N-400 Application for Naturalization

Application for Naturalization

N400-012-FRM-REV-30Day-12072023

OMB: 1615-0052

Document [pdf]
Download: pdf | pdf
Application for Naturalization

USCIS
Form N-400

Department of Homeland Security
U.S. Citizenship and Immigration Services
Date Stamp

For
USCIS
Use
Only

Receipt

OMB No. 1615-0052
Expires 11/30/2025
Action Block

DRAFT
NOT FOR
PRODUCTION
12/07/2023

Remarks

► START HERE - Type or print in black ink. If you do not answer all of the questions, it may take longer for U.S. Citizenship
and Immigration Services (USCIS) to process your Form N-400.
If your parent (including legal adoptive parent) is a U.S. citizen by birth, or was naturalized before you reached your 18th birthday,
you may not need to file Form N-400 as you may already be a U.S. citizen. Before you file this application, please visit the USCIS
website at www.uscis.gov/N-600 for Form N-600, Application for Certificate of Citizenship.

Part 1. Information About Your Eligibility (Select only one box to identify Enter Your 9 Digit A-Number:
► Athe basis of your eligibility or your Form N-400 may be delayed or rejected.)
1.

Reason for Filing (Please see Instructions for eligibility requirements under each provision.):
A.
B.
C.
D.

General Provision. See Instructions: List of General Eligibility Requirements

Spouse of U.S. Citizen. See Instructions: Eligibility Based on Marriage to a U.S. Citizen

VAWA. See Instructions: Eligibility for the Spouse, Former Spouse, or Child of a U.S. Citizen under the Violence
Against Women Act (VAWA)
Spouse of U.S. Citizen in Qualified Employment Outside the United States. See Instructions: Eligibility for the
Spouse of a U.S. Citizen Working for a Qualified Employer Outside the United States
If your residential address is outside the United States and you are filing under Immigration and Nationality Act
(INA) section 319(b), select the USCIS field office where you would like to have your naturalization interview. You
can find a USCIS field office at www.uscis.gov/field-offices.

E.

Military Service During Period of Hostilities. See Instructions: Eligibility and Evidence for Current and Former
Members of the U.S. Armed Forces

F.

At Least One Year of Honorable Military Service at Any Time. See Instructions: Eligibility and Evidence for
Current and Former Members of the U.S. Armed Forces

G.

Other Reason for Filing Not Listed Above

Part 2. Information About You (Person applying for naturalization)
1.

Your Current Legal Name (do not provide a nickname)
Family Name (Last Name)

2.

Given Name (First Name)

Middle Name (if applicable)

Other Names You Have Used Since Birth (see the Instructions for this Item Number for more information about which names
to include)
Family Name (Last Name)

Form N-400 Edition 11/02/22

Given Name (First Name)

Middle Name (if applicable)

Page 1 of 14

Part 2. Information About You (Person applying for naturalization) (continued) AName Change (Optional)
Read the Instructions for this Item Number before you decide whether you would like to legally change your name.
3.

Yes

Would you like to legally change your name?

No (skip to Item Number 4.)

DRAFT
NOT FOR
PRODUCTION
12/07/2023

If you answered “Yes,” type or print the new name you would like to use:
Family Name (Last Name)

4.

USCIS Online Account Number (if any)
►

6.

Given Name (First Name)

5.

Middle Name (if applicable)

Gender

Male

Female

Another Gender Identity

Date of Birth (mm/dd/yyyy)

In addition to your actual date of birth, include any other dates of birth you have ever used, including dates used in connection
with any legal names or non-legal names, in the space provided in Part 14. Additional Information.
7.

If you are a lawful permanent resident, provide the date you became
a lawful permanent resident (mm/dd/yyyy).

8.

Country of Birth

9.

Country of Citizenship or Nationality

If you are a citizen or national of more than one country, list additional countries of nationality in the space provided in Part 14.
Additional Information.
10.

Was one of your parents (including adoptive parents) a U.S. citizen before your 18th birthday?

