How to complete an N 648 (Step by Step)
To complete a Form N-648, you will have to provide the following information:
- Part 1. Applicant Information
- Name
- USCIS A-number
- Address
- U.S. Social security number
- Telephone number
- Email address
- Date of birth
- Gender
- Part 2. Medical Professional Information
- Name
- Business address
- Telephone number
- License number
- Licensing state
- Email address
- Current licenses: medical doctor, doctor of osteopathy, clinical psychologist
- Medical practice type
- Part 3. Information About Disability and/or Impairment(s)
- Clinical diagnosis of applicant’s disability or impairment
- Relevant medical code accepted by the Department of Health and Human Service including Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD)
- Description of disability and/or impairments
- Date and location of first examination
- Date and location of last examination
- Whether you are the medical professional regularly treating the applicant for the listed conditions
- Duration of treatment or name and contact information of applicant’s regularly treating medical professional
- Whether the applicant’s disability and/or impairments lasted or you expect it to last 12 months or more
- Whether the applicant’s disability and/or impairments were the result of the use of illegal drugs
- Cause of applicant’s medical disability and/or impairments
- Clinical methods used to diagnose applicants medical disability and/or impairments
- Explanation of how the applicant's disability and/or impairments affect the ability to demonstrate knowledge and understanding of English or civics
- Whether applicant’s disability or impairments prevent him or her from demonstrating the ability to: read English, write English, speak English, answer questions regarding U.S. history and civics
- Whether an interpreter was used during the examination
- Medical Professional’s Certification
- Whether the medical professional is fluent in another language spoken by the patient
- Certification that applicant’s identity has been verified through a United States or State government-issued photographic identity document
- Signature
- Date
- Interpreter’s Certification
- Name
- Address
- Whether interpreter was used
- Certification of fluency
- Signature
- Date
- Applicant (Patient) Attestation/Release of Information
- Authorization for medical professional to release medical records to U.S. Citizenship and Immigration Services
- SignatureÂ
- Date