Medical Exceptions and Waivers for 2025 Citizenship Questions

Key Takeaways

• Form N-648 allows medical exceptions to English and civics tests for US citizenship applicants with serious disabilities.
• USCIS updated disability exception policies on June 13, 2025, requiring detailed individualized medical evaluations.
• Applicants must submit N-648 with Form N-400; approvals excuse English and civics tests during naturalization.

Medical Exceptions for Citizenship Questions in 2025: Understanding Form N-648 and the USCIS Process

Applying for United States 🇺🇸 citizenship is a major step for many immigrants. One of the main requirements for naturalization is passing the English language and civics tests. However, not everyone can meet these requirements due to serious medical conditions. For these individuals, the United States Citizenship and Immigration Services (USCIS) offers a way to request an exemption through Form N-648. This process is designed to make citizenship possible for people with certain disabilities or impairments. Below, you’ll find a detailed explanation of how medical exceptions work for the citizenship questions in 2025, who qualifies, and what steps are involved.

What Is Form N-648?

Form N-648, officially called the Medical Certification for Disability Exceptions, is a special form that allows applicants for U.S. citizenship to ask for an exemption from the English and civics testing requirements. This exemption is only available to people who have a physical or developmental disability, or a mental impairment, that makes it impossible for them to learn or demonstrate knowledge of English and U.S. civics.

The form must be completed by a licensed medical professional, such as a doctor, clinical psychologist, or osteopath. The medical professional must explain in detail how the applicant’s condition prevents them from meeting the testing requirements. The goal is to ensure that people with serious, long-lasting disabilities are not unfairly denied the chance to become U.S. citizens.

Recent Changes to the Disability Exception Policy

As of June 13, 2025, USCIS updated its policy on disability exceptions for naturalization. This update applies to all new naturalization applications and any Form N-648 filed on or after that date. The changes are meant to make the process clearer and more consistent for everyone involved.

The updated policy:

• Clarifies what medical conditions qualify for the waiver
• Reinforces the need for detailed, individualized medical evaluations
• Aims to ensure fair and equal treatment for all applicants

These changes reflect USCIS’s ongoing efforts to balance the need for accessibility with the integrity of the naturalization process. According to analysis by VisaVerge.com, these updates are expected to help both applicants and medical professionals better understand what is required for a successful waiver request.

Who Is Eligible for a Medical Exception?

To qualify for a medical exception using Form N-648, an applicant must meet all of the following conditions:

• Have a medically determinable physical or developmental disability, or a mental impairment. This means the condition must be diagnosed by a licensed medical professional and supported by medical evidence.
• The condition must have lasted, or be expected to last, at least 12 months. Temporary conditions do not qualify.
• The disability or impairment must prevent the applicant from learning or demonstrating knowledge of English and/or U.S. civics. The focus is on how the condition affects the person’s ability to meet the test requirements, not just the diagnosis itself.

It’s important to note that simply having a diagnosis is not enough. The medical professional must show how the condition specifically affects the applicant’s ability to learn or communicate in English or understand U.S. civics.

What Types of Conditions Qualify?

The N-648 waiver covers a wide range of conditions that can affect a person’s ability to learn or communicate. Some examples include:

• Neurocognitive disorders: Alzheimer’s disease, major neurocognitive disorder, vascular dementia, Parkinson’s disease with cognitive decline
• Mental health conditions: Post-Traumatic Stress Disorder (PTSD), major depressive disorder, anxiety disorders, bipolar disorder, schizophrenia
• Developmental or language-based disorders: Autism spectrum disorder, intellectual disability, aphasia (loss of ability to understand or express speech) after a stroke or brain injury
• Medical conditions with cognitive effects: Diabetes, thyroid dysfunction, chronic pain, cardiovascular disease that affects brain function

This list is not complete. Any condition that seriously affects a person’s ability to learn or communicate may be considered, as long as it meets the requirements explained above.

How Does the N-648 Process Work?

Applying for a medical exception to the citizenship questions in 2025 involves several steps. Here’s a simple breakdown of the process:

1. Get a Medical Evaluation
   • The applicant must be evaluated by a licensed medical professional. This could be a medical doctor (MD), a doctor of osteopathy (DO), or a clinical psychologist (PhD or PsyD).
   • The medical professional will review the applicant’s medical history, perform any needed tests, and determine if the applicant’s condition meets the requirements for a waiver.
2. Complete Form N-648
   • The medical professional fills out Form N-648, providing detailed information about the applicant’s diagnosis, symptoms, and how the condition prevents them from learning English or U.S. civics.
   • The form must include specific examples and explanations. Generic or vague statements are not enough and may lead to denial.
3. Submit Form N-648 with the Naturalization Application
   • The completed Form N-648 should be submitted together with Form N-400, which is the main application for naturalization.
   • If the applicant already filed Form N-400, they can bring Form N-648 to their naturalization interview.
4. USCIS Review
   • USCIS officers will review the N-648 form and the supporting medical evidence.
   • They may ask for more information or clarification if something is unclear.
   • In some cases, USCIS may refer the form to another medical expert for review.
5. Interview and Decision
   • If the waiver is approved, the applicant may be excused from the English test, the civics test, or both, depending on the nature of their disability.
   • The naturalization interview may be conducted in the applicant’s native language if the waiver is granted.
   • If the waiver is denied, the applicant must take the standard tests or may appeal the decision.

What Happens If the Waiver Is Approved?

If USCIS approves the N-648 waiver:

• The applicant does not have to take the English language test, the civics test, or both, depending on what the waiver covers.
• The naturalization interview may be done in the applicant’s preferred language, with the help of an interpreter if needed.
• The rest of the naturalization process continues as usual.

