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

Instructions For Medical Certification For Disability Exceptions (Form N-648) Page 3

DISCLOSURE: The information you provide is voluntary.

However, failure to provide the requested information,

including your Social Security Number, and any requested

evidence, may delay a final decision or result in the denial of

your disability exception request.

ROUTINE USES: The information you provide on this form

may be shared with other federal, state, local, and foreign

government agencies and authorized organizations in

accordance with approved routine uses, as described in the

associated published system of records notices [DHS/

USCIS-007 - Benefits Information System and DHS/

USCIS-001 - Alien File (A-File) and Central Index System

(CIS), which can be found at The

information may also be made available, as appropriate for

law enforcement purposes or in the interest of national

security.

Paperwork Reduction Act

An agency may not conduct or sponsor an information

collection and a person is not required to respond to a

collection of information unless it displays a currently valid

OMB control number. The public reporting burden for this

collection of information is estimated at 120 minutes per

response, including the time for reviewing instructions and

completing and submitting the form. Send comments

regarding this burden estimate or any other aspect of this

collection of information, including suggestions for reducing

this burden, to: U.S. Citizenship and Immigration Services,

Regulatory Coordination Division, Office of Policy and

Strategy, 20 Massachusetts Ave NW, Washington, DC

20529-2140. OMB No. 1615-0060. Do not mail your

completed Form N-648 to this address.

Form N-648 Instructions 03/21/17 Y Page 3

Instructions For Medical Certification For Disability Exceptions (Form N-648) Page 3