Yes

No

If you answered “Yes,” you may already be a U.S. citizen. If you are a U.S. citizen, you should not complete Form N-400.
11.

Do you have a physical or developmental disability or mental impairment that prevents you from
demonstrating your knowledge and understanding of the English language or civics requirements for
naturalization?

Yes

No

If you answered “Yes,” submit a completed Form N-648, Medical Certification for Disability Exceptions, when you file your
Form N-400. See the Naturalization Testing and Exceptions section of the Instructions for additional information about
exceptions from the English language test, including exceptions based on age and years as a lawful permanent resident.

Social Security Update
12.a. Do you want the Social Security Administration (SSA) to issue you an original or replacement Social Security card and update
your immigration status with the SSA if and when you are naturalized?
Yes (Complete Item Numbers 12.b. - 12.c.)
No (Go to Part 3.)
12.b. Provide your Social Security number (SSN) (if any). ►
12.c. Consent for Disclosure: I authorize disclosure of information from this application and USCIS systems
to the SSA as required for the purpose of assigning me an SSN, issuing me an original or replacement
Social Security card, and updating my immigration status with the SSA.

Yes

No

NOTE: If you answered “Yes” to Item Number 12.a., you must also answer “Yes” to Item Number 12.c., Consent for
Disclosure, to receive a card.

Form N-400 Edition 11/02/22

Page 2 of 14

Part 3. Biographic Information

A-

NOTE: USCIS requires you to complete the categories below to conduct background checks. (See the Form N-400 Instructions for
more information.)
1.

Ethnicity (Select only one box)

DRAFT
NOT FOR
PRODUCTION
12/07/2023
Hispanic or Latino

2.

Not Hispanic or Latino

Race (Select all applicable boxes)
American Indian
Asian
or Alaska Native

3.

Height Feet

5.

Eye color (Select only one box)
Black

6.

Black or
African American

Inches

Blue

Brown

Hair color (Select only one box)
Black
Bald (No hair)

4.

Gray

Blond

Native Hawaiian or
Other Pacific Islander

Weight

Pounds

Green

Brown

White

Hazel

Gray

Maroon

Red

Sandy

Unknown/Other

Pink

White

Unknown/Other

Part 4. Information About Your Residence
1.

Physical Addresses

List every location where you have lived during the last 5 years if you are filing based on the general provision under Part 1.,
Item Number 1.a. If you are filing based on other naturalization eligibility options, see Part 4. in the Specific Instructions by
Item Number section of the Instructions for the applicable period of time for which you must enter this information. If you
need extra space, use the space provided in Part 14. Additional Information.
Current Physical Address
In Care Of Name (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

Country

Dates of Residence: From (mm/dd/yyyy)
Physical Address
(Street Number and Name)

2.

ZIP Code

Dates of Residence: To (mm/dd/yyyy)

City or Town

PRESENT

Dates of Residence
State
ZIP Code
From
To
Country
/ Province / Postal Code
(mm/dd/yyyy) (mm/dd/yyyy)

Is your current physical address also your current mailing address?
Yes (If you answered “Yes,” skip to Part 5.)

Form N-400 Edition 11/02/22

No
Page 3 of 14

Part 4. Information About Your Residence (continued)
3.

A-

Current Mailing Address (Safe Mailing Address, if applicable)
In Care Of Name (if any)

DRAFT
NOT FOR
PRODUCTION
12/07/2023

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

Part 5. Information About Your Marital History
1.

What is your current marital status?
Single, Never Married

Married

Divorced

Widowed

Separated

Marriage Annulled

If you are single and have never married, go to Part 6. Information About Your Children.

Yes

2.

If you are currently married, is your spouse a current member of the U.S. armed forces?

3.

How many times have you been married? (See the Specific Instructions by Item Number section of
the Instructions for more information about which marriages to include.)

