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Request For A Hearing On A Decision In Naturalization Proceedings N-336 - Official Federal Forms
| Request For A Hearing On A Decision In Naturalization Proceedings Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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OMB No. 1615-0050: Expires 01/31/2016 Department of Homeland Security U.S. Citizenship and Immigration Services Form N-336, Request for a Hearing on a Decision in Naturalization Proceedings (Under Section 336 of the INA) Print or type all your answers fully and accurately in black ink. Write "N/A" if an item is not applicable. Write "None" if the answer is none. Failure to answer all of the questions may delay your Form N-336. Part 1. Information About You, the Naturalization Applicant 1. Current Legal Name (do not provide a nickname) Family Name (last name) Given Name (first name) Middle Name (if applicable) Your A-Number: A - - For USCIS Use Only Bar Code Date Stamp 2. Date of Birth (mm/dd/yyyy) Remarks Re-Affirm N-400 Denial Re-Determine N-400 Denial 3. Home Address Street Number and Name (do not provide a P.O. Box in this space unless it is your ONLY address.) Apartment Number County ZIP Code Country (foreign address only) City State Province (foreign address only) Postal Code (foreign address only) 4. Mailing Address C/O (in care of name) Street Number and Name City Province (foreign address only) State Country (foreign address only) Apartment Number ZIP Code Postal Code (foreign address only) 5. Daytime Phone Number Work Phone Number (if any) Evening Phone Number ( ( ) ) ( ) ( ) Mobile Phone Number (if any) 6. E-Mail Address (if any) Form N-336 (Rev. 01/07/13) N Part 2. Information About Form N-400 (Application for Naturalization) Denial On Which You Are Requesting a Hearing 1. Form N-400 Receipt Number 2. Date of Form N-400 Denial Notice(mm/dd/yyyy) A - - 3. USCIS Office That Issued Form N-400 Denial Notice Part 3. Reason You Are Requesting a Hearing Provide the reason(s) you are requesting a hearing on your denied Form N-400. If extra space is needed to provide an explanation, attach an additional sheet(s) of paper. You must write your A-Number, the date, the question number, and sign the top of each additional sheet(s). NOTE: Refer to Form N-336 Instructions, Page 1, Document Submission, for documents to submit with your Form N-336. Form N-336 (Rev. 01/07/13) N Page 2 Part 4. Accommodations for Individuals With Disabilities and/or Impairments A Yes No Are you requesting an accommodation for the Form N-336 hearing because of a disability and/or impairment? (see Part 4, Specific Form Instructions, in the Form N-336 instructions for some examples of accommodations) If you checked "Yes," check the box(es) below that apply: I am deaf or hearing impaired and need a sign language interpreter who uses the following language (e.g., American Sign Language (ASL)): I use a wheelchair. I am blind or sight-impaired. I will need another type of accommodation. Explain: Part 5. Your Signature (USCIS will reject your Form N-336 if it is not signed.) I certify, under penalty of perjury under the laws of the United States, that this request, and the evidence submitted with it, is all true and correct. I authorize the release of any information that U.S. Citizenship and Immigration Services needs to determine eligibility for naturalization. Your Signature Date (mm/dd/yyyy) Part 6. Signature of Person Who Prepared This Form N-336 For You (if applicable) I declare that I prepared Form N-336 at the request of the above person. The answers provided are based on information of which I have personal knowledge or were provided to me by the above-named person in response to the questions contained on this Form N-336. Preparer's Printed Name Preparer's Signature Date (mm/dd/yyyy) Preparer's Firm or Organization Name (if applicable) Preparer's Daytime Phone Number ( Preparer's Address Street Number and Name ) City State ZIP Code Province (foreign address only) Country (foreign address only) Postal Code (foreign address only) Preparer's E-Mail Address (if any) Preparer's Fax Number ( ) Form N-336 (Rev. 01/07/13) N Page 3
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