How Immigrants With Disabilities Can Become CITIZENS ----------------------------------------------------------------- First Edition November 27, 1996, Revised December 1996, Revised April 22, 1997 Protection & Advocacy, Inc. Where to Get PAI Services PAI serves persons with eligible disabilities throughout California. Currently PAI has offices in Sacramento, Oakland and Los Angeles. Staff are also located at Regional Centers and State Hospitals in various geographic locations in the state. PAI does not charge people with disabilities for its services. To request PAI services, phone toll-free from anywhere in California, or contact one of PAI's local offices -- 1-800-776-5746 -- legal@pai-ca.org. PAI Bay Area Office: 449 15th Street, Suite 401, Oakland, CA 94612, (510) 839-0811 PAI Central Office: 100 Howe Avenue, Ste 185-N, Sacramento, CA 95825, (916) 488-9950 PAI So. Calif. Area Office: 3580 Wilshire Blvd., Ste 902, Los Angeles, CA 90010, (213) 427-8747 ----------------------------------------------------------------- How Immigrants with Disabilities Can Become Citizens Table of ContentsTopic 1. What Are the Basic Rules to Become a Citizen? 2. How Do I Apply To Become A Citizen? A. I Can't Pass The English And Civics Tests. What Should I Do? B. What If I Cannot Sign My Name on the Application Form Because Of My Disability? C. How Can I Get Help Applying To Naturalize, Since I Can't Leave My Home To Get Photographed And Fingerprinted? D. When Will I Hear Back From INS About My Application? 3. If I Think I Cannot Pass The English And Civics Tests, How Do I Ask For A Waiver? A. How Do I Prove That I Am Disabled? B. What Mental Impairments Qualify For the Waiver? C. Should My doctor Also Explain That I Am Competent to Take the Oath of Allegiance? D. What if INS Doesn't Accept What My Doctor Says? 4. I Get SSI Because I Am Over 65. I Have Tried but Can't Learn English. Can I get a Waiver? 5. Can I Become A Citizen If I Have A Psychiatric Disability Or If I Have A Conservator? 6. What Accommodations Should I Ask For At The INS Interview? 7. How Can I Get A Home Interview or Home Oath? 8. Can I Take The Oath Of Allegiance If I Have A Disability? 9. What Should I Do If INS Denies my Request For Accommodations At the Interview? 10. What Should I Do If INS Denies My Request for a Disability Waiver? 11. What Should I Do If INS Denies my Application to Be a Citizen? 12. Should I Apply To Naturalize On My Own Or Should I Pay A Lawyer Or A Voluntary, Non-profit Community Agency To Help Me? 13. If I Don't Become a Citizen Before August, 1997, Will My SSI be Cut Off? What Should I Do? ATTACHMENTS * INS Application for Naturalization Form N-400 (4 pages) * Declaration of Witnesses When Someone Makes a Mark as Their Signature * California INS Offices * Additional Resources for Citizenship & Naturalization * "Red Flag Issues" about naturalization * Sample Application for Fee Waiver * INS Questions and Answers about the Disability Waiver; INS Fact sheet about the new Disability Waiver Regulations * Instruction Packet for Doctor preparing Form N-648 Medical Certification * Accommodations Packet * Request to take exam and/or oath at home * Sample letter from doctor, conservator or case worker re: legal competence to take naturalization oath * Example of an INS deferral notice, Form N-148 ----------------------------------------------------------------- 1. WHAT ARE THE BASIC RULES TO BECOME A CITIZEN? You can apply to become a citizen (naturalize) if: * You have been a lawful permanent resident for five years; or * You have been a lawful permanent resident for three years, have been married to one U.S. citizen for three years or more, and continue to be married to that U.S. citizen; or * You are the lawful permanent resident child of United States citizen parents; or * You have served in the military for a certain number of years. You have to be at least age 18 to naturalize. Children under age 18 may automatically become citizens when at least one parent naturalizes. If the child does not qualify automatically, the U.S. citizen parent can apply for citizenship for the child. You also have to be a resident of the state and INS district where you have applied for at least 3 months prior to your naturalization interview. Even if you meet these requirements, you may have problems becoming a citizen if you have been arrested or convicted of a crime, have lived outside of the United States for 6 months or more after you became a lawful permanent resident, do not have "good moral character" for reasons such as non-payment of child support, have been part of a communist organization or if there is any reason for INS to question what you said when you applied to become a legal permanent resident (fraud). None of these factors are absolute, so you must talk to an immigration specialist about what to do. See Attachment 5. 2. HOW DO I APPLY TO BECOME A CITIZEN? You start the process of becoming a citizen by filling out INS Form N-400 and submitting this form to the nearest INS office with three recent photographs, a set of fingerprints and a copy of your alien registration card. (Attachment 1 is a copy of the application; Attachment 3 is a list of California INS offices.) You will also have to pay a $95 application fee when you file your N-400. If you cannot afford to the pay the fee because you are on SSI, you can request a fee waiver; not every INS District has agreed to waive the application fee, but it is still worth asking. (See Attachment 6, a sample request for a fee waiver.) A. I Can't Pass The English And Civics Tests. What Should I Do? To pass the English test, you have to read, write, speak and understand English at about a second grade education level. You can show that you can read and write English by taking and passing a standardized test at a certified INS testing center. Even if you have a certificate, the INS officer will ask you questions in English during your INS interview to see if you can speak English. The U.S. civics questions will be taken from a list of 100 sample questions. There is also a standardized test you can take for this requirement. If you can't pass these tests, you should ask for a waiver of the testing requirements when you file your N-400 naturalization application. If you get a waiver, you can become a citizen without having to pass the tests. There are two waivers - one for seniors and the other for people with disabilities. Look at the next section for an explanation of how get these waivers. One of the questions on the N-400 is whether you can speak, read and write English. If you cannot learn English because of your disability, you should answer this question "no," write down "disability waiver" or "senior waiver"next to it and apply for a waiver of the English test (see below). B. What If I Cannot Sign My Name on the Application Form Because Of My Disability? If you cannot sign your name, make a mark on the signature line, have a witness write your name next to your mark and then write his or her own name as "witness." You must also attach a statement from two witnesses that they saw you make your mark on the application form. (Attachment 2 is a witness form they can fill out.) C. How Can I Get Help Applying To Naturalize, Since I Can't Leave My Home To Get Photographed And Fingerprinted? At present, INS does not help people with their applications. Some community non-profit agencies have portable fingerprinting and photography services for their clients; contact the hotlines listed in Attachment 4. If you cannot find anyone to help you and your disability prevents you from preparing your application, we think that INS should help you with your application. You can file a discrimination complaint against INS based on their refusal to assist you. See Attachment 9 for Section 504 complaint forms. D. When Will I Hear Back From INS About My Application? You should submit a stamped self-addressed envelop and INS will send you back a receipt for your application and/or fee. Four to nine months after you turn in your N-400 application form, you should get a letter from INS with the date of your INS examination interview. (If you have not heard from INS after 6 months, you should visit the INS office and bring a copy of your alien registration card and the notice of action INS sent you as a receipt for your application, so INS can do a computer search for your application.) Next, as we discuss below, you will need to: * Pass the English test and civics tests or apply for a waiver; * Have an interview examination with an INS officer; and * Take the oath of allegiance. 