N-336 Form TOC

FORM N-336

FORM TABLE OF CHANGES

OMB RIN 1615-0050

07-21-2011

LOCATION	CURRENT VERSION	PROPOSED VERSION
Top of the Form		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.
For USCIS Only	For USCIS Only Decision: Grant [text box] Denial [text box] Fee: [text box]	For USCIS Only DELETE DELETE DELETE DELETE
First Page (similar to N-400)	[new section]	Bar Code [text box]
First Page (similar to N-400)	[new section]	Date Stamp [text box]
First Page (similar to N-400)	[new section]	Remarks [text box]
For USCIS Only First Page	[new section]	[inside Remarks Block] Concur with Form N-400 Denial. Do Not Concur with Form N-400 Denial.
1. In the Matter of:	1. In the Matter of: (Name of Naturalization Applicant)	DELETE
File Number:	File Number: A-	Your A-Number: [box next to Part 1. box] A _ _ _-_ _ _-_ _ _
2. I am filing a request for hearing on the decision date:	2. I am filing a request for hearing on the decision date:	DELETE
3. Please check the one block that applies:	3. Please check the one block that applies: a. I am not submitting a separate brief, statement, or evidence. [text box] b. I am submitting a separate brief, statement, and/or evidence with this form. [text box] c. I need _________days to submit a brief, statement, and/or evidence to the USCIS. (May be granted only for good cause show. Explain in a separate letter.) [text box]	DELETE
4. Person filing request	4. Person filing request: Name (Type or print in black ink.) Address (Street Number and Name) (Apt. Number) (City) (State) (Zip Code) Signature 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 and did not previously submit such a form.] (Person for whom you are appearing)	Part 1. Information About You, the Naturalization Applicant 1. Current Legal Name (do not provide a nickname) Family Name (last name) [text box] Given Name (first name) [text box] Middle Name (if applicable) [text box] 2. Date of Birth (mm/dd/yyyy) [text box] 3. Home Address Street Number and Name (do not write a P.O. Box in this space unless it is your ONLY address.) [text box] Apartment Number [text box] City [text box] County [text box] State [text box] ZIP Code [text box] Province (foreign address only) [text box] Country (foreign address only) [text box] Postal Code (foreign address only) [text box] 4. Mailing Address C/O (in care of name) [text box] Street Number and Name [text box] Apartment Number [text box] City [text box] State [text box] ZIP Code [text box] Province (foreign address only) [text box] Country (foreign address only) [text box] Postal Code (foreign address only) [text box] 5. Daytime Phone Number [text box] Work Phone Number (if any) [text box] Evening Phone Number [text box] Mobile Phone Number (if any) [text box] 6. E-Mail Address (if any) [text box]
[new section]	[new section]	Part 2. Information About Form N-400 (Application for Naturalization) for Which You Are Requesting a Hearing 1. Form N-400 Receipt Number [text box] 2. Date of Form N-400 Denial Notice (mm/dd/yyyy) [text box] 3. USCIS Office That Issued Form N-400 Denial Notice [text box]
5. Briefly state the reason(s) for this request for a hearing:	5. Briefly state the reason(s) for this request for a hearing: [text box]	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, date, the question number, and sign the top of each additional sheet(s). NOTE: Refer to the Form N-336 Instructions, Page 1, Document Submission, for documents to submit with your Form N-336. [large text box]
	[new section]	Part 4. Accommodations for Individuals With Disabilities and/or Impairments 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) [text box] Yes [text box] No If you checked “Yes,” check the box(es) below that applies: [text box] I am deaf or hearing impaired and need a sign language interpreter who uses the following language (e.g., American Sign Language (ASL)): ____________ [text box] I use a wheelchair. [text box] I am blind or sight impaired. [text box] I will need another type of accommodation. Explain: ___________
[new section]	[new section]	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 [text box] Date (mm/dd/yyyy) [text box]
[new section]	[new section]	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. Preparer’s Printed Name [text box] Preparer’s Signature [text box] Date (mm/dd/yyyy) [text box] Preparer’s Firm or Organization Name (if applicable) [text box] Preparer’s Daytime Phone Number [text box] Preparer’s Address Street Number and Name [text box] City [text box] State [text box] ZIP Code [text box] Province (foreign address only) [text box] Country (foreign address only) [text box] Postal Code (foreign address only) [text box] Preparer’s E-Mail Address [text box] Preparer’s Fax Number [text box]

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