Form DS-5504 APPLICATION FOR A U.S. PASSPORT CORRECTIONS, NAME CHANGE

APPLICATION FOR A U.S. PASSPORT FOR ELIGIBLE INDIVIDUALS
CORRECTION, NAME CHANGE TO PASSPORT ISSUED 1 YEAR AGO OR LESS, AND LIMITED PASSPORT REPLACEMENT
For information or questions, visit the offical Department of State website at travel.state.gov or contact the National
Passport Information Center (NPIC) at 1-877-487-2778 (TDD/TTY: 1-888-874-7793) or NPIC@state.gov.

CAN I USE THIS FORM?
Yes

No

I changed my name, by marriage or court order, less than one year after my most recent U.S. passport book and/or card
was issued and my U.S. passport book and/or card is less than one year old.
OR

Yes

No

My identifying information in my most recent U.S. passport book and/or card was printed incorrectly.
OR

Yes

No

My most recent U.S. passport book was limited to two years or less for a reason other than multiple losses or a seriously
damaged/mulitated passport.

If you answered no to all of the three statements above, STOP. You cannot use this form.
Instead, you must apply on form DS-82 or DS-11 depending on your circumstances.
Passport forms are available at travel.state.gov/passportforms.
NOTICE TO APPLICANTS RESIDING ABROAD
United States citizens residing outside the U.S. and Canada cannot submit this form to domestic addresses listed below. Such applicants should visit
usembassy.gov to find the nearest U.S. embassy or consulate for procedures when applying outside the United States.

IS THERE A FEE WITH THIS APPLICATION?
There is no fee to use this form unless expedited service is requested (see below). Your re-issued passport book and/or card and any documentary
evidence submitted to the Department will be returned to you by priority or first class mail, unless overnight delivery is requested. Photocopies will not be
returned.
Enclose expedited service fee(s) in the form of a personal check or money order. MAKE CHECKS PAYABLE TO "U.S. DEPARTMENT OF STATE." The full
name and date of birth of the applicant must be typed or printed on the front of the check. For information on fees, please visit
travel.state.gov/passportfees.
Do not send cash. The Department cannot be responsible for cash sent through the mail.

WHERE DO I MAIL THIS APPLICATION?

The Department recommends using trackable mailing service when submitting your application.
1. Complete, sign, and date this form.
2. Send this form with your most recent U.S. passport book and/or card, a new color photograph (taken within the last six months), and any required additional
documents.

FOR ROUTINE SERVICE (No fee required):
National Passport Processing Center
Post Office Box 90107
Philadelphia, PA 19190-0107

FOR EXPEDITED SERVICE (Fee required, see below):
National Passport Processing Center
Post Office Box 90907
Philadelphia, PA 19190-0907

Expedited service: Available for a fee. Our website travel.state.gov contains updated information regarding fees and processing times for expedited service.
Expedited service is only available for passports mailed in the United States and Canada. Please write "Expedite" on the outer envelope when mailing.
1-2 Day Delivery: Available for a fee. This service is only available for passport books (and not passport cards) mailed within the United States.
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.
If you choose to provide your email address in item #6 on page 1 of this form, the Department may use that information to contact you in the event there is a
problem with your application or if additional information is required.
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Instruction Page 1 of 4

WHAT TO SUBMIT WITH THIS APPLICATION?
 Your most recent U.S. passport book and/or card;
 A new color photograph (taken within the last six months); and
 Any required additional documents.

A NEW COLOR PHOTOGRAPH
Submit one color photograph, 2x2 inches in size. Photographs must meet the following requirements:
• Head must be 1-1 3/8 inches from the bottom of the chin to the top of the head
• High resolution photo that is not blurry, grainy, or pixelated
• Taken less than six months ago
• No glasses or hat/head covering*
• Use a plain white or off-white background
• Head must face the camera directly with full face in view
• Printed on matte or glossy photo quality paper
(See the full list on travel.state.gov/photos)
*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).
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.

ADDITIONAL DOCUMENTS
NAME CHANGE:
 If your name has changed less than one year after your U.S. passport book and/or card was issued and your U.S. passport
book and/or card is less than one year old, you may use this form.


You must submit a certified name change document such as a certified copy of your marriage certificate or a certified copy of
a court order showing a seal and officiate/judge’s signature. 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.

