Application for Replacement Naturalization/Citizenship Document - Online Filing

Application for Replacement Naturalization/Citizenship Document

N-565-017_83C_Copy Deckv1.1.1_OMBReview

Application for Replacement Naturalization/Citizenship Document - Online Filing

OMB: 1615-0091

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Form Number and Name
OMB Number
Form Edition Date:
Form Expiration Date:
PRA Project:

N-565 Application for Replacement Naturalization/Citizenship Document
1615-0091
2/20/2025
12/31/2027
N-565-017 83C

Revision Key

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• All original (old) text is black.
• All revised (new) text is red.

Example

• All original text is black.
• Any text that is removed from original column will be
removed in the revision column with the words on either side
indicated with red.

Original

Revised

1. Oranges
2. Bananas
3. Apple
4. Pineapple

1. Oranges
2. Bananas

I want to eat a watermelon for lunch and go hiking today.

I want to go hiking
today.

3. Pineapple
4. Pear

Copy Deck Version Info

FILE A FORM: N-565

Column Header Descriptions
Header: If needed, a header is located directly under the dropdown menu and above the body text.
Heading

Body Text

Select the form you want to file online

Use this form to request a replacement of a Certificate of Naturalization, Certificate of Citizenship,
Declaration of Intention, Repatriation Certificate, or to apply for a special certificate of naturalization
to be recognized as a U.S. citizen by a foreign country.

Alert

Link

CTA

Notes

Start form

File a Form

APPLICATION OVERVIEW: N-565

Column Header Descriptions
Heading: The primary heading on a page, typically the first part of a section of the page.
Sub-Heading: The secondary header, typically directly underneath the Heading.
Primary Navigation: A section of the form that contains several pages
Heading

Sub-Heading

N-565, Application For Replacement
Naturalization/Citizenship Document

Before You Start Your Application

Conditional Logic

Body Text

Revision - Body Text

The Application for Replacement Naturalization/Citizenship Document (N-565) is used to apply to U.S. Citizenship and Immigration Services (USCIS) for a replacement of a Certificate of
Naturalization, Certificate of Citizenship, Declaration of Intention, or Repatriation Certificate. You can also use this application to apply for a special certificate of naturalization to have a
foreign country recognize you as a U.S. citizen.

Eligibility

Learn more about applying for a replacement document
Your eligibility to apply for a replacement document depends on the reason for your request. You may apply for a replacement if you were issued a Certificate of Naturalization,
Certificate of Citizenship, Declaration of Intention, or Repatriation Certificate, and at least one of the following applies:
• The document was lost, stolen, destroyed, or mutilated;
• The document is incorrect due to a typographical or clerical error by USCIS;
• Your name was changed by marriage, divorce, annulment, or court order, and you seek a document in your new name; or
• You have a different sex than what is listed on your current document, and you seek a document reflecting the different sex.
In addition, you may apply for a replacement of your Certificate of Citizenship if you obtained a court order or a document issued by the U.S. Government or the government of any
U.S. state that changes your date of birth, and you seek a document with the new date of birth.
You may also file this application if you are a naturalized citizen seeking a special certificate of naturalization for the purpose of a foreign country recognizing you as a U.S. citizen.

Fee

Alert

Required?

Links

https://www.uscis.gov/n-565

Your eligibility to apply for a replacement document depends on the reason for your request. You may apply for a replacement if you were issued a Certificate of
Naturalization, Certificate of Citizenship, Declaration of Intention, or Repatriation Certificate, and at least one of the following applies:
• The document was lost, stolen, destroyed, or mutilated;
• The document is incorrect due to a typographical or clerical error by USCIS;
• Your name was changed by marriage, divorce, annulment, or court order, and you seek a document in your new name; or
• Your certificate or declaration is incorrect because the sex listed on the document does not reflect your sex at birth and you seek a document reflecting your sex at
birth.
In addition, you may apply for a replacement of your Certificate of Citizenship if you obtained a court order or a document issued by the U.S. Government or the
government of any U.S. state that changes your date of birth, and you seek a document with the new date of birth.
You may also file this application if you are a naturalized citizen seeking a special certificate of naturalization for the purpose of a foreign country recognizing you as a
U.S. citizen.

