N‑648 Disability Waiver: A Clear Guide to Psychological Evaluations for U.S. Naturalization
Immigration Evaluations for Citizenship Exam Waiver (N-648)
Immigration Evaluations for Citizenship Exam Waiver (N-648)
When a health condition affects learning, memory, attention, language, or other cognitive functions, the path to U.S. citizenship can feel overwhelming.
The N‑648 Medical Certification for Disability Exceptions exists for exactly these situations.
This page explains, in plain English, how the process works, what USCIS looks for, and how a focused psychological evaluation can support a well‑grounded request. It is written for applicants, families, and attorneys who want a practical, respectful, and clinically sound approach.
Need help now?
Begin Your Immigration Process
Call our Miami office at 305-981-6434 or our Boca Raton office at 561-376-9699 to schedule an evaluation.
We also coordinate with your attorney when applicable.
Need help now?
Begin Your Immigration Process
Call our Miami office at 305-981-6434 or
our Boca Raton office at 561-376-9699 to schedule an evaluation.
We also coordinate with your attorney when applicable.
Need help now?
Begin Your Immigration Process
Call our Miami office
at 305-981-6434 or our
Boca Raton office
at 561-376-9699
to schedule an evaluation.
We also coordinate with your attorney when applicable.
What the N‑648 does (and does not do)
The N‑648 is a form the applicant submits with their naturalization case to request an exception from the English and/or civics testing requirements due to a qualifying medical impairment. In other words, if a condition makes it unrealistic to learn or show knowledge of English and civics, the N‑648 asks USCIS to waive those tests.
It is important to distinguish a waiver from accommodations. Accommodations help people who can still take the tests but need support (for example, extra time or an interpreter for sign language). The N‑648 is different: it tells USCIS that, because of the diagnosed condition, the person cannot reasonably be expected to learn or demonstrate the material even with supports. The correct path depends on the functional impact of the condition, not just the diagnostic label.
Who can complete and certify the N‑648
USCIS requires that the form be certified by one of the following, each licensed to practice in the United States:
Physician (MD)
Doctor of Osteopathic Medicine (DO)
Licensed Clinical Psychologist
Other professionals, such as therapists or nurse practitioners, cannot sign the certification. That said, their treatment records often provide valuable background evidence that a certifying clinician can review.
The heart of a strong N‑648: functional explanation
A diagnosis alone isn’t enough. A persuasive N‑648 ties concrete symptoms to real‑world cognitive limits that block the English or civics tests. In a psychological evaluation, we focus on:
Attention and working memory: Can the person hold new information long enough to learn vocabulary or comprehend interview questions?
Learning and retention: Do memory problems cause rapid forgetting despite repeated practice?
Language processing: Are there disorders (for instance, aphasia) that interfere with understanding or expressing information in English?
Executive functioning: Do planning or mental‑flexibility deficits disrupt studying and test‑taking?
Mood and anxiety: Do severe depression, trauma symptoms, or panic create cognitive drag, dissociation, or physiologic arousal that make study and recall unreliable?
Neurologic sequelae and medications: Do stroke, traumatic brain injury, seizure disorders, or sedating medications compromise information processing?
The evaluation must connect these limitations to the practical tasks involved in preparing for and taking the tests. The write‑up should use direct, specific language rather than vague statements like “the patient has difficulty learning.”
Duration matters
USCIS expects that the condition has lasted, or is expected to last, at least 12 months. Psychological evaluations, therefore, document onset, clinical course, and prognosis. For progressive conditions (for example, major neurocognitive disorder), we explain how decline over time further undermines learning and recall.
Common conditions that may justify an exception
Every case is individual, but these are examples of diagnoses that frequently involve the kind of cognitive limitations relevant to an N‑648:
Major neurocognitive disorder / dementia and related memory disorders
Acquired brain injuries, such as traumatic brain injury or stroke (including aphasia)
Neurodevelopmental conditions, including intellectual disability and autism spectrum disorder
Severe trauma‑related disorders (PTSD with dissociation, hyperarousal, or intrusive symptoms)
Serious mood disorders with documented cognitive slowing, poor concentration, or psychomotor changes
Psychotic disorders that disrupt reality testing, concentration, and organized thinking
Again, the key is not simply the label but the functional impact on learning and demonstration of knowledge.
