Fill in a Valid DS-82 01-2017 US Passport Renewal Application Template

U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS

Please print legibly using black ink only. If you make an error, complete a new form. Do not correct or white out. For information or questions, visit travel.state.gov or contact the National Passport Information Center (NPIC) at

1-877-487-2778 (TDD/TTY: 1-888-874-7793) or [email protected].

SECTION A. ELIGIBILITY TO USE THIS FORM

This form is used by U.S. passport holders to renew their current or recently expired U.S. passport book and/or card (a travel document attesting to one’s identity and issued to U.S. citizens or non-citizen U.S. nationals). This form can be submitted by mail. You are eligible to use this form if you can answer “Yes” to ALL statements below about your passport:

If you answered "NO" to any of the statements above, STOP. You cannot use this form.

You may be eligible to apply on form DS-11 or DS-5504 depending on your circumstances. Visit travel.state.gov for more information.

Notice to Applicants for No-Fee Regular, Service, Official, or Diplomatic Passports: You may use this application if you meet all provisions listed; however, you must consult your sponsoring agency for instructions on proper routing procedures before forwarding this application. Your completed passport will be released to your sponsoring agency and forwarded to you.

Replacing a Lost, Stolen, or Damaged Passport: A United States citizen or non-citizen national may not normally have more than one valid or potentially valid U.S. passport book or more than one valid or potentially valid U.S. passport card at a time. Therefore, when a valid or potentially valid U.S. passport book or card cannot be presented with a new application, you must apply using form DS-11, Application for a U.S. Passport.

The information you provide regarding your lost or stolen valid U.S. passport book or card will be placed into our Consular Lost or Stolen Passport System. This system is designed to prevent the misuse of your lost or stolen U.S. passport book or card. Anyone using the passport book or card that was reported lost or stolen may be detained upon entry into the United States. If you find the

U.S. passport book or card that was reported lost or stolen, immediately report it as found and submit it for cancellation. It has been invalidated. You cannot use that passport book or card for travel.

SECTION B. STEPS TO RENEW A U.S. PASSPORT

1.Complete and sign this form.

2.Attach one color photograph 2x2 inches in size, your previously issued U.S. passport, and supporting documents (See Section D of these instructions).

3.Mail us your application and attachments (See Section E of these instructions).

4.Track application status online at Passportstatus.state.gov.

5.Receive new passport and original supporting documents (that you submitted with your application).

U.S. Department of State

U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS

SECTION C. HOW TO COMPLETE THIS FORM

Please see the instructions below for items on the form that are not self-explanatory. The numbers match the numbered items of the form.

1.Name (Last, First, Middle): Enter the name to appear in the passport. The name to appear in the passport should be consistent with your previous U.S. passport. If you are requesting a passport in a name different from the name that appears on your previous U.S. passport, submit proof of name change if resulting from marriage or legal name change such as a marriage certificate, divorce decree, or court order of name change (if applicable). Information can be found at travel.state.gov/namechange.

2.Date of Birth: Use the following format: Month, Date, and Year (MM/DD/YYYY).

3.Sex: You must select sex marker option “M” (male) or “F” (female) that corresponds with your biological sex at birth.

4.Place of Birth: Enter the name of the city and state if in the U.S. or city and country as presently known.

5.Social Security Number: You must provide a Social Security number (SSN), if you have been issued one, in accordance with Section 6039E of the Internal Revenue Code (26 U.S.C. 6039E) and 22 U.S.C 2714a(f). If you do not have a Social Security number, you must enter zeros in this field and submit a statement, signed and dated, that includes the phrase, “I declare under penalty of perjury under the laws of the United States of America that the following is true and correct: I have never been issued a Social Security Number by the Social Security Administration.” If you reside abroad, you must also provide the name of the foreign country where you reside. The U.S. Department of State must provide your SSN and foreign residence information to the U.S. Department of the Treasury which will use it in connection with debt collection and check against lists of persons ineligible or potentially ineligible to receive a U.S. passport, among other authorized uses. If you fail to provide the information, we may deny your application and the Internal Revenue Service (IRS) may enforce a penalty. Refer all questions on this matter to the nearest IRS office.

8.Mailing Address Line 1 and 2 "In Care Of": For line 1 enter applicant’s Street/RFD #, or P.O. Box or URB. For line 2, if you do not live at the address listed in this field, put the name of the person who lives at this address and mark it "In Care Of".