No

Provide current marriage certificate and any divorce decree, annulment decree, or death certificate showing that your prior
marriages were terminated (if applicable).
If you are filing under one of the categories below, answer Item Numbers 4.a. - 8.:
• Spouse of U.S. Citizen, Part 1., Item Number 1.b.; or
• Spouse of U.S. Citizen in Qualified Employment Outside the United States, Part 1., Item Number 1.d.
If you are not filing under one of the categories above, skip to Part 6.

Your Current Marriage
If you are currently married, including if you are legally separated, provide the following information about your current spouse.
4.a. Current Spouse's Legal Name
Family Name (Last Name)

4.b. Current Spouse's Date of Birth
(mm/dd/yyyy)

Given Name (First Name)

4.c.

Middle Name (if applicable)

Date You Entered into Marriage
with Current Spouse (mm/dd/yyyy)

4.d. Is your current spouse's present physical address the same as your physical address?
Yes
No (If you answered “No,” provide address in Part 14. Additional Information.)
5.a. When did your current spouse become a U.S. citizen?
By Birth in the United States - Go to Item Number 7.
Other - Complete Item Number 5.b.
5.b. Date Your Current Spouse Became a U.S. Citizen (mm/dd/yyyy)
Form N-400 Edition 11/02/22

Page 4 of 14

Part 5. Information About Your Marital History (continued)

A-

► A-

6.

Current Spouse's Alien Registration Number (A-Number) (if any)

7.

How many times has your current spouse been married? (See the Specific Instructions by Item
Number section of the Instructions for more information about which marriages to include.)

DRAFT
NOT FOR
PRODUCTION
12/07/2023

Provide divorce decrees, annulment decrees, or death certificates showing that all of your spouse's prior marriages were
terminated (if applicable).
8.

Current Spouse's Current Employer or Company

Only answer Item Number 8. if you are filing under Part 1., Item Number 1.d., Spouse of U.S. Citizen in Qualified
Employment Outside the United States.

Part 6. Information About Your Children
1.

Indicate your total number of children under 18 years of age.

2.

Provide the following information about your children identified in Item Number 1. For the residence and relationship
columns, you must type or print one of the valid options listed. If any of your children do not reside with you, provide the
address(es) where those children live in Part 14. Additional Information. If you have more than three children, use the space
provided in Part 14. Additional Information.
Residence

Child's Name
(First Name and Family Name)

Relationship

Are you
(Valid options include:
(Valid options include:
Date of Birth resides with me, does not
providing
biological child,
support for this
(mm/dd/yyyy) reside with me, or unknown/
stepchild, legally adopted
child?
missing)
child)
Yes

No

Yes

No

Yes

No

Part 7. Information About Your Employment and Schools You Attended
1.

List where you have worked or attended school full time or part time during the last 5 years if you are filing based on the general
provision under Part 1., Item Number 1.a. If you are filing based on other naturalization eligibility options, see Part 7. in the
Specific Instructions by Item Number section of the Instructions for the applicable period of time for which you must enter
this information. Provide information for the complete time period for all employment, including foreign government
employment such as military, police, and intelligence services. Begin by providing information about your most recent or
current employment, studies, or unemployment. Provide the locations and dates where you worked, were self-employed, were
unemployed, or have studied. If you worked for yourself and not for a specific employer, type or print “self-employed” for the
employer name. If you were unemployed, type or print “unemployed.” If you are retired, type or print “retired.” If you need
extra space to complete Part 7., use the space provided in Part 14. Additional Information.

Name

Employer or School
State/ ZIP Code/
City/Town
Province Postal Code

Employment/School Dates
To
From
Country
(mm/dd/yyyy) (mm/dd/yyyy)

Occupation or
Field of Study

PRESENT

Form N-400 Edition 11/02/22

Page 5 of 14

Part 8. Time Outside the United States
1.

