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; Executive Order 11295 (August 5, 1966); and 22 C.F.R. parts 50 and 51.

PURPOSE: We are requesting the information to ensure that no one has more than one valid U.S. passport book and one valid U.S. passport card at any one time, except as authorized by the U.S. Department of State, and to combat passport fraud and misuse.

The collection of the Social Security number will be used to verify the identity of the person reporting the lost or stolen passport and no other purpose unless authorized by law.

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. 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 your Social Security number and other information on this form is voluntary, but failure to provide the information on this form may, given the form's purpose of verification of your identity, result in processing delays.

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.