AUTHORITIES: Collection of this information is authorized by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; Executive Order 11295 (August
5, 1996); and 22 C.F.R. parts 50 and 51.
PURPOSE: We are requesting this information in order to establish the identity of an applicant for a U.S. passport as part of his or her
application for a U.S. passport. The collection of the Social Security number will be used to verify the identity of you (the affiant) 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 S
tate’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 (the affiant’s) Social Security number and other information on this form is voluntary. Given the
form’s purpose of verification of identity and entitlement of an applicant for a U.S. passport, failure to provide the information may
result in processing delays or denial of the passport application.
PRIVACY ACT STATEMENT
PAPERWORK REDUCTION ACT STATEMENT
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:
Passport Forms Officer, U.S. Department of State, Bureau of Consular Affairs, Passport Services, Office of Program Management
and Operational Support, 44132 Mercure Cir, PO Box 1199, Sterling, Virginia 20166-1199.
DS-60 10-2020
Page 1 of 2
AFFIANT (The person filling out this form)
False statements made knowingly and willfully in passport applications, including affidavits or other supporting documents submitted
to support this application, 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 herein 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.
WARNING
USE OF THIS FORM
This form is used when the name that the passport applicant uses is (1) substantially different from the name on the passport
applicant’s citizenship evidence or (2) the passport applicant’s name was not acquired by marriage or a court order. This form or a
written statement that includes all of the information on this form must be filled out by an affiant (preferably a blood relative) who has
personal knowledge of the passport applicant’s use of both names.
• The person filling out this form is the affiant.
• The form is an affidavit. An affidavit is a signed written statement t
ha
t an affiant swears or affirms is true.
• The form is submitted with an application for a U.S. passport.
The affiant (preferably a blood relative) is the person who has personal knowledge of the passport applicant’s use of both names.
• The affiant must be able to explain the passport applicant’s use of both names in detail.
• The affiant must submit a clear photocopy of the front and back of the valid photo identification the affiant presented to the
passport agent, passport acceptance agent, or notary.
• The affiant must sign the form or written statement in
f
ront of a
passport agent, passport acceptance
agent, or
notary.
• The date of the affiant’s signature must be the same as the
date
of the
passport agent, passport acceptance
agent, or
notary’s
signature.
PASSPORT APPLICANT (The person applying for the passport)
The passport applicant must submit the following:
• Form DS-11, Application for a U.S. Passport
• Original or certified copies of three or more public documents showing that you have used your acquired name publicly and
exclusively for five years or longer (e.g., tax records, medical records, employment records, military records, driver’s license, or
state-issued identification).
• If you can only provide two public documents, submit form DS-60,
Affidavit Regarding a Change of Name
, from two or more people
who can swear or affirm that they have known you by both names and that your new name has been used exclusively for five years
or more.
An affidavit is not needed if an applicant presents a court order or marriage certificate documenting the change of name. The Department will
retain the completed affidavit, and requests for copies of the affidavit should be made at the time of its execution. Final determination of the name(s) to
be shown in the U.S. passport will be made by the Department of State based on all submitted evidence.