3. IF I THINK I CANNOT PASS THE ENGLISH AND CIVICS TESTS, HOW DO I ASK FOR A WAIVER? You can get a waiver of the tests if you have a physical or developmental disability or a mental impairment that prevents you from passing the English and /or U.S. civics tests. The disability or impairment must be expected to last more than 12 months, and must not be a result of illegal drug use. INS issued final regulations about the disability waiver in March, 1997. The new INS instructions are included in Attachment 7 to this manual. The new rules to get a waiver are better and broader than the standards INS had used before. INS now recognizes that the waiver may be granted based on a "combination of impairments" which, taken on their own, might not be sufficiently severe to qualify for a disability exemption. For example, depression alone might not prevent someone from learning English, but combined with partial hearing loss may make it impossible for someone to learn. The doctor should be sure to explain how the combination of problems affects the applicant. INS has also said that it will grant a waiver if you cannot pass the tests because of the results of treatment you are receiving for an illness or disability, for example, if medication your doctor has prescribed for you makes you too sleepy to concentrate and study. A. How Do I Prove That I Am Disabled? To get a disability waiver, you will need to have your doctor, psychiatrist or clinical psychologist fill out an INS medical certification form, called Form N-648. You do not have to have an INS designated Civil Surgeon fill out the form. (INS got rid of that requirement in March, 1997 when it issued final regulations about the disability waiver.) Your doctor needs to explain that you cannot meet either the English or the U.S. Civics tests. There is a packet of instructions for your doctor in Attachment 8. In addition, INS has prepared a set of "Questions and Answers" about the disability waiver, which are included in Attachment 7. The N-648 must be filed within 6 months of when it is completed and signed. See INS Instructions to Doctors, Attachment 8. Beginning in March, 1997, INS wants everyone to submit their doctor's medical certification on the N-648 form when they first file their citizenship application on the N-400 form. However, it may cause a big delay for many applicants -- particularly those faced with loss of their SSI benefits in August, 1997 -- to get and pay for doctor's appointments to fill out the N-648 before they can even submit their naturalization applications. We think that INS should let you turn in a cover letter with the N-400 saying that you need a disability waiver and will submit the medical certification later, so that your application is not delayed. Once you get your N-648 medical certification, do not mailthe original of the medical certification to the INS separate from the N-400 form or INS will lose it. You can mail a copy to INS and ask that it be put in your file, and then bring the original to the naturalization interview. The most important question on the medical certification form is Question 3, which asks the doctor to explain the connection between the applicant's disability and why he or she can't learn English and memorize the answers to the U.S. Civics questions. Your doctor needs to describe your symptoms and compare them to what is required to pass these tests. We have included examples of answers to this question in our cover letter for doctors in Attachment 8(a). INS describes the test requirements in a five page hand-out for doctors. See Attachment 8(b). Your doctor will also have to explain why she is qualified to diagnose your disability. Your doctor does not have to be a specialist as long as she is familiar with your disability. For example, your doctor can say: "I am a medical professional who has treated people with disabilities. I am familiar with the symptoms of mental retardation (or schizophrenia, etc.)." B. What Mental Impairments Qualify For the Waiver? You can get a waiver if you have a mental impairment that results in psychological abnormalities that can be shown by accepted clinical diagnostic techniques. (These techniques include interviews where the person reports their symptoms as well as testing, etc.) Mental impairments developmental, cognitive and learning disabilities, mental retardation and a wide range of psychiatric conditions. The doctor or psychologist must identify the condition with a diagnostic code from the "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition," known as the DSM IV. Many people who do not have major psychiatric or developmental disabilities may still have a mental impairment which prevents them from learning English. Depression is one example. The DSM IV describes the symptoms of a major depressive episode (DSM IV Code 296.XX) as including fatigue and a "diminished ability to think or concentrate." In combination, these symptoms may prevent the applicant from learning a new language. Another DSM IV category is "amnestic disorders," a category of memory impairments (DSM IV Code 294.0, 296.8 or 296.9) which affect the ability to learn new information and represents a decline in the individual's previous level of functioning. If your doctor is unfamiliar with the DSM IV, contact PAI and ask for our testing packet, which provides some simple clinical tests that a doctor can do to diagnose a mental impairment. C. Should My doctor Also Explain That I Am Competent to Take the Oath of Allegiance? As we discuss below, some people who qualify for the disability waiver may still be denied citizenship because INS thinks they are "too" disabled to take the oath of allegiance. It is a good idea to get a separate letter from your doctor that you are competent to take the oath. The N-648 medical certification form does not ask whether the doctor believes the applicant can take a "meaningful oath of allegiance" despite his or her disabilities. Some INS officers have said that doctors should not address the issue of the oath on the medical certification. However, if you already have an appointment with your doctor, a separate letter from your doctor will be helpful in any later appeal. Attachment 11 is a sample doctor letter about your competence to take the oath. D. What if INS Doesn't Accept What My Doctor Says? If the INS examining officer decides that she or he needs more information about your disability or doesn't believe what your doctor has said about your disability, the INS examiner must first consult with a supervisor. If the supervisor agrees, the INS examiner may contact the doctor or psychologist who signed the certification by telephone for more information. See INS Q&A, Attachment 7, page 4. If the INS examiner is still not satisfied, he or she can ask you to get a second medical certification from a different doctor. The INS examiner must get approval from his supervisor and document a legitimate basis for his or her reasons in the applicant's file. INS examiners are also encouraged to consult with any federal agency which has determined that the applicant has a disability. When these steps have been taken, the applicant will be given a new N-648 form to be completed by a different doctor or psychologist. The INS will not refer applicants to any specific doctor or psychologist for a second certification. 4. I GET SSI BECAUSE I AM OVER 65. I HAVE TRIED BUT CAN'T LEARN ENGLISH. CAN I GET A WAIVER? There is an automatic waiver of the English test for older people. If you are over 55 and have been a lawful permanent resident for 15 years or you are over 50 years old and have been a lawful permanent resident for 20 years or more, you do not have to take the English test. (INS calls these the 50/20 and 55/15 rules.) You will need to provide proof of your age and how long you have been a lawful permanent resident to qualify. You do not need a medical certification to get this waiver, but you will still have to pass the U.S. civics test. There is an easier civics test for applicants who are over age 65 and have been lawful permanent residents for more than 20 years. Many elderly people have mental impairments which are not disabling, in the sense that they continue to function independently in their familiar life activities, but which prevent them from learning English or Civics. For example, elderly immigrants may often experience recurrent depression due to separation from loved ones, poor physical health, etc. As we discussed in the previous section, severe depression is a mental impairment that may make it impossible for someone to learn English. 5. CAN I BECOME A CITIZEN IF I HAVE A PSYCHIATRIC DISABILITY OR IF I HAVE A CONSERVATOR? INS has a rule that you can only become a citizen if you are "legally competent" at the time of your interview. Even if you have been involuntarily committed to a mental hospital or if you have a conservator because you have a psychiatric disability (another term is "mental illness"), you may still be "legally competent" to naturalize. The important question is whether you are able to form the intent to become a citizen now and are doing so voluntarily. Question 13 on the N-400 application form asks: "Have you ever been declared legally incompetent or have you ever been confined in a mental institution?" It is very important to answer this question truthfully. (You will not be denied naturalization if you say yes, but you could be denied if you don't tell the truth.) If you say yes, INS will ask you questions during your interview to see if you are legally competent now. If you were hospitalized at a mental hospital in the past, INS may want proof that you are "better" now. Try to get a letter from your doctor (or your conservator if you have one), explaining that you have not been found to be legally incompetent and have the ability to decide whether you want to be a citizen, even though you were once involuntarily committed. Attachment 11 is a sample letter you can show your doctor or conservator. You can also naturalize even if you still have a conservator, since having a conservator is not the same as being legally incompetent for all purposes. If you have a conservator, you can be competent to naturalize and swear allegiance to the United States. California law is very clear that conservators only have the powers given them by law. For matters which are not expressly covered by the conservatorship, there is a strong presumption in California law that you are still competent to make your own decisions. For example, your conservator may have the authority to decide about your money or where you live. But your conservator cannot decide whether you love the United States and are loyal to our government. Those are preferences and beliefs that you have even if you have a conservator and where you are presumed to be competent to make your own decisions. 