ANY CHANGES IN THIS INFORMATION MUST BE REPORTED IMMEDIATELY TO THE OFFICE OF PROTOCOL ON FORM DS-2006.
DS-2007
03-2015
Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time required for searching existing data sources,
gathering the necessary documentation, 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: M/OFM, 3507 International Place NW, Washington, DC 20008.
Page 1 of 1
PAPERWORK REDUCTION ACT STATEMENT
(b) Given (First)
Principal's Name (Surname, Given Name)
FemaleMale
(d) Prefix (e) Suffix (f) Maiden (g) Other (h) Relationship
NOTIFICATION OF DEPENDENTS OF DIPLOMATIC, CONSULAR
AND FOREIGN GOVERNMENT EMPLOYEES
(CONTINUATION SHEET)
(a) Surname (Last)
OMB APPROVAL NO. 1405-0105
EXPIRATION DATE: 03-31-2018
ESTIMATED BURDEN: 10 MINUTES *
22. Family Members Residing in Household in the United States (Continued)
Embassy/Mission PID (If available)
CitizenshipPlace of Birth (City, Country)Date of Birth (mm-dd-yyyy)
(Attach copies)
Visa Status
Yes No
Arrival date if different from principal (mm-dd-yyyy)
U.S. Department of State
The Privacy Act of 1974, as amended, 5 U.S.C. 552a, contains provisions regarding the maintenance, collection, use, and dissemination of information about United
States citizens and aliens lawfully admitted for permanent residence in the United States. The following information is provided in accordance with subsection (e)(3) of the
Privacy Act.
AUTHORITIES: The information is sought pursuant to Vienna Convention on Diplomatic Relations of 1961; Vienna Convention on Consular Relations of 1963; Diplomatic
Relations Act (22 U.S.C. 254a-e); and International Organizations Immunities Act (22 U.S.C. 288e (a)).
PURPOSE: The principal purpose for the collection of this information is to notify the Department of State of dependents for diplomatic, consular, and/or foreign
government employees so the Department can therefore extend various privileges and benefits granted by the above-cited authorities which are predicated upon review
and acceptance of this information by the U.S. Department of State.
ROUTINE USES: The principal users of this information are offices within the U.S. Department of State, including but not limited to, the Office of Protocol, the Office of
Foreign Missions, and the Office of Visa Services. In response to inquiries from law enforcement agencies, the Office of Protocol may confirm status as recognized by
the U.S. Department of State as covered under STATE 36, Security Records. Information may also be provided to other government agencies having statutory or other
lawful authority to maintain such information. Names of the members of diplomatic staff, office addresses, titles, and names of spouses are published quarterly in the
Diplomatic List, U.S. Department of State Publication 10424. Names of Consular Officers, titles, and office addresses are published semi-annually in Foreign Consular
Offices in the United States, U.S. Department of State Publication 10277.
DISCLOSURE: Providing this information is mandatory. Failure to provide the information requested on this form may prevent acceptance and the extension of benefits
to principals or family members as provided in the above-cited authorities.
Please indicate if requesting identification card.
(b) Given (First)
FemaleMale
(d) Prefix (e) Suffix (f) Maiden (g) Other (h) Relationship
(a) Surname (Last)
CitizenshipPlace of Birth (City, Country)Date of Birth (mm-dd-yyyy)
(Attach copies)
Visa Status
Yes No
Arrival date if different from principal (mm-dd-yyyy) Please indicate if requesting identification card.
(b) Given (First)
FemaleMale
(d) Prefix (e) Suffix (f) Maiden (g) Other (h) Relationship
(a) Surname (Last)
CitizenshipPlace of Birth (City, Country)Date of Birth (mm-dd-yyyy)
(Attach copies)
Visa Status
Yes No
Arrival date if different from principal (mm-dd-yyyy) Please indicate if requesting identification card.
PRIVACY ACT STATEMENT