U.S. Department of Justice
Immigration and Naturalization Service
HQ 70/33-P
425 I Street NW Washington, DC 20536
April 7, 1999
MEMORANDUM FOR
ALL REGIONAL DIRECTORS
ALL DISTRICT DIRECTORS (EXCEPT FOREIGN)
ALL OFFICERS IN CHARGE (EXCEPT FOREIGN)
ALL SERVICE CENTER DIRECTORS
FROM: Michael A. Pearson, Executive Associate Commissioner, Office of Field Operations
SUBJECT: Section 312 Disability Naturalization Adjudications
This memorandum provides comprehensive policy guidance for the review of all Forms N-648, Medical Certification for Disability Exceptions, and supercedes the following memoranda:
This memorandum also addresses: (1) issues related to the validity, timeliness, and review of the N-648 at the interview; (2) the addition of doctors of osteopathy to the list of medical professionals authorized to complete the N-648; (3) the role of the District Adjudications Officer (DAO) in the current N-648 review process; (4) procedures for requesting additional information and handling of cases suspected of fraud; (5) procedures field offices must follow to evaluate certain N-648s reviewed since December 30th; and (6) future consolidation of N-648 reviews by medical professionals at the Service Centers. See Attachment G for a summary of information addressed in each section of this memorandum.
A. Disability Exceptions under Section 312
Each Supervisory District Adjudications Officer (SDAO) and DAO responsible for reviewing N-648s should be thoroughly familiar with the standard for the section 312(b) disability exception. The standard is clearly stated in the Immigration and Nationality Act (Act) as well as in the regulations at 8 CFR 312.2.
Section 312(b) provides that the English and civics requirements "shall not apply to any person who is unable because of physical or developmental disability or mental impairment to comply therewith." A doctor must establish that the applicant has a "medically determinable" physical or developmental disability or mental impairment in order for the applicant to qualify for the disability exception. "Medically determinable" means that the disability or impairment, or combination thereof "results from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical or laboratory diagnostic techniques to have resulted in functioning so impaired as to render an individual unable to demonstrate an understanding" of English and/or U.S. history and government.
In simple terms, this standard requires that the doctor establish that the applicant has a physical or mental abnormality that has impaired an individual's functioning so severely that the individual is unable to learn or demonstrate knowledge of English and/or U.S. history and government.
It is important to note that an exception from the section 312 requirements does not waive any other naturalization requirements. Thus, those applicants whose disability exception requests have been accepted must still establish good moral character, residence, assent to the oath, etc.
B. Medical Professionals Authorized to Complete the N-648
Under 8 C.F.R. 312.2, the following medical professionals who are licensed to practice in the United States (including Guam, Puerto Rico, and the Virgin Islands) are authorized to complete an N-648 on behalf of an applicant: 1) medical doctors; 2) doctors of osteopathy ; and 3) clinical psychologists. Doctors must also certify, under penalty of perjury, that their statements are true and correct. In addition, doctors completing the form must attest either that their medical specialty or their experience and other qualifications permit them to make a disability assessment. An N-648 should be reviewed based on the standard of review outlined in Section E below, without regard to the type of authorized medical professional completing the form or the type of disability or impairment diagnosed. Therefore, diagnoses of mental impairments by general practitioners or family doctors are acceptable if the N-648 is otherwise sufficient.
C. Validity and Timeliness of the N-648
Questions also have been raised about the timeliness and expiration of the Form N-648 and whether it is valid only for a certain time period. The only time restriction on the filing of the Form N-648 is the requirement that it be submitted within six months of when it was completed by the doctor. Thus, if filed within the six month timeframe, the Form N-648 is valid and never expires.
If an applicant submits an N-648 for the first time either: (1) with the N-400; (2) at the initial interview; or (3) at reexamination the N-648 is valid as long as it was completed and signed by a certifying physician within six months of when it was submitted. Therefore, DAOs should not reject N-648s that were filed properly with the Form N-400 and submitted within six months of the date of filing, simply because the interview occurs more than six months after the N-400 was filed. For example, an N-648 completed and signed by the certifying doctor on October 1, 1998 must be submitted to the Service no later than April 1, 1999.
However, if the applicant's first N-648 was deemed insufficient and the applicant submits an amended or second N-648, the second or amended N-648 is valid, even if it is more than six months old, as long as it was completed and signed after the date of the applicant's first interview and was submitted by the date specified by the Service in the N-14.