USCIS cannot make any changes to an incorrect date of birth or name on a Certificate of Naturalization if you provided an incorrect date or name on your Form N-400, Application for
Naturalization, and then later swore to the facts of your application by signing Part 16. Signature at Interview. We can only change the name on your Certificate of Naturalization if you
changed your name after you naturalized.
USCIS cannot make any changes to an incorrect date of birth or name on a Certificate of Naturalization if you provided an incorrect date or name on your Form N400, Application for Naturalization, and then later swore to the facts of your application by signing Part 16. Signature at Interview. We can only change the name on
your Certificate of Naturalization if you changed your name after you naturalized.
We will automatically calculate the cost for you before you submit your application. For specific information about fees applicable to this form, see Form G-1055.
Fee waiver: If you are requesting a fee waiver, you cannot file online. You must file a paper version of both the Form I-912, Request for Fee Waiver and the form for the specific
benefit you are requesting. You can review the fee waiver guidance at www.uscis.gov/feewaiver.

https://www.uscis.gov/forms/filing-fees/additionalinformation-on-filing-a-fee-waiver

Refund policy: USCIS does not refund fees, regardless of any action we take on your application, petition, or request, or how long USCIS takes to reach a decision. By continuing this
transaction, you acknowledge that you must submit fees in the exact amount and that you are paying the fees for a government service.

Documents you may need

Please refer to the instructions for the form(s) you are filing for additional information or you may call the USCIS Contact Center at 800-375-5283. For TTY (deaf or hard of hearing) 800767-1833.
Before starting the Application for Replacement Naturalization/Citizenship Document (N-565), you may want to gather the documents you will need to support your application. These
include your original document, if you still have it, and a recent color photograph of yourself.
The other documents you need will depend on the information you provide in the application, such as the reason you are requesting the replacement document.

Biometric services
appointment

We will automatically determine which documents you should provide us as you fill out your application. At the time of filing, you must submit all evidence and supporting
documentation listed.
Biometric Services Appointment. USCIS may require that you appear for an interview or provide biometrics (fingerprints, photograph, and/or signature) at any time to verify your
identity, obtain additional information, and conduct background and security checks, including a check of criminal history records maintained by the Federal Bureau of Investigation
(FBI), before making a decision on your application or petition. If we determine that a biometric services appointment is necessary, we will send you an appointment notice with the
date, time, and location of your appointment. If you are currently overseas, your notice will instruct you to contact a U.S. Embassy, U.S. Consulate, or USCIS office outside the United
States to schedule an appointment.
At your biometrics appointment, you must sign an oath reaffirming that:

After You Submit Your Application

Disability
Accommodations/Modifica
tions
Track your case online
Mail in your original
document

Completing Your Form Online

Respond to requests for
information
Filing online
Complete the Getting
Started section first
Provide as many responses
as you can
We will automatically save
your responses
How to continue filling out
your form
DHS Privacy Notice

• You provided or authorized all information in the application;
• You reviewed and understood all of the information contained in, and submitted with, your application; and
• All of this information was complete, true, and correct at the time of filing.
To request a disability accommodation/modification, follow the instructions on your appointment notice or on the Disability Accommodations for the Public page.

www.uscis.gov/accommodationsinfo

After you submit your form, you can track its status through your USCIS account. Sign into your account often to check your case status and read any important messages from USCIS.
USCIS may require you to mail your original document. This is required if you are applying for a new document for one of the reasons below.

USCIS may require you to mail your original document. This is required if you are applying for a new document for one of the reasons below.

• Current document is mutilated
• Current document has a typographical/clerical error caused by USCIS
• Name changed
• Date of birth changed
• Current document reflects different sex

• Current document is mutilated
• Current document has a typographical/clerical error caused by USCIS
• Name changed
• Date of birth changed
• Current document has incorrect information about your sex

You should include your A-Number with your original document.

Mail your original document to:

USCIS Nebraska Service Center
850 S. Street
Lincoln, NE 68508

If the document was lost in the mail, please submit an online case service request for non-delivery of document prior to submitting Form N-565.

