1. To apply for a new U.S. passport book and/or card: please submit this form with a new DS-11, Application for a U.S. Passport, to any
designated acceptance facility, U.S. passport agency, U.S. embassy, or U.S. consulate abroad.
2. If you are NOT applying for a new U.S. passport book and/or card
, submit this form AND a photocopy of a government-issued photo
identification (such as a driver's license or state-issued identification) to the following address:
3. To report a lost or stolen U. S. passpo
rt by phone, call 1-877-487-2778 and follow the representative's instructions.
4. To report a lost or stolen U. S. passport online
, please visit our website at www.travel.state.gov.
AUTHORITIES: We are authorized to collect this information 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 the information to ensure that no one has more than one valid U.S. passport book and one valid U.S. passport card
at any one time, except as authorized by the U.S. Department of State, and to combat passport fraud and misuse.
The collection of the Social Security number will be used to verify the identity of the person reporting the lost or stolen passport and 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 information 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 and 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 your identity, result in processing delays.
False statements made knowingly and willfully on this form, in U.S. passport applications, or in affidavits or other supporting documents submitted
therewith are punishable by fine and/or imprisonment under U.S. law, including the provisions of 18 U.S.C. 1001 and/or 18 U.S.C. 1542. Alteration
or mutilation of a U.S. passport is punishable by fine and/or imprisonment under the provisions of 18 U.S.C. 1543. The use of a U.S. 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 submitted are subject to verification.
PRIVACY ACT STATEMENT
PAPERWORK REDUCTION ACT STATEMENT
U.S. Department of State
STATEMENT REGARDING A LOST OR STOLEN U.S. PASSPORT BOOK AND/OR CARD
Page 1 of 2
Protect yourself against identity theft! Report a lost or stolen U.S. passport !
For more information, please visit our website: www. travel.state.gov
To report a lost or stolen passport, please choose ONE of the following options:
HOW TO REPORT A LOST OR STOLEN PASSPORT BOOK AND/OR CARD
Public reporting burden for this collection of information is estimated to average ten minutes per response, including time required for searching
existing data sources, gathering the necessary data, providing the information and/or documents 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 and Law Enforcement Liaison, 2201 C Street NW, Washington, D.C. 20520.
* Only use this address to submit this form or other correspondence about lost/stolen passports. For general inquiries, call the National Passport Information Center at 1-877-487-2778.
U.S. Department of State
44132 Mercure Cir
P.O. Box 1227
Sterling, Virginia 20166-1227