D. Appropriate Role of Adjudicators in Reviewing N-648s
DAOs and SDAOs are responsible for determining whether the applicant meets the requirements of section 312. In reviewing the N-648, the DAO's role is to determine whether the N-648 contains sufficient information to establish that the applicant is eligible for a disability exception. The medical professional's role is to certify the applicant's diagnosis and how this condition has affected the applicant's ability to learn or demonstrate knowledge of English and/or U.S. history and civics.
DAOs should not deny the existence of a disability or impairment by questioning the doctor's diagnosis. All SDAOs and DAOs are directed to use courtesy, respect, and sensitivity in reviewing N-648s and in conducting all aspects of the naturalization process for persons with disabilities. DAOs should not:
E. Standard of Review of the N-648
SDAOs and DAOs are responsible for reviewing every N-648 (including instances where an applicant submits multiple N-648s at the same time) to ensure that the required identifying information is provided (e.g., applicant name and A number, certifying doctor's license number, etc.) and that the form contains the required signatures of the applicant and doctor. DAOs should allow applicants to complete missing identifying information at the time of the interview (e.g., applicant's signature or A number). DAOs also should ensure that all questions are legible and answered fully and completely. After reviewing an N-648 for sufficiency, DAOs may either accept the original, amended or second N-648 as sufficient, continue the case and request additional information because the first N-648 is incomplete or insufficient, or reject the second or amended N-648 as insufficient (see Section F below).
1. Clarification of Standard of Review
The most important question on the N-648 form is Part II, Question 3, which asks doctors to "describe any findings of a physical or mental disability or impairment" which, in their professional medical opinion, would prevent the applicant from demonstrating knowledge of English and/or U.S. history and civics. Doctors are asked to answer this question based on their examination of the applicant, and to describe their findings in detail. They are also asked to provide a Diagnostic Statistical Manual (DSM) code if appropriate.
In an attempt to provide DAOs and SDAOs with more specific guidance about the review process, the December 30, 1998 memorandum included criteria for reviewing answers to Question 3. Item two of the four-part response required the certifying doctor to provide: "(2) a detailed explanation of how you reached the diagnosis, including clinical findings and/or confirmatory laboratory tests that you relied upon to make the diagnosis."
Item two has generated some confusion and, in certain instances, N-648s may have been rejected or applicants may have been asked to resubmit N-648s because the certifying doctor failed to provide specific descriptions of the tests performed to support how he or she reached the diagnosis.
Unless and until instructed otherwise, DAOs should not require doctors to provide an explanation of how they reached their diagnosis, or provide a listing of clinical or laboratory techniques used to reach the diagnosis for an N-648 to be acceptable. However, doctors must provide a sufficiently thorough explanation of how the condition they diagnosed has impaired the functioning of the applicant so severely that the applicant is unable to learn or demonstrate knowledge of English and/or U.S. history and government.
Certifying doctors in all instances are required to provide the following three-part response to Question 3:
The focal point of the DAO's review should be to determine if the doctor has clearly stated how the condition affects the applicant's ability to function, i.e., the nexus between the disability, impairment, or combination of impairments and the applicant's ability to learn or demonstrate knowledge of English and/or U.S. history and government. There are no key words, phrases, or tests that will indicate sufficiency of a nexus, nor is there a list of conditions, symptoms, or complications that will always be caused by or linked to certain disabilities or impairments. Rather, DAOs and SDAOs must evaluate each N-648 individually and determine, based on all the information provided in Question 3, whether the applicant has met the burden of showing that the anatomical, physiological, or psychological abnormality described has so impaired the applicant's functioning that he or she is unable to learn or demonstrate knowledge of English and/or U.S. history and government. See Attachment A for examples of insufficient and sufficient answers to question 3 on the N-648.
2. Old Age and Depression
The review standard is exactly the same for all N-648s, regardless of the type of condition described. Therefore, as discussed below, DAOs should review N-648s reflecting mental impairments such as depression, or disabilities related to, associated with, or caused by "old age" the same way they review all other medically determinable conditions that may qualify for a section 312 disability exception.
"Old age" in and of itself, is not a medically determinable physical or developmental disability or mental impairment. However, an individual with a disease or disability that is related to, associated with, or caused by old age (e.g., Alzheimer's, Parkinson's disease, senile dementia, etc.) can qualify for a disability exception. Like any other disease or disability, some diseases or disabilities that result from old age may qualify for a section 312 exception, while others may not.