What we assess during an N‑648 psychological evaluation
Our approach balances clinical thoroughness with compassion and clarity. A typical evaluation may include:
Clinical interview covering medical, psychiatric, developmental, educational, and cultural history.
Cognitive screening to get a quick snapshot of attention, memory, language, and problem‑solving.
Targeted psychometric testing when needed (for example, memory or language tasks) to quantify impairments.
Review of records such as neurology notes, prior testing, therapy summaries, medication lists, and imaging reports.
Functional analysis showing how the condition prevents learning or demonstrating English/civics material.
Clear, concise write‑up that answers the questions adjudicators commonly ask.
We also document whether an interpreter was needed for the evaluation, the language used during testing, and any cultural or educational factors that could influence performance.
Telehealth and in‑person options
Depending on state rules and professional standards, some evaluations may be completed via secure telemedicine. When telehealth is used, we adhere to applicable regulations and ethical guidelines, ensuring that we collect sufficient clinical data to form a reliable opinion.
For many clients, combining telehealth record review with an in‑person cognitive assessment provides the best balance of access and accuracy.
Practical differences between an N‑648 waiver and testing with accommodations
Choosing between these routes can be confusing. Here’s a practical way to think about it:
If the person can learn with support (for instance, studying in their native language, practicing with a tutor, and using extra time on test day), then accommodations may be more appropriate. They will still take the tests.
Suppose the person cannot realistically learn or demonstrate the material even with support because of cognitive limitations that are expected to last at least a year. In that case, the N‑648 waiver is likely the correct path.
A psychological evaluation helps make this call by distinguishing skill gaps from disability‑related limitations.
What USCIS expects to see in a well‑prepared N‑648
While the form is standardized, the content should be individualized. Strong submissions often include:
Specific diagnoses with clear references to clinical criteria and objective findings.
A timeline that establishes the onset and confirms expected duration of at least 12 months.
Straightforward functional statements that map symptoms to failed learning, retention, or demonstration of knowledge.
Assessment methods used (interview, tests, records), including language and need for interpreter.
If relevant, how the condition affects the Oath of Allegiance (for example, comprehension or ability to assent).
Adjudicators can and do compare N‑648 details with the rest of the file and with the applicant’s interview. Consistency matters. We therefore encourage clients to bring prior medical records, school documents, and medication lists to help us paint an accurate picture.
How we work with you (and your attorney)
We respect that naturalization is a major life milestone. Our team coordinates with legal counsel, when involved, to align the evaluation with the broader case strategy. We communicate in Spanish, English, and Portuguese, and we aim for humane, jargon‑free reports that are easy for officers to follow.
Our step‑by‑step process
1. INTAKECALL | 2. SCHEDULING | 3. EVALUATION |
|---|---|---|
We listen to your history, confirm eligibility for an N‑648 evaluation, and discuss documents to gather. | Appointments are offered promptly in Miami and Boca Raton, with telehealth options when appropriate. | Clinical interview plus any needed cognitive testing. |
4. RECORD REVIEW | 5. REPORT DRAFTING | 6. FINALIZATION ANDDELIVERY |
|---|---|---|
We analyze prior reports and imaging to substantiate the diagnosis and its functional effects. | Clear explanations in everyday language, avoiding technical ambiguity. | We send the signed report securely to you and, with permission, to your attorney. |
How we work with you (and your attorney)
We respect that naturalization is a major life milestone. Our team coordinates with legal counsel, when involved, to align the evaluation with the broader case strategy. We communicate in Spanish, English, and Portuguese, and we aim for humane, jargon‑free reports that are easy for officers to follow.
Our step‑by‑step process
1. INTAKECALL | 2. SCHEDULING | 3. EVALUATION |
|---|---|---|
We listen to your history, confirm eligibility for an N‑648 evaluation, and discuss documents to gather. | Appointments are offered promptly in Miami and Boca Raton, with telehealth options when appropriate. | Clinical interview plus any needed cognitive testing. |
4. RECORD REVIEW | 5. REPORT DRAFTING | 6. FINALIZATION ANDDELIVERY |
|---|---|---|
We analyze prior reports and imaging to substantiate the diagnosis and its functional effects. | Clear explanations in everyday language, avoiding technical ambiguity. | We send the signed report securely to you and, with permission, to your attorney. |
Talk to a real person today!
