The current Trump administration and USCIS believe there has been fraud in citizenship applications, allowing certain immigrants to avoid the English and civics tests based on medical grounds, prompting stricter requirements.
Applicants are already required to submit their Form N-648, or Medical Certification for Disability Exceptions, to be exempt from the English or civics test, but now U.S. Citizenship and Immigration Services (USCIS) is demanding that the form include a detailed explanation from the signing physician.
“The [new] guidance confirms that the medical professional completing Form N-648 must explain how the disability or impairment prevents the applicant from meeting the English and civics requirements for naturalization,” states the agency’s new policy.
USCIS adds that a medical statement simply noting a disability
will no longer be sufficient. Even after submitting the report, an immigration officer may request additional information.
“[The] guidance also states that the simultaneous submission of multiple Form N-648s may raise doubts about the credibility of the disability or impairment claim and could be subject to further review,” the agency specifies.

The immigration agency, part of the Department of Homeland Security (DHS) under Secretary Kristi Noem, states it aims to improve the “integrity of the process,” citing fraud, though it does not specify how many cases of fraud it has identified.
“Over the decades, numerous cases of exploitation of the medical certification process have been recorded nationwide,” it asserts. “When a medical professional provides a false certification, it not only undermines the purpose of the disability exception but also weakens the credibility of the entire naturalization system, as it forces USCIS to naturalize individuals who have not demonstrated their eligibility.”
The agency argues that all immigrants seeking U.S. citizenship
must demonstrate: understanding of the English language, knowledge of civic fundamentals, U.S. history, and government structure.
As a result, the conditions for exemptions from these tests are being modified, including requiring a detailed explanation from the physician.
USCIS confirms that the new guidance is supported by two executive orders from President Trump: 14148, or “Initial Rescissions of Harmful Executive Orders and Actions”—which were implemented by former President Joe Biden—and 14159, or “Protecting the American People from Invasion.”
The agency has implemented dozens of changes leading to more requirements and scrutiny of immigration petitions, as well as discretionary decisions by officers to deny visa applications, including Green Cards.
USCIS reported that from February to June, it processed 26,700 individuals for deportation proceedings after issuing a Notice to Appear (NTA) in court following the denial of a migration protection request.
USCIS advises all individuals seeking to file applications with the agency to hire a certified attorney—not a notary public—to avoid wasting time and money or even facing deportation.
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