N-565 Online Filing Copy Deck

N-565-014 REV-60-day FRN+FeeRuleEdits v1.1.2.pdf

Application for Replacement Naturalization/Citizenship Document

N-565 Online Filing Copy Deck

OMB: 1615-0091

Document [pdf]

Download: pdf | pdf

myUSCIS Copydeck: Interactive Forms

Form Number and Name
OMB Number
Form Edition Date:
Form Expiration Date:
PRA Project:

N-565 Application for Replacement Naturalization/Citizenship Document
1615-0091
4/1/2024
2/28/2027
N-565-014 REV

Revision Key

Description

• All original (old) text is black.
• All revised (new) text is red.

Example

• All original text is black.
• Any text that is removed from original column will be
removed in the revision column with the words on either side
indicated with red.

Original

Revised

1. Oranges
2. Bananas
3. Apple
4. Pineapple

1. Oranges
2. Bananas

I want to eat a watermelon for lunch and go hiking today.

I want to go hiking
today.

3. Pineapple
4. Pear

Copy Deck Version Info

FILE A FORM: N-565

Column Header Descriptions
Header: If needed, a header is located directly under the dropdown menu and above the body text.
Heading

Body Text

Select the form you want to file online

Use this form to request 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.

Alert

Link

CTA

Notes

Start form

File a Form

APPLICATION OVERVIEW: N-565

Column Header Descriptions
Heading: The primary heading on a page, typically the first part of a section of the page.
Sub-Heading: The secondary header, typically directly underneath the Heading.
P i
N i ti
A
ti
f th f
th t
t i
l
Heading

Sub-Heading

Revisions

N-565, Application For Replacement
Naturalization/Citizenship Document

Conditional Logic

Body Text

Revisions

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, or Repatriation Certificate.
You can also use this application to apply for a special certificate of naturalization to have a foreign country recognize you as a U.S. citizen.

Links

Revisions

CTA

https://www.uscis.gov/n-565

Learn more about applying for a replacement document
Before You Start Your Application

Eligibility

Your eligibility to apply for a replacement document depends on the reason for your request. You may apply for a replacement if you were Your eligibility to apply for a replacement document depends on the reason for your request. You may apply for a replacement if you were
issued a Certificate of Naturalization, Certificate of Citizenship, Declaration of Intention, or Repatriation Certificate, and at least one of the issued a Certificate of Naturalization, Certificate of Citizenship, Declaration of Intention, or Repatriation Certificate, and at least one of the
following applies:
following applies:
• The document was lost, stolen, destroyed, or mutilated
• The document is incorrect due to a typographical or clerical error by USCIS
• Your name was changed by marriage, divorce, annulment, or court order, and you seek a document in your new name
• You obtained a court order, a government-issued document, or a letter from a licensed health care professional recognizing that your
gender is different from the gender listed on your current document, and you seek a document reflecting the recognized gender.

• The document was lost, stolen, destroyed, or mutilated;
• The document is incorrect due to a typographical or clerical error by USCIS;
• Your name was changed by marriage, divorce, annulment, or court order, and you seek a document in your new name; or
• You have a different gender than what is listed on your current document, and you seek a document reflecting the different gender.

In addition, you may apply for a replacement of your Certificate of Citizenship if you obtained a court order or a document issued by the
In addition, you may apply for a replacement of your Certificate of Citizenship if 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 document with the new date of
U.S. government or the government of any U.S. state that changes your date of birth, and you seek a document with the new date of birth. birth.
You may also file this application if you are a naturalized citizen seeking a special certificate of naturalization for the purpose of a foreign
country recognizing you as a U.S. citizen.

You may also file this application if you are a naturalized citizen seeking a special certificate of naturalization for the purpose of a foreign
country recognizing you as a U.S. citizen.

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 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 Form N-400, Application for Naturalization, and then later swore to the facts of your application by signing Part 16. Signature name on your Form N-400, Application for Naturalization, 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.
at Interview. We can only change the name on your Certificate of Naturalization if you changed your name after you naturalized.

Fee

We will automatically calculate the cost for you before you submit your application. For specific information about fees applicable to this
form, see Form G-1055.

https://www.uscis.gov/forms/filing-fees/additionalinformation-on-filing-a-fee-waiver

Fee waiver: If you are requesting a fee waiver, you cannot file online. You must file a paper version of both the Form I-912, Request for Fee
Waiver and the form for the specific benefit you are requesting. You can review the fee waiver guidance at www.uscis.gov/feewaiver.
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 800-3755283. For TTY (deaf or hard of hearing) 800-767-1833.

