Fillable Printable U.S. Passport Renewal Application for Eligible Individuals
Fillable Printable U.S. Passport Renewal Application for Eligible Individuals
U.S. Passport Renewal Application for Eligible Individuals
I can submit my most recent U.S. passport book and/or U.S. passport
card with this application.
I was at least 16 years old when my most recent U.S. passport book
and/or passport card was issued.
I w as issued my most recent U.S. passport book and/or passport
card less than 15 years ago.
My most recent U.S. passport book and/or U.S. passport card that
I am renewing has not been lost, stolen, mutilated, or damaged.
My U.S. passport has not been limited from the normal ten year
validity period due to passport damage/mutilation, multiple passport
thefts/losses, or non-compliance with 22 C.F.R. 51.41. (Please
refer to the back pages of your U.S. passport book for endorsement
information.)
I use the same name as on my recent U.S. passport book and/or
U.S. passport card.
I have had my name changed by marriage or court order and can
submit proper documentation to reflect my name change.
Yes
No
U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS
PLEASE DETACH AND RE TAIN THIS INSTRUCT ION SHEET FOR YOUR RECORDS
CAN I USE THIS FORM?
Complete the checklist to determine your eligibility to use this form
Yes No
If you answered NO to any of the statements above,
STOP - You cannot use this form!
You must apply on application form DS-11 by making a personal appearance before an acceptance agent
authorized to accept passport applications. Visit travel.state.gov
to find your nearest acceptance facility.
Yes
No
Yes No
Yes
No
--OR--
Date of Application:_____________________
U.S. PASSPORTS, EITHER IN BOOK OR CARD FORMAT, ARE ISSUED ONLY TO U.S. CITIZENS OR NON-CITIZEN NATIONALS. EACH PERSON
MUST OBTAIN HIS OR HER OWN U.S. PASSPORT BOOK OR PASSPORT CARD. THE PASSPORT CARD IS A U.S. PASSPORT ISSUED IN CARD
FORMAT. LIKE THE TRADITIONAL PASSPORT BOOK, IT REFLECTS THE BEARER'S ORIGIN, IDENTITY, AND NATIO NALITY AND IS SUBJECT TO
EXISTING PASSPORT LAWS AND REGULATIONS. UNLIKE THE PASSPORT BOOK, THE PASSPORT CARD IS VALID ONLY FOR ENTRY TO THE
UNITED STATES AT LAND BORDER CROSSINGS AND SEA PORTS OF ENTRY WHEN TRAVELING FROM CANADA, MEXICO, THE CARIBBEAN,
AND BERMUDA. THE U.S. PASSPORT CARD IS NOT VALID FOR INTERNATIONAL AIR TRAVEL.
PLEASE NOTE
: YOUR NEW PASSPORT WILL HAVE A DIFFERENT PASSPORT NUMBER THAN YOUR PREVIOUS PASSPORT.
FAILURE TO PROVIDE INFORMATIO N REQUESTED ON THI S FORM, INCLUDING YOUR SOCIAL SECURITY NUMBER,
MAY RESULT IN SIGNIFICANT PROCESSING DELAYS AND/OR THE DENIAL OF YOUR APPLICATION.
NOTICE TO APPLICANTS RESIDING ABROAD
United States citizens residing abroad CANNOT submit this form to the domestic address listed on the Instruction Page 2. Such applicants should contact the
nearest U.S. Embassy or Consulate for procedures to be followed when applying overseas.
DS-82 08-2013 Inst ruct io n Page 1 of 4
WARNING: False statements made knowingly a nd 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 , inc luding 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 therein or of the pas sport regulations is punishable
by fine and/or imprisonment under 18 U.S.C. 1544. All statements and documents are subject to verification.
See page 2 of the instructions for detailed information on the completion and submission of this form.
