April 1, 2010 VIA E-MAIL: rfs.regs@dhs.gov Department of Homeland Security, USCIS Chief, Regulatory Products Division Clearance Office 111 Massachusetts Avenue, NW Washington, DC 20529-2210 Fax: 202-272-8352 RE: Comments on Revision of Form N-648, 75 Fed. Reg. 5099 (February 1, 2010) Dear Sir or Madam: We, the undersigned organizations, submit the following comments in response to the request for public comment by the U.S. Citizenship and Immigration Services (USCIS) on the revisions to Form N-648 (Medical Certification for Disability Exceptions) at 75 Fed. Reg. 5099 (February 1, 2010). Our interest in the proposed revisions. The undersigned organizations have a great deal of experience assisting applicants with disabilities in the naturalization process. We are members of the Disability Working Group, a group that has been involved in naturalization and disability waiver policy issues for more than a decade. The group was formed by the Immigration and Naturalization Service (INS) in 1999 in response to the settlement in Campos, et al v. INS et al, a lawsuit filed on behalf of disability waiver applicants. Through the group, our organizations met regularly with INS over a period of four years and provided input to INS on policy guidance related to disability waivers, reasonable accommodations, and oath waivers. The group also worked on revisions to the Form N-648 in 2000 that resulted in significant improvements to the form. We were pleased that Director Mayorkas agreed to undertake a new revision of the Form N-648 following our letter to him in September 2009. We greatly appreciate the opportunity we had to meet with USCIS to review and provide feedback on drafts of the Form N-648 before it was published in the Federal Register. The Interpreter s Certification (p. 5) should be removed. The Interpreter s Certification is not found on previous versions of the Form N-648, and was added after our last meeting with USCIS, so we did not have the opportunity to discuss our concerns about it. We have several major concerns about this addition: 1) the failure to recognize situations where an interpreter is not used or needed; 2) USCIS perception of the frequent use of family members as interpreters; and 3) the need to track down multiple interpreters used over a long period of time. Page 1 of 5
First, we note that there may be situations where an interpreter is not used or needed because the applicant has a physical or developmental disability, such as stroke or Down syndrome, that can be clearly diagnosed with a medical test, as opposed to a mental impairment that is diagnosed through clinical observation of signs and symptoms. The language in the Medical Professional s Certification suggests that an interpreter is required if the medical professional is not fluent in the applicant s language. Second, we note that in our experience, family members usually serve as the interpreter for N- 648 applicants, as most applicants do not have the luxury of a professional interpreter. We are concerned that adjudicators may view this in a negative light and be inclined to deny the N-648 as a result. Third, many applicants with long-standing disabilities will have used multiple interpreters over a period of many years. The Interpreter s Certification suggests that applicants and their advocates will be required to track down various interpreters used over the years while being diagnosed and treated for their condition, which is not realistic or feasible. For example, a diagnosis could have been made five years ago with the aid of an interpreter, while the appointment to complete the N- 648 is merely a follow-up visit to check on the applicant s condition. In lieu of the Interpreter s Certification, we recommend adding language to the Medical Professional s Certification stating that the medical professional is satisfied that he/she was able to communicate with the applicant, with or without the use of an interpreter. Please see suggested language below. The Applicant (Patient) Attestation/Release of Information (p. 6) should be modified. In the Applicant (Patient) Attestation/Release of Information on page 6, we strongly object to the language requiring the applicant to certify that the factual information placed within the form is correct (second sentence). The medical professional, not the applicant, is responsible for the content of the Form N-648. This language suggests that the medical professional and/or interpreter needs to explain the entire content of the form to the applicant, a burdensome, additional step that would hinder advocates ability to get the N-648 done properly, cause logistical problems, and further delay what is already a very lengthy process. Furthermore, there is a logical contradiction in requiring persons with cognitive limitations to evaluate and certify the factual information placed in the N-648. This second sentence should be changed to read, I certify under penalty of perjury, pursuant to Title 28, U.S.C. Section 1746, that the information I provided for this form is true and correct. Questions 3 and 5 in Part III (p. 2) request the same information. Question 3 asks for the date the medical professional first examined the applicant, while question 5 asks for the duration of treatment. We recommend deleting question 3. In addition, we question the need for such a high level of detail in the answer to question 5, where the medical professional is asked to count the number of days he/she has been providing treatment. Question 5 should only request the number of years, or months if less than one year. Page 2 of 5
