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. Attach this form, instruction-side facing up, to each sealed group of applications when submitting to the U.S.
Department of State passport agency's drop-off box.
3. If you are submitting documentation in response to the agency's request for more information (“applicant
response” or “AR”) or a passport containing incorrect information for a correction (“rewrite”), please check the
appropriate box in one of the three spaces provided per drop-off list.

USE OF THIS FORM
We use the information collected on this form 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 identifies the courier
company, the courier employee, the receiving U.S. Department of State passport agency, and the applications
received.

FOR INFORMATION OR QUESTIONS
For more information, please visit our website at travel.state.gov. If you have any questions regarding this form,
please contact the National Courier Liaison by email at NationalCourierLiaison@state.gov or by phone at
202-485-6532 Monday - Friday 8:00 a.m.- 5:00 p.m. Eastern Time. You may also send correspondence to the
following address:
U.S. Department of State
CA/PPT/S/PMO/CS
ATTN: National Courier Liaison
44132 Mercure Cir
P.O. Box 1199
Sterling, VA 20166-1199

PAPERWORK REDUCTION ACT STATEMENT
We estimate the public reporting burden for this collection 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: U.S. Department of State, Bureau of
Consular Affairs, Passport Services, Office of Program Management and Operational Support, 44132 Mercure Cir,
P.O. Box 1199 Sterling, Virginia 20166-1199.
DS-4283
06-2020

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U.S. Department of State

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

OMB Control No: 1405-0222
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:

Applicant's Last Name
Example: Doe

Same Day

Three Day

Two Day

Mail Out

Applicant's
DOB

Form

Departure
Date

Foreign
Visa (Y/N)

1/1/1968

DS-82

1/8/2012

No

1
2
3.
4.
5.
6.
7.
8.
9.
10.

Type

Applicant's Last Name

Application Number

Departure Date

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:
Department of State Use Only:
Intake:
DS-4283
06-2020

Signature:
Initial and Date

Mail Open:
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