INFORMATION, QUESTIONS, AND INQUIRIES
Please visit our website at travel.state.gov. In addition, you may contact the National Passport Information
Center (NPIC) toll-free at 1-877-487-2778 (TDD: 1-888-874-7793) or by email at [email protected]ov
. Customer
Service Representatives are available Monday-Friday 8:00a.m.-10:00p.m. Eastern Time (excluding federal
holidays.) Automated information is available 24 hours a day, 7 days a week.
Yes
No
Your most recent U.S. passport book and/or card;
A certified copy of your marriage certificate or court order if your name has changed;
Fees; and
A recent color photograph.
1. YOUR MOST RECENTLY ISSUED U.S. PASSPORT (BOOK AND/OR CARD FORMAT).
Submit your most recently issued U.S. passport book and/or car d. When submittin g a U.S. passport book and/or card with this form, please v erify that the
document was issued at age 16 or older in your current name (or see item #2 below) and issued within the past 15 years. You are also eligible to use this form if
you currently have a U.S. passport book and/or card that complies with the previously listed criteria, and would like to obtain a alternative pr oduct (U .S. passpor t
book and/or card) for the first time
. However, you must submit the product you currently have (U.S. passpo rt book and/or card) with this application. If your U.S .
passport book and/or card has been lost, stolen, damaged, or mutilated, you must apply on the DS-11 application form as specified be lo w.
2. A CERTIFIED MARRIAGE CERTIFICATE OR COURT ORDER. (PHOTOCOPIES ARE NOT ACCEPTED)
If the name you are currently using differs from the name on your most recent U.S. passport, you must submit a certified copy of your marriage certificate or
court order showing the change of name. All documents will be returned to you by mail. If you are unable to document your name change in this manner, you
must apply on the DS -11 application form by makin g a perso nal app earance at (1) a p assport agency; (2) U .S. Embassy or Consulat e, if abroad; (3) an y federal
or state court of record or any probate court accepting passport applications; (4) a designated municipal or county official; or (5) a post office, which has been
selected to accept passport applications.
3. THE CURRENT PASSPORT FEE.
Enclose the fee 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. DO NOT SEND CASH
. Passport S ervic es
cannot be responsib le for cash sent through the mail. By law, the fees are non-refundable. Please visit our website at travel.state.gov
for detailed information
regarding current fees.
OVERNIGHT DELIVERY SERVICE
: If you desire overnight delivery service for the return of your U.S. passport, please include the appropriate fee with your
payment.
FASTER PROCESSING
: For an additional fee, you may request expedited service. Please include this fee in your payment and submit the application to the
appropriate address. Please write "Expedite" on the outer envelope when mailing. Also, TO ENSURE MINIMAL
PROCESSING TIME for expedited
passport book applications, Passport Services recommends using overnight delivery when submitting the application AND including t he appro priate
postage fee for return overnight delivery for the newly issued passport book. Expedited service is available only in the United States. Overnight return
delivery is only available for passport books. Please visit travel.state.gov
for updated information regarding fees, processing times, or to check the status of
your passport application online.
4. A RECENT COLOR PHOTOGRAPH.
Submit a color photograph of you alone, sufficiently recent to be a good likeness of you (taken within the last six months), and 2x2 inches in size. The
image size measured from the bottom of your chin to the top of your head (including hair) should not be less than 1 inch, and not more than 1 3/8 inches. The
photograph must be color, clear, with a full front view of your face, and printed on thin paper with plain light (white or off-white) background. The photograph
must be taken in normal street attire, without a hat, head covering, or dark glasses unless a signed statement is submitted by the applicant verifying the item is
worn daily for religious p urposes or a signed doctor's statement is submitted verifying the item is used daily for medi cal purposes. Headphones, "blu etooth", or
similar devices must not
be worn in the passport photograph. Any photograph retouched so that your appearance is changed is unacceptable. A snapshot,
most vending machin e prin ts, and magazine o r full-leng th photogra phs are unacceptable. A digital p hoto must meet the pr eviously stated qualifications, and will
be accepted for use at the discretion of Passport Services. Please visit our website at trav el.state.gov
for details and information.
WHAT DO I SEND WITH THIS APPLICATION FORM?