6. WHAT ACCOMMODATIONS SHOULD I ASK FOR AT THE INS INTERVIEW? Before you go to your naturalization interview, you need to write to INS and explain what accommodations you will need at your interview, based on your disability. In Attachment 9 we have included two sample request letters. Send a letter to the District Director of your INS district or to the Deputy in charge of Naturalization in your district. You may also want to send a copy to your Congressman. You should send a request letter to INS as soon as you decide what accommodations you will need. Keep a copy for you own files and make one extra copy to bring with you to your actual interview. Accommodations are ways that the interview can be changed from its regular format while still accomplishing what the interview is supposed to accomplish. In the regular INS examination, the applicant goes by himself or herself into a room at a federal office building or off-site processing center. The INS officer asks a series of questions. The purpose of the questions is to find out if everything on the N-400 is true, if there is some other reason that the person should not be a citizen, if the person is legally competent, and finally, if the person loves the United States, believes in our government and wants to be a citizen of the United States and not the country where she or he was born. Some accommodations that you, or other immigrants with disabilities can ask for are: a. having a parent, friend or social worker come into the interview with you as your assistant (and interpreter if you need one). b. having the INS officer tell your assistant the questions he or she wants asked and letting your assistant ask you the questions in front of the INS officer. This may include having your assistant explain to the INS officer what your answers mean, in case you are not verbal and respond by eye-pointing, blinking, or other signals the INS officer may not understand. c. having your assistant confirm under oath that the information on the N-400 application form is correct, if you are not able to remember or explain these facts and your assistant has direct knowledge that they are true. d. asking you questions, or allowing your assistant to ask you questions about your attachment to the United States and our government in a way that you understand. Possible questions could be whether you want to be like others in your family who are citizens, if you love this country, or if you remember the country where you were born and want to go back there to live forever. Attachment 9(c) is an example of interview questions for an applicant with a developmental disability. e. having braille or sign language interpreters available. f. having the INS interview in your home or at a nearby, accessible location, if your doctor provides a letter that this is medically necessary (Attachment 10 is a sample letter from your doctor - you do not need a letter from a Designated Civil Surgeon.) g. allowing you to take a break in the interview before continuing with questioning, or allowing you to swear or make sounds if you have Tourette's syndrome or another, similar psychiatric disability. Although no formal medical certification is required, some INS offices may prefer that the request for special accommodation be accompanied by a letter from the applicant's treating physician stating why the requested accommodation is necessary and how it is related to the applicant's disability). (For example, the San Francisco INS office asks that applicants submit a supporting letter from a doctor.) If the need for the accommodation is obvious, we think that getting a medical letter is burdensome and unnecessary. 7. HOW CAN I GET A HOME INTERVIEW OR HOME OATH CEREMONY? Applicants whose disabilities prevent them from traveling to the INS office may request that they be interviewed at a site away from the INS, like their home or a senior facility. If the INS determines that the applicant has a disability that is serious enough to prevent her from appearing at the INS for her interview, the INS must conduct the interview at a place where the applicant can appear. 8 C.F.R. 334.4. In comments to the disability waiver rules in March, 1997, INS said that "it is the common practice of all Service offices to conduct naturalization interviews and to administer the oath of allegiance outside of the local Service office in instances where the applicant is either home-bound or confined to a medical facility." Final Rule, 8 C.F.R. 312, Federal Register Vol. 62, No. 53, 12919. Attachment 10 has sample request letters for a home interview. Some INS offices regularly send examiners to senior or other care homes to conduct "off-site interviews" at one central site in the community which may be more accessible to some disabled or ill applicants. You should also ask INS to let you take the oath of allegiance at home at the same time as your home interview, assuming you are approved. If your INS office refuses to schedule a home interview or home oath, or if they say you will have to wait much longer than non-disabled applicants, you should file a discrimination complaint (Attachment 9) and call PAI or another legal office for advice. 8. CAN I TAKE THE OATH OF ALLEGIANCE IF I HAVE A DISABILITY? Even if your disability prevents you from passing the English and Civics tests, you will still have to show that you understand and are willing to take the oath of allegiance. The new INS rules are helpful. "[A]n applicant with a disability need not understand every word of the oath at the interview ... INS officers will explain the oath in simplified terms." At a minimum, the applicant will have to show the INS examiner that she understands that she is becoming a U.S. citizen, gives up her allegiance to her former country and is doing so voluntarily. "Officers can accept a wide variety of signals from an applicant, that he/she understands the nature of the oath, including but not limited to a simple head nod, eye blinking, or other signals specific to the individual that clearly mean 'yes' or 'no'." INS Q&A, Attachment 7. Some people with severe disabilities may not be able to communicate, even by blinking. At present, INS will not let a family member, conservator or guardian take the oath as a "proxy" or surrogate" for an applicant. INS Q&A, Attachment 7, Page 8. Even if you cannot communicate, you should apply for naturalization anyway. Some of the proposals in Congress will help people who are trying to naturalize and INS may change its rule about the oath in the future. INS might also make an exception for people who expressed their desire to be a citizen at an earlier time but cannot do so now. For example, people with a progressive disease such as Alzheimer or people with a recent head trauma may have once told family members or others that they wanted to naturalize. Family members can provide evidence of this intent, since the applicant can not communicate now. Since this is not a case where the family member is acting as a "proxy," INS should be asked to permit the oath in these cases. 9. WHAT SHOULD I DO IF INS DENIES MY REQUEST FOR ACCOMMODATIONS AT THE INTERVIEW? What if you ask INS to let a friend or relative help you in the interview and the INS officer refuses? First, ask to speak to a supervisor right away and explain why you need this accommodation. If the INS examining officer still refuses to grant you the accommodation you requested, you can go forward with the interview under protest. You might be able to pass even without the accommodations your requested. If you don't pass, you can appeal. (See next section.) Your first appeal is to an INS adjudications officer, and must be made within 30 days of the written denial. You should also file an administrative complaint against the INS for discrimination based on disability. We have included sample complaint forms in Attachment 9 of this manual. 10. WHAT SHOULD I DO IF INS DENIES MY REQUEST FOR A DISABILITY WAIVER? Although the INS is considering making a separate appeals procedure for denials of requests for disability exceptions, the current procedure is for applicants to follow the regular naturalization appeals process. This process is set out in the INS regulations, 8 C.F.R. 335.3(b), 336.1, 336.2, 336.9. 1) An applicant whose request for an exception is denied may choose to be tested on English and U.S. history and government, or may instead appeal the denial. 2) If the applicant chooses to take, and fails the English and civics test, she may be automatically rescheduled for a second interview. 3) If the applicant fails the test in her second interview, she will be notified that the INS plans to deny her application, and will be instructed about how to file an appeal. 4) An applicant can appeal the denial by requesting, within 30 days, a hearing on the denial (a new interview) with a different officer. The new interview will be held within 180 days of the date the appeal is filed. 5) If the denial is upheld, the applicant can appeal the decision to federal district court, which will re-hear the applicant's case. An applicant can always submit a new application for naturalization. However, the applicant will have to wait the standard waiting time for an interview, except in emergency cases. 11. WHAT SHOULD I DO IF INS DENIES MY APPLICATION TO BE A CITIZEN? First make sure that your application is actually being denied. Sometimes INS will just "defer" or continue your application until you get the right medical certification to qualify for a disability waiver. (Attachment 12 is an example of a deferral notice.) INS also says that it will hold or defer applications from people whom it thinks cannot take the oath. INS Q&A, Attachment 7, page 8. If INS does not approve or deny your application within 120 days of your interview, you can treat this as a denial and appeal. If you have actually been denied or have waited more than 120 days after your interview, you should get legal help right away. Many legal groups are willing to help. Because most immigrants with disabilities have not tried to naturalize before, many of these questions are new. INS may not agree with some of the answers or suggestions in this manual. You can call Protection and Advocacy at 1 (800) 776-5746 for help or to have us explain things in this manual that you may not understand. 