Passport Changes and Corrections DS-5504

Passport Changes  and Corrections DS-5504

"*" indicates required fields

1Applicant Details

2Contact Information

3Travel Plans

4Emergency Contact

5Passport Details

6Order Summary

7Preview Details

1. Applicant Details

Do you need a regular or large passport book?*

Regular Book (Standard)

Large Book (Non-Standard)

The large book is for frequent travelers who need more visa pages.

Applicant's Name*

First Name Middle Name Last Name Name Suffix (Optional)

Date of birth*

MM slash DD slash YYYY

Place of birth*

(City & State if in the U.S. or City & Country as it is presently known.)

Country of Birth*

State/Territory of Birth*

Sex*

Social Security Number*

If you haven’t been issued your SSN yet, simply enter zeros in this field.

Height*

Inches*

Hair Color*

Eye Color*

Occupation*

(if age 16 or older)

Employer or School

(if applicable)

List all other names you have used.

(Examples: Birth Name, Maiden, Previous Marriage, Legal Name Change. Attach additional pages if needed.)

Yes

Former Name A

Former Name A (Optional)

First

Former Name B

Former Name B (Optional)

First

2. Contact Information

Where should the passport be mailed?

Mailing Address*

Mailing Address Line 1: (Street/RFD#, P.O. Box or URB) Address Line 2: (Include Apartment, Suite, etc. If applicant is a child, write "In Care Of" of the parent. Example: In Care Of - Jane Doe, mother) City ZIP / Postal Code Country, (if outside the United States)

Mailing Address State/Territory*

State/Territory

Is this your permanent address?

Please, confirm whether your permanent address is the same as your mailing address.

Yes

Permanent Address*

(Complete if P.O. Box is listed under Mailing Address or if residence is different from Mailing Address. Do not list a P.O. Box)

Street/RFD # or URB Apartment/Unit City ZIP / Postal Code Country

Permanent Address State/Territory*

State/Territory

Preferred Method of Communication*

Mail

Both

Email*

(see application status at passportstatus.state.gov)

Enter Email Confirm Email

Primary Contact Phone Number*

Add Additional Contact Number

Additional Contact Phone Number-1

Additional Contact Phone Number

Phone Type-1

Phone Type

Home

Cell

Work

Additional Contact Phone Number-2

Additional Contact Phone Number

Phone Type-2

Phone Type

Home

Cell

Work

3. Travel Plans

If you don't have any travel plans yet, you can skip this step by selecting "No".

Travel Plans*

(If no travel plans, please select "no")

Yes

Departure Date*

Departure Date

MM slash DD slash YYYY

Return Date*

Return Date

MM slash DD slash YYYY

Countries to be visited*

Countries to be visited

4. Emergency Contact

If no emergency contact is available, you can skip this step

Your Emergency Contact

Provide the information of a person not traveling with you to be contacted in the event of an emergency.

Emergency Contact's Name

First

Emergency Contact's Address

Street/RFD # or URB Apartment/Unit City ZIP Code

Emergency Contact's Address State/Territory

State/Territory

Emergency Contact's Phone Number

Relationship with Emergency Contact

5. Passport Details

Have you ever been issued any of the following documents?*

U.S. Passport Book

U.S. Passport Card

Both

Select Document(s) for which you are applying:*

U.S. Passport Book

U.S. Passport Card

Both

Name*

Name as printed on your most recent passport book

First Name Last Name

Most recent passport book number*

Most recent passport book number

Date*

Most recent passport book issue date

MM slash DD slash YYYY

Name as printed on your most recent passport card*

Name as printed on your most recent passport card

First Name Last Name

Most recent passport card number*

Most recent passport card number

Date*

Most recent passport card issue date

MM slash DD slash YYYY

Have you changed your name since your most recent passport was issued?*

Yes

Changed Name After Passport was issued*

Provide Name Details

First Name Middle Name Last Name

Were your personal details printed incorrectly in your U.S. passport book and/or card?*

Yes

Please select the item(s) that are printed incorrectly*

Please select the item(s) that are printed incorrectly

First Name

Middle Name

Last Name

Date of Birth

Place of Birth

Gender

Corrected First Name*

Corrected First Name

Corrected Middle Name*

Corrected Middle Name

Corrected Last Name*

Corrected Last Name

Correct Gender*

Provide Correct Gender

Correct Date of Birth*

Provide Correct Date of Birth

MM slash DD slash YYYY

Correct Place of birth*

Provide Correct Place Of Birth (City & State if in the U.S. or City & Country as it is presently known.)

Was your most Recent U.S. passport book limited for two years or less?*

Yes

Order Summary

Passport Changes and Corrections DS-5504 Form*

Price:

Select Add-ons

Passport insurance

Priority service

Passport card

Total

Review Application

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Application Unique ID

Phone

This field is for validation purposes and should be left unchanged.