If you are helping a relative apply for U.S. citizenship (naturalization), and have requested a disability-based waiver of the citizenship exam, how will U.S. Citizenship and Immigration Services (USCIS) decide whether to approve or deny the request?
You can submit Form N-648 Medical Certification for Disability Exceptions alongside Form N-400 when you apply for citizenship but, due to a documented medical disability, are unable to learn or speak English sufficiently to pass the citizenship tests or answer questions in English. This form must be very well prepared and contain no indications that either the applicant or the doctor are not "credible" (believable). Under the Trump administration, this previously straightforward form is now rarely approved.
It's important to realize that USCIS is unlikely to review the request for a disability waiver before the naturalization interview itself. The person who actually conducts the interview will review the Form N-648 that the doctor filled out in conjunction with interacting with the applicant.
Now let's look at some of the factors that the USCIS interviewer will likely take into account.
USCIS regularly updates many of its immigration forms. Under the Trump administration, USCIS typically refuses to accept older versions of forms after it switches to a new one. Some of the changes can be substantive. For example, in 2020, USCIS began asking doctors for the date of diagnosis of each disability or impairment mentioned.
To check which edition of Form N-648 USCIS is accepting at the time your relative applies for citizenship, go to www.uscis.gov/n-648.
The timing of the submission also matters. Under USCIS guidance issued in February 2019, Form N-648 must be submitted concurrently with Form N-400 Application for Naturalization. If it isn’t, the immigration officer can reject Form N-648 simply on the grounds of late submission, unless the applicant can provide a credible explanation for the later filing.
This can be confusing for applicants because, due to long wait times under the Trump administration, it often takes USCIS more than six months to process a citizenship application. However, the N-648 is good for only six months in total under the regulations. According to USCIS, as long as the N-648 was valid when submitted with the N-400, it is supposed to be valid throughout the adjudication process. Despite this explicit USCIS guidance, however, some interviewers will still demand a second N-648 from immigrants.
The immigration officer will look to see whether the doctor completed all sections of the form and answered all of the questions. The officer will also confirm that all required signatures are present. If the doctor left any question unanswered or did not provide the required information, or failed to sign the form, the officer has to reject the waiver request.
Even if a question does not directly apply to you or the family member you’re helping to prepare the paperwork, advise the doctor to fill out every single question, including writing “N/A” or “none” for sections that do not apply. USCIS denies many applications for being incomplete if any question is left unanswered, even if those questions do not directly fit the applicant’s situation.
The officer will check that the doctor has made completely clear, using “lay” terms and defining any medical terminology or acronyms, the connection (“nexus”) between the applicant's disability and his or her inability to learn English or U.S. history and civics.
It does not matter if the connection seems obvious. For example, the doctor cannot assume that everybody knows that dementia causes memory problems, and therefore provide one-sentence answers such as: “Because the patient has dementia, she cannot learn English or U.S. history and civics.”
Instead, the doctor will need to have explained the type of negative effects that dementia has on cognitive abilities, including a description of which cognitive abilities are negatively affected. Then, the doctor will need to have explained that, because of these negative affects on the patient's cognitive abilities, he or she is unable to learn English or U.S. history and civics. For example: “Mrs. Torres suffers from dementia, which has a severe negative affect on her cognitive abilities, including memory. Because of these dementia-related negative cognitive effects, including impaired memory, Mrs. Torres is unable to learn English and/or U.S. history or civics.”
What's more, the doctor will have to explain how each relevant disability or impairment affects specific functions of the applicant’s daily life.
Under the Trump administration, fraud determinations and N-648 rejections have increased. An N-648 can be rejected and the applicant can face serious penalties if the immigration officer finds credible doubt, discrepancies, misrepresentation, or fraud as to the applicant’s eligibility for the disability exception.
The officer will review the Form N-648 for signs that the doctor or the applicant is lying about the need for a waiver of the citizenship exam. The officer may also ask the applicant questions to evaluate whether he or she is attempting a fraud. However, the officer will allow the applicant's interpreter to interpret any questions that he or she asks the applicant during this phase of reviewing Form N-648.
Possible “fraud questions” include:
The immigration officer will also be looking for potential credibility “red flags,” such as whether the applicant submitted more than one application from different doctors, whether the doctor is or was under investigation in another case for N-648 fraud, whether the form has sufficient detail, or whether the applicant’s previous medical documentation submitted (such as the I-693 submitted during the green card application process) did not identify a long-term medical condition. Therefore, if your previous medical documentation is inconsistent with your current diagnosis, make sure to address that in detail in your N-648 and have the medical records to back it up.