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 application. These include your original document, if you still have it, and a recent color photograph of yourself.
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 automatically determine which documents you should provide us as you fill out your application. At the time of filing, you must
submit all evidence and supporting documentation listed.
Biometric services appointment

Biometric Services Appointment. 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. If we determine that a biometric services appointment is necessary, we will send you an appointment notice with the date, time,
and location of your appointment. If you are currently overseas, your notice will instruct you to contact a U.S. Embassy, U.S. Consulate, or
USCIS office outside the United States to schedule an appointment.
At your biometrics appointment, you must sign an oath reaffirming that:
• You provided or authorized all information in the application;
• You reviewed and understood all of the information contained in, and submitted with, your application; and
• All of this information was complete, true, and correct at the time of filing.

Disability
Accommodations/Modifications
After You Submit Your Application

Track your case online
Mail in your original
document

To request a disability accommodation/modification, follow the instructions on your appointment notice or on the Disability
Accommodations for the Public page.

www.uscis.gov/accommodationsinfo

After you submit your form, you can track its status through your USCIS account. Sign into your account often to check your case status and
read any important messages from USCIS.
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
If the document was lost in the mail, please submit an online case service request for non-delivery of document prior to submitting Form N565.

Completing Your Form Online

Respond to requests for
information
Filing online
Complete the Getting
Started section first
Provide as many responses
as you can
We will automatically save
your responses
How to continue filling out
your form
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.
Submitting your application online is the same as mailing in a completed paper form. They both gather the same information.
You should answer all questions in the Getting Started section first so we can best customize the rest of your online form experience.
You should provide as many responses as you can. Incomplete fields or sections and missing information can slow down the process after
you submit your form.
We will automatically save your information when you select next to go to a new page or navigate to another section of the form. We will
save your information for 30 days from today, or from the last time you worked on the form.
After you start your form, you can sign in to your account to continue where you left off.
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.

AUTHORITIES: USCIS is collecting the information requested on this application, and the associated evidence, under the Immigration and
Nationality Act (INA) 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 uses 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.

Application Overview

APPLICATION OVERVIEW: N-565

Sub-Heading

Revisions

Paperwork Reduction Act

Security Reminder

Conditional Logic

Body Text

Revisions

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.

ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you provide on this application www.dhs.gov/privacy
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 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.

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, preparing statements, 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:

USCIS may not conduct or sponsor an information collection, and you are 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 44 minutes per response, including the time for reviewing instructions, gathering the required documentation
and information, completing the application, preparing statements, attaching necessary documentation, and submitting the application.
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

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

OMB No. 1615-0091
Expires: 02/28/2027

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.

Links

Revisions

CTA

Start

Application Overview

GETTING STARTED: N-565

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Conditional Logic: Indicates whether the question or subquestion only applies if you meet certain criteria
Primary Nav

Secondary Nav

Getting Started

Type of application

Tertiary Nav

Conditional Logic

Revisions

Paper Form
Question

Revisions

3.1.A
3.1.B
3.1.C
3.1.D
3.1.E
(If 3.1.A, 3.1.B, 3.1.C, or 3.1.D)

(if 3.8.A)
(If 3.3; 3.4; 3.5; 3.6; or 3.7)
[yellow alert]

Revisions

Which document are you applying for?

Why are you requesting a new document?

3.2A
3.3
3.4

3.2B
3.2C

3.5
3.6

3.2D
3.2E

3.7

3.2F

3.8A

3.2G

(if 3.2G)

Question

3.2G(1)

Sub-Question

Revisions

Field Type

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

Radio
Radio
Radio
Radio
Radio

My certificate or declaration was lost, stolen, or
destroyed
My certificate or declaration is mutilated
My certificate or declaration is incorrect due to a
typographical or clerical error by USCIS
My name has legally changed
My date of birth has legally changed through a court
order or U.S. Government-issued document, and I am
applying for a replacement Certificate of Citizenship
I am seeking to change the gender listed on my
document
My reason for applying for a new document is not listed
above.
Provide an explanation.

Checkbox

Revisions

Instructional Text

Help Text

Revisions

Alert

Required?

Notes

Yes
Yes
Yes
Yes
Yes
Select all that apply

Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Textbox

[YELLOW ALERT]
[HEADER] You must mail your original document to USCIS
[BODY] 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:

Preparer and interpreter
information

Preparer information

Is someone assisting you with completing this application?

Yes/No

Radio

(IF YES)

Is a preparer assisting you with completing this application?

Yes/No

Radio

(IF YES)

Is an interpreter assisting you with completing this declaration?

Yes/No

Radio

11.1

What is your preparer's full name?

