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AFFIDAVIT OF PHYSICAL PRESENCE OR RESIDENCE,
PARENTAGE, AND SUPPORT
OMB CONTROL NO. 1405-0187
EXPIRES: 06/30/2023
Estimated Burden: 30 minutes
USE OF THIS FORM
The Affidavit of Physical Presence or Residence, Parentage, and Support is used in adjudicating claims to U.S. citizenship/non-citizen
U.S. nationality by birth abroad to a U.S. citizen and/or non-citizen U.S. national parent. The information collected on this form provides
supporting evidence for a claim to U.S. citizenship/non-citizen U.S. nationality.
HOW TO COMPLETE THIS FORM
Note: Part II and III of this document must be signed before a Consular Officer, Passport Specialist, or Designated Consular/Acceptance
Agent at the time the oath is sworn. A U.S. Consular Officer or Passport Specialist may require additional evidence of one’s relationship to the child
and/or evidence of one’s physical presence or residence in the United States.
O
WARNING
FF
IC
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PART I. The affiant (the U.S. citizen/non-citizen U.S. national parent) must complete this section which includes providing the affiant’s information
as follows:
a. full name
b. marital status
c. U.S. citizen/non-citizen U.S. national status
d. full name of your child(ren), date and place of birth of your child(ren), and your relationship to your child(ren) (whether you are their biological
parent and/or legal parent, or other). A biological parent has a genetic or gestational tie to the child. A legal parent is legally recognized as the
parent of the child.
e. physical presence or residence in the United States
f. physical presence or residence abroad
g. name of the other parent, their citizenship status, and physical presence or residence in the United States
Month and Year [or MM-YYYY format] is acceptable if exact dates of physical presence and/or residence are unknown. You may
be asked to provide exact dates to determine that statutory requirements have been met. If additional space is needed, attach another page.
PART II. If the child(ren) was (were) born out of wedlock and claims acquisition of U.S. citizenship through the father, the
child(ren)’s father must sign this section.
PART III. The affiant parent must sign this section and provide their street address and telephone number.
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PRIVACY ACT STATEMENT
D
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AF
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AUTHORITY: The Department of State is authorized to collect this information pursuant to 8 U.S.C. §§ 1104(a), 1401, 1408 and
1409, and 22 U.S.C. §§ 211a, 213 and 2705.
PURPOSE: The principal purpose of the information gathered is to assist in determining whether a U.S. national parent of a child
born abroad or in a United States territory has met the statutory physical presence or residence requirements for their child to
acquire U.S. nationality at birth; and whether a U.S. national father of a child born abroad out of wedlock has met additional
requirements of 8 U.S.C. § 1409(a) in relation to biological parentage and legal relationship with and financial support of the child
born abroad out of wedlock, in order for such child to acquire U.S. citizenship at birth.
ROUTINE USES: The information solicited on this form may be made available to Federal government entities such as the Social
Security Administration, the Department of Homeland Security, and Department of Justice, in connection with determinations of
citizenship status, administration of federal benefits, and law enforcement purposes as set forth in the System of Records Notices for
Overseas Citizens Services Records and Other Overseas Records, State-05, 81 FR 62235-62239 (2016); Passport Records,
State-26, 80 FR 15653 (2015); and the Department-wide Prefatory Statement of Routine Uses, 73 FR 40649-40651 (2008).
Information also can be made available to appropriate federal, state, local or foreign government entities, such as state law
enforcement agencies, state prosecutors, judicial staff, and Interpol, in connection with law enforcement, safety, welfare and related
matters, as set forth in the aforementioned System of Records Notices. Furnishing the information on this form is voluntary;
however, failure to furnish the requested information may delay or prevent you from documenting your child as a U.S.
citizen/non-citizen U.S. national.
DISCLOSURE: Furnishing the information on this form is voluntary; however, failure to furnish the requested information may
delay or prevent you from documenting your child as a U.S. citizen/non-citizen U.S. national.
PAPERWORK REDUCTION ACT (PRA) STATEMENT
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for
searching existing data sources, gathering the necessary documentation, 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, VA 20166-1199.
DS-5507 09-2020
Instruction Page 1 of 1
U.S. Department of State
AFFIDAVIT OF PHYSICAL PRESENCE OR RESIDENCE,
PARENTAGE, AND SUPPORT
OMB CONTROL NO. 1405-0187
EXPIRES: 06/30/2023
Estimated Burden: 30 minutes
RESET
It is not expected that a transmitting U.S. citizen parent who completes Form DS-2029 would also be required to complete this form.
PART I
(All affiants please complete Part I)
I,
do solemnly swear (or affirm):
Name
That I am a U.S. citizen/non-citizen U.S. national by (choose one of the following):
on
1) birth in
City/Town, State in the United States
2) naturalization on
Date (MM-DD-YYYY)
before the
Name of Court or USCIS Office and U.S. State
Date (MM-DD-YYYY)
3) birth abroad on
Previously Married
That I am (choose all that apply) Married
Single
to
Name
Country
in
Country
IC
IA
Date (MM-DD-YYYY)
L
Married on
U
SE
to U.S. citizen(s) non-citizen U.S. national(s) in
Date (MM-DD-YYYY)
That I am the parent of: (continue on a separate sheet, if necessary)
Date of Birth
(mm(MM-DD-YYYY)
FO
R
Place of Birth
O
N
LY
-N
O
T
Name of Child
O
FF
If terminated, list date and manner of termination (e.g., death or divorce) or enter N/A. (Please use a separate sheet to list
additional marriages and marriage termination.)
