Visit the official Department of State website at travel.state.gov or contact the National Passport Information Center
(NPIC) toll-free at 1-877-487-2778 (TDD: 1-888-874-7793) or by e-mail at NPIC@state.gov
. Customer Service
Representatives are available Monday-Friday 8:00a.m.-10:00p.m. and Saturday 10:00a.m.-3:00p.m. Eastern Time
(excluding federal holidays). Automated information is available 24 hours a day, 7 days a week.
FOR INFORMATION AND QUESTIONS
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PRIVACY ACT STATEMENT
PAPERWORK REDUCTION ACT STATEMENT
AUTHORITIES: The information on this form is requested under the authority of 22 U.S.C. 211a et seq.; 8 U.S.C. 1104;
Executive Order 11295 (August 5, 1966); and 22 C.F.R. parts 50 and 51.
PURPOSE: The information collected on this form will be used to establish the identity of the subject of this affidavit as
part of the subject's application for a U.S. passport. The collection of the Social Security number will be used to verify
your identity and for no other purpose unless authorized by law.
ROUTINE USES: This information may be disclosed to another domestic government agency, a private contractor, a
foreign government agency, or to a private person or private employer in accordance with certain approved routine
uses. These routine uses include, but are not limited 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 Other Overseas Records, and State-26, Passport Records.
DISCLOSURE: Providing your Social Security number and 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.
Public reporting burden for this collection of information is estimated to average 40 minutes per response, including 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 Legal Affairs, Attn: Passport Forms Officer, 44132 Mercure Cir., P.O. Box 1227,
Sterling, VA 20166-1227.
False statements made knowingly and willfully on passport applications or on affidavits or other supporting documents
submitted therewith are punishable by fine and/or imprisonment under 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 passport regulations is punishable by fine and/or imprisonment under 18 U.S.C. 1544. All
statements and documents are subject to verification.