Understanding USCIS Form N-648: Medical Disability Waivers for Naturalization

December 3, 2025
writing on paper

The naturalization exam is a critical step for legal residents seeking U.S. citizenship. It tests proficiency in English and knowledge of U.S. history and government. However, for many individuals, passing this exam is not possible due to medical challenges.


To address this, USCIS Form N-648 provides a pathway for applicants with qualifying disabilities to request an exemption. According to the USCIS Policy Manual:


U.S. law provides an exception for applicants who are unable to meet the required proficiency in English or civics for naturalization because of a physical disability, developmental disability, or mental impairment.


This ensures that individuals with legitimate and documented disabilities are not excluded from the naturalization process.


WHY FORM N-648 IS CHALLENGING


Writing Form N-648 is not straightforward. USCIS officers review these forms carefully, often with skepticism, to ensure that applicants are not avoiding their responsibility to learn the required material. As a result, the form must be written in clear, accessible language that explains the applicant’s medical condition and how it prevents them from meeting exam requirements.


Disabilities vary widely, including:

  • Age-related cognitive decline
  • Head trauma or intellectual disability
  • Mental health conditions such as PTSD, depression, or schizophrenia
  • Side effects of medications or treatments (e.g., chemotherapy-related cognitive impairment)


Each case requires careful documentation and explanation in layman’s terms so that non-medical officers can understand the diagnosis and approve the waiver.


Our Approach

We specialize in preparing N-648 forms that meet USCIS standards. Over time, we have developed strategies to anticipate and address the kinds of objections officers often raise. For example, if an officer questions how someone struggling with cognitive impairment could still learn to drive, we explain the difference between a driving test and the naturalization exam.


In Minnesota, our track record allows us to guarantee acceptance of properly prepared forms. For applicants in other states, we continue working with officers and clients until the forms are accepted—without charging extra fees. When necessary, we collaborate with attorneys or even elected officials to ensure USCIS officers follow their own regulations.


Serving Patients In and Out of State

We have successfully handled hundreds of cases in Minnesota and assisted immigrants from states such as New York, Virginia, Illinois, California, Iowa, the Dakotas and others.


Because our medical licenses are limited to Minnesota, out-of-state applicants have two options:

  1. Virtual collaboration with a local doctor – We review the case virtuqally and provide guidance so the local physician can complete the form.
  2. In-person evaluation in Minnesota – Patients travel to Minnesota, where we can directly diagnose and sign the form.


Both approaches have proven effective, and we provide letters to out-of-state doctors explaining the process.


Case Examples

  • Elderly Russian woman: With multiple chronic conditions (diabetes, hypertension, high cholesterol), she struggled to learn new information. After reviewing her medical history, we diagnosed cerebrovascular disease and explained how it impaired her cognitive function.
  • Young Somali man: A survivor of war trauma and head injury, with no formal education, he suffered from PTSD and cognitive impairment. We documented how these factors prevented him from meeting exam requirements.


While these cases may seem obvious, USCIS officers often raise unexpected objections. Our role is to anticipate these challenges, explain medical realities in plain language, and ensure fair treatment under the law.


Conclusion

Form N-648 is a vital safeguard for immigrants with disabilities, ensuring they are not excluded from citizenship due to medical limitations. Preparing the form requires expertise, persistence, and a deep understanding of both medical conditions and USCIS procedures.


Through careful documentation and advocacy, we help applicants overcome barriers and achieve their goal of becoming U.S. citizens.