9.List all other names you have used: Enter all legal names previously used to include maiden name, name changes, and

previous married names. You can enter up to two names: one in item A and one in item B. If only your last name has changed just enter the last name. If you need more space to write additional names, please use a separate sheet of paper and attach it to this form.

Application Page 1 - Signature Block (below Section 11): Remember to sign this page then complete Application Page 2.

SECTION D. ATTACHMENTS TO SUBMIT WITH THIS FORM

Once you have completed Application Pages 1 and 2, attach the supporting documents as outlined in this section.

1.YOUR MOST RECENTLY ISSUED U.S. PASSPORT BOOK AND/OR CARD

When submitting a U.S. passport book and/or card with this form, please verify that the document was issued at age 16 or older in your current name and issued within the past 15 years. Please submit any valid passport product you have with this application. If your U.S. passport book and/or card has been mutilated, damaged, or reported lost or stolen, you must apply on form DS-11.

2.A RECENT COLOR PHOTOGRAPH See the full list of photo requirements on travel.state.gov/photos.

Attach one photo, 2x2 inches in size. U.S. passport photo requirements may differ from photo requirements of other countries. To avoid processing delays, be sure your photo meets all the following requirements (Refer to the photo template on Application Page 1):

*Head coverings are not acceptable unless you submit a signed statement verifying that it is part of recognized, traditional religious attire that is customarily or required to be worn continuously in public or a signed doctor's statement verifying its daily use for medical purposes. Glasses or other eyewear are not acceptable unless you submit a signed statement from a doctor explaining why you cannot remove them (e.g., during the recovery period from eye surgery). Photos are to be taken in clothing normally worn on a daily basis. You cannot wear a uniform, clothing that looks like a uniform, or camouflage attire.

USE CAUTION WHEN STAPLING YOUR PHOTO: Use 4 staples vertically in the corners as close to the outer edges as possible. Do not bend the photo. Follow the photo template on Application Page 1.

U.S. Department of State

U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS

3.PROOF OF NAME CHANGE: If the name you are currently using is different from the name on your most recent U.S. passport, you must submit a copy of your certified marriage certificate, divorce decree, or original court order showing the change of name. Please make sure all documents are clear and legible. All original documents will be returned to you by mail. If you are unable to document your name change in this manner, you must apply on form DS-11, Application for a U.S. Passport.

4.FEES: Passport service fees are established by law and regulation (see 22 U.S.C. 214, 22 C.F.R. 22.1, and 22 C.F.R.

51.50-56). Do not send cash. The Department cannot be responsible for cash sent through the mail. By law, the passport fees are non-refundable. There is no execution fee to use this form. Newly issued passport cards are delivered via first class mail only. Visit travel.state.gov/passportfees for current fees, payment methods, and how fees are used and processed. Additional fee information is as follows:

Applicant Applying in the United States: Please Visit travel.state.gov/passportfees for current fees, payment methods, and how fees are used and processed.

Applicant Applying Outside the United States: Please see the website of your embassy, consulate, or consular agency for acceptable payment methods.

Other Services Requiring Additional Fee (Visit travel.state.gov for more details):

•Expedited Service: Available for an additional fee. Expedited service is only available for passports mailed in the United States and Canada. Please include the appropriate fee with your payment. Please write "Expedite" on the outer envelope when mailing. Visit travel.state.gov for the current fees and processing times for expedited service.

•1-2 Day Delivery: Available for an additional fee. This service is only available for passport book (and not passport card) mailings in the United States. Please include the appropriate fee with your payment.

•NOTE: To ensure minimal processing time for expedited applications, the Department recommends using 1 – 2 day delivery service to submit the application and to include the appropriate postage fee for 1-2 day return delivery for the newly issued passport book. Please visit travel.state.gov for updated information regarding fees, processing times, or to check the status of your passport application online.

SECTION E. HOW TO SUBMIT THIS FORM

The Department recommends using a trackable mailing service when submitting your application.

Submitting your form depends on your location and how soon you need your passport. Print page one and page two of your application on separate pieces of paper. You do not need to submit instruction pages. Mail this form and attachments to one of the addresses below:

Notice to Applicants Located Outside the United States: U.S. citizens residing outside the United States and Canada cannot submit this form to the domestic addresses listed above. Each U.S. embassy and consulate has different procedures for submitting and processing your application. Visit travel.state.gov to check the U.S. embassy or consulate webpage for more information.

