Alquimedez Mental Health Counseling, we provide psychiatric evaluations for immigration proceedings:
Certification for Disability Exceptions for Citizenship (N-648)
The N-648 is the disability waiver that exempts applicants for U.S. citizenship from (1) demonstrating they can speak, read, and write English and (2) passing a test of U.S. history and civics. With a waiver, the applicant can have the interview in his/her native language and will not have to answer questions about U.S. history and government. U.S. Citizenship and Immigration Services (CIS) relies on the applicant’s doctor’s medical opinion in deciding whether to grant the waiver. CIS generally decides whether to grant or deny citizenship at the naturalization interview. Under current law, the N-648 must be submitted simultaneously with the N-400 application for citizenship.
As the patient’s physician (M.D., D.O., licensed clinical psychologist), you are the only one who can complete the N-648 for your patient and get him/her through this process! Your staff members can help, but you must sign the form. As frustrating as it is, there are no doctors at CIS to evaluate your patient or interpret your medical terminology. The best thing you can do to help your patient is to use clear, straightforward language and remember that CIS has no medical expertise and is looking for specific bits of information, as described below. In addition, CIS officers are not looking to do your patient any favors and will review the form with a skeptical eye. (Often, if they see similar language from one way to another, they may suspect fraud.) Finally, N-648 documents submitted by qualified applicants are rejected every day because they do not contain enough information from the physician.
Note: The doctor completing the N-648 must have the appropriate expertise to diagnose the named disability. If you are not a specialist in the field of the patient’s disability, you should have training, experience, or other qualifications to assess such disability. Sometimes, a specialist may complete the form because the regular treating physician has no such training or capability. Then, he will need to explain the reason and the plan of treatment briefly.
Why do many immigrants need to become U.S. citizens?
The statuses and rights of many immigrants, including Lawful Permanent Residents, are precarious and limited: (1) at any time they may face the risk of being deported from the U.S., and (2) their rights as residents in the U.S. are relatively restrained.
Who is eligible for a disability waiver?
- The applicant must have a medically determinable physical or developmental disability or mental impairment that causes the applicant to be unable to learn English and U.S. history and civics.
- The disability is expected to last at least 12 months.
- The disability is not the result of illegal drug use. However, note that unlawful drug use may make the applicant deportable; be sure the patient consults with an attorney.
Information About Disability and Impairments
Question 1 asks for the clinical diagnosis of the applicant’s disability and impairment, which is the basis for seeking the English and/or civics requirements. Provide the relevant medical code using the DSM and/or ICD codes. Excerpted DSM-5 and ICD-10 Relevant Codes, which may be applicable.
Question two asks for a basic description of the disability and/or impairments:
Examples:
- POST TRAUMATIC STRESS DISORDER AND DEPRESSION: Ms. D suffers from major depression, recurrent and severe, with a history of suicidal ideation resulting in multiple in-patient psychiatric hospitalizations. Ms. D currently receives medication and treatment for depression to control the desire to harm herself. As a result, she does not pose a threat to others. She also has been diagnosed with Post Traumatic Stress Disorder related to war trauma in Bosnia, which persists through nightmares and flashbacks.
- DEMENTIA: The patient has severe dementia. Dementia is the loss of intellectual functioning, which is significant enough to interfere with daily life. Depression or mental illness does not cause this. Instead, it progressively worsens over time and is irreversible. It is present in Ms. N. in the form of forgetfulness, and impairments in understanding, reasoning, learning, and language.
- MULTIPLE SCLEROSIS: The patient has severe, advanced multiple sclerosis. Multiple sclerosis is a degenerative disease of the nerves in the brain and spinal cord. Because of the damage to these nerves, the patient has severe dementia; she is mute, must use a wheelchair to move around, and is incontinent of urine. Her memory, concentration, and judgment are severely impaired.
- BIPOLAR DISORDER: Bipolar II Disorder is characterized by periods of significant depression and hypomania. The patient has problems with a thought disorder and difficulty learning, trouble with memory, and intrusive thoughts coming to her, which block her thinking and ability to plan. The patient has had an intermittent problem most of her adult life, interfering with work and school.
- DEPRESSION: Major Depressive Disorder. The patient feels depressed most of the time. She is disinterested in things. She also gets very anxious and worried. This interferes with her functioning. She has significant problems with concentration.
What if my patient is illiterate in their native language?
The CIS will not approve a waiver for applicants unable to learn solely based on illiteracy in their native language. In many cases, however, the applicant’s illiteracy is causally connected to their disability. For example, illiteracy may result from undiagnosed developmental delay, mainly if the applicant is from a country with few special education programs. Therefore, your answer should stress that the underlying disability is the primary cause of the applicant’s inability to learn English, and/or civics materials.
Can an applicant qualify for an N-648 based on a physical disability?
An applicant with physical disabilities will only be approved for a waiver if the disability or accompanying symptoms affect their ability to learn or demonstrate knowledge. For example, an illness may be accompanied by pain, fatigue, or nausea, impairing concentration and preventing the patient from attending classes.
N-648 is only approved if another disability accompanies deafness or blindness, and deafness or blindness compounds that disability. As such, they are blind or deaf is not a per se disability that prohibits learning. CIS will be looking for ways for a deaf or blind individuals to learn English and civics. If no accommodation could be made for your patient such that they could understand, you must explicitly explain why.
If a patient is blind, CIS will waive the writing requirement but expect the applicant to learn English orally. However, suppose a blind patient cannot understand English or civics due to their disabilities. In that case, you must explain why the patient cannot learn through audiotapes at home or by attending classes where information is presented verbally.
If a patient is deaf, CIS will want to know whether hearing aids improve their hearing enough to allow them to hear and speak. If not, CIS will offer to use a sign language interpreter during the interview or perform the interview in writing. A careful explanation must be given as to why a deaf patient cannot learn if that is the case, even if accommodated in these ways.
Source: https://ethnomed.org/resource/disability-exception-for-citizenship-n-648/#
