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N-648 medical-waiver eligibility

Form N-648, Medical Certification for Disability Exceptions, is the form a licensed medical professional uses to certify that an applicant cannot meet the English or civics requirements (or both) for naturalization due to a medically determinable physical, developmental, or mental impairment. The condition must have lasted, or be expected to last, at least 12 months.
Last verified:·Source:USCIS Policy Manual Vol. 12 Part E Ch. 3 (Current as of December 22, 2025)
8 CFR §312.2(b) — disability exceptions
U.S. law provides an exception for aliens who are unable to meet the required proficiency in English or the knowledge and understanding of the fundamentals of the history, and of the principles and form of government, of the United States ("civics") for naturalization because of a physical disability, developmental disability, or mental impairment. This medical disability exception to the English and civics requirements for naturalization ensures that aliens with legitimate and demonstrated physical or mental disabilities or impairments are not excluded from the naturalization process.
Quoted exactly, without paraphrase, from USCIS Policy Manual Vol. 12 Part E Ch. 3 §A.

Policy alert — June 13, 2025

USCIS scrutiny on N-648 has tightened. Per the June 13, 2025 USCIS Policy Alert, USCIS is changing how Form N-648 is processed by focusing greater attention on the veracity of medical certifications and identification of fraud. Generic provider letters are at higher risk of triggering Requests for Evidence (RFEs).

Source: USCIS Policy Manual Vol. 12 Part E Ch. 3 (Policy Alert section).

N-648 medical-waiver eligibility check

This is informational only. Tell us about the disability category, how long the condition has lasted (or is expected to last), and the certifying provider type. We'll show you whether the inputs map to likely-qualifies under USCIS Policy Manual Vol. 12 Part E Ch. 3 and what your provider's letter must include.

Has your provider previously written an N-648 letter?

Who can certify Form N-648?

USCIS only authorizes the following licensed medical professionals to certify the disability exception form: Medical doctors; Doctors of osteopathy; and Clinical psychologists. These medical professionals must be licensed to practice in any state of the United States, the District of Columbia, Puerto Rico, Guam, the Virgin Islands of the United States, or the Commonwealth of the Northern Mariana Islands.
Quoted exactly, without paraphrase, from USCIS Policy Manual Vol. 12 Part E Ch. 3 §E.

The seven required elements

Per USCIS Policy Manual Vol. 12 Part E Ch. 3 §H (Sufficiency of Form N-648), a sufficient request for the medical disability exception must contain all of the following:

  1. Clinical diagnosis of the applicant's disabilities or impairments that render the applicant unable to meet the English and civics requirements.
  2. Indication whether any disability or impairment has lasted, or is expected to last, at least 12 months.
  3. Statement that the physical or developmental disability or mental impairment is not the result of the illegal use of drugs.
  4. Description of the clinical or laboratory diagnostic methods used to diagnose each disability or impairment.
  5. Date that the medical professional last examined the applicant for the disability or impairment (must be within 180 days of the N-400 filing).
  6. A sufficient explanation of how the applicant's disability or impairment prevents the applicant from meeting the English requirement, the civics requirement, or both requirements (the nexus).
  7. Form N-648 properly completed, certified, and signed by all appropriate parties.

Filing mechanics

When to file

Form N-648 should be filed concurrently with Form N-400 as an attachment. USCIS may accept a late submission (after N-400 filing, including at the interview) if you demonstrate extenuating circumstances.

Certification window

The certifying medical professional must complete the form no more than 180 days before you file Form N-400. Once that requirement is satisfied, the form remains valid for the entire naturalization process tied to that N-400.

Filing fee

$0. There is no USCIS filing fee for Form N-648. The certifying medical professional may charge a separate fee for the examination and for completing the form.

Telehealth

USCIS may accept a Form N-648 certified by an authorized medical professional who completed the applicant's medical examination through a real-time telehealth examination, where state law permits.

Disability exception vs. accommodation — different things

Requesting a disability exception (Form N-648) is different from requesting an accommodation. An accommodation modifies how you take the test (e.g. sign-language interpreter, extended time, off-site interview) without exempting you from the requirements. Form N-648 is not used to request an accommodation.

Reasonable accommodations may include, but are not limited to, sign language interpreters, extended time for completing the English and civics requirements, and completing the English and civics requirements and naturalization interview at an off-site location.
Quoted exactly, without paraphrase, from USCIS Policy Manual Vol. 12 Part E Ch. 3 §D.

Read the deep-dive on N-648 qualifying conditions →

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