11.2

What is your preparer's business or organization name?

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

[delete]
[delete]
[delete]
[delete]
[delete]
[delete]

(IF YES TO PREPARER)

(If non-USA use Province and
text field)
(If non-USA use Postal code
and remove help text)

[delete]

My preparer is not part of a business or organization.
Country
Address line 1
Address line 2
City or town
State/Province

[delete]
[delete]
[delete]
[delete]
[delete]

[delete]

ZIP code/Postal code

[delete]

Text

[delete]

My interpreter is not part of a business or organization.
Country
Address line 1
Address line 2
City or town
State/Province

[delete]
[delete]
[delete]
[delete]
[delete]

Text
Text
Checkbox
Text
Checkbox
Text
Text
Text
Checkbox
Dropdown
Text
Text
Text
Dropdown/Text

[delete]
[delete]
[delete]
[delete]
[delete]

[delete]

ZIP code

[delete]

Text

[delete]

(IF YES TO INTERPRETER)

[delete]

11.4
11.5

11.3
11.4

11.6

11.5

What is your preparer's mailing address?

What is your interpreter's full name?

10.2

What is your interpreter's business or organization name?
[delete]

10.4
10.5

10.3
10.4

10.6

10.5

9.2.b

[delete]

What is your preparer's contact information?

10.1

10.3

(If non-USA use Province and
text field)
(If non-USA use Postal code
and remove help text)

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

Text
Text
Text
Checkbox
Dropdown
Text
Text
Text
Dropdown/ Text

11.3

Interpreter information

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501

What is your interpreter's mailing address?

What is your interpreter's contact information?

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

Daytime telephone number
Mobile telephone number
My preparer does not have a mobile telephone
Email address
My preparer does not have an email address.
Given name (first name)
Family name (last name)
[delete]

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

Street number and name
Apartment, suite, unit, or floor

[delete]
[delete]
[delete]
[delete]

Provide a 5 or 9-digit ZIP code.

[delete]

Provide a 10-digit phone number.
Provide a 10-digit phone number.
Example: [email protected]

Street number and name
Apartment, suite, unit, or floor

Provide a 5 or 9-digit ZIP code.

Text
Text
Checkbox

Provide a 10-digit phone number.
Provide a 10-digit phone number.

Text
Checkbox
Text

Example: [email protected]

[delete]
[delete]
[delete]
[delete]
[delete]
[delete]

Getting Started

ABOUT YOU: N-565
Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Primary Nav

Secondary Nav

About You

Your name

Tertiary Nav

Conditional Logic

Revisions

Paper Form
Question

Revisions

2.1

(IF YES)

Revisions

9.1

9.3

9.2

9.5
2.3

9.3

Other information

1.5

2.6
(IF YES)

(IF 2.5 = YES)

(IF YES = 2.4)

(delete)

1.6

Middle name (if applicable)

How may we contact you?

Middle name
Family name (last name)
Daytime telephone number

What is your current mailing address?

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

2.5

2.4

(delete)

2.5

2.4

What is your A-Number?

What is your A-Number? (if any)

Since becoming a U.S. citizen, have you lost or
renounced your citizenship in any manner?
Has your marital status changed since your
last document was issued?
What is your current marital status?

(delete)

Field Type

Email address (if any)

Revisions

Help Text

Provide a 10-digit phone number.

Text
Text

Example: [email protected]

A-

Text

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

Checkbox
Radio

Provide an explanation.
Yes/No

Text field
Radio

Required? Notes

Simple Table
CTA = + Add another name

Provide a 10-digit phone number.

Text

Alert

Yes

Text
Checkbox

ZIP code/Postal code

Revisions

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

Text
Text
Text

Dropdown
Text
Text
Text
Text

(delete)

Instructional 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.

Text
Text
Radio
Text

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

Single
Married
Divorced
Widowed
Marriage Annulled

Revisions

Text
Middle name (if applicable)

(If non-USA use
Province and text
field)
(If non-USA use
Postal code and
remove help text)

Revisions

Middle name
Family name (last name)
Yes/No
Given name (first name)

Have you used any other names since birth?

9.4

Sub-Question
Given name (first name)

What is your current legal name?

2.2

Your contact
information

Question

We will use your current mailing address to contact you throughout the [moved to help text]
application process. We may not be able to contact you if you do not
provide a complete and valid address.

Street number and name
Apartment, suite, unit, or floor

Provide a 5 or 9-digit ZIP code.

[moved here]
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.