In Part III, the wording in question 11 (p. 4) should be clarified. We recommend the following changes: 11. In your professional medical opinion, which of the following requirements is the applicant unable to demonstrate as a result of his or her disability and/or impairment(s)? (Check all that apply. If none applies, the applicant is not eligible for this exception and you need not complete the remainder of the questions. Please go directly to the Medical Professional s Certification. ) The information in the Medical Professional s Certification (p. 6) should be clarified. In the Medical Professional s Certification on page 6, the information on verifying the applicant s identity is sometimes overlooked by doctors, who sign on the line by accident. We recommend changing the wording as follows: I certify that the applicant s identity has been verified through the following United States or State government issued photographic identity document: permanent resident card state identification card other: We also recommend adding a certification about the use of an interpreter, as follows: Complete the following information about how you communicated with the applicant during the examination(s) that form the basis of this Form N-648 certification: I am fluent in English, but not in, the language spoken by the applicant. I certify that an interpreter fluent in both languages was used during my examination(s) of this applicant. I am fluent in English and, the language spoken by this patient; therefore, an interpreter was not used during my examination(s) of this applicant. USCIS should explain the meaning of authorized representative (p. 6). On page 6, there is a box where the applicant or the applicant s authorized representative is required to sign. USCIS needs to explain in the form instructions the meaning of authorized representative, as this is unclear. Issues in the Form N-648 that need to be addressed in training for adjudicators. In Part III, question 2, the medical professional is asked to provide a basic description of the disability and/or impairment, and a one sentence example is provided. Medical professionals reading this will assume that a one sentence description is sufficient, but in our experience it often is not, as adjudicators will often request additional information about the diagnosis. USCIS should reinforce in its training for adjudicators that a one sentence description is acceptable. Also, USCIS should remind adjudicators that the description of a particular disability, such as Page 3 of 5
Alzheimer s Disease, may be the same for applicants with that disability who are seen by the same doctor, and that using the same language to describe a particular kind of disability that is shared by several applicants is not, by itself, an indication of fraud. Typos that need to be corrected. Several typos on the form need to be corrected. On page 1 under Reminder About Eligibility Requirements, the first sentence should be corrected to state, This form is intended for an applicant who seeks an exception to the English and/or civics requirements... In Part III, questions 3, 4, 5, and 8 refer to the condition listed in number 3. They should refer back to question 1, which asks for the clinical diagnosis. The form instructions need additional clarification. Additionally in the form instructions under Who Is Authorized to Certify This Form? we recommend changing the regulations to allow licensed nurse practitioners and social workers licensed at the clinical level to complete the form. We have already discussed the benefits of such a change in our meetings with USCIS and provided USCIS with sample language. In the example of sufficient responses on page 1 of the instructions, it would be much more helpful to see an example of a physical disability, which is more nuanced, rather than the very obvious example of a developmental disability, so that medical professionals can understand that a physical disability can qualify for a disability waiver. On page 2 of the instructions under General Instructions, USCIS states that the information field in the fillable electronic form will expand to accommodate additional information. However, in our experience the additional information may be readable on the computer, but will be cut off when the form is printed out. We recommend advising the medical professional to attach a separate sheet with the additional information if he or she runs out of space on the fillable form. USCIS should avoid lengthening the form. Finally, we note that with each revision, the Form N-648 is getting longer and more onerous for medical professionals. The form has grown from two pages in 2000, to five pages currently, and now to the proposed six pages. The more onerous the form, the fewer medical professionals will be willing to complete it and the more barriers will result for disabled applicants in the naturalization process. We hope that USCIS will consider our comments with an eye toward keeping the form as concise as possible, and make every effort to streamline the N-648. Thank you for your consideration of our comments. Again, we greatly appreciate the opportunity to provide feedback and participate in the form development process. We are hopeful that the new form will be a significant improvement over the current version. Page 4 of 5
Sincerely, Catholic Legal Immigration Network, Inc. 415 Michigan Ave., NE, 2 nd Floor Washington, DC 20017 Hebrew Immigrant Aid Society 333 Seventh Ave., 16th Floor New York, New York 10001 World Relief 7 E. Baltimore Street Baltimore, MD 21202 Catholic Charities Maine Refugee & Immigration Services 250 Anderson Street Portland, Maine 04101 World Relief DuPage 1825 College Ave, Suite 230 Wheaton, IL 60187 Florida Coastal School of Law Immigrant Rights Clinic 8787 Baypine Road suite 255 Jacksonville FL 32256 HIAS Chicago 216 W. Jackson, Suite 700 Chicago, Illinois 60606 Northwest Immigrant Rights Project (NWIRP) 615 Second Avenue, Suite 400 Seattle, WA 98104 Jacksonville Area Legal Aid Refugee Immigration Project 126 W. Adams St. Jacksonville, FL 32202 International House 322 Hawthorne Lane Charlotte, NC 28204 Legal Aid Society of Minneapolis Immigration Law Project 430 1st Ave. N Suite 300 Minneapolis, MN 55401 Page 5 of 5