If the document was lost in the mail, please submit an online case service request for non-delivery of document prior to submitting Form N-565.
Next

If we need more information from you, we will send you a Request for Evidence (RFE) or Request for Information (RFI). You can respond to our request and upload your documents
through your USCIS account.
Submitting your application online is the same as mailing in a completed paper form. They both gather the same information.
You should answer all questions in the Getting Started section first so we can best customize the rest of your online form experience.
You should provide as many responses as you can. Incomplete fields or sections and missing information can slow down the process after you submit your form.
We will automatically save your information when you select next to go to a new page or navigate to another section of the form. We will save your information for 30 days from
today, or from the last time you worked on the form.
After you start your form, you can sign in to your account to continue where you left off.
AUTHORITIES: USCIS is collecting the information requested on this application, and the associated evidence, under the Immigration and Nationality Act (INA) section 343(a).
PURPOSE: The primary purpose for providing the information on this application is to request a replacement of your Declaration of Intention, Certificate of Naturalization, Certificate
of Citizenship, Repatriation Certificate, or to apply for a special certificate of naturalization as a U.S. citizen to be recognized by a foreign country. DHS uses the information you provide
to grant or deny the replacement document you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, including your Social Security number (if applicable), and any
requested evidence, may delay a final decision or result in USCIS denying your application.
ROUTINE USES: DHS may, where allowable under relevant confidentiality provisions, share the information you provide on this application and any additional requested evidence with
other Federal, state, local, and foreign government agencies and authorized organizations. DHS follows approved routine uses described in the associated published system of records
notices [DHS/USCIS/ICE/CBP-001 Alien File, Index, and National File Tracking System, DHS/USCIS-007 Benefits Information System, and DHS/USCIS-018 Immigration Biometric and
Background Check] and published privacy impact assessments [DHS/USCIS/PIA-016(a) Computer Linked Application Information Management System and Associated Systems, and
DHS/USCIS/PIA-056 USCIS Electronic Information System, and DHS/USCIS/PIA-071 myUSCIS Account Experience] which you can find at www.dhs.gov/privacy. DHS may also share this
information, as appropriate, for law enforcement purposes or in the interest of national security.

www.dhs.gov/privacy

Application Overview

CTA

APPLICATION OVERVIEW: N-565

Sub-Heading
Paperwork Reduction
Act

Conditional Logic

Body Text

Revision - Body Text

Alert

Required?

Links

USCIS may not conduct or sponsor an information collection, and you are not required to respond to a collection of information, unless it displays a currently valid Office of
Management and Budget (OMB) control number. The public reporting burden for this collection of information is estimated at 44 minutes per response, including the time for
reviewing instructions, gathering the required documentation and information, completing the application, preparing statements, attaching necessary documentation, and submitting
the application. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:
U.S. Citizenship and Immigration Services
Office of Policy and Strategy, Regulatory Coordination Division
5900 Capital Gateway Drive, Mail Stop #2140
Camp Springs, MD 20588-0009
Do not mail your completed Form N-565 to this address.

Security Reminder

OMB No. 1615-0091
Expires: 02/28/2027
If you do not work on your application for more than 30 days, we will delete your data in order to prevent storing personal information indefinitely.

Start

Application Overview

CTA

GETTING STARTED: N-565

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Conditional Logic: Indicates whether the question or subquestion only applies if you meet certain criteria
Primary Nav

Secondary Nav

Getting Started

Type of application

Tertiary Nav

Conditional Logic

Paper Form
Question
3.1.A
3.1.B
3.1.C
3.1.D
3.1.E

(If 3.1.A, 3.1.B, 3.1.C, or 3.1.D)

3.2A

Question

Sub-Question

Which document are you applying for?

New Certificate of Citizenship
New Certificate of Naturalization
New Certificate of Repatriation
New Declaration of Intention
Special Certificate of Naturalization to obtain recognition
of my U.S. citizenship by a foreign country

Radio
Radio
Radio
Radio
Radio

My certificate or declaration was lost, stolen, or
destroyed
My certificate or declaration is mutilated
My certificate or declaration is incorrect due to a
typographical or clerical error by USCIS
My name has legally changed
My date of birth has legally changed through a court
order or U.S. Government-issued document, and I am
applying for a replacement Certificate of Citizenship
I am seeking to change the sex listed on my document

Checkbox

Why are you requesting a new document?

3.2B
3.2C
3.2D
3.2E

3.2F

Field Type

Instructional Text

Help Text

3.2G(1)

Alert

Required?

Notes

Yes
Yes
Yes
Yes
Yes
Select all that apply

Checkbox
Checkbox
Checkbox
Checkbox

My certificate or declaration is incorrect because my sex Checkbox
listed on the document does not reflect my biological sex
at birth.
My reason for applying for a new document is not listed
Checkbox
above.
Provide an explanation.
Textbox

3.2G
(if 3.2G)
(If 3.3; 3.4; 3.5; 3.6; or 3.7)
[yellow alert]

Revision

[YELLOW ALERT]
[HEADER] You must mail your original document to USCIS
[BODY] You must mail your original document to USCIS because of the
reason you are requesting a new document. Review of your application
may be delayed if you do not submit your original document.
You should include your A-Number with your original document.
Mail your original document to:

Preparer and interpreter
information

Preparer information

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
Is someone assisting you with completing this application?

