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

OMB No. 1615-0050; Expires 04/30/2012

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:

Re-Affirm N-400 Denial
Re-Determine N-400 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)

C/O (in care of name)

County

Country (foreign address only)

Mailing Address
Street Number and Name

Postal Code (foreign address only)

C/O (in care of name)

Apartment Number

City

State

Zip Code

Province (foreign address only)

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 (10/30/11) N

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

Apt. Number

City

State

Zip Code

Signature (USCIS will reject your Form N-336 if not signed) Date (mm/dd/yyyy)
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 (10/30/11) N Page 2