12. SHOULD I APPLY TO NATURALIZE ON MY OWN OR SHOULD I PAY A LAWYER OR A VOLUNTARY, NON-PROFIT COMMUNITY AGENCY TO HELP ME? Many people do not need to hire a lawyer to help them naturalize. But you should talk to a lawyer if you have been arrested or convicted of a crime, have lived outside of the United States after you became a lawful permanent resident, have not paid child support, have been part of a communist organization and where there may be questions of fraud when you applied to be a legal permanent resident. A list of these "Red Flag" issues is in Attachment 5. There is a big network of voluntary, non-profit agencies which assist with naturalization for a small fee (usually under $100). You can get the names of agencies in your area by calling the hotline/information numbers listed in Attachment 4. Many of the voluntary agencies are certified as outreach sites, which means that INS examining officers will come out to the agency's office for the examination interview. (This is often less frightening than having to go to a federal office building for your interview.) However, most of these groups are set up to work with masses of people in large classes. Some have never worked with immigrants with disabilities and cannot offer the individual assistance these immigrants will need. If you decide to work with a voluntary agency, ask them in advance if they have experience with immigrants with disabilities and if they have ever applied for disability waivers. If they have not, try another agency. You can also file for naturalization with the help of a case worker, friend or family member. File your Form N-400 at the nearest INS office and ask the person who is assisting you to come to the interview with you. 13. IF I DON'T BECOME A CITIZEN BEFORE AUGUST, 1997, WILL MY SSI BE CUT OFF? WHAT SHOULD I DO? The new Welfare Reform law says that you will be cut off SSI by August, 1997 unless you are a citizen or fit into one of the exceptions for immigrants who will be able to stay on SSI. If you have applied to naturalize but haven't yet gotten your certificate of citizenship, Social Security will still send you a cut off notice in June or July of 1997. If you are not yet a citizen when you get your SSI cut-off notice, FILE AN APPEAL WITH SOCIAL SECURITY WITHIN 10 DAYS and your SSI benefits will continue, at least through the first stage of your appeal, called reconsideration. (Social Security gives you an extra 5 days for mailing the notice, so you have 15 days from the date on the cut-off notice.) Ask us to send you our handout, called "SSI Appeals for Non-Citizens," which explains how to appeal. You can also ask us to send you our "SSI Advocate's Reference Packet for Non-Citizens," which has more details about SSI appeals, the exceptions and what you can do. Finally, you can ask INS to speed up, or "expedite" your naturalization application. INS has said that they will only do this for people who have a serious illness or other life-threatening problems, and not for people who are losing their SSI. We think that losing your SSI can be life-threatening if you will be evicted, won't be able to eat, etc., and that applicants should go ahead and ask for "expedited adjudication" based on their individual situation. ----------------------------------------------------------------- ATTACHMENTS 1. INS Application for Naturalization Form N-400 and instructions (7 pages) 2. Declaration of Witnesses When Someone Makes a Mark as Their Signature (Witness statement) (1 page) 3. California INS Offices (List of INS offices in California) (1 page) 4. Additional Resources for Citizenship & Naturalization (hotline/information numbers) (2 pages) 5. "Red Flag Issues" about naturalization (6 pages) 6. Sample Application for Fee Waiver (1 page). 7. INS Questions and Answers about the Disability Waiver; INS Fact sheet about the new Disability Waiver Regulations (14 pages) 8. Instruction Packet for Doctor preparing Form N-648 Medical Certification ( a) Cover Letter to doctor (6 pages) (b) Disability Waiver Evaluation Battery (Supplemental Information for Doctors and Psychologists and INS Instructions for Form N-648 Medical Certification) (1) Physician/Psychologist Form (2 pages) (2) Applicant Questionnaire (2 pages) (3) Cognitive Test (2 pages) (c) Form N-648 Medical Certification (2 pages) 9. Accommodations Packet (a) Form letter for applicant to fill in to ask for accommodations at the INS interview (1 page) (b) Sample letter from advocate to ask for accommodations at INS interview (2 pages) (c) Sample questions for INS interview with an applicant with Developmental Disabilities(2 pages) (d) Sample Discrimination complaint for Violation of Section 504 by denying requested accommodations (4 pages) 10. Request to take exam and/or oath at home (a) Form applicant letter asking to take citizenship exam and/or oath at home (1 page) (b) Form physician statement affirming applicant's need to take citizenship exam and/or oath at home (1 page) 11. Sample letter from doctor, conservator or case worker re: legal competence to take naturalization oath (1 page) 12. Example of an INS deferral notice, Form N-148 (1 page) ----------------------------------------------------------------- Attachment 1: INS Form N-400 - Application for Naturalization and Instructions (7 pages) Form N-400 is available from the INS, or call PAI at 1-800-776-5746 or legal@pai-ca.org ----------------------------------------------------------------- Attachment 2: Witness Statement When Some Makes A Mark DECLARATION OF WITNESSES WHEN SOMEONE MAKES A MARK AS THEIR SIGNATURE INSTRUCTIONS TO WITNESSES: California Code of Civil Procedure 17 provides that "signature or subscription includes mark, when the person cannot write, his name being written near it by a person who writes his own name as a witness; provided, that when a signature is by mark it must, in order that the same may be acknowledged or may serve as the signature to any sworn statement, be witnessed by two persons who must subscribe their own names as witness thereto." If a person makes their mark on a document, one witness must write the person's name on the document next to the mark and then write his or her own name with the word "witness" next to it. Then this witness and a second witness must both sign this form and attach it to the document. PROOF OF SUBSCRIBING WITNESS # 1 I witnessed (name of applicant) ________________________ make his mark on the following document:____________________________________________, which is attached to this declaration. I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on (date): ____________________________ at (place): ______________________________, California. Type or print witness' name and address:_______________________________________ (Signature of witness) _____________________________________ _____________________________________ PROOF OF SUBSCRIBING WITNESS # 2 I witnessed (name of applicant) ________________________ make his mark on the following document:____________________________________________, which is attached to this declaration. I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on (date): ___________________________ at (place): ______________________________, California. Type or print witness' name and address:_______________________________________ (Signature of witness) _____________________________________ _____________________________________ ----------------------------------------------------------------- Attachment 3: List of INS offices in California (1 page) California INS Offices Los Angeles District Office, District Director: Richard K. Rogers, District Director (Acting): Donald B. Looney, 300 North Los Angeles St., Los Angeles, CA 90012, 8:00 A to 4:30 P (Mon-Fri), Phone: 213/894-2780 San Diego District Office, District Director: James B. Turnage, Jr., Deputy District Director: Clifton J. Rogers, 880 Front Street, Ste. 1234, San Diego, CA 92188, 8:00 A to 4:30 P (Mon-Fri), Phone: 619/557-5645 San Francisco District Office, District Director: Charles Demore, Deputy District Director: Phillip L. Waters, 630 Sansome Street, San Francisco, CA 94111-2280, 7:45 A to 4:15 P, Phone: 415/705-3102 Fresno Sub-Office, Officer in Charge: Don Riding, 865 Fulton Mall, Fresno, CA 93721-2816, 7:00 A - 4:30 P, Phone: 209/487-5132 Sacramento Sub-Office, Officer in Charge: Lionel Nurse, 711 "J" Street, Sacramento, CA 95814, 8:00 A - 3:30 P, Phone: 916/498-6480 San Jose Sub-Office, Officer in Charge: (open), 280 S. First Street Rm. 1150, San Jose, CA 95113, 7:30 A - 4:30 P, Phone: 408/535-5191 ----------------------------------------------------------------- Attachment 4: Additional Resources for Citizenship & Naturalization (hotline/information numbers) (2 pages) Call PAI at 1-800-776-5746 for a copy of this list, or legal@pai-ca.org ----------------------------------------------------------------- Attachment 5: "Red Flag Issues" re: Naturalization In English, Spanish, Chinese (6 pages) Call PAI at 1-800-776-5746 for a copy in the language you need, or legal@pai-ca.org ----------------------------------------------------------------- Attachment 6: Sample Application for Fee Waiver (1 page) Application available from INS, or call PAI at 1-800-776-5746, or legal@pai-ca.org. ----------------------------------------------------------------- Attachment 7 (14 pages): INS Questions and Answers about the Disability Waiver, INS Fact sheet about the new Disability Waiver Regulations Call PAI at 1-800-776-5746, or legal@pai-ca.org to find out how to get a copy. ----------------------------------------------------------------- Attachment 8(a): Instructions to Doctors for Disability Waiver Preparing Form N-648 Medical Certification (6 pages, plus 6-page Disability Waiver Evaluation Battery) Attachment 8(b)(6 pages) INS Supplemental Information for Doctors and Psychologists INS Instructions for Form N-648 Medical Certification Attachment 8(c) Form