Yes/No

Radio

(IF YES)

Is a preparer assisting you with completing this application?

Yes/No

Radio

(IF YES)

Is an interpreter assisting you with completing this declaration?

Yes/No

Radio

11.1

What is your preparer's full name?

11.2

What is your preparer's business or organization name?

Given name (first name)
Family name (last name)

11.3
11.4

What is your preparer's contact information?

Text
Text
Text
Checkbox
Text
Text
Checkbox
Text
Checkbox
Text
Text
Text
Checkbox
Text
Text
Checkbox

(IF YES TO PREPARER)

11.5
Interpreter information

(IF YES TO INTERPRETER)

10.1

What is your interpreter's full name?

10.2

What is your interpreter's business or organization name?

10.3
10.4

What is your interpreter's contact information?

10.5
9.2.b

What language is your interpreter using to interpret this application
for you?

My preparer is not part of a business or organization.
Daytime telephone number
Mobile telephone number
My preparer does not have a mobile telephone number.
Email address
My preparer does not have an email address.
Given name (first name)
Family name (last name)
My interpreter is not part of a business or organization.
Daytime telephone number
Mobile telephone number
My interpreter does not have a mobile telephone
number.
Email address
My interpreter does not have an email address.

Text
Checkbox
Text

A preparer is anyone who completes or helps you
complete all or part of your application using
information and answers that you provide.
An interpreter is anyone who translates or helps
you translate all or part of your application using
information and answers that you provide.

Provide a 10-digit phone number.
Provide a 10-digit phone number.
Example: user@domain.com

Provide a 10-digit phone number.
Provide a 10-digit phone number.

Example: user@domain.com

Getting Started

ABOUT YOU: N-565
Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Primary Nav

Secondary Nav

About You

Your name

Tertiary Nav

Conditional Logic

(IF YES)

Your contact
information

Paper Form
Question

Question

Sub-Question

Field Type

Instructional Text

2.1

What is your current legal name?

Given name (first name)

Text

Middle name (if applicable)
Family name (last name)
Yes/No
Given name (first name)

Text
Text
Radio
Text

Your current legal name is the name on your birth certificate, unless it
changed after birth by a legal action such as marriage or court order. Do
not provide any nicknames here.

How may we contact you?

Middle name (if applicable)
Family name (last name)
Daytime telephone number

Text
Text
Text
Text
Checkbox

Provide a 10-digit phone number.

What is your current mailing address?

Mobile telephone number (if any)
This is the same as my daytime
telephone number.
Email address (if any)
In care of name (if any)

Text
Text

Country
Address line 1
Address line 2
City or town
State/Province

Dropdown
Text
Text
Text
Text

Example: user@domain.com
We will use your current mailing address to contact
you throughout the application process. We may not
be able to contact you if you do not provide a
complete and valid address.

ZIP code/Postal code

Text

A-

Text

2.2

9.1

Have you used any other names since birth?

9.2
9.3
2.3

(If non-USA use
Province and text
field)

Other information

(If non-USA use
Postal code and
remove help text)

(IF 2.5 = YES)

1.6

What is your A-Number? (if any)

2.5

I do not have or know my A-Number.
Since becoming a U.S. citizen, have you lost or Yes/No
renounced your citizenship in any manner?

2.4

What is your current marital status?

Provide an explanation.
Single
Married
Divorced
Widowed
Marriage Annulled

Checkbox
Radio

Help Text

Alert Required? Notes

Yes

Other names used may include nicknames, aliases, and maiden names.
Provide all other names you have ever used.

Simple Table
CTA = + Add another name

Provide a 10-digit phone number.

Street number and name
Apartment, suite, unit, or floor

Provide a 5 or 9-digit ZIP code.

Yes
Yes
Yes
Yes

Yes

Provide a 7, 8, or 9-digit number. If your A-Number is fewer than 9 digits,
the system will automatically add zero(s) after the "A" and before the first
digit so there is a total of 9 digits, for example: A-001234567.

