Form N-336 Request for Hearing on a Decision in Naturalization Proc

OMB No. 1615-0050; Expires 01/31/2011

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

Department of Homeland Security
U.S. Citizenship and Immigration Services

(Under Section 336 of the INA)
For USCIS Only

Decision:

Fee:

Grant
Denial

Part 1. In the Matter of:

File Number:

Current Legal Name (do not list a nickname.)
Family Name (last name)

A-

Given Name (first name)
Middle Name (if applicable)

Home Address (do not write a P.O. Box in this space.)
Street Number and Name

Apartment Number

City

State

Zip Code

Province (foreign address only)

County

Country (foreign address only)

Mailing Address
Street Number and Name

Apartment Number

C/O (in care of name)

Postal Code (foreign address only)

C/O (in care of name)

City

Province (foreign address only)

Zip Code
Country (foreign address only)

Signature

Postal Code (foreign address only)

Date (mm/dd/yyyy)

2. Please check the one block that applies:
a.

I am not submitting a separate brief, statement, or evidence.

b.

I am submitting a separate brief, statement, and/or evidence with this form.

c.

I need

days to submit a brief, statement, and/or evidence

to the USCIS. (May be granted only for good cause shown. Explain in a separate letter.)

Form N-336 (Rev. 12/09/10) Y

3. Person filing request:
Name (Type or print in black ink.)
Address (Street Number and Name)

Apt. Number

City

State

Signature

Date (mm/dd/yyyy)

Zip Code

I am an attorney or representative and I represent the applicant requesting a hearing on a naturalization proceeding.
[You must attach Form G-28, Notice of Entry of Appearance as Attorney or Representative, if you are an attorney
or representative.]
(Person for whom you are appearing)

4. Briefly state the reason(s) for this request for a hearing:

Form N-336 (Rev. 12/09/10) Y Page 2