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 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.

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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.

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 Number 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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