Text field
Radio

About You

YOUR REQUEST: N-565

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages
Primary Nav

Secondary Nav

Your Request

Current document

Revision

Tertiary Nav

Conditional Logic

Revision

Paper Form
Question
1.5
1.7
1.7
1.1

Your document was lost,
stolen, or destroyed
You have an error
correction

(IF LOST, STOLEN, OR
DESTROYED (3.2A))
(IF TYPOGRAPHICAL
OR CLERICAL ERROR
(3.2C))

1.2
1.3
1.4
3.2(1)
4.1

4.2
Your name was changed

(IF NAME CHANGED
(3.2D))

Your date of birth was
changed

You seek a document
reflecting a different sex

Special Certificate of
Naturalization

Revision

What is the certificate or declaration number on your current
document?
Which U.S. Citizenship and Immigration Services (USCIS) Office
or court issued your certificate or declaration?
When was this certificate or declaration issued?
In which name was your current certificate or declaration
issued?

Sub-Question

Revision - Sub-Question

Field Type

What is your date of birth on your certificate or declaration?
What is your country of birth?
What is your country of former citizenship or nationality?
When, where, and how was your document lost, stolen, or
destroyed?
What was the typographical or clerical error in your document
that needs to be corrected?
Provide an explanation of what is incorrect on your current
certificate or declaration
Why has your name changed?

MM/DD/YYYY
Given name (first name)

Date
Text

Middle name (if applicable)
Family name (last name)
MM/DD/YYYY

Text
Text

Name
Date of birth
Sex
Other

Checkbox

Marriage, divorce, or annulment

Radio
Radio
Date
Checkbox
Date
Date

What is the date on the court order?
What is the date on the government-issued document?

6.2

What is your new date of birth?

MM/DD/YYYY

Date

(IF SEX CHANGED
(3.2F))

7.1

What sex do you want listed on your new document?

Male
Female

Radio

(If 3.1.E)

8.1

What is the name of the foreign country?

(If 3.1.E)

8.2

What is the name of the foreign official who is requesting this
certificate?
What is the foreign official's title?
What is the foreign official's government agency?
What is the foreign official's address?

Alert

Required? Notes

What is your biological sex at birth?

Select all that apply

Text field

6.1A
6.1B

8.2
8.2
8.3

Help Text

Dropdown
Dropdown
Text

6.1A

(If 3.1.E)
(If 3.1.E)
(If 3.1.E)
(If 3.1.E)
(If 3.1.E)

Revision

Text

When did your name change?
How was your date of birth changed?

5.1B

Instructional Text

Text

Court order
MM/DD/YYYY
Court order
U.S. Government-issued document
MM/DD/YYYY
MM/DD/YYYY

(IF DOB CHANGED
(3.2E))
(if court order)
(if U.S. Governmentissued document)

You seek a document
reflecting a different sex

5.1A

Question

Select all that apply

Provide the new date of birth as shown in the court
order or U.S. Government-issued document.
Based on your selection, a sex of “M” (male) or “F” USCIS recognizes two sexes, male (“M”) and female
(female) will be reflected on your secure documents (“F”), and will issue your document reflecting your
if your application is approved.
biological sex at the time of birth. USCIS does not
issue a document indicating a sex that is
inconsistent with your sex as established by your
birth certificate issued at or closest to the time of
birth, or in secondary evidence you provided to
USCIS, if applicable.

Dropdown
Given name (first name)

Text

Middle name (if applicable)
Family name (last name)

Text
Text
Text
Text
Dropdown
Text
Text
Text
Text
Text

Country
Address line 1
Address line 2
City or town
State/Province
Zip code/Postal code

Street number and name
Apartment, suite, unit, or floor
Provide a 5 or 9-digit ZIP code.

Your Request

EVIDENCE: N-565

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Primary Nav
Secondary Nav
Revision
Evidence
2" x 2" photo of you

Tertiary Nav

Conditional Logic

Revision

Paper Form

Evidence Title
2" x 2" Photo Of You

Revision

Field Type
Upload

Revision

Instructional Text
If you reside in the United States, USCIS may request that you attend an appointment at an ASC to have your photograph taken. If
you reside outside the United States, you must submit two identical color passport-style photographs of yourself taken recently.

Revision

Document type
2" x 2" photo

Revision

Upload a recent color photograph of yourself that measures 2 inches by 2 inches, with your face measuring 1 inch to 1 3/8 inch
from your chin to the top of your head. Your eyes should be between 1 1/8 inch and 1 3/8 inch from the bottom of the photo.
Make sure your whole face is visible, you are facing the camera directly, and the background is white or off-white. Your head must
be bare, unless contrary to your religious beliefs.
If you need help understanding the photo requirements or want to resize, rotate, or crop your photo, you can use to the
Department of State's photo composition tools.
U.S. government-issued photo
identification

U.S. Government-Issued
Photo Identification

Upload

Upload an image or copy of your U.S. Government-issued photo identification.

