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    n-648 last one

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    Medical Certification for

    Disability Exceptions USCIS


    Form N-648
    Department of Homeland Security OMB No. 1615-0060
    U.S. Citizenship and Immigration Services Expires 09/30/2027

    ► START HERE - Type or print in black ink.


    Please read the instructions before examining the applicant and filling out this form.
    In general, applicants for naturalization must demonstrate that they understand the English language, including the ability to read,
    write, and speak words in ordinary usage. They must also demonstrate knowledge and understanding of the fundamentals of the
    history, principles, and form of government of the United States. These are called the “English and civics requirements.” This form is
    used for applicants to seek an exception to the English and civics requirements due to a physical or developmental disability or mental
    impairment that has lasted, or is expected to last, 12 months or more. Applicants seeking such an exception should submit this form as
    an attachment to the Form N-400, Application for Naturalization.
    Please note:
    Only medical doctors, doctors of osteopathy, or clinical psychologists can certify the form.
    Additionally, they must be licensed to practice in the United States (including the U.S. territories of the Commonwealth of the
    Northern Mariana Islands, Guam, Puerto Rico, and the Virgin Islands) to certify the form.
    While staff of the medical practice associated with the certifying medical professional certifying the form may assist in its
    completion, the certifying medical professional is responsible for the accuracy of the form's content and therefore must sign it.
    Answer all the questions regarding medical information, using common terminology that a person without medical training can
    understand, with no abbreviations. Failure to fully and accurately complete this form, including all applicable signatures, may
    result in the form being found insufficient.

    Part 1. Applicant Information USCIS USE ONLY

    1. Applicant's Legal Name This N-648 is:


    Sufficient
    Family Name (Last Name) Given Name (First Name)
    Insufficient
    Continued/RFE

    Middle Name (if any) Reviewer

    2. Alien Registration Number (A-Number) (if any) 3. Date of Birth (mm/dd/yyyy)


    ► A- Location & Date

    Part 2. Certifying Medical Professional Information


    1. Certifying Medical Professional's Name
    Family Name (Last Name) Given Name (First Name)

    Middle Name (if any)

    Form N-648 Edition 09/25/24 Page 1 of 5


    Part 2. Certifying Medical Professional Information (continued) ► A-

    2. Certifying Medical Professional's Business Address


    Street Number and Name Apt. Ste. Flr. Number

    City or Town State ZIP Code (USPS ZIP Code Lookup)

    Province Postal Code Country

    3. License Number 4. Licensing State

    5. Business Telephone Number 6. Email Address (if any)

    7. I am currently licensed as a (select all that apply):


    Medical Doctor Doctor of Osteopathy Clinical Psychologist

    8. Medical Practice Type:

    9. Did you use an interpreter: Yes No


    10. If No, I did not use an interpreter because:

    I am fluent in English and , the language spoken by this applicant.

    This applicant speaks English.

    Part 3. Information About Disabilities and/or Impairments


    1. Provide the clinical diagnosis and medical code for all physical or developmental disabilities and/or mental impairments that
    affect the applicant's ability to meet the English and/or civics requirements. Also, clearly describe how each disability and/or
    impairment prevents the applicant from learning English and/or civics. Responses should use common terminology, without
    abbreviations, that a person without medical training can understand. Refer to page 2 of the Instructions for an example. Please
    provide the relevant medical code as accepted by the U.S. Department of Health and Human Services (HHS). This includes the
    Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). For
    example, “DSM-V 318.1 Intellectual Disability (Severe)” or “2022 ICD-10-CM F72 Severe intellectual disabilities.”

    Form N-648 Edition 09/25/24 Page 2 of 5


    Part 3. Information About Disabilities and/or Impairments (continued) ► A-

    2. What clinical or laboratory diagnostic techniques did you use to diagnose each of the applicant's disabilities and/or
    impairment(s) listed in Part 3., Item Number 1.?

    3. Have any of the applicant's disabilities and/or impairments listed in Part 3., Item Number 1. lasted, or do Yes No
    you expect any of them to last, 12 months or more? If your answer is “No,” do not complete this form
    because the applicant is not eligible for this exception.
    4. Are any of the disabilities and/or impairment(s) listed in Part 3., Item Number 1. the result of the Yes No
    applicant's illegal use of drugs? If your answer is “Yes” for all of the disabilities or impairments, do not
    complete this Form because the applicant is not eligible for this exception.
    5. If yes, for some disabilities or impairments, identify which disabilities or impairments are the result of the applicant's illegal use
    of drugs.

