Fillable Form N-648

Form N-648, Medical Certification for Disability, is a form used to request an exception to the English and civics testing requirements.

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What is Form N-648?

Form N-648, Medical Certification for Disability Exceptions, is a document used to obtain an exception to the English or civics requirements for the United States Naturalization. It is used by applicants with a physical or developmental disability or mental impairment that has lasted or is expected to last in 12 months or more.

How to fill out Form N-648?

Do not use abbreviations or jargon when filling out Form N-648. Use common or understandable terminologies so that a person without medical training can understand your responses.

Part 1. APPLICANT INFORMATION

This section is for the applicant or patient’s use only.

Last Name

Enter your last name.

First Name

Enter your first name.

Middle Name

Enter your middle name.

USCIS A-Number

Enter your Alien Registration Number.

Address

Enter your street number and name.

U.S. Social Security Number

Enter your Social Security Number.

City

Enter your city.

State or Province

Enter the state or province where you live.

Zip Code or Postal Code

Enter your ZIP or postal code.

Telephone Number

Enter your telephone number.

E-Mail Address

Enter your email address.

Date of Birth

Enter your birthdate.

Gender

Mark Male, if you are a male.

Mark Female, if you are a female.

Part 2. MEDICAL PROFESSIONAL INFORMATION

This section is for the medical professional's use only.

Special Instructions:

The medical professional must utilize common terminologies for a better understanding.

The U.S. Citizenship Immigration Services (USCIS) recommends certifying medical professionals to use the electronic Form N-648. If not, they must write legibly using black ink.

The medical professional must answer all applicable questions and items on Form N-648. Otherwise, the USCIS may mark it insufficient.

Last Name

Enter your last name.

First Name

Enter your first name.

Middle Name

Enter your middle name.

Business Address

Enter your business street number and name.

City

Enter your business city address.

State or Province

Enter the state or province where you operate your business.

Zip Code or Postal Code

Enter the ZIP or postal code where you operate your business.

Telephone Number

Enter your telephone number.

License Number

Enter your license number.

Licensing State

Enter the state where you are licensed to practice medicine.

E-Mail Address

Enter your email address.

Currently licensed as a

Mark all appropriate boxes.

Medical Doctor

Mark the box if you are a licensed medical doctor.

Doctor of Osteopathy

Mark the box if you are a licensed doctor of osteopathy.

Clinical Psychologist

Mark the box if you are a licensed clinical psychologist.

Medical Practice Type

Enter your medical practice type.

Note: The medical professional must enter the applicant's name and USCIS A-Number on top of each page of Form N-648.

Applicant's Name

Enter the applicant's name.

USCIS A-Number

Enter the applicant's Alien Registration Number or A-Number.

Part 3. INFORMATION ABOUT DISABILITY and/or IMPAIRMENTS(S)

Provide the clinical diagnosis of the applicant's disability and/or impairment, that form the basis for seeking an exception to the English and/or civics requirements. If applicable, please provide the relevant medical code as accepted by the Department of Health and Human Services (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 2015/16 ICD-10-CM F72 Severe intellectual disabilities.

Enter your clinical diagnosis of the applicant's disability and or impairment.

Provide a basic description of the disability and/or impairments, for example, Intellectual Disability (Severe) is a genetic disorder that causes lifelong intellectual disability, developmental delays, and other problems.

Enter a basic description of the applicant's disability and or impairment.

Date you first examined the applicant regarding the conditions listed in number 1.

Date

Enter the date you first examined the applicant regarding the conditions listed in number 1.

Location

Enter the location where you first examined the applicant. If it is the same business address on Page 1, enter Same as Business Address.

Date you last examined the applicant regarding the conditions listed in number 1, if different from above.

Enter the date you last examined the applicant regarding the conditions listed in number 1.

Location

Enter the location where you last examined the applicant. If it is the same business address on Page 1, enter Same as Business Address.

Are you the medical professional regularly treating this applicant for the conditions listed in Item Number 1?

Yes

Mark the box if you are the regular medical professional who treats the applicant's conditions. Then, enter the duration of treatment.

Mark the box if you are not the regular medical professional who treats the applicant's conditions. Then, enter the necessary information below.

Name of Regularly Treating Medical Professional and Address

Last Name

Enter the last name of the medical professional who regularly treats the applicant's medical condition.

First Name

Enter the first name of the medical professional who regularly treats the applicant's medical condition.

Middle Name

Enter the middle name of the medical professional who regularly treats the applicant's medical condition.

Business Address

Enter the medical professional’s business street number and name who regularly treats the applicant's medical condition.

City

Enter the city where the medical professional who regularly treats the applicant's medical condition operates.

State or Province

Enter the state or province where the medical professional who regularly treats the applicant's medical condition operates.

Zip Code or Postal Code

Enter the ZIP or postal code where the medical professional who regularly treats the applicant's medical condition operates.

Telephone Number

Enter the telephone number of the medical professional who regularly treats the applicant's medical condition.

Explanation

Provide an explanation of why you are certifying this form instead of the applicant's regular medical professional.