N-648 Medical Certification (2 pages) ----------------------------------------------------------------- Attachment 9(a) (1 page) Applicant's Request for Accommodations at INS interview (applicant may fill in blanks and send in)TO: District Director, Immigration and Naturalization Service Address: ________________________________________________________________ ________________________________________________________________ From: ________________________________________________________________ (Print Applicant's name) Address ________________________________________________________________ ________________________________________________________________ Telephone number: ______________________________________ Alien Registration Number: _____________________________ Re: ACCOMMODATIONS FOR MY DISABILITY AT MY INS NATURALIZATION INTERVIEW SCHEDULED FOR __________________ I have the following disability: _________________________________________________ (Circle one:) I am / am not requesting a waiver of the testing requirements based on my disability. Because of my disability, it is hard for me to: _____________________________________ _________________________________________________________________ ____________ Please make the following accommodations for me at my INS interview: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _____________ Signature: ____________________________________ Date: __________________ ----------------------------------------------------------------- Attachment 9(b) Sample letter from advocate to ask for accommodations at INS interview ( 2 Pages){Date} Section Chief, Citizenship Immigration and Naturalization Service {Local District Office} Re: Applicant's Name, Alien Registration Number Dear , I am representing _________________________ concerning his application for naturalization. I will be accompanying him to his naturalization interview on , 1997. I will submit a G-28 form at that time. My client, _________________________, has a developmental disability. Because of his disability, he is very shy and has difficulty dealing with strangers. As a result, he may not respond to questions from a strange federal official and will pretend that he does not understand or hear the questions asked of him. He will not understand questions framed in an abstract manner, but does understand concrete issues, such as whether he wishes to remain in the United States or return to his country of birth. Although he has a low IQ due to his developmental disability, he is aware, responsive and has significant skills. In fact, he works for a company. Section 504 of the Rehabilitation Act requires all federal agencies to make appropriate accommodations to persons with disabilities in order that they may benefit from the programs and services offered. I request the following accommodations for my client in his interview: 1. I request that I be allowed ask my client the questions that the examining officer wishes to have asked. After the examiner asks his or her questions, I will re-phrase them and pose them to my client directly. 2. I request that my client be asked questions in a manner which accommodates his disability. It is not appropriate to ask if he knows what it means to be a citizen or if he knows why he is here. It is appropriate to ask him if he wants to remain in the United States, if he wants to go back to [his country of birth] forever, or if he will do anything to hurt this country. I will be glad to discuss additional questions with the examining officer at the time of the interview. 3. If my client is unable to respond to my questions during the INS interview because he is too frightened or shy, I request that his father, __________, be allowed to testify regarding my client's status and intentions. Mr. ______ has cared for his son since birth and can testify from first hand knowledge regarding the accuracy of the information on the N-400, the existence of any bars to naturalization and statements regarding his son's desire to be a citizen. Thank you for your assistance in this matter. I look forward to our interview tomorrow morning. Sincerely, {Advocate} CC: [Clients] District Director, INS District ----------------------------------------------------------------- Attachment 9(c) Sample Questions for an INS Interview with an Applicant with Developmental Disabilities(2 pages) INS: How old are you? Client: [silent] Advocate: Please ask him yes and no questions only. Advocate: [To client]: Are you 20 years old? Client: No. Advocate: Are you 37 years old? Client: Yes. INS: Do you know what it means to tell the truth? Client: No Advocate: Are you a liar? Client: No. Advocate: Would you tell a lie here? Client: No. INS: What is your address? Client: [Silent] Advocate: Do you live with your parents? Client: Yes. Advocate: His parents' address is _______ INS: What is your telephone number? Client: [silent] Advocate: His parent's number is _____. INS: Do you know what it means to be a citizen? Client: [silent] Advocate: Do you want to be a citizen like your Mom and Dad? Client: Yes. Advocate: Do you want to go back to [county of birth] to live? Client: No Advocate: Do you want to keep living here with your Mom and Dad? Client: Yes. INS: [re: duty to bear arms] Do you know what a war is? Client: No INS: If there was a war, would you fight for America? Client: [silent] Advocate: If your Dad told you to help America, would you do it? Client: Yes Advocate: Would you do anything to hurt America? Client: No. The INS officer also asked some appropriate questions, as follows: INS [re existence of criminal arrests]: Do you know what a police man is? Client: Yes INS: Have you ever met a police man in person? Client: No INS: Are you a bad person? Client: No. ----------------------------------------------------------------- Attachment 9(d) (4 pages) - Sample Discrimination complaint for Violation of Section 504 SECTION 504 COMPLAINT AGAINST THE IMMIGRATION AND NATURALIZATION SERVICE FOR DISCRIMINATION ON THE BASIS OF DISABILITY OR FOR FAILURE TO ACCOMMODATE TO DISABILITY NEEDS Federal agencies including the Immigration and Naturalization Service (the "INS") are subject to Section 504 of the Rehabilitation Act, 29 U.S.C. 794. (The American with Disabilities Act does not apply to the federal government.) Section 504 says that federal agencies cannot discriminate against persons with disabilities. One form of discrimination is the denial of reasonable accommodations that would enable persons with disabilities to participate in a program, service or process. Since the INS is a federal agency, Section 504 requires that it provides reasonable accommodations to the disability needs of people applying for naturalization. For example Section 504 requires the INS to be accessible to persons who use wheelchairs and walkers, who are blind, deaf or homebound. Section 504 also requires the INS to be accessible to persons with mental or cognitive impairments. This means that when persons have difficulties getting through the naturalization process due to their cognitive or mental impairments, they INS should provide them with the reasonable accommodations they request. If you believe you have been treated unfairly because of your disability, you have a right to file a Section 504 Civil Rights complaint. Unfair treatment that may violate Section 504 of the Rehabilitation Act includes: * Not providing you with the extra time you need to complete the English, history and civic exams or taking the oath of allegiance. * You need a sign language interpreter for your meeting with the INS and the INS will not provide an interpreter. * You cannot get to the INS office for the interview or oath ceremony and the INS will not come to your home or conduct the interview by telephone. * You go to the INS office for help in understanding a notice you received but you are treated rudely or impatiently when you ask for help even though the INS knows that you have the kind of disability that may interfere with your ability to cooperate or understand. * The INS does not take into consideration your disability limitations and your petition for a waiver when deciding whether or not you should take the naturalization tests. * It is difficult for you to express yourself or it is difficult to understand you, but the INS does not take the time to understand what you are trying to say. * The INS will not provide the naturalization examination at a time and place that is convenient for you and the INS knows that a special time is needed do to your disability. * You request that a family member advocate or social worker be with you at the time of the INS interview or examination and the INS does not allow it. HOW TO FILL OUT THE SECTION 504 COMPLAINT FORM * If you do not have a permanent address, you should use someone else's address. After address write "c/o" or "in care of" and then the other person's name and address. * On the "disability" question, you can identify your disability or impairment either by stating the type of disability or by describing how the disability affects you, or both. For instance, you could write in "mental retardation" or "mental retardation which makes it difficult for me to be in a room with strange people without having someone I know be with me." Or you could write in "spinal cord injury" or "paralysis which makes it difficult for me to write." * On the question, "when did the discrimination happen," that is usually the date (month and year) you were treated unfairly, and the location where it happened. For example, this could be the date of the interview when you were denied a reasonable accommodation or a waiver. * On the question, "what happened?," explain why you believe you were treated unfairly because of your disability or impairment. You are not limited to the space provided. Feel free to include additional pages to better explain the incident. Important: The Section 504 complaint is to be filed in