Fillable Form N-336: Request for a Hearing on Naturalization Proceedings (USCIS)

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Form N-336: Request for a Hearing on Naturalization Proceedings (USCIS)

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The Form N-336: Request for a Hearing on Naturalization Proceedings (USCIS) form is 7 pages long and contains:

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U.S. Citizenship and Immigration Services (USCIS) is an office of the U.S. Branch of Homeland Security (DHS) that oversees the nation's naturalization and migration framework. It is a successor to the Immigration and Naturalization Service (INS), which was disintegrated by the Homeland Security Act of 2002 and supplanted by three segments inside the DHS: USCIS, Immigration and Customs Enforcement (ICE), and Customs and Border Protection (CBP).

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Form N-336 Edition 11/08/19 Page 1 of 7
Request for a Hearing on a Decision in Naturalization
Proceedings Under Section 336
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form N-336
OMB No. 1615-0050
Expires 11/30/2021
Date Stamp
Attorney State Bar Number
(if applicable)
Select this box if
Form G-28 is
attached.
Attorney or Accredited Representative
USCIS Online Account Number (if any)
To be completed by an
Attorney or Accredited
Representative (if any).
For USCIS Use Only
Remarks
Re-Affirm N-400 Denial Re-Determine N-400 Denial
START HERE - Type or print in black ink.►
►
A-
Part 1. Information About You, the Naturalization Applicant
Family Name (Last Name) Given Name (First Name) Middle Name
Current Legal Name (do not provide a nickname)1.
NOTE: Type or print "N/A" if an item is not applicable. Type or print "None" if the answer is none. Failure to answer all of the
questions may delay your Form N-336.
Date of Birth (mm/dd/yyyy) 4. USCIS Online Account Number (if any)
3.
5.
Barcode
Enter Your 9 Digit A-Number:
Family Name (Last Name) Given Name (First Name) Middle Name
Other Names Used (if any)
Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete
this section, use the space provided in Part 8. Additional Information.
2.
►
Street Number and Name Apt. Flr. NumberSte.
State
ZIP Code
Province or Region Country
Postal Code
City or Town County
Physical Address (do not provide a PO Box in this space unless it is your only address)
Form N-336 Edition 11/08/19 Page 2 of 7
Part 2. Information About Form N-400 Denial On Which You (the Naturalization Applicant) Are
Requesting a Hearing
Form N-400 Receipt
Number
1.
Date of Form N-400 Denial
Notice (mm/dd/yyyy)
2.
3.
USCIS Office That Issued Form N-400
Denial Notice
►
A-
Part 1. Information About You, the Naturalization Applicant
(continued)
Mailing Address 6.
Part 3. Biographic Information
Not Hispanic or LatinoHispanic or Latino
Ethnicity (Select only one box)1.
American Indian or
Alaska Native
Race (Select all applicable boxes)2.
Native Hawaiian or
Other Pacific Islander
Black or African
American
Asian White
Feet InchesHeight3.
4. Weight Pounds
5. Eye Color (Select only one box)
Blue GreenBrown Hazel MaroonGray Pink Unknown/Other
Hair Color (Select only one box)
6.
Black
BlondBald
(No hair)
Brown
RedGray
Unknown/
Other
Sandy White
Black
Street Number and Name Apt. Flr. NumberSte.
State
In Care Of Name (if any)
ZIP CodeCity or Town County
Work Telephone Number
7. Contact Information
A.
Evening Telephone Number
B.
Did you file your Form N-400 on the basis of qualifying military service?4. Yes No
Province or Region CountryPostal Code
Form N-336 Edition 11/08/19 Page 3 of 7
Part 4. Reason You Are Requesting a Hearing
Provide the reasons you are requesting a hearing on your denied Form N-400. If you need extra space to complete this section, use the
space provided in Part 8. Additional Information.
►
A-
Form N-336 Edition 11/08/19 Page 4 of 7
NOTE: Read the Penalties section of the Form N-336 Instructions before completing this section.
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
Naturalization Applicant's Statement
►
A-
1.
I can read and understand English, and I have read and understand every question and instruction on this request
and my answer to every question.
A.
Naturalization Applicant's Statement Regarding the Interpreter
At my request, the preparer named in Part 7., ,
prepared this request for me based only upon information I provided or authorized.
2. Naturalization Applicant's Statement Regarding the Preparer
understood everything.
every question in
The interpreter named in Part 6. read to me every question and instruction on this request and my answer to
, a language in which I am fluent, and I
B.
5. Naturalization Applicant's Email Address (if any)
Naturalization Applicant's Contact Information
3. 4.
Naturalization Applicant's Daytime Telephone Number Naturalization Applicant's Mobile Telephone Number (if any)
Part 5. Naturalization Applicant's Statement, Contact Information,
Certification, and Signature
Naturalization Applicant's Certification
NOTE TO ALL NATURALIZATION APPLICANTS: If you do not completely fill out this request, USCIS may deny your request.
