Here is your pdf: U.S. Department of State – Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card

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eforms.state.gov

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The access date was:
Access date: 2019-04-12 17:39:26.234733

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The content is as follows:

1. To apply for a new U.S. passport book and/or card

please submit this form with a new DS-11,

Application for a U.S. Passport

, to any

designated acceptance facility, U.S. passport agency, U.S. embassy, or U.S. consulate abroad.

2. Report a lost or stolen U.S. passport online by visiting our website at tr

avel.state.gov

.3. Report a lost or stolen U.S. passport by phone by calling 1-877-487-2778 (TDD: 1-888-874-7793) and following the representat

ive’s

instructions.

4. Submit this form by mail AND

a photocopy of a government-issued photo identification (such as a driver’s license or state-issued

identification) to the following address* ONLY IF

you are NO

T applying for a new U.S. passport book and/or card:

AUTHORITIES:

We are authorized to collect this information by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; 8 U.S.C. 1737; Executive Order 11295

(August 5, 1966); and 22 C.F.R. Parts 50 and 51.

PURPOSE:

We are requesting the information to ensure that no one has more than one valid U.S. passport book and one valid U.S. passport

card

at any one time, except as authorized by the U.S. Depa

rtment of State, and to combat passport fraud and misuse.

The collection of the Social Security number will be used to

verify the identity of the person

reporting the lost or stolen pas

sport and to identify the

passport being reported lost or stolen. Ther

e is no other purpose unless authorized by law.

ROUTINE USES:

This information may be disclosed to another domestic governmen

t agency, a private contractor, a foreign government agency, or

to a private person or private employer in accordance with ce

rtain approved routine uses. Thes

e routine uses include, but are

not limited to, law

enforcement activities, employment verifi

cation, fraud prevention, border security,

counterterrorism, litigation activities, an

d activities that meet the

Secretary of State’s responsibility to protect U.S. citizens and non-citizen nationals abroad.

More information on the routine uses for the information can be f

ound in System of Records Notices State-05, Overseas Citizen S

ervices Records

and Other Overseas Records and State-26, Passport Records.

DISCLOSURE:

Providing your Social Security number and other information on th

is form is voluntary, but failure to provide the information

on this

form may, given the form’s purpose of verificati

on of your identity, result in processing delays.

False statements made knowingly and willfully on this form, in U.

S. passport applications, or in affidavits or other supporting

documents submitted

therewith are punishable by fine and/or imprisonment under U.S. la

w, including 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 impr

isonment under the provisions of 18 U.S.C. 1543. The use of a

U.S. passport in

violation of the restrictions contained th

erein or of the passport regulations is puni

shable by fine and/or imprisonment under

18 U.S.C. 1544. All

statements and documents submitted

are subject to verification.

WARNINGPRIVACY ACT STATEMENT

ORU.S. Department of State

STATEMENT REGARDING A LOST OR ST

OLEN U.S. PASSPORT BOOK AND/OR CARD

DS-64 07-2018

Page 1 of 2

Protect yourself against identity theft! Report a lost or stolen U.S. passport!

For more information, please visit our website: travel.state.gov

To report a lost or stolen passport, please choose ONE

of the following options:

HOW TO REPORT A LOST OR STOLEN PASSPORT BOOK AND/OR CARD

Public reporting burden for this collection of information is esti

mated to average five minutes per response, including time re

quired for searching

existing data sources, gathering the necessa

ry data, providing the information and/or documents required, and reviewing the fin

al 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: U.S.

Department of State, Bureau of Consular

Affairs, Passport

Services, Office of Legal Affairs, Attn: Passport Forms Offi

cer, 44132 Mercure Cir., P.O. Box 1227, Sterling, VA 20166-1227.

ORORATTN: CLASP

U.S. Department of State

CA/PPT/S/L/LE

44132 Mercure Cir

P.O. Box 1227

Sterling, VA 20166-1227

* Only

use this address to submit this form or other correspondence about

lost/stolen passports. For general inquiries, call the Nati

onal Passport Information Center at 1-877-487-2778.

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