The critical determination for SDAOs and DAOs adjudicating a Form N-648 that reflects a disability related to old age is not whether the disease or disability is solely the result of old age. Rather, the SDAO and DAO should assess whether the Form N-648 reflects that the impairment results in functioning so impaired that the applicant is unable to learn or demonstrate knowledge of English and/or U.S. history and government. In making that determination, the DAOs should again focus on whether the doctor has established a sufficient nexus between the condition and how that condition has resulted in the applicant's impaired functioning.
Similarly, the Service has not adopted a particular or special rule for adjudicating Form N-648s reflecting "depression" as the stated disability. Depression should be treated like any other disease or disability and evaluated based on the standard under section 312. Thus, again, SDAOs and DAOs should assess whether the Form N-648 reflects that the described condition results in functioning so impaired that the applicant is unable to meet the requirements of section 312, and should rely on the criteria above in making that determination.
F. Procedures for Review of and Action on N-648s
Under 8 CFR 312.2(b)(2), applicants are required to file the N-648 with their N-400. However, the Service has given applicants wide latitude in submitting N-648s during the interview process. Service policy is to allow applicants two opportunities to present a sufficient N-648. In addition, under 8 CFR 312.5, applicants should receive two opportunities to meet the requirements of section 312 of the INA. Some District Offices have requested clarification about the timing of N-648 submissions at the interview and testing applicants on English and/or U.S. history and government (hereinafter "English and civics").
The section below addresses the various stages of the interview process and what actions officers should take at each stage when an N-648 is involved. Attached to this memorandum are several documents related to the N-648 process. All district offices must use these attachments and discontinue use of any local or previous request for information sheets prepared for Form N-648s. The following documents are attached to this memorandum:
Most of the information SDAOs and DAOs need to determine the sufficiency of an N-648 should appear on the original N-648, amended N-648, or supplementary documentation (if any) provided by the certifying doctor. In general, DAOs are expected to make the initial determination on an N-648. The supervisory approval required under NQP4 prior to the final decision on the case is not required before the DAO can make an initial decision about whether to accept or reject the N-648. In keeping with normal procedures, DAOs should consult with SDAOs about cases with N-648s involving complex questions or issues that need to be resolved before making an initial decision on such N-648s. DAOs should also consult with SDAOs about cases where there is evidence of fraud in the N-648 process (see Section H below).
At all stages in the N-648 review process, DAOs should keep the applicant informed about the status of the N-648 review process, whether the applicant will be tested on English or civics, and in which language the interview will be conducted. For example, if an applicant's N-648 is deemed sufficient, DAOs should advise the applicant that the N-648 has been accepted and that the interview will proceed in his or her native language (if an interpreter is available). If an applicant's N-648 is insufficient, DAOs should advise the applicant that the N-648 has not been accepted, and that the applicant will be tested on English and civics. However, if the DAO is or was unable to swear in the applicant because of his or her inability to speak English, the DAO should explain that the applicant has not met the requirement of being able to speak English but will have another opportunity to meet the English and civics requirements. DAOs and SDAOs should comply with the following procedures when reviewing N-648s at the initial interview or on reexamination:
1. Initial or Preliminary Interview-
No N-648 in A-File or Presented at Interview
If, at a preliminary interview, the A-file does not contain an N-648 and the applicant does not present one, the DAO should:
2. Initial or Preliminary Interview--N-648 Included in A-File or Presented at Interview
If, at a preliminary interview, the A-file contains an N-648 or the applicant submits one, the DAO should:
3. Reexamination--Applicant Fails to Appear or Fails to Submit an Amended or Second N-648
If an applicant fails to appear for reexamination, he or she must notify the Service of the reasons for non-appearance. If the applicant fails to establish good cause for the nonappearance, the applicant will be deemed to have failed the second examination pursuant to 8 CFR § 312.5(b) and the Service shall deny the application for naturalization pursuant to 8 CFR § 336.1.