To Make an Appointment With Any of Our Providers Call 952-933-8900
December 21, 2025
Learn how USCIS Form N-648 helps individuals with medical disabilities qualify for U.S. citizenship. Life Medical provides expert N-648 evaluations in St. Louis Park, MN.
December 19, 2025
IMPORTANT CLARIFICATION ABOUT FORM N-648 Form N-648 (Medical Certification for Disability Exceptions) allows certain applicants to request an exemption from the English and/or civics requirements for U.S. naturalization due to a qualifying medical condition. A key point to understand: Any licensed medical doctor (MD or DO) or clinical psychologist may complete Form N-648. The provider does NOT need to be a USCIS-designated civil surgeon to complete Form N-648. Civil surgeon certification is only required for Form I-693 (Report of Medical Examination and Vaccination Record) and does not apply to N-648 disability waivers. What matters most is that the evaluating provider: Is properly licensed Has sufficient medical expertise Clearly explains how the patient’s condition prevents them from meeting naturalization exam requirements Completes the form accurately and in accordance with USCIS standards WHAT IS FORM N-648 AND WHY DOES IT MATTER? Becoming a U.S. citizen requires passing a naturalization exam that includes English proficiency and U.S. civics knowledge. For some individuals, physical, developmental, or mental impairments make it impossible to meet these requirements. Form N-648 provides a lawful medical exemption for applicants whose condition prevents them from learning or demonstrating the required knowledge. Approval depends on clear, thorough medical documentation , not on the provider being a civil surgeon. WHO MAY QUALIFY FOR AN N-648 MEDICAL WAIVER? USCIS requires evidence of a legitimate medical condition that directly interferes with the ability to meet exam requirements. Common qualifying conditions include: Dementia or age-related cognitive decline Traumatic brain injury Stroke or cerebrovascular disease Intellectual or developmental disabilities PTSD, schizophrenia, or severe depression Neurological conditions affecting memory or language Medication side effects that impair cognitive function Each case is evaluated individually. The critical factor is demonstrating the functional impact of the condition on learning, memory, or communication. WHY THE QUALITY OF THE MEDICAL EVALUATION MATTERS USCIS officers review N-648 forms carefully and often critically. Applications may be denied if: The explanation is vague or overly technical The connection between the diagnosis and exam limitations is unclear Documentation does not adequately support the condition The form fails to anticipate common USCIS concerns A well-prepared evaluation explains complex medical issues in plain language and directly addresses how the condition prevents exam completion.  HOW LIFE MEDICAL HANDLES N-648 EVALUATIONS Life Medical provides in-person N-648 evaluations exclusively at our St. Louis Park, Minnesota location . Our approach combines medical expertise with a strong understanding of USCIS expectations. Comprehensive Medical Assessment Our evaluations include: Review of medical history and diagnoses Medication review and cognitive side effects Relevant medical records and testing Assessment of learning, memory, and functional limitations Clear, USCIS-Focused Documentation USCIS officers are not clinicians. We complete Form N-648 using clear, accessible language while meeting all medical and legal requirements. PRICING FOR N-648 DISABILITY WAIVERS Life Medical offers transparent, flat-rate pricing for N-648 evaluations: $1,500 for an individual evaluation $2,500 for couples evaluated together This pricing includes: Comprehensive medical evaluation Completion of Form N-648 Follow-up support if USCIS requests additional information LOCATION FOR N-648 SERVICES All N-648 evaluations are conducted at: Life Medical – St. Louis Park 4201 Excelsior Boulevard St. Louis Park, MN 55416 Phone: (952) 933-8900 Spanish and Russian-speaking staff are available at this location.
October 23, 2025
Take a look at our new website. Updated graphics and layout. Easier to navigate. Lots of new information for patients. A great new feature on the new website is the "MyChart" equivalent available to the clinic and the patient portal. Patients registering for the portal will have access to their ongoing progress notes, and lab results. This feature is similar to the MyHealth portal utilized by Fairview and other large health providers. Patients will get notifications about upcoming appointments with providers. They can immediately communicate directly with their providers and staff using the electronic message system within the portal. We have recently implemented The PRISMA System here at Life Medical . This is an interoperability toolkit that allows for easy data exchange between different medical clinics. This feature has allowed our clinic access to records from other groups including Fairview, Park Nicollet and Allina. We can now get patient information very quickly without the time-consuming “request for records” process. This makes it much easier for every medical practitioner to provide a higher level of continuity of care. Patients no longer need to hesitate to be seen outside of their current health group, because there are no longer data exchange limitations. Life Medical is a great clinic because we are always taking steps to improve our patients’ experiences.