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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out Part I, 'APPLICANT INFORMATION'. Ensure all fields are completed accurately, including the applicant's name, USCIS A-Number, and contact details. Use clear black ink if completing by hand.
- Proceed to Part II, 'MEDICAL PROFESSIONAL INFORMATION'. The certifying medical professional should provide their details and check applicable licenses. If additional space is needed, attach continuation sheets as necessary.
- In Part III, 'INFORMATION ABOUT DISABILITY and/or IMPAIRMENT(S)', the medical professional must answer all questions regarding the applicant's condition. This includes providing clinical diagnoses and explaining how the disability affects English comprehension.
- Finally, ensure that both the medical professional and interpreter (if applicable) complete their certifications at the end of the form. Signatures must be dated appropriately.
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