Yes
Yes
Yes
Yes

Yes

Provide a 7, 8, or 9-digit number. If your A-Number is fewer than 9
digits, the system will automatically add zero(s) after the "A" and before
the first digit so there is a total of 9 digits, for example: A-001234567.

(delete)

Radio

About You

YOUR REQUEST: N-565

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages
Primary Nav

Secondary Nav

Your Request

Current document

Tertiary Nav

Conditional Logic

Revisions

Paper Form
Question

Revisions

Question

1.4

1.5

1.6

1.7

1.6
1.1

1.7

What is the certificate or declaration number on your current
document?
Which U.S. Citizenship and Immigration Services (USCIS) Office
or court issued your certificate or declaration?
When was this certificate or declaration issued?
In which name was your current certificate or declaration
issued?

1.2

Your document was lost,
stolen, or destroyed
You have an error
correction

(IF LOST, STOLEN, OR
DESTROYED (3.2A))
(IF TYPOGRAPHICAL (IF TYPOGRAPHICAL
OR CLERICAL ERROR OR CLERICAL ERROR
(3.4))
(3.2C))

1.3
3.2B

1.3
1.4
3.2(1)

4.1

4.2
Your name was changed

Your date of birth was
changed

Your gender changed

(IF NAME CHANGED
(3.5))

(IF NAME CHANGED
(3.2D))

(IF DOB CHANGED
(IF DOB CHANGED
(3.6))
(3.2E))
(if court order)
(if U.S. Governmentissued document)

5.1A-B

5.1B

What is your country of former citizenship or nationality?
When, where, and how was your document lost, stolen, or
destroyed?
What was the typographical or clerical error in your document
that needs to be corrected?

5.2

(delete)

6.1A-B

6.1A

How was your date of birth changed?

Revisions

Field Type

What is your country of birth?

MM/DD/YYYY
Given name (first name)

Date
Text

Middle name (if applicable)
Family name (last name)
MM/DD/YYYY

Text
Text

Dropdown
Text
Name
Date of birth
Gender
Other

Marriage, divorce, or annulment
Court order

Court order

MM/DD/YYYY

Date

What gender designation do you want listed on your new
document?

Court order
Male
Female
Licensed health care professional's certification of gender
Government-issued document reflecting the gender change Another gender identity

Checkbox

(delete)

Male
Female

Radio

(If 3.1.E)

8.1

What is the name of the foreign country?

(If 3.1.E)

8.2

What is the name of the foreign official who is requesting this
certificate?

8.2
8.2
8.3

What is the foreign official's title?
What is the foreign official's government agency?
What is the foreign official's address?

Help Text

Alert

Required? Notes

(delete)
(delete)
(delete)

Country
Address line 1
Address line 2
City or town
State/Province
Zip code/Postal code

Date
Text
Text
Text
Checkbox

Radio
(delete)
(delete)
(delete)

Select all that apply

Date
Date

(delete)

Provide the new date of birth as shown in the court
order or U.S. Government-issued document.
Select all that apply
Select all that apply.
Indicate how you identify. Based on your selection,
a gender of “M” (male), “F” (female) or “X” (another
gender identity) will be reflected on your secure
documents if your application is approved.
(delete)

Dropdown

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

Select all that apply

Radio

What is your new date of birth?

What is your current gender designation?

When did your name change?
(delete)

Marriage, divorce, or annulment

6.2

(delete)

Revisions

Text field

What is the date on the court order?
What is the date on the government-issued document?

How did you officially change your gender?

Instructional Text

Dropdown

Checkbox

6.1A
6.1B

7.1

Revisions

Text

MM/DD/YYYY
Given name (first name)
Middle name (if applicable)
Family name (last name)
Court order
U.S. Government-issued document
MM/DD/YYYY
MM/DD/YYYY

(IF GENDER CHANGED (IF GENDER CHANGED 7.1A
(3.7))
(3.2F))

(If 3.1.E)
(If 3.1.E)
(If 3.1.E)
(If 3.1.E)
(If 3.1.E)

Sub-Question

Text

Provide an explanation of what is incorrect on your current
certificate or declaration
Why has your name changed?
On what date did your name change?
What is your new legal name?

7.2
Special Certificate of
Naturalization

5.1A

What is your date of birth on your certificate or declaration?

Revisions

Text
Middle name (if applicable)

Text
Text
Text
Text
Dropdown
Text
Text
Text
Text
Text

Street number and name
Apartment, suite, unit, or floor
Provide a 5 or 9-digit ZIP code.

