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APPLICATION FOR A U.S. PASSPORT
NAME CHANGE, DATA CORRECTION, AND LIMITED PASSPORT BOOK REPLACEMENT
PLEASE DETACH AND RETAIN THIS INSTRUCTION SHEET FOR YOUR RECORDS
CAN I USE THIS FORM
Complete this checklist to determine your eligibility to use this form
You must apply on application form DS-11 or DS-82 depending on your circumstances. Please refer to those forms, visit
, or contact the National Passport Information Center for further information.
I have changed my name since my most recent U.S. passport book
and/or passport card was issued less than one year ago;
My identifying information in my most recent U.S. passport book and/or U.S.
passport card was printed incorrectly;
My most recent, full-fee U.S. passport book was limited in validity and was issued less
than one year ago.
Date of Application:____________________________
FOR INFORMATION, QUESTIONS, AND INQUIRIES:
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 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 NATIONALITY 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 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]
Service Representatives are available Monday-Friday 8:00a.m.-10:00p.m. Eastern Time (excluding federal
holidays.) Automated information is available 24/7.
Instruction Page 1 of 4
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.
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.
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 USC 1001, 18 USC 1542, and/or 18 USC
1621. Alteration or mutilation of a passport issued pursuant to this application is punishable by fine and/or imprisonment under the provisions of
18 USC 1543. The use of a passport in violation of the restrictions contained therein or of the passport regulations is punishable by fine and/or
imprisonment under 18 USC 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.
If you choose to provide your email address in Item #6 on this application, Passport Services will use that information to contact you in the event there is a
problem with your application or if you need to provide information to us.
If you answered NO to ALL of the three statements above,
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