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

Request for a Hearing on a Decision in Naturalization
Proceedings Under Section 336

USCIS
Form N-336

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

OMB No. 1615-0050
Expires 11/30/2021

For USCIS Use Only
Barcode

Date Stamp

Remarks
Re-Affirm N-400 Denial
To be completed by an
Attorney or Accredited
Representative (if any).

Re-Determine N-400 Denial
Attorney State Bar Number
(if applicable)

Select this box if
Form G-28 is
attached.

Attorney or Accredited Representative
USCIS Online Account Number (if any)

► START HERE - Type or print in black ink.
NOTE: Type or print "N/A" if an item is not applicable. Type or print "None" if the answer is none. Failure to answer all of the
questions may delay your Form N-336.
Enter Your 9 Digit A-Number:

Part 1. Information About You, the Naturalization Applicant
1.

Current Legal Name (do not provide a nickname)
Family Name (Last Name)

2.

► A-

Given Name (First Name)

Middle Name

Other Names Used (if any)
Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete
this section, use the space provided in Part 8. Additional Information.
Family Name (Last Name)

3.

Date of Birth (mm/dd/yyyy)

Given Name (First Name)

4.

Middle Name

USCIS Online Account Number (if any)
►

5.

Physical Address (do not provide a PO Box in this space unless it is your only address)
Street Number and Name
Apt. Ste. Flr. Number

City or Town

Province or Region

Form N-336 Edition 11/08/19

State

County

Postal Code

ZIP Code

Country

Page 1 of 7

► A-

Part 1. Information About You, the Naturalization Applicant
(continued)
6.

Mailing Address
In Care Of Name (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

Province or Region

7.

State

County

Postal Code

ZIP Code

Country

Contact Information
A. Work Telephone Number

B. Evening Telephone Number

Part 2. Information About Form N-400 Denial On Which You (the Naturalization Applicant) Are
Requesting a Hearing
3.

1.

Form N-400 Receipt
Number

4.

Did you file your Form N-400 on the basis of qualifying military service?

2.

Date of Form N-400 Denial
Notice (mm/dd/yyyy)

USCIS Office That Issued Form N-400
Denial Notice

Yes

No

Part 3. Biographic Information
1.

Ethnicity (Select only one box)
Hispanic or Latino

2.

Not Hispanic or Latino

Race (Select all applicable boxes)
Asian

American Indian or
Alaska Native
3.

Height

Feet

4.

Weight

Pounds

5.

Eye Color (Select only one box)
Black

6.

Black or African
American

Native Hawaiian or
Other Pacific Islander

White

Inches

Blue

Brown

Gray

Green

Hazel

Maroon

Pink

Unknown/Other

Hair Color (Select only one box)
Bald
(No hair)

Black

Form N-336 Edition 11/08/19

Blond

Brown

Gray

Red

Sandy

White

Unknown/
Other

Page 2 of 7

Part 4. Reason You Are Requesting a Hearing

► A-

Provide the reasons you are requesting a hearing on your denied Form N-400. If you need extra space to complete this section, use the
space provided in Part 8. Additional Information.

Form N-336 Edition 11/08/19

Page 3 of 7

Part 5. Naturalization Applicant's Statement, Contact Information,
Certification, and Signature

► A-

NOTE: Read the Penalties section of the Form N-336 Instructions before completing this section.

Naturalization Applicant's Statement
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.

Naturalization Applicant's Statement Regarding the Interpreter
A.

I can read and understand English, and I have read and understand every question and instruction on this request
and my answer to every question.

B.

The interpreter named in Part 6. read to me every question and instruction on this request and my answer to
every question in
, a language in which I am fluent, and I
understood everything.

2.

Naturalization Applicant's Statement Regarding the Preparer
At my request, the preparer named in Part 7.,

,

prepared this request for me based only upon information I provided or authorized.

Naturalization Applicant's Contact Information
3.

Naturalization Applicant's Daytime Telephone Number

5.

Naturalization Applicant's Email Address (if any)

4.

Naturalization Applicant's Mobile Telephone Number (if any)

Naturalization Applicant's Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any and all of my records
that USCIS may need to determine my eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this request, in supporting documents, and in my USCIS records, to other
entities and persons where necessary for the administration and enforcement of U.S. immigration law.
I understand that USCIS may require me to appear for an appointment to take my biometrics and, at that time, if I am required to
provide biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and provided or authorized all of the information in my request;
2) I understood all of the information contained in, and submitted with, my request; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my request, I understand all of the
information contained in, and submitted with, my request, and that all of this information is complete, true, and correct.

Naturalization Applicant's Signature
6.

Naturalization Applicant's Signature

Date of Signature (mm/dd/yyyy)

NOTE TO ALL NATURALIZATION APPLICANTS: If you do not completely fill out this request, USCIS may deny your request.

Form N-336 Edition 11/08/19

Page 4 of 7

Part 6. Interpreter's Contact Information, Certification, and Signature

► A-

Provide the following information about the interpreter.

Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

Interpreter's Given Name (First Name)

2.

Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province or Region

ZIP Code

Country

Postal Code

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

6.

Interpreter's Email Address (if any)

5.

Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification
I certify, under penalty of perjury, that:
, which is the same language specified in Part 5.,
I am fluent in English and
Item B., in Item Number 1.; and I have read to this naturalization applicant in the identified language every question and instruction
on this request and his or her answer to every question. The naturalization applicant informed me that he or she understands every
instruction, question, and answer on the request, including the Naturalization Applicant's Certification, and has verified the
accuracy of every answer.

Interpreter's Signature
7.

Interpreter's Signature

Form N-336 Edition 11/08/19

Date of Signature (mm/dd/yyyy)

Page 5 of 7

Part 7. Contact Information, Declaration, and Signature of the Person
Preparing this Request, if Other Than the Naturalization Applicant

► A-

Provide the following information about the preparer.

Preparer's Full Name
1.

Preparer's Family Name (Last Name)

Preparer's Given Name (First Name)

2.

Preparer's Business or Organization Name (if any)

Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province or Region

Postal Code

ZIP Code

Country

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

5.

Preparer's Mobile Telephone Number (if any)

Preparer's Statement
7.

A.

I am not an attorney or accredited representative but have prepared this request on behalf of the naturalization applicant
and with the naturalization applicant's consent.

B.

I am an attorney or accredited representative and my representation of the naturalization applicant in this case
extends
does not extend beyond the preparation of this request.
NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited Representative, with this request.

Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this request at the request of the naturalization applicant. The
naturalization applicant then reviewed this completed request and informed me that he or she understands all of the information
contained in, and submitted with, his or her request, including the Naturalization Applicant's Certification, and that all of this
information is complete, true, and correct. I completed this request based only on information that the naturalization applicant
provided to me or authorized me to obtain or use.

Preparer's Signature
8.

Preparer's Signature

Form N-336 Edition 11/08/19

Date of Signature (mm/dd/yyyy)

Page 6 of 7

Part 8. Additional Information
If you need extra space to provide any additional information within this request, use the space below. If you need more space than
what is provided, you may make copies of this page to complete and file with this request or attach a separate sheet of paper. Type or
print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to
which your answer refers; and sign and date each sheet.
1.

Family Name (Last Name)

Given Name (First Name)

2.

A-Number (if any) ► A-

3.

A. Page Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

Middle Name

D.

4.

A. Page Number

D.

5.

A. Page Number

D.

6.

A. Page Number

D.

Form N-336 Edition 11/08/19

Page 7 of 7