Physician-Identified Barriers to Completing the “Medical Certification for Disability Exceptions” (N-648) Citizenship Forms for Applicants with Disabilities

Applicants for U.S. citizenship through naturalization whose disabilities prevent completion of the required English and civics examinations may submit Form N-648 (“Medical Certification for Disability Exceptions”), in which a licensed medical professional documents the limitations preventing fulfillment of these requirements. Given the central role of the N-648 in the naturalization process for applicants with disabilities and the critical role of physicians in its completion, the objective of this study was to assess physician familiarity with the N-648, perceived barriers to completion, and recommended facilitators to improve the process. We conducted a cross-sectional survey of physicians from various states and specialties that consisted of closed- and open-ended questions. Open-ended responses were reviewed and grouped into themes using an inductive approach. A total of 80 physicians were surveyed, most of whom reported limited familiarity (76%) with the N-648 yet willingness to complete the form (93.8%). Major barriers to completion included lack of clear instructions, insufficient time, and extensive documentation requirments. Physicians recommended increased training, dedicated visit times, and greater staff support as potential facilitators. Findings highlight a critical gap in physician knowledge and institutional support related to the N-648 form. Addressing these barriers through provider education, workflow adjustments, and policy guidance could improve access to disability-based naturalization accommodations and promote health equity for applicants with disabilities.