Your Request

EVIDENCE: N-565

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Primary Nav
Secondary Nav
Revision
Evidence
2" x 2" photo of you

Tertiary Nav

Conditional Logic

Revision

Paper Form

Evidence Title
2" x 2" Photo Of You

Revision

Field Type
Upload

Revision

Instructional Text
If you reside in the United States, USCIS may request that you attend an appointment at an ASC to have your photograph taken. If
you reside outside the United States, you must submit two identical color passport-style photographs of yourself taken recently.

Revision

Document type
2" x 2" photo

Revision

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.
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.
U.S. government-issued photo
identification

Evidence of change in marital
status

(if yes to 2.4-change in marital
status since original document
issued)

(delete)

U.S. Government-Issued
Photo Identification

Upload

Upload an image or copy of your U.S. Government-issued photo identification.

Government-issued photo identification

Evidence Of Change In
Marital Status

Upload

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 status. Such documents may include your marriage certificate, divorce decree, annulment
decree, or spouse's death certificate.

Marriage certificate
Divorce decree
Annulment decree
Spouse's death certificate

(Moved here)
Evidence of your lost, stolen,
or destroyed document

(Moved here)
(IF 3.2A, LOST, STOLEN, OR
DESTROYED)

(Moved here)
Evidence Of Your Lost,
Stolen, Or Destroyed
Document

(Moved here)
Upload

(moved here)
Evidence of your mutilated
document

(moved here)
(IF 3.2B, MUTILATED)

(moved here)
Evidence Of Your Mutilated
Document

(moved here)
Upload

(Moved here)
Upload an image or copy of your original document if you have one.

(Moved here)
Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

You can also upload a copy of a police report and/or a sworn statement explaining what happened to the document and any
attempts to retrieve the document.

(moved here)
Upload an image or copy of your original mutilated document.

(moved here)
Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

You also must mail your original mutilated 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
P.O. Box 82521
Lincoln, NE 68501

(moved here)
(IF 3.2C, CLERICAL/TYPO ERROR)

(moved here)
Evidence of clerical or
typographical error

(moved here)
Upload

(moved here)
Evidence Of Clerical Or
Typographical Error

(moved here)
Upload images or copies of documents supporting your explanation of the error and request for a new document.

(moved here)
Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

You also must mail your incorrect 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
P.O. Box 82521
Lincoln, NE 68501

(moved here)
Evidence of your name change
by marriage

(moved here)
(IF 3.2D, NAME CHANGE BY
MARRIAGE, DIVORCE, OR
ANNULMENT)

(moved here)
Evidence Of Your Name
Change By Marriage

(moved here)
Upload

(moved here)
Upload an image or copy of the original certified marriage certificate, divorce certificate or annulment decree that shows your
legally changed name.

(moved here)
Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate
Original certified marriage certificate
Original divorce certificate
Original annulment decree

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

(moved here)
Evidence of your name change
by court order

(moved here)
(IF 3.2D, NAME CHANGE BY
COURT ORDER)

(moved here)
Evidence Of Your Name
Change By Court Order

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
(moved here)
Upload an image or copy of the original or certified court order that shows your legally changed name.

(moved here)
Upload

(moved here)
Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate
Original or certified court order that shows
legally changed name

You also must mail your original or certified 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
P.O. Box 82521
Lincoln, NE 68501

(moved here)
Evidence of your date of birth
change

(moved here)
(IF 3.2E, DOB CHANGE)

(moved here)
Evidence Of Your Date Of
Birth Change

(moved here)
Upload

(moved here)
Upload an image or copy of the original or certified U.S. Government-issued document, court order, or a vital record document
establishing the date of birth change.

(moved here)
Birth certificate
Certificate recognizing foreign birth
Certificate of birth abroad
Other similar vital records issued by U.S. state
where you resided when the document was
issued

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.

File Requirements
Revision
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file

Alerts

Required?

Links
Notes
https://travel.state.gov/cont
ent/travel/en/passports/howapply/photos.html

(Moved here)
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or
TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload
a full English translation and the translator's
certification with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores,
and parentheses
• Maximum size: 12MB per file
(moved here)
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
(moved here)
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
(moved here)
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
(moved here)
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
(moved here)
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file

Mail your original document to:

Court order showing legally
changed gender

(IF GENDER CHANGE BY COURT
ORDER)

(delete)

Court Order Showing
Legally Changed Gender

(delete)

Upload

(delete)

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

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
(delete)

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

Certified copy of court order granting change
of sex or gender

(delete)

Mail your original document to:
USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
(moved here)
Your naturalization certificate

Loss of citizenship

(moved here)
(IF 3.1E, SPECIAL CERTIFICATE
OF NATURALIZATION TO OBTAIN
RECOGNITION OF MY U.S.
CITIZENSHIP BY A FOREIGN
COUNTRY)

D14:D15

Evidence of incorrect document

(IF RENOUNCED U.S.
CITIZENSHIP)

(IF 2.5 = yes, RENOUNCED U.S.
CITIZENSHIP)

(IF REASON NOT LISTED ABOVE) (IF 3.2G, REASON NOT LISTED
ABOVE)

(moved here)
Your Naturalization
Certificate

(moved here)
Upload

(moved here)
Upload an image or copy of your naturalization certificate.

