Instructions For Medical Certification For Disability Exceptions (Form N-648) (Page 2 of 3) in pdf

9. What clinical methods did you use to diagnose the

General Instructions

applicant's medical disability and/or impairments listed

in Part 3. Item Number 1?

USCIS recommends that the certifying medical

professional complete and print the fillable electronic

"The patient was diagnosed in utero through a Chorionic

Form N-648 located in the "FORMS" section at

Villus Sampling (CVS). CVS is a test done during early

pregnancy that can identify certain genetic disorders or

1. Type or print clearly using black ink. Keep all information

chromosomal birth defects, such as "Severe intellectual

disabilities."

within the area provided. If you require additional space to

complete the answer to any item, the information fields in

10. Clearly describe how the applicant's disability and/or

the fillable electronic form will expand to accommodate

impairments, affect his or her ability to demonstrate a

the additional information. If you are not completing an

knowledge and understanding of English and/or civics.

electronic version of the form and you continue to need

extra space to complete any item, type or print the

"The patient's condition is a global, lifelong impairment

applicant's name and Alien Registration Number (A-

that severely affects cognition, language, and motor skills.

Number) at the top of each continuation sheet and indicate

While many individuals with mild to moderate forms of

the part and number of the item to which the answer refers.

Severe intellectual disabilities are capable of daily tasks

You must sign and date each continuation sheet.

and working in the community, this patient suffers from a

2. All questions must be answered fully and accurately. If an

particularly severe form. Because of this impairment, his

memory is deficient, he cannot learn new skills, and he is

item is not applicable, indicate it with "N/A." If the

not capable of reasoning but only of performing simple

answer is none, type or print "None."

daily activities. The patient's severe intellectual disability

3. The medical professional must provide the completed form

makes him incapable of learning a new language (even

to the applicant.

basic words) and demonstrating the required knowledge of

U.S. history and government."

USCIS Forms and Information

What Are the Penalties for Making False

You can get USCIS forms and immigration-related

Representations?

information on the USCIS Internet website at

You may order USCIS forms by calling our toll-free number

Both the applicant and the medical professional are required to

at 1-800-870-3676. You may also obtain forms and

attest to the contents of this form under penalty of perjury.

information by telephoning our National Customer Service

Title 18, United States Code, Section 1546, provides that:

Center at 1-800-375-5283.

Whoever knowingly makes under oath, or as permitted under

Instead of waiting in line for assistance at your local USCIS

penalty of perjury under Section 1746 of Title 28, United

office, you can schedule an appointment online at

States Code, knowingly subscribes as true, any false statement

Select "Schedule an appointment online" and

with respect to a material fact in any application, affidavit, or

follow the screen prompts to set up your appointment. Once

other document required by the immigration laws or

you finish scheduling an appointment, the system will

regulations prescribed thereunder, or knowingly presents any

generate an appointment notice for you.

such application, affidavit, or other document containing any

such false statement, shall be fined in accordance with this

USCIS Privacy Act Statement

title or imprisoned not more than 10 years, or both.

If either the applicant or the medical professional includes in

AUTHORITIES: The information requested on this form,

this form any information that the party knows to be false, that

and the associated evidence, is collected pursuant to Section

person may be liable for criminal prosecution under U.S. laws.

1103, 1423, and 1427 of the Immigration and Nationality Act,

In addition to the criminal penalties under Title 18 of the

as amended INA Section 101, et seq.

United States Code, Section 274C of the Immigration and

PURPOSE: The primary purpose for providing the requested

Nationality Act and 8 U.S.C. 1324c provides for civil

information on this form is to determine if you have

penalties.

established eligibility for an exception to the English language

and/or U.S. history and civic requirements due to a physical or

developmental disability or mental impairment that has lasted,

or is expected to last, 12 months or more. USCIS requests that

you provide your Social Security Number to facilitate and

expedite the adjudication of your request. USCIS will use the

information provided to grant or deny the exception sought.

Form N-648 Instructions 03/21/17 Y Page 2

Instructions For Medical Certification For Disability Exceptions (Form N-648) Page 2

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