Fillable N-336 Request for a Hearing on a Decision in Naturalization Proceedings

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N-336 Request for a Hearing on a Decision in Naturalization Proceedings

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The N-336 Request for a Hearing on a Decision in Naturalization Proceedings form is 8 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 12/23/16 N Page 1 of 8
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 05/31/2019
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)
List 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 9. Additional Information.
2.
►
Physical Address (do not provide a PO Box in this space unless it is your only address)
Street Number and Name Apt. Flr. NumberSte.
State
ZIP Code + 4
-
Province or Region
(foreign address only)
Country
(foreign address only)
Postal Code
(foreign address only)
City or Town County
Form N-336 12/23/16 N Page 2 of 8
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 Code + 4
-
City or Town County
Province or Region
(foreign address only)
Country
(foreign address only)
Postal Code
(foreign address only)
Daytime Telephone Number
7. Contact Information
A.
Work Telephone Number (if any)
B.
Evening Telephone Number
C.
Mobile Telephone Number (if any)
D.
Email Address (if any)E.
Form N-336 12/23/16 N Page 3 of 8
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 9. Additional Information.
NOTE: Refer to the What Evidence Must You Submit section of Form N-336 Instructions for documents to submit with your Form
N-336.
►
A-
Form N-336 12/23/16 N Page 4 of 8
Part 5. Accommodations for Individuals With Disabilities and/or
Impairments
Are you requesting an accommodation because of your disabilities and/or impairments?
NoYes
If you answered "Yes" to Item Number 1., select any applicable box.
A.
I am deaf or hard of hearing and request the following accommodation. (If you are requesting a sign-language
interpreter, indicate for which language (for example, American Sign Language).)
1.
B.
I am blind or have low vision and request the following accommodation:
I have another type of disability and/or impairment. (Describe the nature of your disability and/or impairment and the
accommodation you are requesting.)
C.
NOTE: Read the information in the Form N-336 Instructions before completing this part.
Part 6. Naturalization Applicant's Statement, Contact Information, Certification, and Signature
NOTE: Read the Penalties section of the Form N-336 Instructions before completing this part.
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 8., ,
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 7. 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)
Form N-336 12/23/16 N Page 5 of 8
Part 6. Naturalization Applicant's Statement, Contact Information,
Certification, and Signature (continued)
►
A-
Naturalization Applicant's Certification
NOTE TO ALL NATURALIZATION APPLICANTS: If you do not completely fill out this request or fail to submit required
documents listed in the Instructions, 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 information from any of
my records that USCIS may need to determine my eligibility for the immigration benefit I seek.
I further 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 laws.
I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or
signature) 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.
Part 7. Interpreter's Contact Information, Certification, and Signature
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 Country
ZIP Code + 4
-
Form N-336 12/23/16 N Page 6 of 8
Interpreter's Certification
Date of Signature (mm/dd/yyyy)Interpreter's Signature
Interpreter's Signature
7.
Part 7. Interpreter's Contact Information, Certification, and Signature
Interpreter's Contact Information
4. Interpreter's Daytime Telephone Number
Interpreter's Email Address (if any)6.
►
A-
I certify, under penalty of perjury, that:
I am fluent in English and
, which is the same language specified in Part 6.,
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)
Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Request, if Other
Than the Naturalization Applicant
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 Country
ZIP Code + 4
-
Form N-336 12/23/16 N Page 7 of 8
Preparer's Certification
Preparer's Signature Date of Signature (mm/dd/yyyy)
Preparer's Signature
8.
Part 8. Contact Information, Declaration, and Signature of the Person
Preparing this Request, if Other Than the Naturalization Applicant
(continued)
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 whose representation extends beyond preparation
of this request, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as
Attorney or Accredited Representative, with this request.
►
A-
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.
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.
Form N-336 12/23/16 N Page 8 of 8
Part 9. 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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N-336 Request for a Hearing on a Decision in Naturalization Proceedings

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Completed 17 November 2019

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