A-

List below all the trips that you have taken outside the United States during the last 5 years if you are filing based on the general
provision under Part 1., Item Number 1.a. If you are filing based on other naturalization eligibility options, see Part 8. in the
Specific Instructions by Item Number section of the Instructions for the applicable period of time for which you must enter
this information. Start with your most recent trip and work backwards. Do not include day trips (where the entire trip was
completed within 24 hours) in the table. If you have taken any trips outside the United States that lasted more than 6 months,
see the Required Evidence - Continuous Residence section of the Instructions for evidence you should provide. If you need
extra space to complete this section, use the space provided in Part 14. Additional Information.

DRAFT
NOT FOR
PRODUCTION
12/07/2023

Date You Left the
United States
(mm/dd/yyyy)

Date You Returned
to the United States
(mm/dd/yyyy)

Countries to
Which You
Traveled

Part 9. Additional Information About You

When a question includes the word “EVER,” you must provide information about any of your actions or conduct that occurred
anywhere in the world at any time, unless the question specifies otherwise. If you answer “Yes” to any of the questions in Item
Numbers 1. - 14. in Part 9. Item Numbers 1. - 14., provide explanations and any additional information in the space provided in
Part 14. Additional Information.
1.

Have you EVER claimed to be a U.S. citizen (in writing or any other way)?

Yes

No

2.

Have you EVER registered to vote or voted in any Federal, state, or local election in the United
States? If you lawfully voted only in a local election where noncitizens are eligible to vote, you may
answer “No.”

Yes

No

3.

Do you currently owe any overdue Federal, state, or local taxes in the United States?

Yes

No

4.

Since you became a lawful permanent resident, have you called yourself a “nonresident alien” on a
Federal, state, or local tax return or decided not to file a tax return because you considered yourself to
be a nonresident?

Yes

No

5.a. Been a member of, involved in, or in any way associated with any Communist or totalitarian party
anywhere in the world?

Yes

No

5.b. Advocated (supported and promoted) any of the following, or been a member of, involved in, or in any
way associated with any group anywhere in the world that advocated any of the following:

Yes

No

Have you EVER:

Opposition to all organized government;
World communism;
The establishment in the United States of a totalitarian dictatorship;
The overthrow by force or violence or other unconstitutional means of the Government of the
United States or all forms of law;
The unlawful assaulting or killing of any officer or officers of the Government of the United States
or of any other organized government because of their official character;
The unlawful damage, injury, or destruction of property; or
Sabotage?
Form N-400 Edition 11/02/22

Page 6 of 14

Part 9. Additional Information About You (continued)

A-

Have you EVER been a member of, involved in, or in any way associated with, or have you EVER provided money, a thing of
value, services or labor, or any other assistance or support to a group that:
6.a. Used a weapon or explosive with intent to harm another person or cause damage to property?

Yes

No

DRAFT
NOT FOR
PRODUCTION
12/07/2023

6.b. Engaged (participated) in kidnapping, assassination, or hijacking or sabotage of an airplane, ship,
vehicle, or other mode of transportation?

Yes

No

6.c. Threatened, attempted (tried), conspired (planned with others), prepared, planned, advocated for, or
incited (encouraged) others to commit any of the acts listed in Item Numbers 6.a. or 6.b.?

Yes

No

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following:
7.a. Torture?

Yes

No

7.b. Genocide?

Yes

No

7.c. Killing or trying to kill any person?

Yes

No

7.d. Intentionally and severely injuring or trying to injure any person?

Yes

No

7.e. Any kind of sexual contact or activity with any person who did not consent (did not agree) or was
unable to consent (could not agree), or was being forced or threatened by you or by someone else?

Yes

No

Yes

No

7.g. Causing harm or suffering to any person because of their race, religion, national origin, membership in
a particular social group, or political opinion?

Yes

No

8.a. Have you EVER served in, been a member of, assisted (helped), or participated in any military or
police unit?

Yes

No

8.b. Have you EVER served in, been a member of, assisted (helped), or participated in any armed group (a
group that carries weapons), for example: paramilitary unit (a group of people who act like a military
group but are not part of the official military), self-defense unit, vigilante unit, rebel group, or guerrilla
group?