If an applicant appears for reexamination but fails, without good cause, to submit an amended or second N-648, the DAO should:
If an applicant appears for reexamination and can demonstrate good cause for failure to submit an amended or second N-648, the DAO should:
4. Reexamination--Applicant Submits Amended or Second N-648
If, at the reexamination, the applicant submits an amended or second N-648, the DAO should:
5. Reexamination--Applicant Submits N-648 for the First Time
If, at the beginning of the reexamination the applicant submits an N-648 for the first time, the DAO should:
Once the second or amended N-648 is received, the DAO should:
6. Postponed Reexamination for Good Cause
If an applicant appears for a reexamination that was previously postponed for good cause and submits an amended or second N-648, the DAO should:
If an applicant appears for an examination that was previously postponed for good cause but fails to submit an amended or second N-648, the DAO should:
G. Final Denials of N-400s with N-648s
The Service has determined that the current procedures for a hearing on a naturalization denial under section 336 of the Act is adequate to address N-648-related cases. A denial of an N-400 is always based on a failure to meet one or more statutory requirements for naturalization. The N-648 is a request for an exception from the section 312 requirements. Therefore, if the Service determines that an applicant is not eligible for a disability exception and the applicant fails to pass the English and civics tests, the Service will deny the N-400 for failure to meet the section 312 requirements. Thus, the N-648 review is part of the overall adjudication of the N-400 and does not have a separate appeal process.
Under 8 CFR 336.2, SDAOs or DAOs conducting a section 336 hearing may conduct a de novo hearing or review the decision of the original adjudicator. An applicant may submit additional documentation for review at the hearing, including a new N-648. If the applicant does not submit a new N-648, the SDAO or DAO should review the N-648s in the A-file for sufficiency. An applicant may not submit an N-648 for the first time at the hearing. Further, if the N-648(s) reviewed at the hearing is deemed insufficient on review, the applicant does not receive another opportunity to submit an N-648.
To ensure consistency in preparation of N-400 denials in disability cases, officers should include the bases for rejection of an N-648 in the attachment to the Form N-335. See Attachment E for sample language which will advise the applicant of the bases for rejection of the N-648.
H. Procedures for Cases of Suspected Fraud
The Service is concerned about allegations of fraud in the N-648 program and is committed to developing anti-fraud measures that target individuals who abuse the system or attempt to gain an immigration benefit through submission of fraudulent N-648s. The Service is currently working with several INS components and outside agencies to develop credible fraud approaches.
The Service anticipates issuing field guidance in the near future that will detail our fraud initiative and instruct SDAOs and DAOs on:
In the interim, District Offices should utilize current local procedures for benefit fraud referral and investigation. In general, DAOs should use the Notice of Incomplete N-648 to request the applicant and/or certifying physician clarify any questions or issues. Where there is evidence of fraud, DAOs should discuss the case with the SDAOs. After consultation, the SDAO should determine whether the case is referred to Investigations and whether the DAO should request that a second N-648 be completed by a different authorized medical professional.
I. Second Review of N-648s Based on December 30, 1998 Memorandum
As stated in Section E, the December 30th memorandum may have inadvertently caused a number of N-648s to be rejected or sent back for revision because the certifying doctor failed to provide specific descriptions of how he or she reached the diagnosis, i.e., the laboratory or clinical tests performed. The Service has made a commitment to reevaluate N-648s reviewed and rejected since December 30th to ensure that the sufficiency determination is based on the current standard for disability exceptions as restated in this memorandum. Thus, all N-648s reviewed since the December 30th memorandum that were deemed insufficient solely because the certifying doctor failed to provide specific descriptions of how he or she reached the diagnosis should be reevaluated based on the current standard for N-648 review, as restated in this memorandum.
We will issue further guidance shortly as to when to begin the review, how the review will be conducted, the timeframes for completion, and the reporting requirements. We anticipate the number of cases that will need to be reevaluated will be small and should fall into the following categories:
1. Cases Continued Based on December 30th Guidance
For cases where applicants were continued for reexamination, the applicant will be providing an amended or second N-648. Upon submission of the amended or second N-648, SDAOs and DAOs should review the N-648 for sufficiency based on the standard in this memorandum and follow the procedures outlined in section F above for further action on the case.
2. N-400s Denied On or After December 31st Based Solely on Rejection of N-648 and Applicant's Failure of the English and Civics Tests
All District Offices must identify for review N-400s denied on or after December 31st based exclusively on failure to meet section 312 requirements and where an N-648 was rejected solely because the certifying doctor failed to provide specific descriptions of how he or she reached the diagnosis. SDAOs and DAOs will need to reevaluate these N-648s for sufficiency based on the standard in this memorandum and follow the procedures outlined in section F for further action on the case.