Government-issued photo identification

Evidence of change in marital
status

Evidence Of Change In
Marital Status

Upload

If your marital status has changed since your original document was issued, you must upload an image or copy of the document
establishing your change in marital status. Such documents may include your marriage certificate, divorce decree, annulment
decree, or husband's or wife's death certificate.

Marriage certificate
Divorce decree
Annulment decree
Husband's or wife's death certificate

Upload an image or copy of your original document if you have one.

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

Evidence of your lost, stolen,
or destroyed document

(IF 3.2A, LOST, STOLEN, OR
DESTROYED)

Evidence Of Your Lost,
Stolen, Or Destroyed
Document

Upload

Evidence of your mutilated
document

(IF 3.2B, MUTILATED)

Evidence Of Your Mutilated
Document

Upload

You can also upload a copy of a police report and/or a sworn statement explaining what happened to the document and any
attempts to retrieve the document.

Upload an image or copy of your original mutilated document.

Mail your original document to:
USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
Evidence of clerical or
typographical error

(IF 3.2C, CLERICAL/TYPO ERROR)

Evidence Of Clerical Or
Typographical Error

Upload

Upload images or copies of documents supporting your explanation of the error and request for a new document.

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

You also must mail your incorrect original document to USCIS to complete your application. You should include your A-Number with
your original document.
Mail your original document to:
USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501

Evidence of your name change
by marriage

Evidence Of Your Name
Change By Marriage

(IF 3.2D, NAME CHANGE BY
MARRIAGE, DIVORCE, OR
ANNULMENT)

Upload

Upload an image or copy of the original certified marriage certificate, divorce certificate or annulment decree that shows your
legally changed name.

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate
Original certified marriage certificate
Original divorce certificate
Original annulment decree

You also must mail your original or certified document to USCIS to complete your application. You should include your A-Number
with your original document.
Mail your original document to:

Evidence of your name change
by court order

Evidence Of Your Name
Change By Court Order

(IF 3.2D, NAME CHANGE BY
COURT ORDER)

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
Upload an image or copy of the original or certified court order that shows your legally changed name.

Upload

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate
Original or certified court order that shows
legally changed name

You also must mail your original or certified document to USCIS to complete your application. You should include your A-Number
with your original document.
Mail your original document to:
USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501

Evidence of your date of birth
change

Evidence Of Your Date Of
Birth Change

(IF 3.2E, DOB CHANGE)

Upload

Upload an image or copy of the original or certified U.S. Government-issued document, court order, or a vital record document
establishing the date of birth change.

Birth certificate
Certificate recognizing foreign birth
Certificate of birth abroad
Other similar vital records issued by U.S. state
where you resided when the document was
issued

A U.S. Government document may include:
• Birth certificate
• Certificate recognizing foreign birth
• Certificate of birth abroad
• Other similar vital records issued by the U.S. state where you resided when the document was issued

Alerts

Required?

Links
Notes
https://travel.state.gov/cont
ent/travel/en/passports/howapply/photos.html

• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

You also must mail your original mutilated document to USCIS to complete your application. You should include your A-Number
with your original document.

File Requirements
Revision
• Clear and readable
• Accepted file formats: JPG, JPEG, PDF, TIF or TIFF
• No encrypted or password-protected files
• If your documents are in a foreign language, upload a
full English translation and the translator's certification
with each original document.
• Upload no more than five documents at a time
• Accepted file name characters: English letters,
numbers, spaces, periods, hyphens, underscores, and
parentheses
• Maximum size: 12MB per file

You also must mail your original document to USCIS to complete your application. You should include your A-Number with your
original document.
Mail your original document to:

Your naturalization certificate

Loss of citizenship

D14:D15

Evidence of incorrect document

USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501
Upload an image or copy of your naturalization certificate.

(IF 3.1E, SPECIAL CERTIFICATE
OF NATURALIZATION TO OBTAIN
RECOGNITION OF MY U.S.
CITIZENSHIP BY A FOREIGN
COUNTRY)

Your Naturalization
Certificate

Upload

Naturalization certificate

(IF 2.5 = yes, RENOUNCED U.S.
CITIZENSHIP)

Loss Of Citizenship

Upload

Upload an image or copy of a document explaining how and why you lost or renounced your United States citizenship.