CORRECTION:


If there is an error in your recently issued, valid U.S. passport book and/or card, you must submit the appropriate document
showing the correct information (e.g. certified birth certificate or certified marriage certificate as described above.)

LIMITED PASSPORT REPLACEMENT:


If you are re-applying because your U.S. passport book was limited in validity due to a lack of citizenship evidence or identity,
you must submit evidence of your U.S. citizenship (such as a government-issued birth certificate or a U.S. Certificate of
Naturalization) and/or evidence of your identity (such as a driver's license or a state-issued identification card). You must
establish your citizenship and identity to the satisfaction of the Department of State. We may ask you to provide additional
evidence to support your claim to U.S. citizenship and/or your identity. Please refer to the letter included with your passport
for instructions.



If your U.S. passport book was limited due to sex transition, please visit travel.state.gov/sexmarker for information on the
documentation you need to submit with this application.



Passport books limited in validity due to serious damage or multiple losses cannot be extended. Please contact the
National Passport Information Center or visit travel.state.gov for more information.
All documentary evidence that is not damaged, altered, or forged will be returned to you. Photocopies will not be
returned.

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Instruction Page 2 of 4

INFORMATION ON HOW YOU RECEIVE YOUR PASSPORT(S)
Separate mailings: You may receive your newly issued U.S. passport book and/or card and your documentary evidence in two separate mailings.
If you are applying for both a U.S. passport book and card, you may receive three separate mailings: one with your documentary evidence; one with
your newly issued U.S. passport book, and one with your newly issued U.S. passport card. Photocopies will not be returned.
Passport numbers: Each newly issued passport book and/or card will have a different passport number than your previous one.
"In care of": If you do not live at the address listed in the "mailing address" section of this application, put the name of the person who does live at
that address and write "In Care Of" in item #8 on page 1. If the applicant is a minor child, you must include the “in care of” name of the
adult registered to receive mail at this address.
Moved? If your mailing address changes prior to receipt of your new passport, please contact the National Passport Information Center (NPIC) at
1-877-487-2778 (TDD/TTY: 1-888-874-7793) or NPIC@state.gov.
NOTE: The U.S. Department of State will not mail a U.S. passport book and/or card to a private address outside the United States or Canada.

WHAT IS THE DIFFERENCE BETWEEN A PASSPORT BOOK AND A PASSPORT CARD?
The U.S. passport card is not valid for international air travel. Unlike the U.S. passport book, the U.S. passport card is valid only for entry at land
border crossings and sea ports of entry when traveling from Canada, Mexico, the Caribbean, and Bermuda.
The maximum number of letters provided for your given name (first and middle) on the U.S. passport card is 24 characters. If both your given names
are more than 24 characters, you must shorten one of the given names you list on item #1 on page 1 of this form.
Both the U.S. passport book and card are U.S. passports. They reflect the bearer's identity and nationality, and they are subject to existing passport
laws and regulations. U.S. passports are only issued to U.S. citizens or non-citizen U.S. nationals.

HOW FEES ARE ESTABLISHED AND PROCESSED
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), and are collected at the
time you apply for the passport service.
If we fail to receive full payment of the applicable fees (for example, if your check is returned for any reason or you dispute a passport fee
charge to your credit card), the U.S. Department of State will take action to collect the delinquent fees from you under 22 C.F.R. Part 34, and the
Federal Claims Collection Standards (see 31 C.F.R. Parts 900-904). In accordance with the Debt Collection Improvement Act (Pub.L. 104-134), if
the fees remain unpaid after 180 days and no repayment arrangements have been made, we will refer the debt to the U.S. Department of Treasury
for collection. Debt collection procedures used by the U.S. Department of Treasury may include referral of the debt to private collection agencies,
reporting of the debt to credit bureaus, garnishment of private wages, and administrative offset of the debt by reducing, or withholding eligible
federal payments (e.g. tax refunds, Social Security payments, federal retirement, etc.) by the amount of your debt, including any interest penalties
or other costs incurred. In addition, non-payment of passport fees may result in the invalidation of your passport. An invalidated passport book or
card cannot be used for travel.
If you send us a check, it will be converted into an electronic funds transfer (EFT). This means we will copy your check and use the account
information on it to electronically debit your account for the amount of the check. The debit from your account will usually occur within 24 hours and
will be shown on your regular account statement. You will not receive your original check back. We will destroy your original check, but we will keep
the copy of it. If the EFT cannot be processed for technical reasons, you authorize us to process the copy in place of your original check. If the EFT
cannot be completed because of insufficient funds, we may try to make the transfer up to two times, and we will charge you a one-time,
non-refundable fee of $25, which we will also collect by EFT.

