Medical Certification for Disability Exceptions

• Legal Form Number: N-648
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Form N-648 Edition 08/19/22 Page 1 of 5

Medical Certification for

Disability Exceptions

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form N-648

OMB No. 1615-0060

Expires 08/31/2024

START HERE - Type or print in black ink.►

Part 1. Applicant Information

1.

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.

Only medical doctors, doctors of osteopathy, or clinical psychologists can certify the form.

Applicant's Legal Name

2.

Family Name (Last Name) Given Name (First Name)

Middle Name (if any)

USCIS USE ONLY

This N-648 is:

Sufficient

Insufficient

Continued/RFE

Reviewer

Location & Date

Please note:

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.

Alien Registration Number (A-Number) (if any)

►A-

3. Date of Birth (mm/dd/yyyy)

Part 2. Certifying Medical Professional Information

1. Certifying Medical Professional's Name

Family Name (Last Name) Given Name (First Name)

Middle Name (if any)