Written statement

(IF 3.2G, REASON NOT LISTED
ABOVE)

Evidence Of Incorrect
Document

Upload

Upload images or copies of any documents supporting your explanation of the error and request for a replacement document.

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate
Other supporting documents

Note: USCIS regulations require this special certificate when a foreign state requires proof of your citizenship for any
legitimate purpose, except for admission to the foreign country or in processing their own immigration benefit requests.

Original document from USCIS

Original Document From
USCIS

(IF 3.2C,
TYPOGRAPHICAL/CLERICAL
ERROR, 3.2D, NAME CHANGE,
3.2E, DOB CHANGE, 3.2F, SEX
CHANGED)

Upload

Upload an image or copy of your original document.

Certificate of Naturalization
Certificate of Citizenship
Declaration of Intention
Repatriation Certificate

You also must mail your original document to USCIS to complete your application. You should include your A-Number with your
original document.
Mail your original document to:
USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501

Evidence of your sex at birth

(IF, 3.2F, SEX CHANGED)

Evidence Of Your Sex at
Birth

Upload

Upload an image or copy of the original or certified U.S. Government-issued document, court order, or a vital record document
establishing your biological sex at the time of birth as established by your birth certificate issued at the time of birth or issued
closest to the time of birth.
A U.S. Government document may include:
• Birth certificate
• Certificate recognizing foreign birth
• Certificate of birth abroad
• Other similar vital records issued by the U.S. state where you resided when the document was issued
You also must mail your original document to USCIS to complete your application. You should include your A-Number with your
original document.

Birth certificate
Certificate recognizing foreign birth
Certificate of birth abroad
Other similar vital records issued by U.S. state
where you resided when the document was
issued

Mail your original document to:
USCIS Nebraska Service Center
P.O. Box 82521
Lincoln, NE 68501

Evidence

ADDITIONAL INFORMATION: N-565
Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Paper Form Question: The number in the paper form associated with the question.
Primary Nav
Secondary Nav
Tertiary Nav
Conditional Logic
Additional Information Additional information

Paper Form Question Question
Additional Information

Sub-Question

Field Type

Instructional Text
Help Text
If you need to provide any additional information for any of your answers to the questions in this
form, enter it into the space below. You should include the questions that you are referencing.

Alert

Required?
No

Notes
Large Table Pattern
Ghost Sub Nav

If you do not need to provide any additional information, you may leave this section blank.

Additional Information

REVIEW AND SUBMIT: N-565

Column Header Descriptions
Primary Navigation: A section of the form that contains several pages.
Secondary Navigation: A single page within a section.
Conditional Logic: A column used to indicate whether the question or subquestion only applies if you meet certain criteria.
Paper Form Question: The number in the paper form associated with the question.
Question: Based on content from the paper form. Often re-written from a statement into a question.
Primary Nav

Secondary Nav

Review and Submit

Review your
application

Conditional Logic

Paper form question

Question

Sub-Question

Field Type Instructional Text

Check your application before you submit

Help Text

Alert

Required?

Please review your ${formType} and check it for accuracy and completeness before you submit it.

CTA

Notes

We encourage you to provide as many responses as you can throughout the ${formType}. Missing or incomplete information
may slow down the review process after you submit your ${formType}.

Different copy based on if
the user did not answer a
required question

Your fee

You can return to this page to review your ${formType} as many times as you want before you submit it.
Your form filing fee is: $0

Alerts and warnings

Refund policy: USCIS does not refund fees, regardless of any action we take on your application, petition or request, or how
long USCIS takes to reach a decision. By continuing this transaction, you acknowledge that you must submit fees in the exact
amount and that you are paying the fees for a government service.
You have one or more alerts and warnings based on the information you provided in your application.
A red alert means you have incomplete responses or inconsistent data. You cannot submit your application with any
alerts.
A yellow warning means you may be missing information or may need to follow-up with us about your responses. You
can still submit your application, but some warnings may slow down the review process after you submit your
application.
A green alert means you have completed all required fields and responses.

Your application
summary

Here is a summary of all the information you provided in your application.

Review the N-565 form information

Make sure you have provided responses for everything that applies to you before you submit your application. You
can edit your responses by going to each application section using the site navigation.
We also prepared a draft case snapshot with your responses, which you can download below.
View draft snapshot

Preparer’s certification (IF PREPARER)

Preparer's certification and signature

Your preparer must read and agree to the certification below.

