Form N-648 - Medical Certification For Disability Exceptions

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OMB No. 1615-0060; Expires 03/31/2019

Form N-648, Medical Certification for

Department of Homeland Security

Disability Exceptions

U.S. Citizenship and Immigration Services

ALL parts of this form, except the "APPLICANT ATTESTATION" and "INTERPRETER'S CERTIFICATION" must be certified by a

licensed medical professional as provided in the instructions for Form N-648. Before certifying this form, the medical professional must

conduct an in-person examination of the applicant. (See instructions for Form N-648 for additional information which is also located in the

"FORMS" section at )

Reminder About Eligibility Requirements

Completing and Certifying This Form

This form is intended for an applicant who seeks an exception to the

All questions or items must be answered fully and accurately.

English and/or civics requirements due to a physical or

Responses should utilize common terminology, without

developmental disability or mental impairment that has lasted, or is

abbreviations, that a person without medical training can understand.

expected to last, 12 months or more. An applicant who with

U.S. Citizenship and Immigration Services (USCIS) recommends

reasonable accommodations provided under the Rehabilitation Act of

that the certifying medical professional use the electronic Form

1973 can satisfy the English and civics requirements does not need to

N-648 located in the "FORMS" section If the

submit this form. Reasonable accommodations include, but are not

medical professional completes the form by hand, then responses

limited to, sign language interpreters, extended time for testing, and

must be legible and appear in black ink.

off-site testing.

Type or print clearly in black ink.

Part 1. APPLICANT INFORMATION

USCIS USE ONLY

I certify that I have examined:

This N-648 is:

Sufficient

Last Name

First Name

Middle Name

USCIS A-Number

Insufficient

A-

Continued/RFE

Address (Street Number and Name)

U.S. Social Security Number

Reviewer

City

State or Province

Zip Code or Postal Code

Location & Date

Telephone Number

E-Mail Address (if any)

Date of Birth

Gender

Male

Female

Part 2. MEDICAL PROFESSIONAL INFORMATION

Type or print clearly in black ink. If you need more space to complete an answer, use a separate sheet of paper. Type or print the applicant's name

and Alien Registration Number (A-Number), at the top of each sheet of paper and indicate the part and number of the item to which the answer

refers. You must sign and date each continuation sheet. You must answer and complete each question since USCIS will not accept an incomplete

Form N-648. You may, but are not required to, attach to this completed form supportive medical diagnostic reports or records regarding the applicant.

NOTE: Only medical doctors, doctors of osteopathy, or clinical psychologists licensed to practice in the United States (including the U.S. territories

of Guam, Puerto Rico, and the Virgin Islands) are authorized to certify the form. While staff of the medical practice associated with the medical

professional certifying the form may assist in its completion, the medical professional is responsible for the accuracy of the form's content.