(moved here)
Naturalization certificate

Note: USCIS regulations require this special certificate when a foreign state requires proof of your citizenship for any
legitimate purpose, except for admission to the foreign country or in processing their own immigration benefit requests.

Loss Of Citizenship

Upload

Upload an image or copy of a document explaining how and why you lost or renounced your United States citizenship.

Written statement

Evidence Of Incorrect
Document

Upload

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

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate
Other supporting documents

Evidence of your lost, stolen, or (Moved)
destroyed document

(IF LOST, STOLEN, OR
DESTROYED)

(Moved)

Evidence of your mutilated
document

(IF MUTILATED)

(Moved)

Evidence Of Your Lost,
Stolen, Or Destroyed
Document

(Moved)

Upload

(Moved)

Upload an image or copy of your original document if you have one.

(Moved)

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

(Moved)

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

(Moved)

You can also upload a copy of a police report and/or a sworn statement explaining what happened to the document and any
attempts to retrieve the document.

Evidence Of Your Mutilated (Moved)
Document

Upload

(Moved)

Upload an image or copy of your original mutilated document.
You also must mail your original mutilated 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
P.O. Box 82521
Lincoln, NE 68501

Original document from USCIS

(IF TYPOGRAPHICAL/CLERICAL
ERROR, NAME CHANGE, DOB
CHANGE, GENDER CHANGE)

(IF 3.2C,
TYPOGRAPHICAL/CLERICAL
ERROR, 3.2D, NAME CHANGE,
3.2E, DOB CHANGE, 3.2F,
GENDER CHANGE)

Original Document From
USCIS

Upload

Upload an image or copy of your original document.

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

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
P.O. Box 82521
Lincoln, NE 68501

Evidence of clerical or
typographical error

(Moved)

(IF CLERICAL/TYPO ERROR)

(Moved)

Evidence Of Clerical Or
Typographical Error

(Moved)

Upload

(Moved)

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.
Mail your original document to:
USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501

(Moved)

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

(Moved)

• Clear and readable
(delete)
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
(moved here)
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
(Moved)
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
(Moved)
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
(Moved)
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file

Evidence

EVIDENCE: N-565

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Primary Nav
Secondary Nav
Revision
Evidence of your name change (Moved)
by marriage

Tertiary Nav

Revision
Conditional Logic
(IF NAME CHANGE BY MARRIAGE, (Moved)
DIVORCE, OR ANNULMENT)

Paper Form

Evidence Title
Evidence Of Your Name
Change By Marriage

Revision
(Moved)

Field Type
Upload

Revision
(Moved)

Instructional Text
Upload an image or copy of the original certified marriage certificate, divorce certificate or annulment decree that shows your
legally changed name.

Revision
(Moved)

Document type
Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate
Original certified marriage certificate
Original divorce certificate
Original annulment decree

Revision
(Moved)

(Moved)

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate
Original or certified court order that shows
legally changed name

(Moved)

Birth certificate
(Moved)
Certificate recognizing foreign birth
Certificate of birth abroad
Other similar vital records issued by U.S. state
where you resided when the document was
issued

(Moved)

Certified copy of court order granting change
of sex or gender

(delete)

Amended birth certificate
(delete)
Passport recognizing the gender change
Driver's license reconizing the gender change

(delete)

Letter from a licensed health care
professional

(delete)

(Moved)

Naturalization certificate

(Moved)

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

Evidence of your name change
by court order

(Moved)

(IF NAME CHANGE BY COURT
ORDER)

(Moved)

Evidence Of Your Name
Change By Court Order

(Moved)

Upload

(Moved)

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
Upload an image or copy of the original or certified court order that shows your legally changed name.
You also must mail your original or certified 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
P.O. Box 82521
Lincoln, NE 68501

Evidence of your date of birth
change

(Moved)

(IF DOB CHANGE)

(Moved)

Evidence Of Your Date Of
Birth Change

(Moved)

Upload

(Moved)

Upload an image or copy of the original or certified U.S. Government-issued document, court order, or a vital record document
establishing the date of birth change.
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.