addition to regular appeals or a request for waivers. That is, the Section 504 complaint is not be filed as substitute to an appeal or an examination waivers. It is very important that you file a request for waivers and request an appeal to any denial immediately. WHERE TO MAIL THE SECTION 504 COMPLAINT Mail your Section 504 complaint to the District Director of the local office of the Immigration and Naturalization Service. [In San Francisco, mail a copy to Terry Rice, Citizenship Branch, U.S. Immigration and Naturalization Service, 630 Sansome St, SF (415-705-3509).] Mail a second copy to Robert Bach, Executive Associate Commissioner, Immigration and Naturalization Service, 425 "I" Street NW, Room 7100, Washington D.C. 20536. Keep a copy of your Complaint and write on your copy the date you put it in the mail. You should follow up if you do not get something in the mail from the INS within four to six weeks. The telephone number for the citizenship branch is (415) 705-3509. Explain that you filed a Section 504 civil rights complaint against the INS so that you are directed to the right person. ----------------------------------------------------------------- Attachment 9(d) - 504 Discrimination Complaint COMPLAINT AGAINST THE IMMIGRATION AND NATURALIZATION SERVICE FOR VIOLATION OF SECTION 504 BECAUSE OF DISCRIMINATION ON THE BASIS OF DISABILITY Mail To: _________________________________________________________ District Director, INS District Office Robert Bach, Executive Associate Commissioner, Immigration and Naturalization Service, 425 "I" Street NW, Room 7100, Washington D.C. 20536. Complainant: _____________________________________________________________ (This is the name of the person who was subjected to the discrimination) Alien Registration No._______________________________________________ Address__________________________________________________________ __ _________________________________________________________________ _ Day Phone_________________________________________________________ Evening or Message Phone____________________________________________ Respondent: (This is the INS or the Person who you believed committed the discrimination) _________________________________________________________________ _________________________________________________________________ ______________ Is the Complaint being sent by someone other than the person who was subjected to discrimination? If yes, please fill in below: Name_____________________________________________________________ Relationship_____________________________________________________ ___ Address__________________________________________________________ __ _________________________________________________________________ _ Day Phone_________________________________________________________ Evening or Message Phone____________________________________________ Disability: ______________________________________________________________ _________________________________________________________________ _______ _________________________________________________________________ _______ _________________________________________________________________ _______ _________________________________________________________________ _______ When did the discrimination happen? ________________________________________ _________________________________________________________________ _______ _________________________________________________________________ _______ _________________________________________________________________ _______ _________________________________________________________________ _______ _________________________________________________________________ _______ _________________________________________________________________ _______ What happened? _________________________________________________________ _________________________________________________________________ _______ _________________________________________________________________ _______ _________________________________________________________________ _______ _________________________________________________________________ _______ _________________________________________________________________ _______ _________________________________________________________________ _______ I swear under penalty of perjury that the foregoing is true and correct. Executed __________________ (date) in ________________________ (city), California. Signature______________________________________ ----------------------------------------------------------------- Attachment 10(a): Sample Applicant letter - Request for home exam/oath APPLICANT LETTER Example of letter used by applicant for U.S. Citizenship requesting administration of exam and/or oath at home DATE To: Immigration and Naturalization Service Dear Sir: Due to my medical condition, as documented in the attached statement from my physician, I am requesting that the naturalization process)es) checked below be carried out at my residence rather than at the usual location. _____ Citizenship Exam _____ Oath of Citizenship My residence address is: If you wish to contact me, I can be reached during the day at the following telephone number: Sincerely, (Applicant's signature) PRINTED NAME OF APPLICANT The statement prepared by the applicant's physician needs to accompany this letter. ----------------------------------------------------------------- Attachment 10(b): Physician Statement - Request for home exam/oath PHYSICIAN STATEMENT Example of statement used by naturalization applicant's physician affirming applicant's need to take citizenship exam and/or oath at home DATE To: Immigration and Naturalization Service RE: (Name of patient/applicant for naturalization) I am the attending physician for the above-named patient, who I understand is currently applying for U.S. citizenship. I am writing to affirm all of the following with regard to this patient: I have diagnosed the patient has having (INDICATE DIAGNOSED CONDITION). As a result of this condition the patient is unable to (DESCRIBE LIMITATIONS). Because of these limitations, the patient is unable to participate in (INDICATE THE CITIZENSHIP EXAM AND/OR OATH OF CITIZENSHIP) at the usual location(s), and needs to be permitted to carry out these activities at his/her residence. If you wish to contact me, my telephone number is: Yours truly, NAME OF ATTENDING PHYSICIAN This statement needs to accompany the letter sent to INS by the applicant. ----------------------------------------------------------------- Attachment 11: Sample letter re: legal competence/capacity to take an oath (1 page) INSTRUCTIONS TO DOCTOR, CONSERVATOR OR CASE WORKER: please re-type this letter on your own stationary, adding facts about the person applying for naturalization and give the letter to the applicant to take to his or her INS interview. SAMPLE LETTER RE: LEGAL COMPETENCY AND CAPACITY TO TAKE NATURALIZATION OATH TO: Immigration and Naturalization Service Date: ________________________ Re: ________________________________________ (Name of applicant for naturalization) Alien registration number: ________________________________ This letter is to inform you about ____________________, his legal competence and his capacity to take an oath of allegiance. ______________________ has been my client/patient/conservatee since _______. He has been diagnosed with ________. Despite this disability, ________ is capable of expressing his desires and preferences. He can interact in a social setting, and he has many self care skills. He is capable of forming loyalties and expressing a preference about his citizenship. He expresses love for this country and a desire to become part of the community. To summarize, our records show that _____ has a significant disability and mental impairment severe enough that he is not capable of taking tests in English literacy, U.S. history and government, but he is capable of taking and understanding an oath of allegiance. If applicable: ____ was involuntarily committed to a ________ institution in ____. However, ______ is no longer subject to involuntary commitment proceedings. In addition, _________ has never been declared legally incompetent. [Either: He has a conservator who is authorized to make decisions regarding his [estate; the provision of food, clothing and clothing; or list areas of limited conservatorship] [or] He has a representative payee who handles his SSI payments, but he manages other aspects of his own affairs. Respectfully, ________________________________________________ Doctor/Conservator/case worker NOTE: Having a conservator is not the same as being legally incompetent. Even if an individual has a conservator, he or she can be competent to naturalize and swear allegiance to the United States. California law is very clear that conservators only have the powers given them by law. For matters which are not expressly covered by the conservatorship, there is a strong presumption in California law that the individual is still competent to make his or her own decisions. ----------------------------------------------------------------- Attachment 12: INS deferral notice Please call PAI at 1-800-776-5746 if you need a copy of Attachment 12. ---------- Protection & Advocacy, Inc. LOS ANGELES LEGAL OFFICE, 3580 Wilshire Boulevard, Suite 902, Los Angeles, CA 90010-2512, Telephone: (213) 427-8747, Fax: (213) 427-8767, Toll Free/TTY/TDD: (800) 776-5746, legal@pai-ca.org ----------------------------------------------------------------- Instructions to Doctors Re: Completing the N-648 Medical Certification for INS Disability Waivers for Applicants Seeking Naturalization (revised, June 11, 1997) Dear Doctor, Thank you for your time and cooperation in helping your patient with a naturalization application. Your patient has asked for your help in getting a disability waiver. Generally, applicants for citizenship must be able to read, write and speak English, and have knowledge of U.S. history and civics. However, an applicant who qualifies for a "disability waiver" is exempt from one or both of these requirements. Who is Eligible for a Disability Waiver 1. An applicant for a disability waiver must have a medically determinable physical or developmental disability, or mental impairment, that causes the applicant to be unable to learn English and/or U.S. history and civics. 