N-648 Medical Waivers - How Are They Working For You?: Questions and Answers from CIS Ombudsman's Teleconference

The following are questions discussed during the November 2, 2007 teleconference. We have posted answers received from USCIS for a number of questions and will post the rest as soon as we have them.

1. Origin of Impairment - The caller noted that the N-648 memo issued in May 2006 requires the doctor to note the origin of impairment.  However, the Form N-648 only asks for the diagnosis. Doctors are not aware of this requirement from the form. The requirements for the medical examiner can only be found in hard to find places on USCIS’ website.  Can USCIS add a supplemental sheet to the form to explain this additional requirement?

• USCIS Response on April 30, 2008: USCIS appreciates this observation. USCIS is currently revising the form N-648, and will address this issue in this revision. Note: the original language of the May 10, 2006 memorandum concerning the medical professional's explanation of the origin of the claimed disability has been superseded by similar language in the guidance memorandum of September 17, 2007.

2. Presumption of Fraud - A caller from California stated that often adjudicators pressure applicants to take the naturalization exam so that they do not have to adjudicate the waiver. Adjudicators are disinclined to approve the waiver if the applicant looks young and healthy. Officers are not familiar with medical terms and do not understand medical disabilities, but are taking on the role of a medical examiner. The caller stated that officers are operating from a presumption of fraud.  Other than the issuance of the September 2007 memo, what other steps is USCIS taking to train adjudicators on these issues?

• USCIS Response on April 30, 2008: Several points are raised in this message:
  • Very often officers will not be familiar with medical terms and medical disabilities. Therefore, it is crucial that the medical professional explain in plain English and layman's terms how the medical professional diagnosed the impairment and how the diagnosed condition affects the applicant's ability to learn or demonstrate English proficiency and/or knowledge of U.S. history and government.
  • As stated in the September 2007 memo, the adjudicator should assume that the medical professional's diagnosis is valid unless there is credible doubt about the veracity of the medical certification.
  • USCIS has initiated N-648 training in several field offices and will continue to do so.
  • In addition, local offices are instructed to maintain a point-of-contact for the N-648 program. The point-of-contact will be an adjudicator with expert knowledge of N-648 adjudications or a supervisory adjudications officer who is responsible for administration of the N-648 program within the district or field office. The point-of-contact will be responsible for overseeing N-648 training and quality assurance within the district or field office.

3. Adjudicators’ Line of Questioning - A caller from New York stated that the officers are questioning applicants about their daily activities and that this line of questioning is contrary to USCIS guidance; officers are trying to make a determination on their medical impairment.  What types of questions does USCIS instruct its adjudicators are appropriate to ask in an N-648 interview?

• USCIS Response on April 30, 2008: If the adjudicator believes that there is credible doubt about the veracity of the medical certification, the adjudicator may question the applicant about his/her medical care, job duties, community and civic affairs, and/or other daily living activities.

4. Multiple N-648s - One practitioner stated that she has provided multiple N-648s for one applicant because applicants may see multiple doctors due to multiple medical conditions. She stated that this practice should not be presumed fraud.  What is USCIS’ policy on multiple N-648s submitted for one applicant?

• USCIS Response on April 30, 2008: The submission of multiple Form N-648s, by itself, is not sufficient grounds to reject a request for an exception to the English and/or U.S. history and government requirements. However, the submission of multiple Form N-648s may raise credible doubts about the veracity of the medical certifications or justify additional scrutiny to ensure the applicant is entitled to the exception unless there is evidence of changed facts or circumstances that would explain the basis for filing multiple forms.

5. Submission of N-648 not concurrently filed with N-400 -  One caller said that the September 2007 memo indicates that submission of N-648s after the N-400 will raise credible doubts. She asked what would happen to cases filed before the issuance of this memo.  Please advise.

• USCIS Response on April 30, 2008: The September 2007 memo states that the submission of Form N-648 after the filing of the N-400 “may” raise credible doubts about the veracity of the medical certifications or justify additional scrutiny. If an applicant is entitled to a waiver, closer scrutiny of the applicant's case will not change that. All N-648 Forms are reviewed and adjudicated based on the September 2007 memo, regardless of the date of filing.

6. Civil Surgeons - One caller stated that he does not agree that USCIS should designate civil surgeons to complete N-648s. Many of his clients are low income and civil surgeons will charge significant fees. Also, many applicants that need the N-648 have been going to a certain doctor for many years and a doctor-patient relationship has been established; to require a civil surgeon to complete the form after one examination does not make sense.

7. Solutions - The Ombudsman challenged the callers to try to come up with solutions that would allow legitimate cases to go through the system while accounting for the large number of fraudulent cases.  One caller suggested that USCIS reach out to the Medical Board to conduct training for doctors as well as include penalties for perjury.