Yes

No

Have you EVER worked, volunteered, or otherwise served in a place where people were detained
(forced to stay), for example, a prison, jail, prison camp (a camp where prisoners of war or political
prisoners are kept), detention facility, or labor camp, or have you EVER directed or participated in any
other activity that involved detaining people?

Yes

No

10.a. Were you EVER a part of any group, or did you EVER help any group, unit, or organization that used
a weapon against any person, or threatened to do so?

Yes

No

10.b. If you answered “Yes” to Item Number 10.a., when you were part of this group, or when you helped
this group, did you ever use a weapon against another person?

Yes

No

10.c. If you answered “Yes” to Item Number 10.a., when you were part of this group, or when you helped
this group, did you ever threaten another person that you would use a weapon against that person?

Yes

No

11.

Have you EVER sold, provided, or transported weapons, or assisted any person in selling, providing,
or transporting weapons, which you knew or believed would be used against another person?

Yes

No

12.

Have you EVER received any weapons training, paramilitary training, or other military-type training?

Yes

No

13.

Have you EVER recruited (asked), enlisted (signed up), conscripted (required to join), or used any
person under 15 years of age to serve in or help an armed group, or attempted or worked with others to
do so?

Yes

No

14.

Have you EVER used any person under 15 years of age to take part in hostilities or attempted or
worked with others to do so? This could include participating in combat or providing services related
to combat (such as serving as a messenger or transporting supplies).

Yes

No

7.f.

Not letting someone practice their religion?

If you answered “Yes” to Item Number 8.a. or Item Number 8.b., include the name of the country,
the name of the military unit or armed group, your rank or position, and your dates of involvement in
your explanation in Part 14. Additional Information.
9.

Form N-400 Edition 11/02/22

Page 7 of 14

Part 9. Additional Information About You (continued)

A-

If you answer “Yes” to any part of Item Number 15. below, complete the table below with each crime or offense even if your
records have been sealed, expunged, or otherwise cleared. You must disclose this information even if someone, including a judge,
law enforcement officer, or attorney, told you that it is no longer on your record, or told you that you do not have to disclose the
information. If you need extra space, use the space provided in Part 14. Additional Information. Submit evidence to support your
answers with your Form N-400.

DRAFT
NOT FOR
PRODUCTION
12/07/2023

Include all the crimes and offenses in the United States or anywhere in the world (including domestic violence, driving under the
influence of drugs or alcohol, and crimes and offenses while you were under 18 years of age) which you EVER:
Committed, agreed to commit, or asked someone else to commit;

Were arrested, cited, detained, or confined by any law enforcement officer, military official (in the U.S. or elsewhere), or
immigration official;
Were charged with committing, helping commit, or trying to commit;
Pled guilty to;

Were convicted of;

Were placed in alternative sentencing or a rehabilitative program for (for example, diversion, deferred prosecution, withheld
adjudication, or deferred adjudication); or
Received a suspended sentence, clemency, amnesty, or pardon for, or were placed on probation or paroled for.
15.a. Have you EVER committed, agreed to commit, asked someone else to commit, helped commit, or
tried to commit a crime or offense for which you were NOT arrested?

Yes

No

15.b. Have you EVER been arrested, cited, detained or confined by any law enforcement officer, military
official (in the U.S. or elsewhere), or immigration official for any reason, or been charged with a crime
or offense?

Yes

No

What was the crime or
offense? (If convicted,
provide crime of conviction.
Date of the Crime
If not convicted, provide
or Offense
crime or offense listed in
(mm/dd/yyyy)
arrest, citation, charging
document, or crime
committed.)

16.

Date of your
conviction or
guilty plea
(if applicable)
(mm/dd/yyyy)

What was the result or
disposition of the arrest,
citation, or
Place of Crime or
charge? (no charges
Offense (City or
Town, State, Country) filed, convicted, charges
dismissed, detention,
jail, probation, etc.)

If you received a suspended sentence, were placed on probation, or were paroled, have you completed
your suspended sentence, probation, or parole?

