FWAB Form - 2013 Version for Comparison

FWAB_60Day_20170309.pdf

Federal Write-In Absentee Ballot (FWAB)

FWAB Form - 2013 Version for Comparison

OMB: 0704-0502

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0704-0502 can be found here:

Document [pdf]

Download: pdf | pdf

You can vote wherever you are.
If you do not receive your absentee ballot from your State 30 days before the
election (or sooner if necessary), use this ballot as a backup. If you send this
ballot in and then later receive your State’s ballot, you should fill out and
return your State ballot as well. Officials will count only one ballot.
All States and territories accept this ballot to vote for federal offices (for
instance, President or U.S. Senator), but State laws vary about using it for
other elections. Some States allow this form to be used for voter registration.
To learn about your State’s rules, see the Voting Assistance Guide. It has
everything you need to know about absentee voting in all States, territories
and the District of Columbia. To read the Guide, either go to
www.fvap.gov/vao/vag or ask your Voting Assistance Officer for a copy.

1. Carefully fill out your Voter Information form
and Backup Ballot.

Print clearly in black ink.

2. Be sure to sign the Voter Information form.
DO NOT sign your ballot or include any personal
information. Keep your ballot anonymous.

This form is for you if you are:
 On active duty in the Uniformed

Services or Merchant Marine
 An eligible spouse or dependent
 On active duty in the National Guard
under State orders (some States only)
 A U.S. citizen living outside the
United States.

Agency Disclosure Statement
The public reporting burden for this collection of
information is estimated to average 15 minutes per
response, including time to review instructions,
gathering and maintaining the data needed, and
completing and reviewing the collection of information.
Send comments regarding this burden estimate or any
other aspect of this collection of information, including
suggestions for reducing the burden to: Department of
Defense, Washington Headquarters Services, Executive
Services Directorate, Information Management Division,
4800 Mark Center Dr., East Tower, Suite 03F09,
Alexandria, VA 22350-3100. [OMB Control #07040502]. Respondents should be aware that
notwithstanding any other provision of law, no person
shall be subject to any penalty for failing to comply with
a collection of information if it does not display a
currently valid OMB control number. DO NOT RETURN
YOUR FORM TO THE ADDRESS ABOVE.

Privacy Act Statement

3. Remove the adhesive liner from the top and
sides of your ballot. Fold and seal tightly.

If you require additional pages for candidates or
ballot initiatives, photocopy the ballot page and
fill in the necessary information. Fold and seal
extra pages inside the official ballot.

4. Assemble your documents for mailing.
Put your ballot and Voter Information form into the
envelope.
Write your name and mailing address on the front,
then fill in the address of your election office. The
address can be found online at FVAP.gov. All
States accept this form by mail, but vary on email
and fax. See your State’s rules in the Voting
Assistance Guide online at FVAP.gov.

Questions? Email vote@fvap.gov

Authority: The authority to collect your personal
information on this form comes from 52 U.S.C. § 20301,
“Uniformed and Overseas Citizens Absentee Voting Act
(UOCAVA).”
Principal purpose: This form serves as an application for
registration and/or request an absentee ballot for all
persons covered by UOCAVA.
Routine use(s): There is no retention of this information
by the Federal government. Completed forms are sent by
you to an appropriate State election official.
Disclosure: Your disclosure of personal information is
voluntary. However, failure to provide the requested
personal information may keep the pertinent jurisdiction
from processing this request and may prevent you from
voting absentee.

Voter Information
Federal Write-In Absentee Ballot (FWAB)

Have you already registered and requested an absentee ballot?

□ Yes Fill out this form and the Backup Ballot. Send them both.
□ No — You must register and request an absentee ballot before filling out the FWAB for:
AL, AS, AR, CT, FL, GU, HI, ID, IL, IN, IA, KS, LA, MI, NH, NJ, NM, NY, PA, PR, RI,
TX, VT, WV, and WY. If your State is listed, complete an FPCA online at FVAP.gov.
— If your State is not listed, send in this form and the Backup Ballot.

1. Who are you?






I am on active duty in the Uniformed Services or Merchant Marine - OR -  I am an eligible spouse or dependent.
I am an activated National Guard member on State orders.
I am a U.S. citizen living outside the country, and I intend to return.
I am a U.S. citizen living outside the country, and my return is uncertain.
I am a U.S. citizen living outside the country, and I have never lived in the United States.

