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U.S. Department of State OMB Control No.: 14050160 Expiration Date: 04302025 Estimated Burden: 40 MinutesAPPLICATION FOR A U.S. PASSPORT FOR ELIGIBLE INDIVIDUALS CORRECTION, NAME CHANGE TO PASSPORT
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PASSPORT FORM DATE 04302025 STATE OF POTOMAC DEPARTMENT OF STATE U.S. POSTAL SERVICE OF PASSPORT-USPS-DISPATCH-DISPATCH-FULLY-ASSIGNED-FULL APPLICATION REQUEST FOR PASSPORT (CIVIL STATUS ELDER SEX), CODE 4C, E, G OR R, D. This application request will terminate on the last day of the month of : 1) the date you are contacted by U.S. mail and received an acknowledgement of receipt of your application, and 2) 5 months from the date that you are contacted by U.S. mail and received an acknowledgement of receipt of your application, your application will be deemed granted. Please provide your full name including surname and date of birth. FILL ALL GRIPS AND ENSURE THE QUALITY OF YOUR MATERIALS. All information required must be submitted through electronic means. A valid photo identification must be presented as part of this application. Complete all fields with your completed application. If you are presenting documentation other than an original document issued by the United States, State Department, including the original passport or other travel document, please ensure that: 1. The document is not expired; 2. The document is presented in an unexpired, complete form; 3. The document displays the current foreign country of travel; 4. The document has a visible name (including the holder's middle name); 5. The name of the document holder can be verified; and 6. The document bears the expiration date and not less than 10 months have passed since original issuance. The U.S. Department of State maintains a list of valid identification. SINCE THIS IS AN AFFORDABLE PROCESS, THE GOVERNMENT DOES NOT RECEIVE ANY FEDERAL FUNDS. The fee for a DS-5504 is 85 per application. The processing, storage and shipping and handling fees will apply, as follows: The DS-5504 process will begin the morning of your interview and will continue through the mailing of your passport to you. A DS-5504 will be mailed by USPS in a self-addressed and stamped envelope within 4-6 weeks of the official receipt of your application. (If an appointment is made, your DS-5504 will be mailed 2-4 weeks before the appointment date.

Who needs a DS-5504 form?

An eligible individual who wants to apply for a US passport should complete this form. An eligible individual is a US citizen who has changed their name and the US passport was issued less than one year ago; the information in their previous passport was incorrect; or the previous US passport was limited in validity and issued less than one year ago.

What is the purpose of the DS-5504 form?

This form provides the personal information about the applicant which is required to issue a US passport. The US passport exists in card and book format. The passport in card format is not valid for international air travel.

What documents must accompany the DS-5504 form?

The application for US passport should be accompanied by the most recent US passport; a recent color photograph (the photo requirements are listed on the second page of the form); evidence to support a name change (birth certificate or marriage certificate) or other data change. All the supporting documents (except the photos) will be returned to the applicant.

When is the DS-5504 form due?

This application is completed when there is a need. The estimated time for completing the form is 60 minutes.

What information should be provided in the DS-5504 form?

The application asks for the following details from the applicant:

  • Type of the required document (Passport book, Passport Card, Both)
  • Applicant’s name
  • Applicant’s date and place of birth
  • Applicant’s social security number
  • Mailing address
  • Passport book and/or passport card information
  • Applicant’s appearance (height, hair color, eye color)
  • Occupation
  • Employer or school
  • Emergency contact
  • Travel plans
  • Reason of applying for a new passport

The applicant should also sign and date the form.

What do I do with the application after the completion?

The completed form is forwarded to National Passport Processing Center, Philadelphia, PA.


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