NOTICE TO APPLICANTS FOR NO-FEE REGULAR, SERVICE, OFFICIAL, OR DIPLOMATIC PASSPORTS
You may use this application if you meet all of the 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 for forwarding to you.

PROTECT YOURSELF AGAINST IDENTITY THEFT - REPORT YOUR PASSPORT LOST OR STOLEN
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 submit form DS-64, Statement Regarding a Lost or Stolen U.S. Passport. Your statement must detail why the
previous U.S. passport book or card cannot be presented.
The information you provide regarding your lost or stolen 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 U.S. 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, report it as found, and submit it for cancellation. It has been invalidated. You may not use that U.S. passport book
or card for travel.
For more information about how to report a lost or stolen U.S. passport book or card, please call the National Passport Information Center (NPIC) at
1-877-487-2778 (TDD/TTY: 1-888-874-7793) or visit travel.state.gov/loststolen.
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Instruction Page 3 of 4

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 the 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.

FEDERAL TAX LAW
Section 6039E of the Internal Revenue Code (26 U.S.C. 6039E) and 22 U.S.C. 2714a(f) require you to provide your Social Security number (SSN),
if you have one, when you apply for or renew a U.S. passport. If you have never been issued an SSN, enter zeros in item #5 on page 1 of this form.
If you are residing abroad, you must also provide the name of the foreign country in which you are residing. The U.S. Department of State must
provide your SSN and foreign residence information to the U.S. Department of Treasury. If you fail to provide the information, your application may
be denied, and you are subject to a $500 penalty enforced by the Internal Revenue Service (IRS). All questions on this matter should be directed to
the nearest IRS office.
Your Social Security number will be provided to the U.S. Department of Treasury, and may be used in connection with debt collection and checked
against lists of persons ineligible or potentially ineligible to receive a U.S. passport, among other authorized uses.

ACTS OR CONDITIONS
If any of the below-mentioned acts or conditions have been performed by or apply to the applicant, a supplementary explanatory statement
under oath (or affirmation) by the applicant should be attached and made a part of this application.
I have not been convicted of a federal or state drug offense or convicted of a “sex tourism” crimes statute, 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.

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, 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. 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 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 section of the instructions to this form. Your Social Security
number will be provided to the Department of the Treasury and may be used in connection with debt collection, among other purposes authorized and
generally described in this section.

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,
Office of Program Management and Operational Support, 44132 Mercure Cir, PO Box 1199, Sterling, Virginia, 20166-1199.

DS-5504 xx-xxxx

Instruction Page 4 of 4

APPLICATION FOR A U.S. PASSPORT FOR ELIGIBLE INDIVIDUALS
CORRECTION, NAME CHANGE TO PASSPORT ISSUED 1 YEAR AGO OR LESS, AND LIMITED PASSPORT REPLACEMENT

Use black ink only. If you make an error, complete a new form. Do not correct.

OMB CONTROL NO. 1405-0160
OMB EXPIRATION DATE: XX-XX-XXXX
ESTIMATED BURDEN: 40 MIN

Please select the document(s) for which you are applying:

U.S. Passport Book

U.S. Passport Card

Both

The U.S. passport card is not valid for international air travel. See instruction page 3.

Regular Book (Standard)

Large Book (Non-Standard)

The large book is for frequent international travelers who need more visa pages.

1. Name Last

D

Middle

First

3. Sex

2. Date of Birth (mm/dd/yyyy)
-

M

-

-

DP

DOTS Code
Exp.

4. Place of Birth (City & State if in the U.S., or City & Country as it is presently known.)

F

6. Email (See application status at passportstatus.state.gov)

5. Social Security Number

O

End. #

-

7. Primary Contact Phone Number
-

@

-

8. Mailing Address Line 1:(Street/RFD#, PO Box, or URB)

Address Line 2: (Include Apartment, Suite, etc. If applicant is a child, write “In Care Of” the parent. Example: In Care Of - Jane Doe, mother)

City

Country (if outside the United States)

Zip Code

State

9. List all other names you have used. (Example: Birth Name, Maiden, Previous Marriage, Legal Name Change. Attach additional pages if needed.)
A.