    6. For disabilities and/or impairments listed in Part 3., Item Number 1., provide the date you last examined the applicant.

    Date (mm/dd/yyyy)

    7. Do any of the disabilities or impairments listed in Part 3., Item Number 1. prevent the applicant from demonstrating the
    following? Select all that apply. If none applies, do not complete this Form because the applicant is not eligible for this
    exception.
    The ability to: Read English Speak English Write English
    Answer questions regarding United States history and civics, even in a language the applicant understands.

    Part 4. Ability to Understand Oath of Allegiance


    The applicant will not be able to naturalize without a legal guardian, surrogate, or an eligible designated representative unless they are
    able to understand and communicate that they understand the meaning of the Oath of Allegiance. The Oath may be administered in
    the applicant's language of choice and they may communicate their understanding in any manner (for example, by nodding).
    1. Is the applicant able to understand and communicate that they understand the meaning of the Oath of Yes No
    Allegiance to the United States?

    Form N-648 Edition 09/25/24 Page 3 of 5


    Part 5. Interpreter Information and Certification ► A-

    If in-person interpretation services were used during the medical examination, the interpreter must fill out this section, sign, and date
    the certification. If telephonic interpretation services were used during the medical examination, the certifying medical professional
    must complete all items in this section, except Item Number 6.
    1. Was a telephonic or video facilitated interpreter used during the examination of the applicant? Yes No
    2. Interpreter's Name
    Family Name (Last Name) Given Name (First Name) Middle Name (if applicable)

    Interpreter's Contact Information


    3. Interpreter's Daytime Telephone Number 4. Interpreter's Mobile Telephone Number (if any)

    5. Interpreter's Email Address (if any)

    Interpreter's Certification
    I certify that I am fluent in English and the following language, .
    I further certify that I have accurately and completely interpreted all communications between the certifying medical professional and
    the applicant that occurred on , the date(s) of the examination(s) that form the basis of this certification.

    6. Interpreter's Signature (not required for telephonic interpretations) Date of Signature (mm/dd/yyyy)

    Part 6. Applicant's (Patient's) Attestation/Release of Information


    1. I, (Applicant's Name),
    authorize (the Licensed medical doctor,
    doctor of osteopathy, or clinical psychologist completing this form) to release to U.S. Citizenship and Immigration Services
    (USCIS) all relevant physical and mental health information related to my medical status for the purpose of applying for an
    exception from the English language and U.S. civics requirements for naturalization. I certify under penalty of perjury, pursuant
    to 28 U.S.C. section 1746, that the information I provided to the certifying medical professional is true and correct. I certify
    under penalty of perjury, pursuant to 28 U.S.C. section 1746, that I have attended an appointment with
    (Licensed medical doctor, doctor of osteopathy, or clinical psychologist) and was then
    diagnosed by him or her. I am aware that the knowing placement of false information on Form N-648 and related documents
    may also subject me to civil penalties under 8 U.S.C. section 1324c and INA section 274C. I understand that if this form is not
    completely filled out or if I fail to submit any required documentation, I may be found ineligible for the requested medical
    disability exception.
    2. Applicant Signature (or mark if applicant is unable to sign) Date of Signature (mm/dd/yyyy)

    Form N-648 Edition 09/25/24 Page 4 of 5


    Part 7. Medical Professional's Certification ► A-

    I certify that:
    1. I have examined the applicant/patient listed in Part 1. above.
    2. I will furnish relevant medical records to USCIS, if requested to do so by USCIS, based on the applicant's consent in
    Part 6.
    3. This applicant's identity has been verified through the following United States or State government-issued photographic
    identity document:

    Permanent Resident Card State ID Number:

    Other Identification (Indicate type and ID Number):

    Additionally, I certify, under penalty of perjury under the laws of the United States of America, that the information on this form and
    any evidence submitted with it are all true and correct. I am aware that the knowing placement of false information on Form N-648
    and related documents may also subject me to criminal penalties including under 18 U.S.C. section 1546, civil penalties under 8
    U.S.C. section 1324c and Immigration and Nationality Act (INA) section 274C, and civil license suspension or revocation by the
    appropriate authorities.
    4. Certifying Medical Professional Signature Date of Signature (mm/dd/yyyy)

    Form N-648 Edition 09/25/24 Page 5 of 5

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