PRIVACY ACT STATEMENT

AUTHORITIES: Collection of this information is authorized by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; 26 U.S.C. 6039E, 22 U.S.C. 2714a(f), Section 236 of the Admiral James W. Nance and Meg Donovan Foreign Relations Authorization Act, Fiscal Years 2000 and 2001; Executive Order 11295 (August 5, 1966); and 22 C.F.R. parts 50 and 51.

PURPOSE: This information is being collected in order to determine your eligibility to be issued a U.S. passport. Your Social Security number is used to verify your identity.

ROUTINE USES: This information may be disclosed to another domestic government agency, a private contractor, a foreign government agency, or to a private person or private employer in accordance with certain approved routine uses. These routine uses include, but are not limited to, law enforcement activities, employment verification, fraud prevention, border security, counterterrorism, litigation activities, and activities that meet the Secretary of State's responsibility to protect U.S. citizens and non-citizen nationals abroad. Your Social Security number will be provided to the Department of the Treasury and may be used in connection with debt collection, among other purposes authorized and generally described in this section. More information on the Routine Uses for the system can be found in System of Records Notices State-05, Overseas Citizens Services Records and Other Overseas Records and State-26, Passport Records.

DISCLOSURE: Providing information on this form is voluntary. Be advised, however, that failure to provide the information requested on this form may cause delays in processing your U.S. passport application and/or could result in the refusal or denial of your application. Failure to provide your Social Security number may result in the denial of your application (consistent with 22 U.S.C. 2714a(f)) and may subject you to a penalty enforced by the Internal Revenue Service, as described in the Federal Tax Law section of the instructions to this form.


INSTRUCTIONS

  • This form filler tool is not an online passport application.
  • Instead, the form filler allows you to electronically enter your data and print a paper form with a barcode unique to the data entered. Once you electronically complete your answers and print the form, you will then submit the form by mail, or in person, depending on the form type. (DS-82 and DS-5504 forms by mail; DS-11 form in person)
  • Depending on the form(s) you fill out, the estimated burden time to use this form filler may be anywhere from 40 to 90 minutes. After you print your form, please review the OMB number, expiration date, burden time estimate, and the full Privacy Policy and Paperwork Reduction Act Statement.
  • Since the data you enter is directly captured in your application’s unique barcode, please do not make any handwritten changes, corrections or additions to the data, or to the form after it is printed, as it may cause data errors and processing delays.
  • If you notice an error after printing your form, or if you leave a field blank, please start over and complete a new form.
  • Alert to families: Please do not use software programs or tools to digitally transfer or copy data from one family member’s passport application form to another, as the barcode and information is only tied to one applicant’s data.
  • For the DS-11 form, do not sign your name. You must wait to take the oath and sign the form in front of a passport acceptance agent at a designated passport acceptance facility or in front of a U.S. Department of State employee at a passport agency or center.
  • For DS-82 and DS-5504 forms, you must sign and date the application with the date on which you are completing the online form. Applications submitted without your signature and date will not be processed and will be returned to you.
  • Your information is not saved by the form filler and can no longer be accessed after you print your form. Please carefully check your answers because you cannot correct typographical or data errors after the form is printed.
  • Go to travel.state.gov/passport for more information on how and where to apply for and renew your passport.