2. The disability must be expected to last at least 12 months. 3. The disability must not be the result of illegal drug use. The Doctor's Role in the Application Process When deciding whether the disability waiver should be granted, the Immigration and Naturalization Service (INS) relies on the medical opinion of the applicant's doctor, who must be a medical doctor or clinical psychologist licensed in the U.S. The doctor provides this medical opinion completing INS Form N-648 (Medical Certifications for Disability Exceptions). Attached are specific instructions for completing each section of the N-648. Diagnosing Mental Impairments Some patients may have mental impairments, such as depression or dementia, which are not the presenting diagnosis, but may nonetheless make it impossible to learn English. Attached is a "Cognitive Disability Battery" with an interview checklist and simple testing protocol you can be use to support a diagnosis of a mental impairment. This testing battery is for your use as a doctor; you should keep it in your patient's chart to support your diagnosis. Do not send it to INS. Since INS requires a DSM IV code number, references for common diagnoses are listed at page 5. HOW TO COMPLETE THE N-648 MEDICAL CERTIFICATION FORM * Print or type your answers on the form or attach a separate answer sheet. INS officials say they cannot read handwriting and will reject medical certifications if they are not legible. If you attach a separate document, you must still sign the certification form and write in the space after each question: "See attached letter." * You do not have to, and should not, seal the envelope containing the completed medical certification. The applicant has a right to review the completed medical certification form. Sealing the envelope was required for Civil Surgeon opinions regarding visa adjustment. It is not required for naturalization applications. * Illegal use of drugs - Question 4. If, in response to Question 4, you believe that the disability may be the result of the illegal use of drugs (or you are not sure whether drugs are involved), DO NOT COMPLETE THE FORM. If any information regarding illegal drug use is disclosed to INS, your patient may face deportation. * Meaningful oath requirement. The INS is requiring that all applicants for naturalization have the ability to take a meaningful oath of allegiance to the U.S. If you believe that the applicant can understand the oath, even though she cannot learn English, mention this on Form N-648. If you are uncertain, do not mention the applicant's competence or ability to take the oath, as this is not required on Form N-648. * Your qualifications - Question 6. You do not have to be a specialist, as long as you are familiar with the causes and symptoms associated with your patient's disability. This experience may come from treating other patients or from medical training. * Truthfulness of certification. The doctor signs Form N-648 under penalty of perjury. This certification under penalty of perjury is no different from the truthfulness standard required for signing other government forms and insurance claim statements. Note that as long as you do not knowingly provide false information to the INS, you cannot be subjected to any civil penalties or liabilities. If the INS officer needs more information, she may contact the certifying doctor for supporting documentation. Since INS examiners have no medical experience, they may ask you to explain the basis for your diagnosis. If INS questions you, please explain that clinical evidence may include statements from the patient and her family about the her mental state. (See, for example, the attached interview checklist and applicant questionnaire.) Note: In Part 1 of Form N-648, the applicant has agreed to release her medical records for purposes of the naturalization application. * Describe your patient's symptoms - Question 3. This is the most important part of the form. Your answer must have these three parts (the three "C"s): (A) The nature and origin of your patient's disability or illness (CAUSE); (B) The specific symptoms associated with the disability or illness which make it impossible for him to learn English and/or U.S. history and civics (CONNECTION); and (C) Your conclusion that the applicant cannot learn English and/or cannot learn U.S. history and civics (CONSEQUENCE). * In answering Question 3, the following symptoms are relevant to the CONNECTION between the disability and learning English and/or U.S. history and civics: Memory impairment: inability to learn new information or to recall previously learned information; Disturbance in executive functioning, which involves planning, organizing, sequencing and abstracting; Difficulties with concentration and focus; Delirium, disorientation, confusion, agitation; Difficulty in expressing herself or in understanding what is said to her (expressive/receptive communication disorders); Painful or medically fragile conditions that impair concentration and prevent your patient from leaving home to attend English and/or U.S. history and civics classes; Fatigue, loss of energy or a sense of hopelessness (often associated with depression), which impairs concentration and prevents your patient from leaving home to attend English and/or U.S. history and civics classes; Paranoia, hostility, anxiety and/or delusions which prevent your patient from expressing what she knows or has learned; Unpredictable behavior in response to stress and anxiety (which may be a result of post-traumatic stress disorder or other anxiety disorders) so that your patient cannot perform in a testing, classroom or interview/interrogation setting; Low intellectual functioning and/or learning disabilities that affect reading and writing ability. DEVELOPMENTAL DISABILITIES * In answer to Question 4 on the medical certification, developmental disabilities must be manifested before age 22. If you did not treat the patient prior to age 22, explain how you know that this requirement is met, for example, you can explain that (a) this is a condition (such as cerebral palsy) which only occurs at birth, (b) you have reviewed medical records from when your patient was under age 22, or (c) family members reported the existence of clinical symptoms indicating developmental delays prior to age 22 -- such as learning difficulties, placement in special education, or eligibility for regional center services. * For regional center doctors, it is preferable to schedule an appointment to examine the applicant before completing Form N-648. If this is impossible, in response to Question 1, which asks the date of the last examination, indicate the date you reviewed the regional center medical records. On a separate sheet, explain that the nature and severity of the of the developmental disability is so clear and well-documented that a physical examination is unnecessary. PHYSICAL DISABILITIES * Because physical illness or disability alone will not prevent your patient from learning English and/or U.S. history and civics, you must identify those symptoms associated with the condition which do affect his ability to pass the tests. For example, illness may be accompanied by pain, fatigue or nausea, which prevent him from attending classes and studying, and which impair concentration. * Medication or treatment for a condition may affect vision, cause drowsiness or nausea, or have other side effects that prevent your patient from the physical act of attending classes and studying. * Patients who are deaf may be able to learn English and U.S. history and civics through written materials. The answer to Question 3 must explain why this is not possible for your patient. For example, if he is illiterate in his own language, or if there are no learning materials available in his language, then he cannot learn English and U.S. history and civics if he is deaf. Similarly, you must explain why a patient who is blind cannot learn English through audiotapes -- if, for example, there are no audiotapes available in his primary language, then he cannot learn English and U.S. history and civics if he is blind. * Illness and physical disability may also be accompanied by mental impairments as discussed below. MENTAL IMPAIRMENTS * If your patient already has a diagnosis of a psychiatric disability, such as schizophrenia or bi-polar illness, your medical certification needs to list his symptoms. Many of those symptoms will already be documented in his medical records. * If you are a general practitioner, the mental disorder may be secondary and may not be the reason your patient initially came to you for treatment. You do not have to refer your patient to a psychiatrist or clinical psychologist to complete Form N-648 regarding a mental impairment. (As we discuss below, you may want to refer your patient for follow-up treatment, but a referral only for the INS medical certification is unnecessary and expensive.) INS requires that the mental disorder be "medically determinable." "Medically determinable" is defined as resulting from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. Clinical techniques include interviewing the patient and/or her family to identify symptoms. The attached "Cognitive Disability Battery" will provide clinical evidence of a mental impairment for purposes of the INS medical certification. However, since INS does not want copies of any medical records or test results, keep the completed testing battery in your patient's chart; do not send it to INS as an