WHERE DO I MAIL THIS APPLICATION?
FOR ROUTINE SERVICE:
National Passport Processing Center
Post Office Box 90155
Philadelphia, PA 19190-0155
FOR EXPEDITED SERVICE (Additional Fee):
National Passport Processing Center
Post Office Box 90955
Philadelphia, PA 19190-0955
DS-82 08-2013
See below for more detailed information.
Instru ct i on Pa g e 2 of 4
NOTE REGARDING MAILING ADDRESSES: Passport Services will not mail a passport to a private address outside the United States. If you do not live at the
address listed in the "mailing address", then you must put the name of the person and mark it as "In Care Of." 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 or visit travel.state.gov
.
NOTE: You may receive your newly issued document and your returned citizenship evide nce in separate mailings. If you are applying for both a passpor t book
and/or card, you may receive three separate mailings; one with your returned citizenship evidence; one with your newly issued passport book, and one with
your newly printed passport card.
If you choose to provide your email address in Item #6 on this application, Passport Services may use that address to contact you in the event there is a problem
with your application or if additional information is required.
Due to the sensitivity of the enclosed documents, Passport Services recommends using trackable mailing service when submitting your application.
DS-82 08-2013
FEDERAL TAX LAW
Section 6039E of the Internal Revenue Code (26 USC 6039E) requires you to provide your Social Security number (SSN), if you have one, when
you apply for a U.S. passport or renewal of a U.S. passport. If you have not been issued a SSN, enter zeros in box #5 of this form. If you are
residing abroa d, you must also provide the name of the foreign country in which you are residing. The U.S. De partment of State must provide your
SSN and foreig n residence info rmatio n to the U.S. Depa rtment of Treasury. If you fa il to provide the informa tion, you are subj ect to a $500 penalty
enforced by the IRS. All questions on this matter should be directed to the nearest IRS office.
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 fee of $25, which we will also collect by EFT.
NOTICE TO CUSTOM ERS APPLYING OUTSIDE A STATE DEPARTMENT FACILITY
Passport service fees are established by law and regulation (s ee 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 the Department fails to receive full payment of the applicable fees because, for example, 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 fro m you under 22 C.F.R. Part 34, an d the Federal Cla ims Collection Standards (see 31 C.F.R. Parts 900-904). In accord ance with
the Debt Collection Improveme nt Act (Pub.L. 104-134), if the fees remain unpaid after 180 days and no repayment arrangements have been mad e,
the Department 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 U.S. passport book and/or card. An invalidated passport card cannot be used for travel.
REMITTANCE OF FEES
Your Socia l Security num ber will be provided to the U.S. Department o f Treasury, used in conne ction with deb t collection an d checked against lists
of persons ineligible or potentially ineligible to receive a U.S. passport book and/or card, among other authorized uses.
OTHER USES OF SOCIAL SECURI TY NUMBER
IMPORTANT NOTI CE TO APPLICANTS WHO HAVE LOST OR HAD A PREVIOUS U.S. PASSPORT BOOK
AND/OR PASSPORT CARD STOLEN
A United States citizen may not normally bear more tha n one valid or poten tially 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. p assp ort book or U.S passport card cannot be presented with a new
application, it is necessary to submit a Form DS-64, Statement Regarding a Lost or Stolen U.S. Passport. Your statement must detail why the
previous U.S. passport book or U.S. passport card cannot be presented.
The information you provide regarding your lost or stolen U.S. passport book or passport 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 passport card. Anyone using the
passport book or passport card reported as lost or stolen may be detained upon entry into the United States. Should you locate the U.S. passport
book or passport card reported lost or stolen at a later time, report it as found, and submit it for cancellation. It has been invalidated
. You may not
use that passport book or passport card for travel.
PROTECT YOURSELF AGAINST IDENTITY THEFT!
REPORT YOUR LOST OR STOLEN U.S. PASSPORT BOOK OR PASSPORT CARD!