The immigration officer can also deny an N-648 for credibility grounds for “any other articulable grounds that are supported by the record,” according to the Trump administration’s most recent guidance. This extremely broad, catch-all language has opened the door for extensive denials by immigration officers for discrepancies, real or perceived, large or small.
Thus, any N-648 submitted must be impeccably prepared and the medical reasons for the waiver documented in the extreme.
The immigration officer is not a doctor. He or she is supposed to rely on the doctor's diagnosis and opinion regarding whether the applicant can take the citizenship exam. The officer's focus should be on the Form N-648, namely:
Some officers, however, will ask questions that touch on issues that the doctor does not have to, and did not, address in the form, especially under the broad discretionary powers they've been given under the most recent memorandum.
For example, although doctors need not provide information about how the applicant's disability affects “activities of daily living,” some officers will ask questions about an applicant's living situation. Under the 2019 guidance, an officer may ask questions about the discrepancies between an immigrant’s file, including daily life, and their N-648. The officer may ask who the applicant lives with, whether anybody helps him or her with cooking and cleaning, whether the applicant takes public transportation unassisted, and whether the applicant has a driver's license.
As a practical matter, it's a good idea to just answer the officer's questions about “activities of daily living.” If the officer determines that the applicant's ability to perform a particular activity of daily living, such as preparing meals, means that the applicant does not qualify for a medical waiver, the applicant's interpreter or attorney should ask to speak with a supervisor.
An officer may ask other improper questions. Again, however, unless the questions are outrageous (as in, impolite, unprofessional, or improper), it is probably best to answer them and then ask to speak to a supervisor if the officer appears to be “acting like a doctor” by making an independent judgment about the need for a disability waiver.
Finally, the officer might say that the doctor failed to perform a particular medical test or diagnostic method, or might request medical records or proof that the applicant takes prescription medications. Under current USCIS rules, the officer is not supposed to make these sorts of requests, because they amount to an attempt to undermine and question the medical determination of the doctor. Again, asking to speak to a supervisor is the best option.
If the applicant's doctor indicated that he or she qualifies for a complete exam waiver, and the USCIS officer accepts this, the applicant will not have to speak English, write a sentence in English, read a sentence in English, or answer any questions about U.S. civics or U.S. history.
Instead, the officer will then allow the applicant's interpreter to interpret all of the officer's questions during the rest of the interview. Then, the officer will review the applicant's Form N-400 and ask the applicant many of the questions on that form to make sure that all of the information is complete, accurate, and truthful.
It is also possible that the doctor indicated that the applicant qualifies only for a partial waiver of one, two, or three of the elements of the citizenship exam (the four elements of the citizenship exam are: (1) speaking English; (2) reading English (3) writing English; and (4) correctly answering at least 6 out of 10 “civics” questions regarding U.S. history, government, and geography.)
If the applicant qualifies for only a partial waiver, the immigration officer will conduct only the part of the citizenship exam that the doctor said the applicant is able to take and pass.
In the past, an N-648 was considered a low-risk application. However, under the Trump administration, immigration officers are extremely focused on finding discrepancies as a basis for fraud or denial. Because the penalties can be so severe, if you intend to file an N-648, work with an attorney or qualified advocate before submitting.
If your N-648 is denied, the reason for the denial is extremely important. An immigration officer may deny an N-648 for insufficiency, lack of credibility, fraud, or material misrepresentation.
If your N-648 is denied simply for being insufficient, the immigration officer will proceed with your interview as if you had not submitted an N-648 (testing you on English, civics, and so forth). You can choose not to continue. However, your refusal will count as a failed attempt to pass the English and civics test. You can also choose to submit additional information, and the immigration officer will conduct a re-examination. However, if you do this, make sure that the new information is consistent with your previously submitted documentation, or you risk a fraud finding.
In the worst-case scenario, if the immigration officer suspects that you or your doctor has committed fraud or made a material misrepresentation in the N-648, the officer might refer a case to their fraud investigation unit, the Fraud Detection and National Security Directorate (FDNS). If the officer determines that fraud occurred, USCIS will send you an explanation in your naturalization denial notice. Penalties for committing fraud or making material misrepresentations can be serious, up to and including deportation.
Your best chance of success is to invest significant time in working closely with the medical professional, including visiting the provider several times if necessary, to get a comprehensive N-648 and preventing any opportunity for a denial.