What was your
sentence
(if applicable)?
(For example,
90 days in jail,
90 days on
probation)

Yes

No

If you answer “Yes” to any of the questions in Item Numbers 17.a. - 19., provide an explanation in the space provided in Part 14.
Additional Information. Submit evidence to support your answers.

Form N-400 Edition 11/02/22

Page 8 of 14

Part 9. Additional Information About You (continued)

A-

Have you EVER:
17.a. Engaged in prostitution, attempted to procure or import prostitutes or persons for the purpose of
prostitution, or received any proceeds or money from prostitution?

Yes

DRAFT
NOT FOR
PRODUCTION
12/07/2023

No

17.b. Manufactured, cultivated, produced, distributed, dispensed, sold, or smuggled (trafficked) any
controlled substances, illegal drugs, narcotics, or drug paraphernalia in violation of any law or
regulation of a U.S. state, the United States, or a foreign country?

Yes

No

17.c. Been married to more than one person at the same time?

Yes

No

17.d. Married someone in order to obtain an immigration benefit?

Yes

No

17.e. Helped anyone to enter, or try to enter, the United States illegally?

Yes

No

17.f. Gambled illegally or received income from illegal gambling?

Yes

No

17.g. Failed to support your dependents (pay child support) or to pay alimony (court-ordered financial
support after divorce or separation)?

Yes

No

17.h. Made any misrepresentation to obtain any public benefit in the United States?

Yes

No

18.

Have you EVER given any U.S. Government officials any information or documentation that was
false, fraudulent, or misleading?

Yes

No

19.

Have you EVER lied to any U.S. Government officials to gain entry or admission into the United
States or to gain immigration benefits while in the United States?

Yes

No

If you answer “Yes” to Item Numbers 20. - 21. below, provide an explanation in the space provided in Part 14. Additional
Information and see the Specific Instructions by Item Number, Part 9. Additional Information About You of the Instructions for
more information.
20.

Have you EVER been placed in removal, rescission, or deportation proceedings?

Yes

No

21.

Have you EVER been removed or deported from the United States?

Yes

No

Federal Law requires nearly all people born as male who are either U.S. citizens or immigrants, 18 through 25 years of age, to register
with Selective Service. See www.sss.gov.
22.a. Are you a person born as a male who lived in the United States at any time between your 18th and 26th
birthdays? (Do not select “Yes” if you were a lawful nonimmigrant for all of that time period.)

Yes

No

22.b. If you answered “Yes,” to Item Number 22.a., did you register for the Selective Service?

Yes

No

22.c. If you answered “Yes,” to Item Number 22.b., provide information about your registration.
Date Registered (mm/dd/yyyy) Selective Service Number

If you answered “No,” to Item Number 22.b. see the Specific Instructions by Item Number, Part 9. Additional Information
About You of the Instructions for more information.
If you answer “Yes” to Item Numbers 23. - 24., provide an explanation in the space provided in Part 14. Additional Information.
23.

Have you EVER left the United States to avoid being drafted in the U.S. armed forces?

Yes

No

24.

Have you EVER applied for any kind of exemption from military service in the U.S. armed forces?

Yes

No

25.

Have you EVER served in the U.S. armed forces?

Yes

No

Form N-400 Edition 11/02/22

Page 9 of 14

Part 9. Additional Information About You (continued)

A-

If you answered “No” to Item Number 25., go to Item Number 30.a.
26.a. Are you currently a member of the U.S. armed forces?

Yes

No

26.b. If you answered “Yes” to Item Number 26.a., are you scheduled to deploy outside the United States,
including to a vessel, within the next 3 months? (Call the Military Help Line at 877-247-4645 if you
transfer to a new duty station after you file your Form N-400, including if you are deployed outside the
United States or to a vessel.)

Yes

No

26.c. If you answered “Yes,” to Item Number 26.a., are you currently stationed outside the United States?

Yes

No

26.d. If you answered “No” to Item Number 26.a., are you a former U.S. military service member who is
currently residing outside of the U.S.?

