Form N-336, Request For A Hearing On A Decision In Naturalization Proceedings
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2OMB No. 1615-0050; Expires 04/30/2012
N-336, Request for a Hearing on a
Decision in Naturalization Proceedings
Department of Homeland Security
(Under Section 336 of the INA)
U.S. Citizenship and Immigration Services
For USCIS Only
Decision:
Re-Affirm N-400 Denial
Fee:
Re-Determine N-400 Denial
Part 1. In the Matter of:
File Number:
Current Legal Name (do not list a nickname.)
A-
Family Name (last name)
Given Name (first name)
Middle Name (if applicable)
Home Address (do not write a P.O. Box in this space.)
Street Number and Name
C/O (in care of name)
Apartment Number
City
County
State
Zip Code
Province (foreign address only)
Country (foreign address only)
Postal Code (foreign address only)
Mailing Address
Street Number and Name
C/O (in care of name)
Apartment Number
City
State
Zip Code
Province (foreign address only)
Country (foreign address only)
Postal Code (foreign address only)
Signature
Date (mm/dd/yyyy)
2. Please check the one block that applies:
a.
I am not submitting a separate brief, statement, or evidence.
b.
I am submitting a separate brief, statement, and/or evidence with this form.
c.
I need
days to submit a brief, statement, and/or evidence
to the USCIS. (May be granted only for good cause shown. Explain in a separate letter.)
Form N-336 (10/30/11) N
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