Inst ruct io n Page 3 of 4
NOTICE TO APPLICANTS FOR OFFICIAL, DIPLOMATIC, OR NO-FEE PASSPORTS
You may use this application if you meet all of the provisions listed on Instruction Page 2, 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.
For more information or to report your lost or stolen U.S. passport book or passport card by phone, call NPIC at:
1-877-487-2778 or visit our website at travel.state.gov
.
SPECIAL NOTICE TO U.S. PASSPORT CARD APPLICANTS ONLY
The maximum number of letters provided for your given name (first and middle) on the U.S. passport card is 24 characters. The 24 characters may be
shortened due to printin g restrictions. If both your given n ames are more than 24 charac ters, you must shorten one of yo ur giv en names you list on item 1 of
this form.
DS-82 08-2013
ACTS OR CONDITIONS
If any of the below-mentioned acts or conditions have been performed by or apply to the applicant, the portion which applies should be lined out,
and a supplementary explanatory statement under oath (or affirmation) by the applicant should be attached and made a part of this application.
I have not, since acquiring United States citizenship/nationality, been naturalized as a citizen of a foreign state; taken an oath or made an
affirmation or other formal declaration of allegiance to a foreign state; entered or served in the armed forces of a foreign state; accepted or
performed the duties of any office, post, or employment under the government of a foreign state or political subdivision thereof; made a formal
renunciation of nationality either in the United States, or before a diplomatic or consular officer of the United States in a foreign state; or been
convicted by a court or court martial of competent jurisdiction of committing any act of treason against, or attempting by force to overthrow, or
bearing arms against the United States, or conspiring to overthrow, put down, or to destroy by force, the government of the United States.
Furthermore, I have not been convicted of a federal or state drug offense or convicted for "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; a
subpoena received from the United States in a matter involving federal prosecution for, or grand jury investigation of, a felony.
PRIVACY ACT STATEMENT
ELECTRONIC PASSPORT STATEMENT
The U.S. Department of State now issues an "Electronic Passport" book, which contains an embedded electronic chip. The electronic passport
book continues to be pro of of the bearer's United States citizenship/nationality and identity, and looks and functions in the s ame way as a passport
without a chip. The addition of an electronic chip in the back cover enables the passport book to carry a duplicate electronic copy of all information
from the data page. The electronic passport book is usable at all ports-of-entry, including those that do not yet have electronic chip readers.
Use of the electronic format provides the traveler the additional security protections inherent in chip technology. Moreover, when used at
ports-of-entry equipped with electronic chip readers, the electronic passport book provides for faster clearance through some of the port-of-entry
processes.
The electronic passport book does not require special handling or treatment, but like previous versions should be protected from extreme heat,
bending, and from immersion in water. The electronic chip must be read using specially formatted readers, which protects the data on the chip from
unauthorized reading.
The cover of the electronic passport book is printed with a special symbol representing the embedded chip. The symbol will appear in
port-of-entry areas where the electronic passport book can be read.
Instruction Page 4 of 4
PAPERWORK REDUCTIO N ACT STATEMENT
Public reporting bu rden for this collection of information is e stimated to averag e 40 minutes per response, inclu ding 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: U.S. Department of State, Bureau of Consular
Affairs, Passport Services, Office of Program Management and Operational Support, 2201 C Street NW, Washington, D.C. 20520.
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; 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 requested in order to verify your identity. Failure to provide your Social Security number on this form may delay
processing of your application.
ROUTINE USES: This information may be disclosed to another domestic governme nt agency, a private contractor, a foreign government agency,
or to a private person or private emplo yer in accordance with certain approved routine uses. These routine uses include, but are not l imite d 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 Citizen Services Records and
State-26, Passport Records.
DISCLOSURE: Providing your Social Security number a nd the other information on this form is voluntary, but failure to provide the information on
this form may, given the form's purpose of verification of identity and entitlement to a U.S. passport, result in processing delays or denial of the
passport application.
Failure to provide your Social Security number may also subject you to a 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 Tre asury and may
be used in connection with debt collection, among other purposes as authorized and generally described in this section. Providing your Social
Security number and other information requested on this form is otherwise voluntary.
