Transmittal Tracking or Delivery Confirmation Number
Facility Identification Number (Non-State Only) Name of Facility or Consular Post Date (mm-dd-yyyy) (Check one)
Routine Expedite Form of
Name of Acceptance Agent (AA) - (Non-State Only) Telephone Number of AA or ACS Unit Email Address of AA or ACS Unit
Entry
Number
Applicant's Name
(Please Print or Type)
Date of Birth
(mm-dd-yyyy)
Type of Passport Requested
Diplomatic Official Service
No-Fee
Regular
DD Form
1056
Included
Authorization
Memo
Included
*Travel
Authorization
Request for
PPT Service
DS-1640
1.
2.
3.
4.
5.
6.
7.
8.
9.
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20.
DS-7691
06-2017
Stamp or Seal of AA or Consular Officer (if available) Prepared by Total # of Applications Included
CONSULAR OFFICERS - THIS TRANSMITTAL FORM IS TO BE INCLUDED IN THE ENVELOPE WITH THE TRACKING NUMBER LISTED ABOVE WHEN MAILING OR
OTHERWISE DELIVERING SPECIAL ISSUANCE PASSPORT APPLICATIONS.
ACCEPTANCE AGENTS (AA) - PLEASE FOLLOW THE ABOVE INSTRUCTIONS AND RETAIN A COPY OF THIS TRANSMITTAL FORM FOR AT LEAST 
24 MONTHS FOR YOUR RECORDS IN ACCORDANCE WITH THE PASSPORT AGENT'S REFERENCE GUIDE.
* FOR THE DEPARTMENT OF STATE - TM-FOUR. FOR ALL OTHER FEDERAL AGENCIES INCLUDING THE DEPARTMENT OF DEFENSE - PERMANENT CHANGE 
OF STATION (PCS) ORDERS.
By checking this box, I, _______________________ , certify
that I am the individual submitting this document.
Date (mm-dd-yyyy)
Tourist
DoD/FED
(Exception)
SPECIAL ISSUANCE PASSPORT APPLICATION NO-FEE TRANSMITTAL
U.S. Department of State
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