Form N-648: The Medical Disability Exception to the English and Civics Tests

These are two different things.

If you can pass the tests with an accommodation, you do not need Form N-648. You can ask for both if you need both: for example, a person who is deaf may ask for a sign language interpreter and also file Form N-648.

According to the USCIS Policy Manual, the disability or impairment must:

• be "medically determinable," which means it can be shown with accepted clinical or laboratory methods;
• have lasted, or be expected to last, at least 12 months; and
• stop you from meeting the English requirement, the civics requirement or both, even with reasonable accommodations.

The same diagnosis can affect two people in different ways. One person may only need more time; another may need the exception.

1. 1Download the current edition from uscis.gov/n-648. On October 29, 2026 the edition date was 09/25/24.
2. 2See an authorized medical professional. A licensed medical doctor, doctor of osteopathy or clinical psychologist must examine you, in person or, where state law allows, by real-time telehealth.
3. 3The professional completes and certifies the form (Parts 1 to 3). If an interpreter helped in person during the exam, the interpreter fills out and signs Part 5, the interpreter section. If the interpreter helped by phone or video, the medical professional completes Part 5 instead.
4. 4You complete and sign your part: the Applicant's (Patient's) Attestation/Release of Information. A legal guardian, surrogate or designated representative may sign for you in some cases.
5. 5File it with your Form N-400. USCIS may not consider a form that was completed more than 180 days before you file the N-400. If you file online, you can upload it as evidence.
6. 6Supporting records are optional. The medical professional may attach diagnostic reports or medical records that support the form.

The Policy Manual says Form N-648 should be filed with the N-400. USCIS may accept a late form if you show extenuating circumstances, for example a condition that started or got worse after you filed. The officer will ask why it was late. Filing several different forms from different doctors can raise questions if they do not match.

The officer reviews your form. If the officer finds it sufficient, you do not take the part of the test it covers, and the interview continues. If the form says you cannot meet the English speaking requirement, you may use an interpreter during the interview.

If the officer finds the form insufficient, you take the tests. If you do not pass, the officer explains the problems with the form in writing and schedules a second test 60 to 90 days later. You can bring new medical evidence to that appointment. If questions about the form must be asked, the officer asks them in your preferred language, with an interpreter. You still answer questions about your application; to prepare, read citizenship interview questions.

USCIS warns about fraud with Form N-648 and lists court cases against people who sold false certifications. Remember:

• USCIS does not charge a fee for Form N-648. A doctor may charge for the exam and for completing forms.
• You can check a professional's license with your state medical board.
• Never sign a form with false information.

Some people with a health condition can still pass with time and practice, or with an accommodation. Citizo lets you study at your own pace with flashcards that play the question and answer in English as many times as you want. If you are 65 or older with 20 years as a permanent resident, see also the 65/20 rule, which shortens the list to 20 questions. For a simple routine, read how to study for the citizenship test.