J. Denials of Naturalization Applications Based on Failure to Assent to the Provisions of the Oath of Allegiance
Congress did not waive the oath of allegiance requirement for persons with disabilities when it passed the section 312 exception amendment. Therefore, the oath of allegiance is still required for all naturalization applicants. This position has been confirmed by the Office of Legal Counsel at the Department of Justice.
Decisions made on cases where the applicant has a significant cognitive impairment will be difficult. DAOs may be under intense pressure from family members and advocates to naturalize these individuals. If possible, DAOs should attempt to explain to family members the requirements of section 337 of the Act, and how, as the law is currently written, the oath cannot be waived for adult naturalization applicants.
DAOs must determine that the applicant:
K. Reasonable Accommodations and Modifications under the Rehabilitation Act
With accommodations or modifications, many applicants with disabilities will be able to meet the section 312 requirements. Section 504 of the Rehabilitation Act of 1973 requires all Federal agencies to make reasonable accommodations for persons with disabilities. Applicants are not required to file an N-648 or present a letter or other documentation from their doctor to request an accommodation or modification to the naturalization process because of a disability.
1. Reasonable Accommodations for Signatures on Naturalization Forms
All applicants for naturalization submitting a N-648 are required to sign the form. However, in certain instances, applicants with disabilities may not be able to provide a full signature or are completely unable to sign the required forms. As a reasonable accommodation, DAOs should permit a legal guardian (including a family member holding legal guardian status) to sign the N-648 on behalf of the disabled applicant. Alternatively, the DAO should accept a mark as the applicant's signature.
In general, at the conclusion of the interview, an applicant is required to sign the N-400 under penalty of perjury (jurat section). While a legal guardian may sign the preparer's box on the N-400 (Part 12 on the current N-400), the legal guardian may not sign the N-400 on behalf of the applicant at the conclusion of the interview. However, where the applicant can make some kind of mark, the DAO should accept such mark as a reasonable accommodation for the signature. In cases where the applicant is unable to make any type of mark but has indicated assent to the requirements for naturalization, the DAO should note in the jurat section that he or she has determined that the applicant has assented and responded to the questions on the N-400. No actual signature will thus be noted.
2. Other Modifications to the Naturalization Process
Not all applicants with disabilities will want or require a complete exception to the testing requirements. In such instances, DAOs are expected to make accommodations to allow applicants with disabilities to take the English and civics tests. For example, individuals who are blind or visually impaired should be tested orally; hearing impaired individuals should be offered a written test or provided with a sign language interpreter upon their request; and those with limited or no use of their hands should not be required to demonstrate their writing abilities.
Aside from the modifications that can be made to the test administration, DAOs must give consideration to modifications to the actual interview that would accommodate persons with disabilities. DAOs may continue to permit, under appropriate circumstances, a disabled naturalization applicant's family member or legal guardian to accompany the applicant during the interview. In addition, at the discretion of the Service, a family member or legal guardian can in some instances assist with the interview by acting as the approved English language interpreter for those applicants whose disability prevents them from fulfilling the English proficiency requirements of section 312. However, prior to the start of the interview, the DAO should ensure that the family member or legal guardian understands that the interview is being conducted with the applicant, not the family member or legal guardian. The DAO should make clear that the role of the family member or guardian is to be an interpreter and not to assist the applicant in answering questions or to answer questions for the applicant. In addition, for applicants who cannot speak, family members and legal guardians should be asked about which particular physical motions or signals the applicant uses to communicate certain meanings, so the DAO knows how to interpret such signals during the interview process.
DAOs are reminded again of the need for the utmost courtesy, respect and sensitivity in adjudicating cases where the applicant requests an accommodation for the section 312 requirements. Making acceptable accommodations or modifications to the entire naturalization process is our mandate under the Rehabilitation Act of 1973.
L. Future Consolidation of N-648 Reviews by Medical Professionals at the Service Centers
With the implementation of Direct Mail and Complete File Review, the Service is planning to transfer the review of the N-648s from the District Offices to the Service Centers, where medical professionals will review the forms. At this time, the Service does not have a specific timeframe for such transfer. However, consolidation of the N-648 review process at the Service Centers will:
We anticipate that the transfer of N-648 reviews to the Service Centers will also coincide with a revision to the Form N-648. The Immigration Services Division will be working in the coming months to develop a revised Form N-648 as well as transition procedures and procedures to govern the review of the forms at the Service Centers.
Questions about this guidance should be directed through the Regional Offices to Alison Morris, Immigration Services Division, Office of Field Operations, on (202) 616-7759.
Attachments (7)