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HOW TO REPORT YOUR LOST OR STOLEN PASSPORT:
If you are applying for a new passport, please submit this form with the new passport
application to any designated acceptance facility, passport agency, or U.S. consular official.
If you are not currently applying for a new passport, send this form or a recovered lost or
stolen passport to the following address:
(Please do not attempt to use this address for any passport related service other than that
described above.)
U.S. Department of State
Passport Services
Consular Lost/Stolen Passport Section
Attn: CLASP
1111 19th Street, NW, Suite 500
Washington, DC 20036
To report your lost or stolen passport by phone, call: 202-955-0430
Or visit our website: www. travel.state.gov
PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS
AUTHORITIES: The information solicited on this form is requested pursuant to provisions 22 U.S.C. 211a, et seq.;
Executive Order 11295 (August 5, 1966); Title 22, Part 51, Code of Federal Regulations (CFR); and in particular 22
CFR 51.2(b) and 51.8(b).
PURPOSE: The primary purpose for soliciting the information is to ensure that no person shall bear more than one
valid or potentially valid United States passport book and one valid passport card at any one time, except as
authorized by the U.S. Department of State, and to combat passport fraud and misuse.
ROUTINE USES: The information solicited on this form may be made available as a routine use to other government
agencies, to assist the U.S. Department of State in adjudicating passport applications and requests for related
services, and for law enforcement and administrative purposes. It may also be disclosed pursuant to court order.
The information may be made available to foreign government agencies to fulfill passport control and immigration
duties or to investigate or prosecute violations of law. The information may also be made available to private U.S.
citizen 'wardens' designated by U.S. embassies and consulates.
CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: Except as noted, failure to provide the information
requested on this form may result in the denial of a United States passport, related documents, or service to the
individual seeking such passport, documents, or service. The disclosure of your social security number on this form
is voluntary and in accordance with the authorities listed above and will be used in the processing of your statement
regarding your lost or stolen passport and as described in the preceding paragraphs.
*Public reporting burden for this collection of information is estimated to average 5 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 sent them to: A/GIS/DIR, Room 2400 SA-22, U.S.
Department of State, Washington, DC 20522-2202.
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False statements made knowingly and willfully in passport applications or in affidavits or other supporting documents
submitted therewith are punishable by fine and/or imprisonment under 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.
WARNING
OR