Call our Miami office at 305-981-6434 or our Boca Raton office at 561-376-9699 to schedule an evaluation.
Prefer messaging?
Talk to a real person today!
Call our Miami office
at 305-981-6434 or our Boca Raton office
at 561-376-9699 to schedule an evaluation.
Prefer messaging?
Talk to a real person today!
Call our Miami office
at 305-981-6434 or
our Boca Raton office
at 561-376-9699
to schedule an evaluation.
Prefer messaging?
How to prepare for your appointment
Bringing organized information can speed up the process and improve accuracy:
Government ID and any prior immigration correspondence
Names and doses of current medications
Hospital or clinic notes, prior evaluations, brain imaging summaries if available
Contact information for treating providers or caregivers who can describe day‑to‑day functioning
Information about education history and languages spoken
If you use an interpreter, we will record their details. We will also note the language used during testing and any cultural or educational factors that might influence performance, so adjudicators understand the context.
FAQ
FAQ
No. The N‑648 addresses the testing requirements only. USCIS still reviews the rest of your naturalization application and must be satisfied you meet all other criteria.
No. The disability exception is not intended to cover impairments caused by illegal drug use. If other qualifying conditions exist, we evaluate those on their own merits.
Yes, you should be prepared for an interview. The officer may ask about your daily functioning and medical history in a manner consistent with your file. If an interpreter is needed, that will be recorded.
In some situations, yes, provided state laws and professional standards are followed and the evaluation yields enough clinical detail to support reliable conclusions.
No. Age by itself is not a reason for a waiver. We must document how a medical condition prevents learning or demonstration of the required knowledge.
Dr. Benejam typically completes these examinations in 7 business days. In most circumstances, this is enough. But, we may expedite results for a rush charge. Please contact Dr. Benejam for further information about rush pricing.
Based on the coverage of your healthcare plan, your insurance company will assess if you are eligible for reimbursement of the cost of this evaluation. Dr. Benejam, on the other hand, does not take any type of health insurance.
Why choose Dr. Benejam for an N‑648 psychological evaluation
Experience with immigration evaluations: We focus on clarity, clinical rigor, and alignment with what adjudicators actually read.
Fast scheduling and turnaround: Appointments are typically available quickly, with prompt delivery of the written report.
Team coordination: We regularly collaborate with immigration attorneys to ensure the evaluation integrates with the client’s overall strategy.
Multilingual care: Spanish, English, and Portuguese.
Accessibility: In‑person in Miami and Boca Raton, with telehealth options when appropriate.
Ethical, careful, and person‑centered
We take time to understand your history and present functioning. We avoid boilerplate language and provide clear clinical explanations, supported by objective observations and testing when useful. Our job is to describe how the condition operates in real life and why standard testing would not produce a meaningful measure of knowledge.
Getting the best possible evaluation to support your case is crucial as part of this procedure. We are ready to work with you and answer any questions you may have as we select the appropriate next steps.
I answer ALL my calls and am completely bilingual (Spanish and English). We offer convenient locations in Miami and Boca Raton and, in some circumstances, we can conduct remote exams using basic technology (e.g., Zoom, FaceTime, Skype, etc.).
Ready to Schedule?
If you or your attorney thinks a disability waiver may be right for you, the next step is a conversation. Our team will explain what the evaluation involves, what records help most, and how to schedule.
Give me a call at 305-981-6434 (Miami Office) or 561-376-9699 (Boca Raton Office) to book your appointment. You can also message WhatsApp 561-376-9699 for quick coordination.
Contact Us to Get Started
Ready to Schedule?
If you or your attorney thinks a disability waiver may be right for you, the next step is a conversation. Our team will explain what the evaluation involves, what records help most, and how to schedule.
Give me a call at 305-981-6434 (Miami Office) or 561-376-9699 (Boca Raton Office) to book your appointment. You can also message WhatsApp 561-376-9699 for quick coordination.