Form DS-86 Statement of Non-Receipt of a U.S. Passport

HOW TO USE THIS FORM

This form is used when you do not receive your U.S. passport in the mail. You have 90 days from the date that your U.S. passport book
or card was issued to report that you have not received it in the mail. If you do not report within 90 days of the issue date, you will be
required to reapply and submit the full passport fee(s). Unless you have immediate travel plans, it is recommended that you wait
14 days from the date your passport was issued before you submit this statement.
Before submitting this statement:
1. Check the status of your U.S. passport application by contacting the National Passport Information Center at 1-877-487-2778
(TDD/TTY: 1-888-874-7793) or NPIC@state.gov. If the passport was mailed to you, ask for the date the passport was issued,
tracking number, and the name and address of the passport agency that issued your passport.
2. Contact the shipping company or postal service, online or by phone, and use the tracking number to track the envelope.
3. Complete all sections of this statement except for the section titled “Issuing Office Only.” You must submit a clear photocopy of the
front and back of your valid government-issued photo identification, such as a driver’s license.
4. Mail this statement and photocopy of your photo identification to the passport agency that issued the passport you did not receive.
Once your statement is received, the U.S. passport book or card that was reported as not received will be cancelled and
cannot be used for travel. If the U.S. passport book or card reported in this statement arrives at a later time, please call the National
Passport Information Center for instructions on where to send your passport.
If you applied for your U.S. passport book or card while outside of the United States, please contact your local U.S. embassy or
consulate for instructions on where to send your passport.
PROTECT YOURSELF AGAINST IDENTITY THEFT - REPORT THE NON-RECEIPT OF YOUR PASSPORT BOOK OR CARD
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 you do not receive your U.S. passport book or
card in the mail, you must submit form DS-86, Statement of Non-receipt of a U.S. Passport.
The information that you provide on this form will be entered into the Consular Lost and Stolen Passport System. This system is
designed to prevent the misuse of the U.S. passport book or card that you did not receive in the mail. Passport(s) reported as not
received will be cancelled and cannot be used for travel. Anyone using the U.S. passport book or card reported on this form, including
yourself, may be detained upon entry into the Unites States. If you find the U.S. passport book or card you reported as not
received, report it as found, and submit it for cancellation. You may not use that passport book or card for travel.

WARNING
False statements made knowingly and willfully in passport applications, including affidavits or other supporting documents submitted
to support this application, are punishable by fine and/or imprisonment under 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.

PRIVACY ACT STATEMENT
AUTHORITIES: Collection of this information is authorized by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; 22 U.S.C. 2714a(f); 26 U.S.C.
6039E, Executive Order 11295 (August 5, 1996); and 22 C.F.R. parts 50 and 51.
PURPOSE: We are requesting this information in order to determine whether to issue a replacement U.S. passport. The collection of
the Social Security number will be used for identity/entitlement to a U.S. passport for verification only and no other purpose unless
authorized by law.
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 noncitizen nationals abroad. 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 your Social Security
number on your passport application may result in the denial of your application (consistent with 22 U.S.C. 2714a(f)).

PAPERWORK REDUCTION ACT STATEMENT
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time required
for searching existing data sources, gathering the necessary data, providing the information and/or documentation 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.
DS-86 xx-xxxx

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U.S. Department of State

STATEMENT OF NON-RECEIPT OF A U.S. PASSPORT
Use black ink only. If you make an error, complete a new form. Do not correct.

OMB Approval No. 1405-0146
Expiration Date: xx-xx-xxxx
Estimated Burden: 15 Minutes

Select the product(s) which you are reporting as not received.

Book Only

U.S. Passport Book and Card
Last Name

Card Only
Middle Name

First Name

Social Security Number

Date of Birth (mm-dd-yyyy)

Telephone Number

Travel Date (mm-dd-yyyy)

Mailing Address (as listed on original application)

Apartment /Unit

Street Address
City

State

ZIP Code

Please explain what you have done to find the passport book or card. (Attach a separate sheet of paper if more space is needed.)

Were the supporting documents that you submitted with your original passport application returned to you?

Yes

No

If no, please describe which document(s) was not received (Example: birth certificate, naturalization certificate, adoption decree, etc.)

YOU MUST SIGN AND DATE THE APPLICATION BELOW
I, the undersigned, certify that I have not received the U.S. passport book and/or U.S. passport card for which I applied. I declare under penalty of perjury that the
statements made on this form are true and correct. I request that a new U.S. passport book and/or U.S. passport card be issued to me, and certify that if I receive the U.S.
passport book and/or U.S. passport card I reported as not received, I will immediately contact the National Passport Information Center at 1-877-487-2778
(TDD/TTY: 1-888-874-7793) or my local U.S. embassy or consulate if I applied outside of the United States and return the recovered passport to the U.S. Department of
State.

Mother/Father/Parent/Legal Guardian's Signature (if applicant is under age 16)

Applicant's Signature (age 16 and older)

Date (mm-dd-yyyy)

ISSUING OFFICE USE ONLY
Was the passport mailed to the correct mailing address?

Yes

No

Was delivery confirmed?

Tracking Number:

Vendor:

Previous U.S. Passport Book Number
Issuing Agency

DS-86 xx-xxxx

UPS

No
Fed Ex

DHL

Date Issued (mm-dd-yyyy)
Date Mailed (mm-dd-yyyy)

Special Postage, if used
Date Issued (mm-dd-yyyy)

Previous U.S. Passport Card Number
Issuing Agency

USPS

Yes

Date Mailed (mm-dd-yyyy)

Special Postage, if used
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