Naturalization Applicant's Signature
Naturalization Applicant's Signature Date of Signature (mm/dd/yyyy)6.
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any and all of my records
that USCIS may need to determine my eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this request, in supporting documents, and in my USCIS records, to other
entities and persons where necessary for the administration and enforcement of U.S. immigration law.
I understand that USCIS may require me to appear for an appointment to take my biometrics and, at that time, if I am required to
provide biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and provided or authorized all of the information in my request;
2) I understood all of the information contained in, and submitted with, my request; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my request, I understand all of the
information contained in, and submitted with, my request, and that all of this information is complete, true, and correct.
Form N-336 Edition 11/08/19 Page 5 of 7
►
A-
Interpreter's Given Name (First Name)Interpreter's Family Name (Last Name)1.
Provide the following information about the interpreter.
Interpreter's Business or Organization Name (if any)2.
Interpreter's Full Name
Interpreter's Mailing Address
3. Street Number and Name Apt. Flr. NumberSte.
City or Town State
Postal CodeProvince or Region Country
ZIP Code
Part 6. Interpreter's Contact Information, Certification, and Signature
Interpreter's Certification
Date of Signature (mm/dd/yyyy)Interpreter's Signature
Interpreter's Signature
7.
Interpreter's Contact Information
4. Interpreter's Daytime Telephone Number
Interpreter's Email Address (if any)6.
I certify, under penalty of perjury, that:
I am fluent in English and
, which is the same language specified in Part 5.,
Item B., in Item Number 1.; and I have read to this naturalization applicant in the identified language every question and instruction
on this request and his or her answer to every question. The naturalization applicant informed me that he or she understands every
instruction, question, and answer on the request, including the Naturalization Applicant's Certification, and has verified the
accuracy of every answer.
5.
Interpreter's Mobile Telephone Number (if any)
Form N-336 Edition 11/08/19 Page 6 of 7
►
A-
Provide the following information about the preparer.
Preparer's Full Name
Preparer's Given Name (First Name)Preparer's Family Name (Last Name)1.
Preparer's Business or Organization Name (if any) 2.
Preparer's Mailing Address
3. Street Number and Name Apt. Flr. NumberSte.
City or Town State
Postal CodeProvince or Region Country
ZIP Code
Part 7. Contact Information, Declaration, and Signature of the Person
Preparing this Request, if Other Than the Naturalization Applicant
I am not an attorney or accredited representative but have prepared this request on behalf of the naturalization applicant
and with the naturalization applicant's consent.
I am an attorney or accredited representative and my representation of the naturalization applicant in this case
7.
Preparer's Statement
A.
B.
NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited Representative, with this request.
extends does not extend beyond the preparation of this request.
Preparer's Contact Information
Preparer's Daytime Telephone Number Preparer's Mobile Telephone Number (if any)
Preparer's Email Address (if any)
4.
6.
5.
Preparer's Certification
Preparer's Signature Date of Signature (mm/dd/yyyy)
Preparer's Signature
8.
By my signature, I certify, under penalty of perjury, that I prepared this request at the request of the naturalization applicant. The
naturalization applicant then reviewed this completed request and informed me that he or she understands all of the information
contained in, and submitted with, his or her request, including the Naturalization Applicant's Certification, and that all of this
information is complete, true, and correct. I completed this request based only on information that the naturalization applicant
provided to me or authorized me to obtain or use.
Form N-336 Edition 11/08/19 Page 7 of 7
Part 8. Additional Information
If you need extra space to provide any additional information within this request, use the space below. If you need more space than
what is provided, you may make copies of this page to complete and file with this request or attach a separate sheet of paper. Type or
print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to
which your answer refers; and sign and date each sheet.
A-Number (if any) ►
A-
3.
2.
Page Number B. Part Number C. Item Number
D.
A.
A.
A.
A.
Page Number
5.
Page Number
Part Number Item NumberC.B.
D.
6.
D.
B. C.
Item NumberPart NumberPage Number
Part Number Item Number
1. Family Name (Last Name) Given Name (First Name) Middle Name
C.B.
D.
4.
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Form N-336: Request for a Hearing on Naturalization Proceedings (USCIS)

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Completed 2 September 2020

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