Form DS-4283 Courier Drop-Off List for U.S. Passport Applications

U.S. Department of State
Courier Drop-Off List for U.S. Passport Applications
INSTRUCTIONS
1. Please provide all required information on this form. Submit one drop-off list for each service type.
2. This form must be attached, instruction side facing up, to each sealed group of applications when submitted to the
U.S. Department of State passport agency's drop-off box.
3. If submitting documentation in response to agency requests for more information (“applicant response” or “AR”) or
a passport containing incorrect identifying information for a correction (“rewrite”), please check the appropriate box
under the form field on one of the three spaces provided per drop-off list.

USE OF THIS FORM
The information collected on this form is used to track U.S. passport applications submitted by private courier
companies to the U.S. Department of State passport agency's drop-off box. This form is used to identify the courier
company, the courier employee, the receiving U.S. Department of State passport agency, and the applications
received.

FOR INFORMATION AND/OR QUESTIONS
For information or questions, please visit our website at travel.state.gov. In addition, contact the National Courier
Liaison by email at NationalCourierLiaison@state.gov or by phone at 202-485-6532 Monday - Friday 8:00 a.m.5:30 p.m. Eastern Standard Time. You may also send correspondence to the following address:

ATTN: Customer Service Operations Officer
U.S. Department of State
CA/PPT/S/PMO/CS
44132 Mercure Cir
P.O. Box 1199
Sterling, Virgnia 20166-1199

PAPERWORK REDUCTION ACT STATEMENT
The public reporting burden for this collection of information is estimated to average 10 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: AATN: PPT Forms Officer, U.S.
Department of State, Bureau of Consular Affairs, Passport Services, Office of Legal Affairs and Law Enforcement
Liaison, 44132 Mercure Cir, P.O. Box 1227 Sterling, Virginia 20166-1227.
DS-4283

11/2015

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U.S. Department of State

COURIER DROP-OFF LIST
FOR U.S. PASSPORT APPLICATIONS

OMB Approval No: 1405-XXXX
Expiration Date: XX-XX-XXXX
Estimated Burden Time: 10 Minutes

Note: Application limits and service types are set by each U.S. Department of State passport agency. Couriers must abide by each passport agency's guidelines.

Passport Agency:

Date:

Courier Company:

Service
Type:

Same Day

Three Day

Two Day

Mail Out

Applicant's DOB

Form

Departure

Foreign Visa
(Y/N)

12/31/1986

DS-82

1/8/2012

No

Applicant's Last Name
Example: Doe
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

AR
Rewrite
AR
Rewrite
AR
Rewrite
I, the undersigned, have delivered passport applications and/or related documents for the above listed applicants on the date written at the top of this form.

Name of Courier Employee:

Signature:

Department of State Use Only: Initial and Date
Intake:
DS-4283

Mail Open:
11/2015

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