What Naturalization Requires

Naturalization is the process by which a lawful permanent resident becomes a United States citizen. To apply, you file Form N-400 with USCIS. The naturalization process evaluates your continuous residence, physical presence, English language ability, knowledge of U.S. history and government (civics), and good moral character.

USCIS will schedule a naturalization interview where an officer will test your English and civics knowledge and review your application. If approved, you will attend a naturalization ceremony and take the Oath of Allegiance.

Why No Medical Exam for N-400

The immigration medical exam (Form I-693) is required to establish that an applicant is not inadmissible on medical grounds when they first apply for permanent residence. Once you are a lawful permanent resident, your medical admissibility has already been determined. Naturalization does not re-evaluate medical admissibility.

There is no provision in the Immigration and Nationality Act requiring a medical examination for naturalization. The N-400 form itself does not ask for medical information, and USCIS does not require Form I-693 as part of the naturalization application.

What USCIS Does Review at Naturalization

At the naturalization interview, USCIS reviews your continuous residence and physical presence in the United States, your ability to speak, read, and write English, your knowledge of U.S. history and civics, your good moral character (including criminal history), and your attachment to the principles of the U.S. Constitution.

USCIS does not review your medical history, vaccination records, or Form I-693 at the naturalization interview. Medical fitness is not a requirement for citizenship.

Medical Conditions and Naturalization Eligibility

Having a medical condition does not disqualify you from naturalizing. Medical inadmissibility grounds apply to the initial grant of permanent residence, not to naturalization. If you have a disability or medical condition that affects your ability to take the English or civics tests, you may be eligible for an exemption or accommodation.

Disability Accommodations for the Naturalization Interview

USCIS offers accommodations for applicants with disabilities. If you have a physical or developmental disability or mental impairment that prevents you from meeting the English or civics requirements, you may file Form N-648 (Medical Certification for Disability Exceptions) with your N-400.

Form N-648 must be completed by a licensed medical or osteopathic doctor or licensed clinical psychologist. This is different from the immigration medical exam — it is a separate form completed by your treating physician, not a civil surgeon.

Common Questions Attorneys Get About This

Immigration attorneys frequently field questions from clients who believe they need a new medical exam for naturalization. This misconception may stem from confusion between the I-485 process (which requires I-693) and the N-400 process (which does not). If your client asks whether they need a new exam for naturalization, the answer is no — unless they are also filing a new I-485 for some reason.