First name

Suffix (Sr., Jr., II)

Middle name

Previous names (if needed)

Last name

Birth date (MM/DD/YYYY)

Social Security Number

____ ____ ____ – ____ ____ –____ ____ ____ ____

- OR -

Driver’s license or State ID

Only the last 4 digits are needed; except for
Hawaii, New Mexico, South Carolina, Tennessee, and Virginia.

2. What is your address in the State or territory where you are registered to vote?
Your voting materials will not be sent to this address.
Street (Not P.O. box)

Apt. number

City, town, village

County

State

ZIP

3. Where are you now? You must give your CURRENT contact information to receive your voting materials.
Your current address.

Contact information:
So election officials can
reach you if there is a
problem with your request.

If your mailing address is different, fill it in here.

Email
Alternate email
Phone: Include country and area codes. Not DSN.
Fax: Include country and area codes. Not DSN.

4. What is your voting preference?
How do you want to
receive your ballot from
your election office?

 Email or online
 Mail
 Fax






│

││

│

Your political party for
primary elections.

5. What additional information must you provide?
The following need more information: Alabama, Alaska, Arizona, Puerto Rico, South Dakota, Vermont, Virginia, and Wisconsin.
See the Voting Assistance Guide online at www.fvap.gov/vao/vag. You may also use this space to clarify your voter information.

6. You must read and sign this statement.
I swear or affirm, under penalty of perjury, that:
 The information on this form is true, accurate, and complete to the best of my knowledge. I understand that a material misstatement of fact in
completion of this document may constitute grounds for conviction of perjury.
 I am a U.S. citizen, am at least 18 years of age (or will be by the day of election), eligible to vote in the requested jurisdiction, and
 I am not disqualified to vote due to having been convicted of a felony or other disqualifying offense, nor have I been adjudicated mentally incompetent;
or if so, my voting rights have been reinstated; and
 I am not registering, requesting a ballot, or voting in any other jurisdiction in the United States, except the jurisdiction cited in this voting form.

Sign here

This information is for official use only. Any unauthorized release may be punishable by law.

Today’s date
Previous editions are obsolete.

Standard Form 76 (Rev.09-2016), OMB No. 0704-0502

Backup Ballot

To find out more about specific candidates
and races in the upcoming election, go to
www.fvap.gov.

Federal Write-In Absentee Ballot (FWAB)
Instructions

Use this Backup Ballot if you do not receive an absentee ballot from your State 30 days before the election. The Backup Ballot can
be used to vote for federal offices. Legal residents of American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands may vote for
all federal offices in the primary election, but only Delegate or Resident Commissioner in the general election. State laws vary about
using the FWAB for other offices like Governor or Mayor. Learn more online at FVAP.gov.
Write in the name or political party of the candidates you choose.
DO NOT write your name or Social Security Number on the ballot.
Candidates for federal offices
President and Vice President

U.S. Senator
U. S. Representative, Delegate, or Resident
Commissioner to Congress

Candidates for non-federal offices
Office

Candidate name

Political party

Ballot initiatives

Standard Form 186 (Rev.09-2016), OMB No. 0704-0502

Official Ballot
Federal Write-In Absentee Ballot

Private
Fold your ballot and keep it private. Put it into the envelope.

Before you seal this envelope:
1. Sign your Voter Information form.
2. Put both the form and the sealed ballot inside this
envelope.

3. Write your name and mailing address on the front,

then fill in the address of your election office, which is
available online at FVAP.gov.

For election officials:
This is an official Federal Write-In Absentee Ballot
authorized by 52 U.S.C. § 20301.
If you have questions about it, contact your State officials.

MM YYYY

_______________________________________________________

(Fill in the address of your election office. The address can be found online at FVAP.gov. )

OFFICIAL VOTING INFORMATION MATERIAL – FIRST CLASS MAIL
No postage necessary in the U.S. Mail – DMM 703.8.0

I have enclosed my ballot for the __ /____ election.

International airmail postage is required if not mailed using the
U.S. Postal Service, APO/FPO/DPO system or diplomatic pouch.

__________________________________
__________________________________
__________________________________
__________________________________
__________________________________

(Your name and current complete military or overseas mailing address)

From

PAR AVION

File Type	application/pdf
File Modified	2017-03-09
File Created	2017-03-09