Guides / Form N-648: The Medical Disability Exception to the Citizenship Tests

Form N-648: The Medical Disability Exception to the Citizenship Tests

Updated: October 30, 2026

Form N-648, Medical Certification for Disability Exceptions, lets you skip the English test, the civics test, or both if a physical or developmental disability or mental impairment prevents you from meeting those requirements. The condition must have lasted, or be expected to last, at least 12 months. A licensed medical doctor, doctor of osteopathy or clinical psychologist in the United States must complete the form and explain how your condition keeps you from learning or showing the knowledge. A diagnosis alone isn't enough. The form has no filing fee.

Who may qualify

The exception is for people whose condition truly prevents them from meeting the educational requirements, even with effort and accommodations. Conditions that may qualify, depending on their severity and effects, include:

• Dementia and other serious cognitive decline
• Developmental or intellectual disabilities
• Serious mental illness that affects memory, concentration or learning
• Effects of a stroke or brain injury
• Severe hearing or vision loss that can't be accommodated in another way

The key is the link between the condition and the requirement. "Has diabetes" doesn't explain why someone can't learn civics. "Severe memory impairment from vascular dementia prevents retention of new information, documented by cognitive testing" does.

The exception isn't for people who simply had little schooling, have trouble with English, or are nervous about tests. For older applicants with long residence, the 50/20, 55/15 and 65/20 rules may help instead.

Who can complete the form

The form must be completed by a medical doctor (MD), doctor of osteopathy (DO) or clinical psychologist licensed to practice in the United States. USCIS notes you can verify a license through your state's medical board. The professional must examine you in person, or by real-time telehealth where state law allows it.

Nurse practitioners, physician assistants, chiropractors and therapists who aren't licensed clinical psychologists can't sign it. Doctors outside the United States can't either.

What the medical professional must explain

Since a USCIS policy update effective June 13, 2025, for applications and N-648s filed on or after that date, the medical professional must explain how the condition prevents you from meeting the English and/or civics requirement. USCIS states that the presence of a disability alone is not sufficient. A strong form generally includes:

• The clinical diagnosis, in clear medical terms
• When the condition began and how long it's expected to last (at least 12 months)
• The tests or examinations used to reach the diagnosis
• How the condition affects functions such as memory, learning, concentration, reading and speaking
• Why those effects prevent you from learning or showing knowledge of English, civics or both
• Which requirement the exception covers: English, civics or both

The professional must answer every question on the form in plain language. Vague or contradictory answers are the most common reason officers find an N-648 insufficient.

When to file

You can submit Form N-648 with your N-400. In that case, answer "Yes" to the disability exception question in Part 2 of the N-400. USCIS's N-648 page says you can also submit it separately at a later date. Filing it with your application gives the officer time to review it before your interview.

USCIS has said that submitting several N-648s for the same applicant may raise credibility concerns and lead to further review. Get one complete, well-supported form rather than several thin ones.

What happens at the interview

The officer reviews the N-648 and may ask you questions about your condition, your daily life and your medical history. If the officer finds the form sufficient, you're excused from the tests it covers. If not, you may be asked to take the tests or provide a corrected form, or the case may be continued.

Even with an approved exception, you still need to meet every other requirement: residence, physical presence, good moral character, and willingness to take the oath. If the condition also prevents you from understanding the Oath of Allegiance, USCIS can waive the oath. A legal guardian, surrogate or designated representative may then act on your behalf, with documents proving their role.

Practical checklist

• Book an appointment with a qualified, licensed professional who knows your condition well
• Bring the blank N-648 and its instructions from uscis.gov/n-648 to the appointment
• Bring your medical records, test results and a list of medications
• Make sure every item on the form is answered and that the form is signed. USCIS rejects unsigned forms.
• Check that the diagnosis matches your other medical records and what you say in the interview
• Keep a full copy for yourself
• If you have a guardian or caregiver, bring proof of that role to the interview

Other accommodations

If you don't need an exception but do need help taking part, such as a wheelchair-accessible room, a sign language interpreter, extra time, or a home visit for someone who is homebound, request an accommodation through uscis.gov/accommodations or the USCIS Contact Center as soon as you get your appointment notice. Accommodations change how you take the test, while the N-648 excuses you from it.

For what happens if you take the tests and don't pass, see failed the citizenship test: what next. The citizenship interview guide explains the full interview.

Frequently asked questions

Does Form N-648 cost anything?

There's no USCIS fee for Form N-648. The doctor or psychologist may charge for the exam and for completing the form.

Can my family doctor fill out the N-648?

Yes, if your family doctor is a licensed MD or DO in the United States and can explain how your condition prevents you from meeting the requirements. A specialist may give a more detailed explanation for complex conditions.

Does an approved N-648 excuse me from the interview?

No. You still attend the interview, unless USCIS arranges an accommodation. You must still answer questions about your application, with an interpreter or representative if needed.

Can I get an exception for English only?

Yes. The form can cover English, civics or both, depending on how your condition affects you. If English is exempted but civics isn't, you may take the civics test in your language with an interpreter.

Prepare for the civics test with Civio: every official question from the 2025 USCIS civics test, Exam Mode with your state's questions, and spaced repetition.

Informational article, not legal advice. Civio is not affiliated with USCIS or any government agency; always check current requirements at uscis.gov.

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