Has the applicant's disability and/or impairments lasted, or do you expect it to last, 12 months or more?

Yes

Mark the box if the applicant's disability and or impairments lasted or you expect it to last in 12 months or more. If so, you may continue to fill out Form N-648.

Mark the box if the applicant still has disability and or impairments, and you do not expect it to last in 12 months or more. If so, go directly to the Medical Professional's Certification section because the applicant is not eligible for this exception.

Is the applicant's disability and/or impairments the result of the applicant's illegal use of drugs?

Yes

Mark the box if the applicant's disability and or impairment is a result of illegal drugs intake. If so, go directly to the Medical Professional's Certification section because the applicant is not eligible for this exception.

Mark the box if the applicant's disability and or impairment is not a result of illegal drugs intake. If so, you may continue to fill out Form N-648.

What caused this applicant's medical disability and/or impairments listed in number 1, if known?

Enter the cause of the applicant's medical disability and or impairment, if known.

What clinical methods did you use to diagnose the applicant's medical disability and/or impairments listed in number 1?

Enter the clinical methods you used to diagnose the applicant's medical disability and or impairment.

Clearly describe how the applicant's disability and/or impairments affect his or her ability to demonstrate knowledge and understanding of English and/or civics.

Provide an explanation about the effect of the diagnosed medical condition on the applicant's ability to demonstrate knowledge and understanding of English and or civics.

In your professional medical opinion, does the applicant's disability or impairments prevent him or her from demonstrating the following requirements?

Mark all applicable boxes. If none, the applicant is not eligible for this exception.

Read English

Mark the box if the diagnosed disability or impairment prevents the applicant from reading English.

Write English

Mark the box if the diagnosed disability or impairment prevents the applicant from writing English.

Speak English

Mark the box if the diagnosed disability or impairment prevents the applicant from speaking English.

Answer questions regarding United States history and civics, even in a language the applicant understands.

Mark the box if the diagnosed disability or impairment prevents the applicant from answering questions regarding the United States history and civics, even in the language he or she understands.

Was an interpreter used during your examination of the applicant?

Yes

Mark the box if there was an interpreter during your examination of the applicant. If so, the interpreter must fill out the Interpreter Certification section.

Mark the box if you did not use an interpreter during your examination of the applicant.

Additional Comments

Enter additional information.

MEDICAL PROFESSIONAL'S CERTIFICATION

I am fluent in English and

Enter the language you and the applicant speak.

I certify that this applicant's identity has been verified through the following United States or State government-issued photographic identity document:

Permanent Resident Card

Mark the box if the applicant's identity has been verified through his or her permanent resident card.

State ID Number

Mark the box if the applicant's identity has been verified through his or her state identification number.

Other Identification

Mark the box if the applicant's identity has been verified through other identification. Then, provide the ID type and number.

Licensed Medical Professional Signature

Enter your signature.

Date

Enter the date upon signing Form N-648.

INTERPRETER'S CERTIFICATION

This section is for the interpreter's use only.

Interpreter Information

Last Name

Enter your last name.

First Name

Enter your first name.

Middle Name

Enter your middle name.

Address

Enter your street number and name.

City

Enter your city.

State or Province

Enter the state or province where you live.

Zip Code or Postal Code

Enter your ZIP or postal code.

Was a phone interpreter used?

Yes

Mark the box if a phone interpreter was used. If so, you are not required to complete the information below.

Mark the box if a phone interpreter was not used. If so, complete the information below.

Interpreter Certification

The following language

Enter the language you fluently speak.

Occurred on

Enter the date when you translated all communications between the medical professional and the applicant.

Interpreter Signature

Enter your signature.

Date

Enter the date upon signing Form N-648

APPLICANT (PATIENT) ATTESTATION/RELEASE OF INFORMATION

This section is for the applicant's use only.

If you complete this section, you authorize the medical professional to release your physical and mental health information to the U.S. Citizenship and Immigration Services.

Enter your name.

Authorize

Enter the medical professional's name.

Applicant or Applicant's Authorized Representative Signature

Enter your or your representative's signature.

Date

Enter the date when you or your representative has signed Form N-648.

What is the U.S. Naturalization?

Naturalization is the process of becoming a U.S. citizen if an individual is born in a foreign country.

To apply for Naturalization, you must:

be at least 18 years of age at the time you apply;

have been a lawful permanent resident for the past three or five years (depending on which Naturalization category you are applying under);

have continuous residence and physical presence in the United States;

be able to read, write, and speak basic English;

demonstrate good moral character;

demonstrate a knowledge and understanding of U.S. history and government;

demonstrate loyalty to the principles of the U.S. Constitution; and

be willing to take the Oath of Allegiance.

What is the purpose of Form N-648?

One of the requirements for Naturalization is the ability to read, write, and speak basic English. It can be a problem for foreign applicants with physical or developmental disabilities or mental impairments. Thus, Form N-648 is used to ask for an exception to this requirement.

How to file Form N-648?

Attach the accomplished Form N-648 to your Form N-400, Application for Naturalization.

Table of Contents

Fillable Form N-648