On 19 October 2022, USCIS issued policy alert PA-2022-25 to go with a new edition of Form N-648, Medical Certification for Disability Exceptions. Applicants for citizenship who cannot meet the English or civics requirements because of a physical or developmental disability or mental impairment use this form, completed by a licensed medical doctor, doctor of osteopathy or clinical psychologist, to ask for an exception. The new edition is dated 08/19/22, and from 21 November 2022 USCIS accepted only that edition.
Key facts
- What New edition of Form N-648 (08/19/22)
- Required from 21 November 2022
- Removed Diagnosis dates, severity, daily-life effects, doctor-patient history questions
- Also Telehealth exams addressed; N-648 may be sent after filing
What changed
The form had been expanded in 2020, and USCIS received public comments that it was burdensome and inconsistently reviewed. The 2022 edition and the updated Policy Manual guidance:
- set out the minimum information needed for a form to be sufficient
- removed questions on the dates of diagnosis and onset, the severity of each condition, the effect on daily life and the doctor-patient relationship
- allow USCIS to accept an N-648 submitted after the N-400 has been filed
- add guidance on telehealth medical examinations
- let an oath waiver be requested on the N-648 or by a written request from an authorized medical professional
Later changes
The 2022 approach did not last unchanged. On 13 June 2025 USCIS issued new guidance that put more weight on checking the accuracy of medical certifications, so read the current Policy Manual rather than relying on the 2022 version.
What this means
If you have a condition that prevents you from learning or showing knowledge of English or civics, talk to a qualified medical professional about Form N-648 before your interview, and make sure they use the current edition from the USCIS N-648 page. If you do not qualify for an exception, you will take the English and civics tests at your interview, so start studying the civics questions for your test version early.