U.S. law provides an exception for aliens who are unable to meet the required proficiency in English or the knowledge and understanding of the fundamentals of the history, and of the principles and form of government, of the United States (civics) for naturalization because of a physical disability, developmental disability, or mental impairment. This medical disability exception ensures that aliens with legitimate and demonstrated physical or mental disabilities or impairments are not excluded from the naturalization process.
You have a physical disability, developmental disability, or mental impairment
Your disability or impairment has lasted, or is expected to last, at least 12 months
Your disability or impairment prevents you from learning or demonstrating knowledge of English, civics, or both
The cause of the disability or impairment is not related to the illegal use of drugs
You have a Form N-648 certified by an authorized medical professional
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Regulatory Criteria
Purpose of the Medical Disability Exception
The medical disability exception to the English and civics requirements for naturalization ensures that aliens with legitimate and demonstrated physical or mental disabilities or impairments are not excluded from the naturalization process.
Examples
Exception from English proficiency requirement
Exception from civics (U.S. history and government) requirement
Exception from both English and civics requirements
Applies to medically determinable physical or developmental disability or mental impairment
Disability or impairment must have lasted or be expected to last at least 12 months
Definition of Medically Determinable
The regulations define medically determinable as an impairment that results from abnormalities which can be shown by medically acceptable clinical or laboratory diagnostic techniques.
Examples
Physical disability demonstrated through clinical diagnosis
Developmental disability confirmed by medical testing
Mental impairment shown through acceptable diagnostic techniques
Abnormalities documented through laboratory testing
Disability affecting functioning such that applicant cannot meet requirements
Authorized Medical Professionals
USCIS only authorizes the following licensed medical professionals to certify the disability exception form (Form N-648).
Examples
Medical doctors (M.D.)
Doctors of osteopathy (D.O.)
Clinical psychologists
Must be licensed to practice in any U.S. state
May also be licensed in District of Columbia, Puerto Rico, Guam, Virgin Islands, or CNMI
Scope of Medical Examination
In order for USCIS to consider a Form N-648 sufficient, the medical professional must complete specific requirements.
Examples
Conduct an examination of the alien
Identify and describe each disability or impairment affecting ability to meet requirements
Explain how each disability or impairment prevents learning or demonstrating knowledge
Attest that the disability has lasted or is expected to last at least 12 months
Attest that the cause is not related to illegal use of drugs
Use common terminology that a person without medical training can understand
Submission of Form N-648
An alien seeking an exception to the English or civics requirements must submit Form N-648 with their naturalization application.
Examples
Submit initial Form N-648 as attachment to Form N-400 (Application for Naturalization)
Late submissions may be accepted with demonstrated extenuating circumstances
Example: Disability developed after filing Form N-400
Example: Medical condition worsened after filing application
Submission of updated Forms N-648 in response to USCIS request is not considered late
Late Submissions
A late submission occurs when an alien submits Form N-648 for the first time after filing Form N-400 (including at the interview).
Examples
USCIS may accept late submissions with demonstrated extenuating circumstances
Aliens may explain circumstances in writing or verbally at interview
New disability developing after filing may justify late submission
Worsening medical condition after filing may justify late submission
Officers evaluate each late submission individually
Distinction Between Exception and Accommodation
Requesting an exception to the English or civics requirements is different from requesting an accommodation for the naturalization test or interview.
Examples
Accommodation modifies how applicant meets requirements; does not exempt
Exception (Form N-648) exempts applicant from English or civics requirements
Accommodations: sign language interpreters, extended time, off-site locations
Same disability may require accommodation for one person, exception for another
Applicant may request both exception and accommodation when both are needed
Multiple Submissions
Only one initial Form N-648 should be submitted with the naturalization application.
Examples
Multiple Forms N-648 may raise questions about validity
Officers ask applicant to explain why multiple forms were submitted
Discrepancies between forms may call validity into question
USCIS may find Form N-648 insufficient if legitimate concerns exist
USCIS may require Form N-648 from a different medical professional
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Application Process
Determine Eligibility
Confirm you have a qualifying physical, developmental, or mental disability.
See Medical Professional
Visit an authorized medical doctor, osteopath, or clinical psychologist.
Complete Form N-648
Have the medical professional certify Form N-648 after examination.
Submit with N-400
Attach Form N-648 to your Application for Naturalization.
USCIS Review
USCIS officer reviews the medical certification for sufficiency.
Interview
Attend naturalization interview; officer may ask questions about Form N-648.
Decision
If approved, proceed with naturalization without English/civics testing.
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Key Benefits
Exception from English language requirement
Exception from civics (U.S. history and government) requirement
Exception from both requirements if applicable
Ensures naturalization process is accessible to those with disabilities
Can be combined with reasonable accommodations when needed
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Documents Needed
Form N-648, Medical Certification for Disability Exceptions
Form N-400, Application for Naturalization
Medical records supporting the disability diagnosis (if applicable)
Documentation of disability duration (at least 12 months)
Supporting evidence of how disability affects learning ability
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Frequently Asked Questions
What is Form N-648?
Form N-648 is the Medical Certification for Disability Exceptions. It is filled out and certified by certain medical professionals on behalf of applicants who are requesting an exception from the English and/or civics requirements for naturalization because of a disability and/or impairment.
Who can complete Form N-648?
Only licensed medical doctors (M.D.), doctors of osteopathy (D.O.), and clinical psychologists may certify Form N-648. They must be licensed to practice in any U.S. state, the District of Columbia, Puerto Rico, Guam, the Virgin Islands, or the Commonwealth of the Northern Mariana Islands.
What is the difference between an exception and an accommodation?
An exception exempts you from the English or civics requirements entirely. An accommodation modifies the manner in which you meet the requirements (such as extended time or a sign language interpreter) but does not exempt you from the requirements. You may request both if needed.
How long must my disability have lasted?
Your disability or impairment must be medically determinable and must have lasted, or be expected to last, at least 12 months.
When should I submit Form N-648?
You should submit Form N-648 as an attachment to your Form N-400 (Application for Naturalization). Late submissions may be accepted if you can demonstrate extenuating circumstances, such as developing a disability after filing your application.
Can USCIS reject my Form N-648?
Yes. USCIS may find Form N-648 insufficient if it does not meet requirements or if there are legitimate concerns about its validity. In such cases, USCIS may require you to submit a new Form N-648 from a different medical professional.
Can I request an exception for English only, civics only, or both?
Yes. Depending on your disability or impairment and how it affects your ability to learn or demonstrate knowledge, you may request an exception from the English requirement, the civics requirement, or both requirements.
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