Form N-648: The Medical Waiver for the Test in 2026

The Form N-648 medical waiver is for people who cannot meet the English or civics rules because of a health condition. It is a medical certificate, not a form you fill in yourself.

The age routes turn on dates. This one turns on a licensed doctor confirming that a disability stops you learning or showing what the test asks for.

Form N-648, Medical Certification for Disability Exceptions, is completed by a licensed medical doctor, doctor of osteopathy or clinical psychologist. It can waive the English requirement, the civics requirement, or both. File it with Form N-400 wherever possible, and the condition must have lasted or be expected to last at least 12 months.

What’s New in 2026

The form survived the 2025 test change without alteration.

Anyone filing Form N-400 on or after 20 October 2025 takes the 2025 civics test, 20 questions from a bank of 128. The USCIS study page sets out both versions and the exceptions alongside them.

A granted N-648 removes the requirement rather than shortening it. The change in question count therefore affects nobody whose civics rule is waived.

Where only English falls away, you still sit civics, in the version matching your filing date.

What the Waiver Can Cover

Three possibilities, and the certifying professional specifies which applies.

English only. This drops the reading, writing and speaking rules and keeps the civics test. You would take civics in your own language, with your own interpreter.

Civics only. The English tests remain and the civics rule falls away.

Both, so neither requirement applies.

The form is not a way out of the process. The interview still happens. Your Form N-400 is still reviewed. You still take the oath at a ceremony.

Who Can Complete It

A narrower list than people assume.

The certificate must come from a licensed medical doctor, a doctor of osteopathy, or a licensed clinical psychologist. They must hold a licence in the United States or its territories.

Other health workers cannot sign it, however well they know you. A nurse practitioner, physiotherapist or counsellor will not do.

The doctor should treat you, or have examined you properly. A form signed by someone who met you once, briefly, invites questions.

They complete the medical sections in their own words and sign it. You do not write the clinical content.

What the Form Has to Establish

Three things, and vagueness fails on all of them.

A clear diagnosis, put in words a non-medical reader can follow. Technical terms alone are no help. USCIS asks for plain description.

A link between the condition and the inability to meet the rule. This is the part most often done badly. A diagnosis alone is not enough. The form must say why that condition stops you learning or showing English or civics.

The condition must have lasted 12 months, or be expected to. Short-term illness does not qualify.

The form must also confirm that illegal drug use did not cause the disability.

When to File It

With Form N-400, wherever possible.

Sending it with the application means USCIS reviews it as part of the case. Otherwise the officer meets it for the first time at interview.

You can hand it in at the interview if things changed, and officers do accept it. The case may then be continued while it is reviewed.

There is no separate fee for Form N-648. Your medical professional may charge for their time, and that cost is yours.

If a form is not enough, USCIS may ask for a new one or continue the case. That is not a refusal. A second, better form often succeeds.

How It Sits Beside the Age Rules

Check the age routes first, because they are simpler.

At 50 with 20 years as a permanent resident, or 55 with 15 years, the English rule is waived on the dates alone. No medical evidence at all. At 65 with 20 years the civics test drops to 10 questions from 20.

If an age rule already covers your situation, you may not need Form N-648 at all. Our page on citizenship test exemptions sets out all four routes together.

The medical route matters most if you are too young for the age rules, or you need civics waived rather than just English.

This page is study material rather than legal advice, and anyone with a complicated situation should take proper advice on it.

FAQ

Who can complete Form N-648?

Only a licensed medical doctor, doctor of osteopathy, or licensed clinical psychologist, licensed to practise in the United States or its territories. Other healthcare professionals cannot certify it regardless of how well they know you.

Does Form N-648 waive the whole interview?

No. It can waive the English requirement, the civics requirement, or both. The interview itself still happens, your application is still reviewed with you, and you still attend an oath ceremony.

Is there a fee for Form N-648?

USCIS charges nothing for the form. Your medical professional may charge for the appointment and for completing it, and that cost falls to you.

When should I file it?

With your Form N-400 wherever possible, so it is reviewed as part of the case. Filing at the interview is permitted but may result in the case being continued while USCIS considers it.

Common Reasons a Form Is Rejected

Four patterns account for most of them.

A diagnosis with no explanation of effect. The form names a condition and stops there, leaving the reader to guess why it prevents learning civics.

Language copied from a template. Officers read many of these and generic wording stands out.

The wrong professional signing. A nurse practitioner or counsellor cannot certify this form, however well they know the patient.

No duration stated. The condition must have lasted, or be expected to last, at least 12 months, and the form has to say so.

Take the form to the appointment and talk it through rather than dropping it off. Ten minutes explaining what the officer needs to see is the difference between one attempt and two.

What Happens at the Interview

The appointment still takes place, and it is shorter.

The officer reviews your Form N-400 with you as normal. Where English is waived, that review runs through your interpreter.

Where the waiver is granted, the officer does not administer the waived tests. If only English was waived, you still take civics. If only civics was waived, you still read and write a sentence.

Bring a copy of the form and your medical records to the appointment. Officers sometimes have questions, and having the paperwork with you avoids a continued case.

Your doctor does not attend. Their part ends when they sign the form.

Talking to Your Doctor About It

Bring the form and explain what it needs, because most doctors see very few of these.

Print Form N-648 and the USCIS instructions and take both to the appointment. A doctor working from memory of a similar form will usually miss what matters.

Explain the two tests in plain terms. One asks you to read and write English. The other asks 20 civics questions in English. Your doctor needs to say why your condition prevents one or both.

Ask them to write the connection explicitly rather than leaving it implied. That single paragraph decides most of these applications.

Allow time. A form completed properly takes longer than a routine appointment, and rushing it produces exactly the version that comes back.

Verdict on the Form N-648 Medical Waiver

Check the age exemptions first, because they need no evidence beyond dates and they cover many people who assume they need a medical route.

Where the Form N-648 medical waiver is the right path, everything rests on the doctor explaining the link between the condition and the rule, in plain words. A diagnosis alone is the most common reason a form comes back.

File it with your application rather than producing it at the interview, and expect the appointment itself to go ahead either way.