Yes

No

DRAFT
NOT FOR
PRODUCTION
12/07/2023

If you answer “Yes” to Item Numbers 27. - 29., provide an explanation in the space provided in Part 14. Additional Information.
27.

Have you EVER been court-martialed or have you received a discharge characterized as other than
honorable, bad conduct, or dishonorable, while in the U.S. armed forces?

Yes

No

28.

Have you EVER been discharged from training or service in the U.S. armed forces because you were
an alien?

Yes

No

29.

Have you EVER deserted from the U.S. armed forces?

Yes

No

For Item Numbers 30.a. - 37. see Specific Instructions by Item Number, Part 9. Additional Information About You. If you
answer “Yes” to Item Number 30.a., provide an explanation in the space provided in Part 14. Additional Information.
Yes

30.a. Do you now have, or did you EVER have, a hereditary title or an order of
nobility in any foreign country?

No (skip to Item Number 31.)

30.b. If you answered “Yes,” to Item Number 30.a., are you willing to give up any inherited titles or orders
of nobility,

Yes

No

(list titles), that you have in a

foreign country at your naturalization ceremony?

If you answer “'No” to any question except Item Number 33., see the Oath of Allegiance section of the Instructions for more
information.
31.

Do you support the Constitution and form of Government of the United States?

Yes

No

32.

Do you understand the full Oath of Allegiance to the United States (see Part 16. Oath of Allegiance)?

Yes

No

33.

Are you unable to take the Oath of Allegiance because of a physical or developmental disability or
mental impairment? If you answer “Yes,” skip Item Numbers 34. - 37. and see the Legal Guardian,
Surrogate, or Designated Representative section in the Instructions.

Yes

No

34.

Are you willing to take the full Oath of Allegiance to the United States?

Yes

No

35.

If the law requires it, are you willing to bear arms (carry weapons) on behalf of the United States?

Yes

No

36.

If the law requires it, are you willing to perform noncombatant services (do something that does not
include fighting in a war) in the U.S. armed forces?

Yes

No

37.

If the law requires it, are you willing to perform work of national importance under civilian direction
(do non-military work that the U.S. Government says is important to the country)?

Yes

No

Form N-400 Edition 11/02/22

Page 10 of 14

Part 10. Request for a Fee Reduction

A-

For information about fees, fee waivers, and reduced fees, see Form G-1055, Fee Schedule, at www.uscis.gov/g-1055. To apply for a
reduced fee, complete Item Numbers 1. - 5.b. If you are not eligible for a reduced fee, complete Item Number 1. and proceed to
Part 11.
1.

My household income is greater than 150% and under 200% of the Federal Poverty Guidelines (see Instructions for required
documentation).

DRAFT
NOT FOR
PRODUCTION
12/07/2023
Yes (complete Item Numbers 2. - 5.b.)
No (skip to Part 11.)

2.

Total household income

3.

My household size is:

4.

Total number of household members earning income including yourself:

Yes

5.a. I am the head of household.

No

5.b. Name of head of household (if you selected “No” in Item Number 5.a.):

Part 11. Applicant's Contact Information, Certification, and Signature
Applicant's Contact Information

Provide your daytime telephone number, mobile telephone number (if any), and email address (if any).
1.

Applicant's Daytime Telephone Number

3.

Applicant's Email Address (if any)

2.

Applicant's Mobile Telephone Number (if any)

Applicant's Certification and Signature
I certify, under penalty of perjury, that I provided or authorized all of the responses and information contained in and submitted with
my application, I read and understand or, if interpreted to me in a language in which I am fluent by the interpreter listed in Part 12.,
understood, all of the responses and information contained in, and submitted with, my application, and that all of the responses and the
information are complete, true, and correct. Furthermore, I authorize the release of any information from any and all of my records
that USCIS may need to determine my eligibility for an immigration request and to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
4.

Applicant's Signature (or signature of a legal guardian, surrogate, or designated
representative, if applicable)

Form N-400 Edition 11/02/22

Date of Signature
(mm/dd/yyyy)

Page 11 of 14

Part 12. Interpreter's Contact Information, Certification, and Signature

A-

Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

2.