B.

Most recent U.S. passport book number

Book Issue Date (mm/dd/yyyy)

STAPLE

STAPLE

Your name as printed on your most recent U.S. passport book and/or passport card

2" x 2"

2" x 2"

STAPLE

STAPLE
Attach a color photograph
taken within the last six months

10. U.S. Passport Information

Most recent U.S. passport card number

Card Issue Date (mm/dd/yyyy)

CONTINUE TO PAGE 2

YOU MUST SIGN AND DATE THE APPLICATION IN THE DESIGNATED AREA BELOW

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, since acquiring U.S. citizenship or nationality,
performed any of the acts listed under "Acts or Conditions" on page four of the instructions of this application (unless 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 documents 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 four of the instructions to the application form.

x

Applicant's Legal Signature - age 16 and older

Date

FOR ISSUING OFFICE ONLY

x

Mother/Father/Parent/Legal Guardian's Signature (if identifying minor)
Name Change

Replacement

Correction:

LName

FName

MName

DOB

Sex

POB

Other

From:
To:
BC

Nat/Citz Cert

Report of Birth

Prev PPT

MC

Adoption C/O

Filed/Issued/Place:

NC C/O

ACRQ

Other

Doc #:

Other:
Attached:
EF

DS-5504 xx-xxxx

Postage

Other

* DS 5504 A 11 2013 1 *
Page 1 of 2

Name of Applicant (Last, First & Middle)

11. Height

12. Hair Color

Date of Birth (mm/dd/yyyy)

13. Eye Color

15. Employer or School (if applicable)

14. Occupation (if age 16 or older)

16. Additional Contact Phone Numbers
Home

Cell

Home

Work

Cell

Work

17. Permanent Address: (Complete if PO Box is listed in Mailing Address or if residence is different from Mailing Address. Do not list a PO Box.)
Apartment/Unit
Street/RFD # or URB

City

Zip Code

State

18. Your Emergency Contact (Provide the information of a person not traveling with you to be contacted in the event of an emergency.)
Name

Address: Street/RFD # or PO Box

State

City

Zip Code

Apartment/Unit

Relationship to Applicant

Phone Number

19. Travel Plans (If no travel plans, please write “none”)
Departure Date (mm/dd/yyyy) Return Date (mm/dd/yyyy)

Countries to be visited

Please complete the following questions
Has your name changed by marriage or court
order less than one year after your U.S.
passport book and/or card was issued?
Yes

No

If yes, and your submitted passport book and/or
card is less than one year old, please complete
this section with your new name.

Name Last

First

Middle

Note: You must submit evidence documenting your name change (such as a certified marriage certificate or a certified court order) and your current U.S.
passport book and/or card, along with this completed form to the address listed on instruction page 1.
If you cannot or did not meet the above criteria, please complete form DS-82, U.S. Passport Renewal Application for Eligible Individuals or form
DS-11, Application for a U.S. Passport.
Was your identifying information printed
incorrectly in your U.S. passport
book and/or card?
Yes

Name Last

Middle

First

No

If yes, only check the box(es) next to the field(s)
that need to be corrected and complete the
information as it should appear.

Date of Birth (mm/dd/yyyy)

Sex

Place of Birth (State or Country)

M
F

Note: Please submit evidence documenting your correct identifying information (such as a certified marriage certificate or birth certificate) and your current
U.S. passport book and/or card, along with this completed form to the address listed on instruction page 1.
Was your most recent U.S. passport book limited for
two years or less?
Yes

No

If yes, please submit evidence of your U.S. citizenship (such as
U.S. birth certificate or naturalization certificate) and/or evidence of
your identity (such as a driver’s license or state-issued ID card). Visit
travel.state.gov/sexmarker for information on sex transition.
DS-5504 xx-xxxx

Note: To complete a limited U.S. passport book replacement, your submitted U.S.
passport book must not be expired. Passport books limited in validity because of
multiple losses, damages, or mutilations cannot be extended.
Please be sure to enclose your U.S. passport book along with this application to the
address listed on instruction page 1.

* DS 5504 A 11 2013 2 *
Page 2 of 2