I certify, under penalty of perjury, that I prepared this application for the applicant at his or her request and with express consent and that all of the
responses and information contained in and submitted with the application are complete, true, and correct and reflects only information provided by
the applicant. The applicant reviewed the responses and information and informed me that he or she understands the responses and information in
or submitted with the application.
As the applicant's preparer, you must sign on paper and provide your signature page to the applicant. Follow these steps:

1. Download the Preparer Signature page
2. Print the Preparer Signature page
3. Read and sign the Preparer Signature page
4. Give the signed Preparer Signature page to the applicant
The applicant will need to scan and upload your completed signature page on the next screen.
Preparer signature
(IF PREPARER)
Interpreter certification (IF INTERPRETER)

11.6
10

Preparer's Signature Upload
Interpreter's certification and signature

Upload
I certify, under penalty of perjury, that I am fluent in English and the language provided in the Getting Started section of this application, and I have
interpreted every question on the application and Instructions and interpreted the applicant’s answers to the questions in that language, and the
applicant informed me that he or she understood every instruction, question, and answer on the application.
As the applicant's interpreter, you must sign on paper and provide your signature page to the applicant. Follow these steps:

Scan and upload your preparer's completed signature page below.
Your interpreter must read and agree to the certification below.

1. Download the Interpreter Signature page
2. Print the Interpreter Signature page
3. Read and sign the Interpreter Signature page
4. Give the signed Interpreter Signature page to the applicant
The applicant will need to scan and upload your completed signature page on the next screen.
Interpreter signature
Your certification and
signature

(IF INTERPRETER)

10.6
9

9.4

Pay and submit

(If "Your signature" is
complete)

Interpreter's Signature Upload
Applicant's certification and signature

Applicant's signature

Pay for and submit your application

Upload
I certify, under penalty of perjury, that I provided or authorized all of the information contained in and submitted with my application, I read and
understand or, if interpreted to me in a language in which I am fluent by the interpreter listed in the Getting Started section, understood, all of the
responses and information contained in, and submitted with, my application, and that all of the responses and information are complete, true, and
correct. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my eligibility for an
immigration request and to other entities and persons where necessary for the administration and enforcement of U.S. immigration law.
I have read and agree to the applicant's statement

Checkbox
Text

Scan and upload your interpreter's completed signature page below.
You must read and agree to the certification below. If you knowingly and willfully falsify or conceal a material fact or
submit a false document with your application, we can deny your application and may deny any other immigration
benefit. You may also face criminal prosecution and penalties provided by the law.

You must provide your digital signature below by typing your full legal name. If you do not completely fill out this
application, or if you do not submit the required documents listed in the Instructions, we may deny your application.
We will record the date of your signature with your application.
The final step to submit your Form N-565, Application for Replacement Naturalization/Citizenship Document, is to pay
the required fee.

Yes

Your application fee is: $[xxx].
Refund policy: By continuing this transaction, you agree that you are paying for a government service and that the
filing fee, biometric services fee and all related financial transactions are final and not refundable, regardless of any
action USCIS takes on an application, petition or request, or how long USCIS takes to reach a decision. You must
submit all fees in the exact amounts.
We will send you to Pay.gov — our safe, secure payment website — to pay your fees and submit your form online.
Here are the steps in the payment and submission process:

Pay and
submit

1. Provide your billing information on Pay.gov
2. Provide your credit card or U.S. bank account information
3. Submit your payment
When you have paid your fee, your application will be submitted.

(Successful submission)
(No nav)
(Unsuccessful card
declined) (No nav)

You successfully submitted your N-565
You did not submit your N-565

Pay.gov will redirect you to a uscis.gov confirmation screen, which will include your receipt number. Please keep a copy of your
receipt number for your records. You can track the status of your application through your USCIS online account.
We will contact you if we have any questions or need additional information. You can track the status of your application
through your USCIS online account.
Your payment failed because your credit or debit card was declined.

(Unsuccessful submission)
(No nav)

You did not submit your N-565

You can try again now to sign and submit your declaration or save and exit.
Your payment failed or was canceled before it could be processed on Pay.gov.
You can try again now to sign and submit your petition or save your petition and exit. We will save your petition for 30 days
from when you started it.

Go to my
cases
Sign and
submit
Sign and
submit

Review & Submit

File Type	application/pdf
Author	Microsoft Office User
File Modified	2025-03-14
File Created	2025-03-14