File Requirements
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file

Revision
(Moved)

Alerts

Required?

Links

Notes

(Moved)

Mail your original document to:

Court order showing legally
changed gender

(Moved)

(IF GENDER CHANGE BY COURT
ORDER)

(Moved)

Court Order Showing
Legally Changed Gender

(Moved)

Upload

(Moved)

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
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.

(Moved)

Mail your original document to:
USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
Government-issued document (delete)
reflecting the requested gender
designation

(IF GOVERNMENT-ISSUED
DOCUMENT REFLECTING THE
GENDER CHANGE)

(delete)

Government-Issued
Document Reflecting The
Requested Gender
Designation

(delete)

Upload

(delete)

Upload an image or certified copy of the government-issued document that shows your legally changed gender.
An acceptable government-issued document may include:
• Amended birth certificate
• Passport recognizing the gender change
• Driver's license recognizing the gender change
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:

Letter from licensed health care (delete)
professional

(IF LICENSED HEALTH CARE
(delete)
PROFESSIONAL'S CERTIFICATION
OF GENDER)

Letter From Licensed
Health Care Professional

(delete)

Upload

(delete)

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
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:
• A court order granting change of sex or gender
• 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
• The health care professional's assessment of your gender identity
You also must mail your original document to USCIS to complete your application. You should include your A-Number with your
original document.

• Clear and readable
(Moved)
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
(delete)
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file

Mail your original document to:

Your naturalization certificate

(Moved)

(IF SPECIAL CERTIFICATE OF
NATURALIZATION TO OBTAIN
RECOGNITION OF MY U.S.
CITIZENSHIP BY A FOREIGN
COUNTRY)

(Moved)

Your Naturalization
Certificate

(Moved)

Upload

(Moved)

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
Upload an image or copy of your naturalization certificate.

Evidence

ADDITIONAL INFORMATION: N-565
Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Paper Form Question: The number in the paper form associated with the question.
Primary Nav
Secondary Nav
Tertiary Nav
Conditional Logic
Additional Information Additional information

Paper Form Question Question
Additional Information

Sub-Question

Field Type

Instructional Text
Help 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.

Alert

Required?
No

Notes
Large Table Pattern
Ghost Sub Nav

If you do not need to provide any additional information, you may leave this section blank.

Additional Information

REVIEW AND SUBMIT: N-565

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Conditional Logic: A column used to indicate whether the question or subquestion only applies if you meet certain criteria.
Paper Form Question: The number in the paper form associated with the question.
Question: Based on content from the paper form. Often re-written from a statement into a question.
Primary Nav

Secondary Nav

Revisions

Conditional Logic

Paper form question

Revisions

Review and Submit Review your
application

Question

Revisions

Sub-Question

Revisions

Check your application before you submit

Field
Type

Revisions Instructional Text

Revisions

Help Text

Alert

Required?

Please review your ${formType} and check it for accuracy and completeness before you submit it.

CTA

Notes

We encourage you to provide as many responses as you can throughout the ${formType}. Missing or incomplete
information may slow down the review process after you submit your ${formType}.

Different copy based on
if the user did not
answer a required
question

Your fee

You can return to this page to review your ${formType} as many times as you want before you submit it.
Your form filing fee is: $0

Alerts and warnings

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.
You have one or more alerts and warnings based on the information you provided in your application.
A red alert means you have incomplete responses or inconsistent data. 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

A green alert means you have completed all required fields and responses.
Here is a summary of all the information you provided in your application.

Review the N-565 form information

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 statement

Preparer’s
certification

(IF PREPARER)

11.7A

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Preparer's statement

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11.7B

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11.7B

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Preparer's certification and signature

I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the
applicant's consent.

(delete)

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 the applicant understands all of the information contained in, and
submitted with, the application, including the Applicant's Declaration and Certification, and that all of this information is complete,
true, and correct. I completed this application based only on the information that applicant provided to me or authorized me to obtain
As the applicant's preparer, you must sign on paper and provide your signature page to the applicant. Follow these steps:

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Radio

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Radio

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Radio

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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.

View draft snapshot
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.

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Your preparer must read and agree to the certification below.

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
Preparer signature
Interpreter
certification

(IF PREPARER)
(IF INTERPRETER)

11.8
10

11.6

The applicant will need to scan and upload your completed signature page on the next screen.

Preparer's Signature Upload
Interpreter's certification and signature

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 in the identified language every question and instruction on this application and his or
her answer to every question. The applicant informed me that he or she understands every instruction, question, and answer on the
application, including the Applicant's Declaration and Certification, and has verified the accuracy of every answer.
As the applicant's interpreter, you must sign on paper and provide your signature page to the applicant. Follow these steps:

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 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.