Biological Parent? Legal Parent? Other? Specify Below
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
AF
T
That I have been physically present or have had a residence in the United States as follows: (please see instructions; if
additional space is needed, attach another page)
D
R
Place (City,State)
Date
(MM-DD-YYYY)
Date
(MM-DD-YYYY)
From
To
From
To
From
To
From
To
From
To
Purpose
(Indicate purpose(s) of stay: vacation, family visit, business
trip, studies, employment, residence, etc.)
Note: If claiming a residence in the United States during any of the above periods, please provide the address (street and house/
apartment number) of your principal dwelling place (of general abode) in the "Place (City,State)" section above. You may be asked to
provide supporting evidence regarding your residential address. Examples of documents that can help demonstrate residence
include, but are not limited to: property rental leases and payment receipts; deeds; utility bills; property tax records; automobile
registrations; professional licenses; employment records or information; income tax records; stamped school transcripts; military
records; income records including W-2 salary forms; vaccination and medical records.
DS-5507 09-2020
Application Page 1 of 3
That I have been physically present or have had a residence abroad as follows: (please see instructions; if additional space is
needed, attach another page)
Place (City, State)
Date
Date
(MM-DD-YYYY)
(MM-DD-YYYY)
From
To
From
To
From
To
From
To
From
To
Purpose
(Indicate purpose(s) of stay: vacation, family visit,
business trip, studies, employment, residence, etc. If
working abroad, provide the name of employer. Specify
if in U.S. government employment or military service or
on orders as a dependent.)
U
SE
That the other parent of the above-named child(ren) for whom this application for a Consular Report of Birth Abroad
and/or U.S. passport is being filed is:
Name
IC
IA
L
Is not a citizen or national of the U.S.
Is a citizen or national of the U.S.
If the other parent is a U.S. citizen/non-citizen U.S. national it is by: (choose one)
1) birth in
on
before the
Name of Court or USCIS Office and U.S. State
R
Date (MM-DD-YYYY)
O
2) naturalization on
Date (MM-DD-YYYY)
FF
City/Town, State in the United States
3) birth abroad on
FO
to U.S. citizen(s)/non-citizen U.S. national(s) in
Date (MM-DD-YYYY)
Country
T
The other parent has been physically present or has had a residence in the United States as follows:
LY
-N
O
(PROVIDE ONLY IF THE OTHER PARENT IS A U.S. CITIZEN OR NON-CITIZEN U.S. NATIONAL) (see note on previous page about address
information to be provided if claiming a residence in the United States; please see instructions; if additional space is needed, attach another page)
Purpose
Date
Date
Place (City, State)
(Indicate purpose(s) of stay: vacation, family visit,
(MM-DD-YYYY)
(MM-DD-YYYY)
business trip, studies, employment, residence, etc.)
To
From
To
From
To
From
To
From
To
D
R
AF
T
O
N
From
PART II
(ALL U.S. National Fathers of a Child Born Abroad Out of Wedlock)
PLEASE STOP HERE! Part II of this document must be signed before a Consular Officer, Passport Specialist, or
Designated Consular/Acceptance Agent at the time the oath is sworn.
I am the biological father through whom the child is claiming U.S. citizenship. I agree to provide financial support for the child
until they reach the age of eighteen years.
Signature of Affiant
SUBSCRIBED AND SWORN (AFFIRMED) before me this
day of
,
.
[SEAL]
Signature and Title of Consular Officer, Passport Specialist or
Designated Consular/Acceptance Agent Administering Oath
DS-5507 09-2020
Application Page 2 of 3
PART III
(Oath: To be completed by all affiants)
PLEASE STOP HERE! Part III of this document must be signed before a Consular Officer, Passport Specialist, or
Designated Consular/Acceptance Agent at the time the oath is sworn.
A U.S. Consular Officer or Passport Specialist may require additional evidence of one’s relationship to the child and/or evidence of
one’s physical presence or residence in the United States.
I solemnly swear (or affirm) that all the statements contained in this affidavit are true and complete to the best of my knowledge and
belief, and that this affidavit is for the purpose of establishing my relationship to the aforementioned child(ren) and their claim to
U.S. citizenship.
Signature of Affiant
Telephone Number
Present Street Address
State
SUBSCRIBED AND SWORN (AFFIRMED) before me this
day of
,
L
.
Zip Code
IC
IA
at
Country
U
SE
City
FF
[SEAL]
D
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AF
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T
FO
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O
Signature and Title of Administering Officer
DS-5507 09-2020
Application Page 3 of 3
| File Type | application/pdf |
| File Modified | 2023-02-13 |
| File Created | 2020-09-30 |