Fillable N-4 Monthly Report on Naturalization Papers

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N-4 Monthly Report on Naturalization Papers

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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-4 08/01/17 Y Page 1 of 2
In compliance with the naturalization laws and regulations, listed below are each oath administration ceremony conducted under the
jurisdiction of the above named court during the month and
OMB NO. 1615-0051; Expires 08/31/2019
N-4, Monthly Report
on Naturalization Papers
Department of Homeland Security
U.S. Citizenship and Immigration Services
Date of
Ceremony
Court List Number Place of Ceremony
Number of Persons
Administered Oath
Number of
Voided Certificates
(County or District)
(City, State, and Zip Code)
By
(Clerk of Court)
(Deputy Clerk)
Date: Office of the Clerk of the Court
U.S. Citizenship and Immigration Services:
year.
I have also enclosed the duplicate court list endorsed by me as clerk of the above named court during the same month, except for those
that have already been delivered personally to your representative. Those so delivered are indicated by an (*) next to the court list
number.
Also enclosed are ( ) voided Certificates of Naturalization. A specific listing of the voided certificates may be found on
each endorsed court list.
Form N-4 08/01/17 Y Page 2 of 2
Instructions
This form is to be submitted monthly by the clerk of any court conducting naturalization activities in conformity with Section 339 of
the Immigration and Nationality Act (8 USC 1450), and Title 8, Code of Federal Regulations, Part 339. The completed form, with a
copy and all attachments, should be submitted to the District Office of U.S. Citizenship and Immigration Services (USCIS) having
jurisdiction over the location of the court.
U. S. Citizenship and Immigration Services
Headquarters Office of Field Operations
111 Massachusetts Avenue, N.W., 2nd Floor
Washington, D.C. 20529
Our authority for collecting the information reported on Form N-4 is contained in Section 339 of the Immigration and Nationality Act
(INA) (8 USC 145D). The information contained in this form will be used by USCIS to finalize the record process regarding persons
naturalized and to determine payments to the courts as provided in Section 344(f) of the INA (8 USC 1455).
An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of information
unless it displays a currently valid OMB control number. The public reporting burden for this collection of information is estimated at
30 minutes per response, including the time for reviewing instructions and completing and submitting the form. 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, Regulatory Coordination Division, 20 Massachusetts Avenue, N.W., Washington, DC
20529-2140. OMB No. 1615-0051. Do not mail your completed Form N-4 to this address.
Authority to Collect Information
The USCIS office receiving the form shall retain the duplicate and all attachments, and forward the original to:
Paperwork Reduction Act
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N-4 Monthly Report on Naturalization Papers

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Completed 17 November 2019

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