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What about Medical Concerns for Naturalization Applicant?

What about Medical Concerns for Naturalization Applicant?

The following information summarizes information provided by the USCIS in the Revised N-648 Training for External Stakeholders (public brochure).

Naturalization:  General Eligibility Requirements

  • 18 years of age at filing
  • Lawful Permanent Resident in the US
  • Residence and Physical presence in US
  • Good Moral Character (GMC)
  • Attachment to Constitution
  • Passage of the English and Civics exam
  • Willing to take the Oath of Allegiance

Educational Requirements 
The law requires naturalization applicants to demonstrate:

  •  An ability to understand, read, write, and speak English, and
  •  A knowledge of U.S. civics (U.S. history and government)

Typically a naturalization applicant is required to establish at the time of the N-400 interview the ability to read English, write English, Speak English and answer questions regarding United States history and civics, in English, or even in a language the applicant understands if he or she qualifies for using his or her own native language due to duration of permanent residence in the U.S. and the age of the applicant.  However, if the applicant is incapable of reading, writing, speaking or learning U.S. history due to a physical or developmental condition or disability, a medical professional may attest to such disability or impairment to waive the educational requirements.  If, in the medical professional’s opinion, the applicant is capable of some abilities, but incapable of others, Question 11 on the N-648 allows the medical professional to mark only or all disabilities that apply.

When the naturalization applicant appears for interview, the USCIS officer will review the form N-648, and if question 11 indicates the applicant is exempt from all educational requirements, the USCIS officer will interview the applicant in the applicant’s native language through the use of an interpreter and will not test the applicant on any of the educational requirements.

If the medical professional only marked some disabilities in Question on Form N-648, then the USCIS officer will only test the applicant on those areas that the form does not indicate should be exempted.
If the USCIS officer determines that the Form N-648 is insufficient at the initial naturalization interview, the USCIS will give the applicant the opportunity to take each portion of the naturalization test, including the civics portion and documenting the applicant’s ability to read, write and speak in English. If the applicant is incapable of responding to the test items, refuses to respond, or indicates in any manner a refusal to respond to certain portions of the test, then the USCIS officer will mark the test failed according to each portion (reading, writing, speaking, or civics exam) and issue a request called a Request for Evidence for the Form N-648 to be completed and list the reason(s) the one previously provided was insufficient.

If the response to the Request for evidence is submitted timely, then the USCIS will review whether it is sufficient.  Whether it is the completed N-648 addressing the previous insufficiency(ies) or a newly completed N-648, Question 11 on the form will be reviewed to see which elements of the educational requirements would be exempted for the naturalization applicant.  If it is found that the applicant is exempted from all educational requirements, or the applicant previously successfully passed the portion of the exam not exempted, then the applicant will be reviewed for naturalization based on all other naturalization criteria.  If the applicant is eligible to naturalize, the naturalization application will be approved and the applicant will be scheduled to appear for an oath ceremony to take the Oath of Allegiance and complete the naturalization process.

If the response to the Request for evidence is submitted timely, but the USCIS officer finds that the previous one corrected remains insufficient or a newly completed N-648 is insufficient, then the USCIS officer will provide the applicant a second opportunity to retake each portion of the naturalization exam that the applicant failed or refused to respond during the initial interview.  If during the second naturalization interview, the applicant fails or refuses to take any portion of the test, the USCIS will deny the naturalization application for failure to meet the educational requirements for naturalization.  (See 8 CFR 312)

What should the naturalization applicant do if he or she believes (or a family member, guardian or care-taker believes) the applicant has a medical or developmental disability that inhibits his or her ability to speak English, read English, write English or learn the U.S. history required for the naturalization educational requirement?

Seek the advice of a medical professional to determine if the applicant’s medical or developmental disability has a causal connection to the person’s inability to retain U.S. history information or speak, read or write in English.  Then ask the medical professional to complete Form N-648. 

Revised Form N-648

Since October 18, 2011, USCIS will only accept the new revised form N-648, which includes a translator’s certification and the medical professional attesting to whether the exam was performed with the assistance of a translator either through his or her own fluency in other language or through the use of a translator.  The revised form N-648 also removes the requirement for the applicant to provide whether any other governmental agency has made a disability determination and removes the requirement that the medical professional needs to review ability to perform daily life activities.

The new form, Section 3, Questions 1-12 request the medical professional to provide the following:

  • Provide the clinical diagnosis, and DSM IV code (if applicable), of the applicant’s disability and/or impairment(s) that form the basis for seeking an exception to the English and/or civics requirements.
  • Provide a basic description of the disability and/or impairment.
  • Date of the first examination of the applicant regarding the condition(s) listed in number 1?
  • Date of the last examination of the applicant regarding the condition(s) listed in number 1, if different from above.
  • Are you the medical professional regularly treating this applicant for the conditions listed in number 1?
  • Has the applicant’s disability and/or impairment(s) lasted, or do you expect it to last, 12 months or more?
  • Is the applicant’s disability and/or impairment(s) the result of the applicant’s illegal use of drugs?
  • What caused this applicant’s medical disability and/or impairment(s) listed in number 1, if known?
  • What clinical methods did you use to diagnose the applicant’s medical disability and/or impairments(s) listed in number 1?
  • Clearly describe how the applicant’s disability and/or impairment(s) affect his or her ability to demonstrate knowledge and understanding of English and/or civics.
  • In your professional medical opinion, does the applicant’s disability or impairment(s) prevent him or her from demonstrating the following requirements? The ability to read English; write English; speak English, answer questions regarding the United States history and civics, even in a language the applicant understands.
  • Was an interpreter used during your examination of the application?

What is the role of the Medical Professional?

Per the USCIS, there are specified activities that the medical professional must do himself or herself in completing the form N-648.

  • The medical professional must have conducted an in– person medical examination of the applicant to certify the form.
  • Staff associated with the medical professional may assist in completing the form BUT the medical professional alone is responsible for verifying the accuracy of the content and for certifying the form. 
  • Responses to questions on the form must be legible and appear in black ink.
  • Responses to questions on the form should utilize common terminology, without abbreviations.
  • All questions and items requested on the form must be answered fully, none should be left blank. 

How does one prove the medical condition relates to the applicant’s inability to take the naturalization exam or educational requirements?

Answer: There must be a nexus, meaning a causal connection.
The medical professional must explain the nature and extent of any medical condition and explain how the medical condition relates to the applicant’s inability to comply with the educational requirements for naturalization. 

USCIS Example of an Insufficient Nexus 
The medical professional wrote “patient has Down syndrome” as the only 
connection to the educational requirements.

This example is insufficient because it does not state what the condition or diagnosis of the condition means as to how the applicant can or cannot perform tasks required to learn information, retain or memorize information, or whether the patient has the ability to perform general daily tasks or have intellectual capabilities.  The physician must state the reason why or how the condition, disease or impairment affects the abilities of the patient, however obvious the physician believes the impairment to be.

USCIS Example of a Sufficient Nexus 
“The patient’s condition is a global, lifelong impairment that severely affects cognition, language, and motor skills. While many individuals with mild to moderate forms of Down syndrome are capable of daily tasks and working in the community, this patient suffers from a particularly severe form. Because of this impairment, his memory is deficient, he cannot learn new skills, and he is not capable or reasoning but only of performing simple daily activities. The patient’s severe intellectual disability (mental retardation) makes him incapable of learning a new language (even basic words) and demonstrating the required knowledge of U.S. history and government.”