Form N-648: The Medical Disability Exception to the Citizenship Test

Form N-648, Medical Certification for Disability Exceptions, is how you request an exception to the English test, the civics test, or both, when a physical disability, developmental disability, or mental impairment prevents you from learning or demonstrating that knowledge. USCIS charges no filing fee for Form N-648.

This guide explains who can use Form N-648, who can sign it, when to file it, and the mistakes that make a form insufficient. Every case is different, so this is general information, not a substitute for advice from a doctor or a lawyer.

Who can request an exception with Form N-648?

• You have a medically determinable physical or developmental disability or mental impairment.
• The condition has lasted, or is expected to last, at least 12 months.
• The condition prevents you from meeting the English requirement, the civics requirement, or both, even with reasonable accommodations.
• The condition is not the result of illegal drug use.

Advanced age or being unable to read are not, by themselves, reasons to use Form N-648. What USCIS looks for is the link between the condition and your ability to learn. The medical professional must explain specifically how the condition keeps you from learning or answering.

Who can certify Form N-648?

According to USCIS, only three kinds of professionals licensed to practice in the United States can certify Form N-648:

• Medical doctors.
• Doctors of osteopathy.
• Clinical psychologists.

The professional must examine you in person, or through a real-time telehealth exam where state law allows it. An interpreter may help during the exam. An in-person interpreter signs the interpreter section. If the interpreting was by phone or video, the medical professional completes that section.

What must Form N-648 include?

• A clinical diagnosis of each disability or impairment.
• Confirmation that the condition has lasted or is expected to last at least 12 months.
• A statement that the condition is not the result of illegal drug use.
• The clinical or laboratory methods used to make the diagnosis.
• The date of the most recent exam.
• A specific explanation of how the condition prevents you from meeting the English requirement, the civics requirement, or both.
• All required signatures: the medical professional, you, and the interpreter if one was used.

The explanation must be specific to you. USCIS can find a form insufficient if the explanation is generic and could apply to anyone. The form should use plain language a non-medical reader can understand.

When do you file Form N-648?

File Form N-648 together with your Form N-400. The medical professional must certify it no more than 180 days before you file Form N-400. Once that is met, the form stays valid for the whole process connected to that N-400.

USCIS may accept a late Form N-648 (filed after the N-400, including at the interview) if you show extenuating circumstances, such as a condition that started or got worse after you filed. Submitting several forms with conflicting information can raise doubts.

An exception is not the same as an accommodation

An accommodation does not excuse you from the test. It changes how you take it, for example extra time, a sign language interpreter, or an interview at an off-site location. Request accommodations at uscis.gov/accommodations, not with Form N-648. You can request both if you need both.

If USCIS finds the form insufficient

• The officer still gives you the test. If you pass, the interview continues as usual.
• If you fail, USCIS issues a Request for Evidence (RFE) explaining the problems and schedules a re-exam 60 to 90 days later.
• At the re-exam you can submit a corrected Form N-648. If it is still insufficient and you fail a second time, the application is denied.

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What to do next

If you are well enough to study, preparing for the test is still the surest path. If you are 50 or older with a Green Card for at least 20 years, or 55 or older with one for at least 15 years, read our guide to the 65/20, 50/20 and 55/15 rules first. You may be exempt from English without Form N-648.

If you think you need Form N-648, talk with the doctor who treats you. If you are unsure about your case, ask an immigration attorney or a Department of Justice recognized organization.