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 cor rect; 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 one of the instructions to the application form.
YOU MUST SI G N AND DAT E THE APPLIC AT ION IN THE DESIGNATED AREA BELOW
* DS 82 C 08 2013 1 *
OtherPostageEFBk Fee Cd Fee
STAPLE 2" x 2" STAPLE
STAPLE 2" x 2" STAPLE
x
Date
Applicant's Legal Signature
FOR ISSUING OFFICE ONLY
Marriage Certificate
Court Order
From
Date of Marriage/Place Issued:
Date Filed/Court:
Attached:
U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS
OMB CONTROL NO. 1405-0020
OMB EXPIRATION DATE: 12-31 -20 16
ESTIMATED BURDEN: 40 MIN
Please Print Legibly Using Black Ink Only
End. #
Exp.
DS-82 08-2013
Page 1 of 2
Other:
To:
DOTS C ode
DPOD
CONTINUE TO PAGE 2
For Issuing Office Only
Attention: Read WARNING on page 1 of instructions
Please select the document(s) for which you are applying:
U.S. Passport Book
U.S. Passport Card
28 Page Book (Standard)
Note: The 52 page optio n is for those who frequently travel abroad durin g the passpor t validity peri od, and is r ecommen ded
for applicants who have previously required the addition of visa pages.
A. B.
City Zip Code Country, if outside the United StatesState
9. List all other names you have used. (Examples: Birth Name, Maiden, Previous Marriage, Legal Nam e Change. Attach additional pages if needed)
Address Line 2: Clearly label Apartment, Company, Suite, Unit, Building, Floor, In Care Of or Attention if applicable. (e.g., In Care Of - Jane Doe, Apt # 100 )
4. Place of Birth (City & State if in the U.S., or City & Country as it is presently known.)
First
Middle
- -
MF
3. Sex
6. Email Address (e.g., my_email@domain.com)
@
7. Primary Contact Phone Number
5. Social Security Number
2. Date of Birth (mm/dd/yyyy)
-- -
1. Name Last
Issue date (mm/dd/yyyy)
Most recent passport book number
10. Passport Book and/or Passport Card Information
Your name as printed on your most recent U.S. passport book and/or passport card
11. Name Change Information Complete if name is different than last U.S. passport book or passport card
Changed by Mar riage
Changed by Court Order
Place of Name Change (City/State)
Please submit a certified copy. (Photocopies are not accepted!)
Most recent passport card number
Issue date (mm/dd/yyyy)
PPT BK C/R PPT BK S/R
8. Mailing Address: Line 1: Street/RFD#, P.O. Box, or URB.
Date (mm/dd/yyyy)
Both
52 Page Book (Non-Standard)
The U.S. passport card is not valid for international air travel. For more information see page 1 of instructions.
-
Attach a color photograph taken
within the last six months
PPT CD C/R
PPT CD S/R
17. Additional Contact Phone Numbers
12. Height 14. Eye Color
15. Occ upation
16. Employer or School (if applicable)
18. Permanent Address: If P.O. Box is listed under Mailing Address or if residence is different from Mailing Address.
Apartment/Unit
City Zip Code
19. Emergency Contact - Provide the information of a person not traveling with you to be contacted in the event of an emergency.
Name Apartment/Unit
City Relationship
20. Travel Plans
Departure Date (mm/dd/yyyy)
Countries to be visited
Date of Birth (mm/dd/yyyy) Name of Applicant (Last, First & Middle)
STOP! YOU HAVE COMPLETED YOUR APPLICATION
BE SURE TO SIGN AND DATE PAGE ONE
Home Cell
Work
Home Cell
Work
State
Address: Street/RFD # or P.O. Box
State Zip Code Phone Number
Return Date (mm/dd/yyyy)
DS-82 08-2013
Page 2 of 2
13. Hair Color
* DS 82 C 08 2013 2 *
Str e et/RFD # or URB (No P.O. Box)