Interpreter's Business or Organization Name

Interpreter's Given Name (First Name)

DRAFT
NOT FOR
PRODUCTION
12/07/2023

Interpreter's Contact Information
3.

Interpreter's Daytime Telephone Number

5.

Interpreter's Email Address (if any)

4.

Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification and Signature

I certify, under penalty of perjury, that I am fluent in English and

,

and I have interpreted every question on the application and Instructions and interpreted the applicant's answers to the questions in that
language, and the applicant informed me that they understood every instruction, question, and answer on the application.
6.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Part 13. Contact Information, Certification, and Signature of the Person Preparing this Application, if
Other Than the Applicant
Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name

Preparer's Given Name (First Name)

Preparer's Contact Information
3.

Preparer's Daytime Telephone Number

5.

Preparer's Email Address (if any)

4.

Preparer's Mobile Telephone Number (if any)

Preparer's Certification and Signature
I certify, under penalty of perjury, that I prepared this application for the applicant at their request and with express consent and that
all of the responses and information contained in and submitted with the application are complete, true, and correct and reflects only
information provided by the applicant. The applicant reviewed the responses and information and informed me that they understand
the responses and information in or submitted with the application.
6.

Preparer's Signature

Form N-400 Edition 11/02/22

Date of Signature (mm/dd/yyyy)

Page 12 of 14

Part 14. Additional Information

A-

If you need extra space to provide any additional information within this application, use the space below. If you need more space
than what is provided, you may make copies of this page to complete and file with this application or attach a separate sheet of paper.
Type or print your name and A-Number at the top of each sheet; indicate the Page Number, Part Number, and Item Number to
which your answer refers; and sign and date each sheet.

DRAFT
NOT FOR
PRODUCTION
12/07/2023

1.

Family Name (Last Name)

Given Name (First Name)

2.

Page Number

Part Number

Item Number

3.

Page Number

Part Number

Item Number

4.

Page Number

Part Number

Item Number

5.

Page Number

Part Number

Item Number

Middle (if applicable)

Do not complete Parts 15. or 16. until the USCIS officer instructs you to do so at the interview.

Form N-400 Edition 11/02/22

Page 13 of 14

Part 15. Signature at Interview

A-

I swear (affirm) and certify under penalty of perjury under the laws of the United States of America that I know that the contents of
this Form N-400, Application for Naturalization, subscribed by me, including corrections, are complete, true, and correct. The
evidence submitted by me are complete, true, and correct.
Subscribed to and sworn to (affirmed) before me

DRAFT
NOT FOR
PRODUCTION
12/07/2023
USCIS Officer's Printed Name or Stamp

Applicant's Signature

Date of Signature (mm/dd/yyyy)

USCIS Officer's Signature

Part 16. Oath of Allegiance

If your application is approved, you will be scheduled for a naturalization ceremony at which time you will be required to take the
following Oath of Allegiance immediately prior to becoming a naturalized citizen. By signing below you acknowledge your
willingness to take this Oath:
I hereby declare on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince, potentate,
state, or sovereignty, of whom or which I have heretofore been a subject or citizen;
that I will support and defend the Constitution and laws of the United States of America against all enemies, foreign, and domestic;
that I will bear true faith and allegiance to the same;

that I will bear arms on behalf of the United States when required by the law;

that I will perform noncombatant service in the armed forces of the United States when required by the law;
that I will perform work of national importance under civilian direction when required by the law; and

that I take this obligation freely, without any mental reservation or purpose of evasion; so help me God.
Applicant's Signature

Form N-400 Edition 11/02/22

Date of Signature (mm/dd/yyyy)

Page 14 of 14


File Typeapplication/pdf
File TitleForm N-400, Application for Naturalization
SubjectN-400 Application for Naturalization
AuthorUSCIS
File Modified2023-12-07
File Created2023-11-30

© 2024 OMB.report | Privacy Policy