attachment to the medical certification. * Follow-up on a diagnosis of a mental disorder. If you are not a mental health professional, and you identify a mental disorder that could be alleviated through treatment, you may refer your patient for follow-up treatment. Resources include the county mental health clinics and some nonprofit community centers. * Examples of DSM IV diagnostic codes. These codes might be relevant for elderly immigrant patients not previously diagnosed with a mental disorder: 293.0 Delirium due to (general medical condition) 780.09 Delirium, Not Elsewhere Specified (NOS) 290.10 Dementia of Alzheimer Type, uncomplicated 290.40 Vascular Dementia, uncomplicated 294.1 Dementia due to (general medical condition, can include MS, etc.) 295.8 Dementia NOS 294.0 Amnestic Disorder due to (general medical condition) 205.8 Amnestic Disorder NOS 296.30 Major depressive disorder, recurrent, unspecified severity 300.4 Dysthymic disorder 309.81 Post-traumatic stress disorder 300.02 Generalized anxiety disorder 300.00 Anxiety disorder NOS 309.0 Adjustment reaction with depressed mood Examples of Answers to Question 3 INS Form N-648 Medical Certifications PHYSICAL DISABILITY CAUSE: Mrs. A. has congestive heart failure, atherosclerosis and high blood pressure. These conditions were diagnosed approximately three years ago. CONNECTION: As a result of these conditions, Mrs. A. has symptoms of extreme fatigue, recurrent pneumonia and debilitating headaches. As a result of her fatigue, frequent illness and headaches, she cannot attend English language or U.S. history and civics classes, and does not have the stamina to study on her own. Moreover, her fatigue and headaches make it impossible for her to concentrate enough to learn a new language or to memorize new information. CONSEQUENCE: Mrs. A. is unable to pass the written or spoken English tests or the U.S. history and civics test in order to naturalize. MENTAL IMPAIRMENT - VASCULAR DEMENTIA CAUSE: Mr. B. has vascular dementia secondary to arterial hypertension and heart disease, DSM IV 290.40. He was diagnosed in this office four years ago. CONNECTION: Symptoms of his dementia include memory impairment (an impaired ability to learn new information or recall previously learned information), and cognitive disturbances, including an impairment of executive functioning, planning, sequencing, organizing and abstracting information. As a result of these symptoms, Mr. B. does not have the ability to learn a new language or to recall what he may have learned in the past. CONSEQUENCE: Mr. B. is unable to pass the written or spoken English tests or the U.S. history and civics test in order to naturalize. MENTAL IMPAIRMENT - DEPRESSION/ BLINDNESS CAUSE: Ms. C. is blind and also has severe, recurrent depressive episodes with psychotic features, DSM IV 296.34. CONNECTION: Ms. C.'s symptoms include fatigue, inability to concentrate and a sense of hopelessness. She also has delusions that her children are stealing from her. Her depression and delusions result in functional disability so that she is unable to leave her home due to fatigue and fear. As a result, she cannot attend classes to learn English or U.S. history and civics. She cannot initiate new tasks, such as studying from audio tapes. Her psychological symptoms also make it impossible for her to overcome the disability posed by her blindness. CONSEQUENCE: As a result of the combination of her blindness and depression, Mrs. C. is unable to pass the written or spoken English tests or the U.S. history and civics test in order to naturalize. If you have more questions about completing the medical certification Form N-648, you or your patient can call PAI at 1-800-776-5746 and ask for an intake appointment. ----------------------------------------------------------------- Cognitive Disability Battery Physician Checklist (c) David D. Fox, Ph.D. 1997 The Human Factors Groups (213) 938-7815 ----------------------------------------------------------------- Applicant's Name: _________________________________ Age: _________ Sex: _________ Physician's name: ____________________________________ Today's date: _____________ Name of translator: ___________________________ Relationship to applicant: __________ Instructions: 1. Please review the Applicant Questionnaire completed by your patient and clarify any problem areas. 2. Complete the checklist below based on your observations and the material gathered in the Applicant Questionnaire. 3. Administer the Cognitive Test on the following pages. 4. Classify the degree of cognitive impairment indicated at the bottom of this page. Checklist Check which cognitive symptoms you have observed in the patient/applicant or you believe the patient has based on their questionnaire: ___ disorientation to time, place, person ___ confusion ___ inability to carry out actions ___ expressive or receptive language problems (other than English deficiencies) ___ dressed inappropriately for weather ___ unable to identify spouse ___ unable to identify you ___ unable to identify who brought him/her to evaluation ___ slowed response times ___ severe concentration problems ___ significant short term memory loss ___ unable to recall major life events ___ poor hygiene ___ gait disturbance ___ unable to write legibly ___ serious depression ___ flat affect ___ agitation ___ delusional thinking Scoring: Total the number of failed items on the Cognitive Deficit Test. This is the Deficit Score. For each observation checked above, add 1 point to the Deficit Score. Deficit Score -- Degree of Cognitive Impairment 0-9 -- little or none 9-16 -- mild to moderate >16 -- moderate to severe Those with moderate to severe impairment probably cannot learn English or civics information adequately. ----------------------------------------------------------------- Cognitive Disability Battery Applicant Questionnaire (c) David D. Fox, Ph.D. 1997 The Human Factors Groups (213) 938-7815 ----------------------------------------------------------------- Applicant's Name: ___________________________________ Age: ________ Sex: _______ Date of birth: ____________ City and Country where born: __________________________ Education: _________________ What languages do you speak: ________________________ Address: _________________________________________________________________ ____ Phone number: ______________________ Instructions: Please read these questions to the applicant in their native language and fill in the answers. If necessary, explain the question. If you know the answer to a question but the applicant does not or if it is something you have observed, put your initials next to the answer. Today's date: ___________ Name of person translating: ________________ Relationship to applicant: _______________ History What kinds of jobs have you had? ________________________________________________ What is the worst sickness you have ever had? ______________________________________ How many times have you been in the hospital? __________ Check which of the following have you ever had: ___ knocked unconscious ___ heart attack ___ stroke ___ diabetes ___ cancer ___ high blood pressure ___ treated by a psychiatrist (a mental doctor) ___ seizures or fainting Current condition: Current medical problems: _________________________________________________________________ ____ Current medicines: _________________________________________________________________ _____ How much alcohol do you drink each week? __________ How much do you smoke each week? __________ Does someone else keep your money, pay your bills and do all your shopping? Yes No Can you read signs in English? Yes No Can you read an English newspaper or book? Yes No Current Symptoms: Check the problems you have now: Thinking and learning: ___ can't learn English even when you tried ___ very slow to understand things ___ lose track of what you are thinking ___ mind goes blank ___ difficulty solving problems ___ difficulty making change at the store ___ difficulty following recipes ___ can't tell right from left ___ can't do simple arithmetic ___ trouble learning new things ___ often disorganized ___ get very confused Orientation: ___ forgetting your name ___ forgetting where you are ___ forgetting what the date is ___ forgetting your address and phone number ___ forgetting when and where you were born ___ get lost easily ___ difficulty recognizing people you know Language: ___ unable to say words ___ unable to read things in your native language ___ slurred speech ___ difficulty writing ___ forgetting the names of common objects ___ trouble giving and understanding directions to places ___ unable to write or spell your own name Motor: ___ difficulty getting dressed ___ tremors or shakiness ___ problems drawing ___ can't control muscles ___ can't use utensils to eat Memory: ___ cannot remember things that happened recently ___ can't pay attention for more than a minute ___ very easily distracted ___ forgetting to do things ___ forgetting the names of your family members ___ losing things around the house Psychological: ___ chronic sadness ___ a lot of anxiety and worry ___ seeing or hearing things others do not ___ extreme fatigue ___ feeling hopeless most of the time ___ impatience with yourself and others ___ loss of interest in most everything Daily living skills: ___ can't use the phone ___ forgetting the value of coins ___ can't use basic tools (like scissors) ___ can't use public transportation ___ can't cross the street safely ___ not concerned about hygiene ___ can't help around the house ___ can't order food in a restaurant ___ can't tell time ___ needs help using the toilet ----------------------------------------------------------------- Cognitive Disability Battery Cognitive Test (c) David D. Fox, Ph.D. 1997 Please call or e-mail Dr. Fox to request a copy of the Cognitive Test The Human Factors Groups (213) 938-7815 or DFoxpsych@aol.com ---------- End of Document