Medical Certification For Disability Exceptions
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#1115-0205
U. S. Department of Justice
Medical Certification For Disability Exceptions
Immigration and Naturalization Service
INSTRUCTIONS FOR FORM N-648 MEDICAL
CERTIFICATION FOR DISABILITY EXCEPTIONS
Purpose of This Form.
The Immigration and Naturalization Service's (INS) regulations require that applicants seeking an
exception
from
the
English
and
U.S.
history
and
government
(civics)
requirements
for
naturalization based on physical or developmental disability or mental impairment submit this
certification form, completed by a licensed medical doctor or a licensed clinical psychologist,
along with a completed application for naturalization (Form N-400).
This certification form will
be used by the INS to determine whether applicants for naturalization are entitled to an exception
to the requirements.
In accordance with the Rehabilitation Act of 1973, INS makes reasonable modifications and/or
accommodations to allow individuals with disabilities to participate in testing required for
naturalization.
Reasonable modifications and/or accommodations may include but are not limited
to: Braille test forms, sign language interpreters, or off-site testing.
Applicants should be advised
that
if
reasonable
modifications
and/or
accommodations
will
allow
them
to
demonstrate
knowledge of basic English and U.S. history and civics, this medical certification form is not
required.
Part I of the form must be completed and signed by the applicant.
A legal guardian may sign the
N-648 authorizing the release of additional medical records to the Service.
The form also
contains an acknowledged release by the applicant of his or her medical records to include both
physical and mental health. Part II of the form must be completed and signed by the licensed
medical doctor or licensed clinical psychologist performing the assessment of the applicant.
The
licensed medical doctor or licensed clinical psychologist is required to attest to the truthfulness of
his or her certification under penalty of perjury and agree to release his or her medical records
relating to the applicant upon request by the INS.
General Instructions.
Please answer all questions by typing or printing clearly in black ink.
Indicate that an item is not
applicable with "N/A".
If an answer is "none," write "none".
If you need extra space to answer
any item, attach a sheet of paper with the name of the applicant, and the alien registration
number (A#), and your complete name including first name, middle name and last name, with
appropriate title. Also, indicate the number of the item to which the answer refers.
Additional medical reports may be submitted but they must be limited to not more than two
pages, and have the name of the applicant, alien registration number (A#), and your signature
on each page of the attachments.
Additional medical records may be submitted but will not be
accepted as a substitute for complete responses to questions asked on the certification form.
1.
You are requested to provide an accurate assessment of the applicant's disability or
impairment so the INS can determine whether to grant an exception to the English language and
history and civics requirements for naturalization.
2.
The INS requires that the licensed medical doctor or licensed clinical psychologist completing
the form for the applicant be experienced in the area of the applicant's disability, and able to
diagnose the applicant's disability and/or impairments.
A certification must be made as to
whether the applicant has the ability to learn English and civics sufficient to pass the INS'
citizenship test.
The tests require an ability to speak and write basic English and the ability to
answer basic questions about the history and civics of the United States.
Form N-648 (06/24/97) Internet
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