SECTION F. RECEIVING YOUR PASSPORT AND SUPPORTING DOCUMENTS

•Difference Between U.S. Passport Book and Card: The book is valid for international travel by air, land, and sea. The card is not valid for international air travel, only for entry at land border crossings and seaports of entry when traveling from Canada, Mexico, Bermuda, and the Caribbean. The maximum number of letters provided for your given name (first and middle) on the card is 24 characters. If both your given names are more than 24 characters, you must shorten one of your given names you list on item #1 of Application Page 1.

•Separate mailings: You may receive your newly issued U.S. passport book and/or card and your citizenship evidence in two

separate mailings. If you are applying for both a book and card, you may receive three separate mailings: one with your returned evidence, one with your newly issued book, and one with your newly issued card. All documentary evidence that is not damaged, altered, or forged will be returned to you. Photocopies will not be returned.

•Passport numbers: Each newly issued passport book or card will have a different passport number than your previous one.

•Shipping and Delivery Changes: If your mailing address changes prior to receipt of your new passport, please contact NPIC.

NOTE: We will not mail a U.S. passport to a private address outside the United States or Canada.

•Passport Corrections, Non-Receipt/Undeliverable Passports, and Lost/Stolen Passport: For more information visit travel.state.gov or contact NPIC.

U.S. Department of State

U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS

WARNING

False statements made knowingly and willfully in passport applications, including affidavits or other documents submitted to support this application, are punishable by fine and/or imprisonment under U.S. law including the provisions of 18 U.S.C. 1001, 18 U.S.C. 1542, and/or 18 U.S.C. 1621. Alteration or mutilation of a passport issued pursuant to this application is punishable by fine and/or imprisonment under the provisions of 18 U.S.C. 1543. The use of a passport in violation of the restrictions contained herein or of passport regulations is punishable by fine and/or imprisonment under 18 U.S.C. 1544. All statements and documents are subject to verification.

Failure to provide information requested on this form, including your Social Security number, may result in significant

processing delays and/or the denial of your application.

ACTS OR CONDITIONS

The applicant agrees with the following statement:

I am not currently required to register under the sex offender registration program of any jurisdiction for a sex offense against a minor. I have not been convicted of a federal or state drug offense or convicted of a statutory "sex tourism" crime, and I am not the subject of an outstanding federal, state, or local warrant of arrest for a felony; a criminal court order forbidding my departure from the United States; or a subpoena received from the United States in a matter involving federal prosecution for, or grand jury investigation of, a felony.

If any of the above-mentioned acts or conditions have been performed by or apply to the applicant, a supplementary explanatory statement under oath (or affirmation) by the applicant is required to be attached and made part of this application.

PRIVACY ACT STATEMENT

AUTHORITIES: Collection of this information is authorized by 22 U.S.C. 211 a 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: We are requesting this information 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 U.S. 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 Citizen 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 also 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 penalty enforced by the Internal Revenue Service, as described in the Federal Tax Law on Instruction Page 2 (Section C) to this form.

PAPERWORK REDUCTION ACT STATEMENT

Public reporting burden for this collection of information is estimated to average 40 minutes per response, including the time required for searching existing data sources, gathering the necessary data, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: Passport Forms Officer, U.S. Department of State, Bureau of Consular Affairs, Passport Services, Office of Program Management and Operational Support, 44132 Mercure Cir, PO Box 1199, Sterling, Virginia 20166-1199.

For more information about your application status, online tools, current fees, and

processing times, please visit travel.state.gov.

YOU MUST SIGN AND DATE THE APPLICATION IN THE DESIGNATED AREA BELOW. THEN COMPLETE PAGE 2

I declare under penalty of perjury all of the following: 1) I am a citizen or non-citizen national of the United States and have not performed any of the acts listed under "Acts or Conditions" on page 4 of the instructions of this application (unless an explanatory statement is attached); 2) the statements made on the application are true and correct; 3) I have not knowingly and willfully made false statements or included false statements in support of this application; 4) the photograph submitted with this application is a genuine, current photograph of me; and 5) I have read and understood the warning on page 4 of the instructions to the application form.

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