Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16

OMB 1405-0216

OMB 1405-0216

The Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor under Age 16 (DS-5525) is used in conjunction with the Application for a U.S. Passport (DS-11). This form is only for use if the written consent of the non-applying parent or guardian cannot be obtained. The statement must explain in detail the non-applying parent or guardian's unavailability, and recent efforts made to contact the non-applying parent/guardian. This form is not to be used if the non-applying parent/guardian refuses, or claims it is inconvenient, to provide notarized consent for the minor applicant.

The latest form for Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16 expires 2023-11-30 and can be found here.


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