If the waiver is denied, the applicant will need to take the required tests or consider other options, such as appealing the decision or submitting a new, more detailed N-648 form.

Common Reasons for Denial

USCIS may deny a Form N-648 waiver for several reasons, including:

• The medical evaluation is not detailed enough or lacks specific examples.
• The diagnosis does not clearly explain how the condition affects the applicant’s ability to learn or communicate.
• The form is incomplete or contains errors.
• The medical professional is not properly licensed or qualified.
• The condition is temporary or does not meet the 12-month requirement.

To avoid these problems, it’s important to work with a knowledgeable medical professional and provide as much detail as possible.

Expert Tips for a Successful N-648 Application

• Choose the right medical professional. Make sure the person completing the form is licensed and experienced in diagnosing and treating the applicant’s condition.
• Provide detailed information. The form should include clear, specific examples of how the disability affects learning or communication.
• Avoid generic statements. USCIS wants to see individualized evaluations, not copied or template answers.
• Include supporting documents. Attach medical records, test results, and other evidence that supports the diagnosis and the impact on learning.
• Review the form carefully. Double-check for mistakes, missing information, or unclear answers before submitting.

Organizations like Project Citizenship offer free help and resources for people applying for N-648 waivers. Their guidance can be especially helpful for applicants who are unsure about the process or need help finding a qualified medical professional.

Real-World Examples

To better understand how the N-648 waiver works, here are a few real-life scenarios:

• Maria, age 70, with Alzheimer’s disease: Maria has been living in the United States 🇺🇸 for 20 years. She wants to become a citizen but cannot remember new information due to Alzheimer’s disease. Her doctor completes Form N-648, explaining how her memory loss makes it impossible for her to learn English or U.S. civics. USCIS approves her waiver, and she is able to complete the naturalization process without taking the tests.
• Ahmed, age 45, with severe PTSD: Ahmed fled his home country due to war and now lives in the United States 🇺🇸. He suffers from severe PTSD, which causes panic attacks and makes it very hard for him to focus or learn new things. His psychologist documents his condition and how it affects his ability to study for the citizenship tests. His waiver is approved, and he is interviewed in his native language.
• Li, age 60, with a recent stroke: Li had a stroke that left him unable to speak or understand English. His doctor explains on Form N-648 that the stroke caused aphasia, a language disorder, and that Li cannot learn or communicate in English. USCIS grants the waiver, and Li is able to continue with his citizenship application.

These examples show how the waiver can help people with serious, long-lasting disabilities become U.S. citizens, even if they cannot meet the usual testing requirements.

How Does the N-648 Waiver Affect Rights and Pathways to Citizenship?

The N-648 waiver does not change the basic rights or benefits of U.S. citizenship. It simply removes the barrier of the English and civics tests for those who truly cannot meet them due to disability. Approved applicants still need to meet all other requirements for naturalization, such as:

• Being a lawful permanent resident (green card holder)
• Meeting residency and physical presence requirements
• Demonstrating good moral character
• Taking the Oath of Allegiance

The waiver is not a shortcut or an easier path to citizenship. It is a necessary accommodation for people with significant medical challenges.

Comparing the N-648 Waiver to Other Exceptions

There are a few other exceptions to the English and civics requirements, but they are based on age and length of permanent residency, not medical conditions. For example:

• Applicants age 50 or older who have lived in the United States 🇺🇸 as permanent residents for at least 20 years can take the civics test in their native language.
• Applicants age 55 or older with at least 15 years of permanent residency can also take the civics test in their native language.

However, these age-based exceptions do not exempt applicants from the civics test itself. Only the N-648 waiver can excuse someone from both the English and civics tests due to disability.

Future Outlook: What’s Next for Disability Exceptions?

USCIS may continue to update and refine its policies on disability exceptions. One trend is the increased use of telehealth for medical evaluations, which can make it easier for applicants to access qualified professionals, especially in rural or underserved areas. As technology and medical understanding improve, the process may become even more accessible.

For the most up-to-date information, applicants should check the USCIS Policy Manual, Volume 12, Part E, Chapter 3, which explains the rules for medical disability exceptions in detail.

Key Takeaways and Next Steps

• Form N-648 is the official way to request a medical exception to the citizenship questions 2025 for people with serious, long-lasting disabilities.
• Applicants must provide detailed medical evidence showing how their condition prevents them from learning English or U.S. civics.
• The process requires careful documentation and the help of a licensed medical professional.
• If approved, the applicant may be excused from the English and civics tests and can complete the naturalization process with needed accommodations.
• Applicants should review the latest USCIS guidance and consider seeking help from organizations like Project Citizenship.

If you or someone you know may qualify for a medical exception, start by talking to a trusted doctor or psychologist. Make sure to use the official Form N-648 and follow the instructions closely. For more information, visit the USCIS official website or consult with an immigration attorney.

By understanding the rules and preparing carefully, eligible applicants can use the N-648 waiver to overcome barriers and achieve their dream of U.S. citizenship, even when facing serious health challenges.

Learn Today

Form N-648 → A medical certification form requesting exemption from English and civics tests for citizenship applicants.
Naturalization → The legal process by which a non-citizen becomes a U.S. citizen.
USCIS → United States Citizenship and Immigration Services, government agency managing immigration and naturalization processes.
Civics Test → An exam on U.S. government and history required for citizenship applicants.
Medical Exception → An exemption allowing applicants with disabilities to skip language and civics tests during naturalization.

This Article in a Nutshell

Form N-648 enables disabled applicants to request test exemptions in 2025 naturalization. USCIS requires thorough medical proof. Approval allows skipping English and civics tests. Updated policies improve clarity and fairness, supporting applicants with disabilities to achieve citizenship despite testing barriers.
— By VisaVerge.com