Scan and upload your preparer's completed signature page below.
Your interpreter must read and agree to the certification below.

Upload

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
Interpreter signature
Your statement

Your signature

(Page and all content
deleted)

Your certification and
signature

The applicant will need to scan and upload your completed signature page on the next screen.

(delete)

10.7
9.2

10.6
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Interpreter's Signature Upload
Applicant's statement

(delete)

(IF PREPARER)

(delete)

9.1B

(delete)

Applicant's statement regarding the preparer

(delete)

(IF INTERPRETER)

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9.1A

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Applicant's statement regarding the interpreter (delete)

(If "Your statement" is
complete)

(delete)

(IF INTERPRETER)
(IF NO INTERPRETER)

Applicant's certification and signature

I can read and understand English, and have read and understand every question and instruction on this application, as well as my answer
to every question.
At my request, the preparer named in the Getting Started section of this application prepared this application for me based only upon the
information I provided or authorized.
The interpreter named in the Getting Started section of this application read to me every question 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
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. Furthermore, I authorize the release of any information from
any 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 laws.

(delete)

Upload
Checkbox

(delete)

Scan and upload your interpreter's completed signature page below.
You must read and agree to the statement below.

(delete)

Checkbox

(delete)

You must read and agree to the statement below.

(delete)

Checkbox

(delete)

You must read and agree to the statement below.

(delete)

I certify, under penalty of perjury, that I provided or authorized all of the 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 the Getting Started section,
understood, all of the responses and information contained in, and submitted with, my application, and that all of the responses and
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.

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 the law.

I understand that USCIS will require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or
signature) 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.

9.6
Pay and submit

(If "Your signature" is
complete)

9.4

Applicant's signature
Pay for and submit your application

By my signature, 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.
I have read and agree to the applicant's statement

Checkbox
Text

You must provide your digital signature below by typing your full legal name. If you do not completely fill out this
application, or if you do not submit the required documents listed in the Instructions, we may deny your
application. We will record the date of your signature with your application.
The final step to submit your Form N-565, Application for Replacement Naturalization/Citizenship Document, is
to pay the required fee.

Yes

Your application fee is: $[xxx].
Refund policy: By continuing this transaction, you agree that you are paying for a government service and that
the filing fee, biometric services fee and all related financial transactions are final and not refundable, regardless
of any action USCIS takes on an application, petition or request, or how long USCIS takes to reach a decision.
You must submit all fees in the exact amounts.
We will send you to Pay.gov — our safe, secure payment website — to pay your fees and submit your form online.
Here are the steps in the payment and submission process:

Pay and
submit

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.

(Successful submission)
(No nav)
(Unsuccessful card
declined) (No nav)

You successfully submitted your N-565
You did not submit your N-565

Pay.gov will redirect you to a uscis.gov confirmation screen, which will include your 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
We will contact you if we have any questions or need additional information. You can track the status of your
application through your USCIS online account.
Your payment failed because your credit or debit card was declined.

(Unsuccessful
submission) (No nav)

You did not submit your N-565

You can try again now to sign and submit your declaration or save and exit.
Your payment failed or was canceled before it could be processed on Pay.gov.
You can try again now to sign and submit your petition or save your petition and exit. We will save your petition for 30
days from when you started it.

Go to my
cases
Sign and
submit
Sign and
submit

Review & Submit

WARNINGS, ALERTS, NOTICES, AND ERRORS: N-565

Column Header Descriptions
Section: The primary nav where the alert can be found.
Page: The secondary nav where the alert can be found.
Type: The color of the alert (Red Yellow Blue Green)
Section
Page
Type
Getting Started

Type of application

Yellow alert

Conditional Logic

Message

(If 3.3; 3.4; 3.5; 3.6; or 3.7)
[yellow alert]

[YELLOW ALERT]
[HEADER] You must mail your original document to USCIS

Link

Notes

[BODY] 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:

Evidence

Review and Submit

Yellow alert

•Preparer's signature upload
•Interpreter's signature upload

Yellow alert

[If user does not upload required evidence]

If evidence is not uploaded

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
h5. [YELLOW ALERT]
[HEADER] You should provide evidence
[BODY] If you do not provide evidence, your application processing may be delayed.
h5. [YELLOW ALERT]
[HEADER] You should provide evidence
[BODY] If you do not provide evidence, your application processing may be delayed.

Alerts

File Type	application/pdf
Author	Microsoft Office User
File Modified	2024-04-15
File Created	2024-04-15