Fillable Form DS-5504
DS-5504 Form is an Application for a U.S. Passport for changing your name in a valid passport or to extend validity for a limited passport or correct a priniting error.
What is Form DS-5504?
Holders of a United States passport use Form DS-5504, Application for a U.S. Passport Name: Change, Data Correction, and Limited Passport Book Replacement, to request corrections on their passport.
According to the instructions section of Form DS-5504, you may use the form:
If you do not meet any of the circumstances mentioned, you must apply using Form DS-11, Application for a U.S. Passport, or Form DS-82, U.S. Passport Renewal Application for Eligible Individuals, depending on your circumstances.
How to fill out Form DS-5504?
Form DS-5504 is a two-page form with additional four pages for instructions. Provide all the required information accurately to avoid further errors in your passport.
Select the document(s) for which you are applying:
Mark the “US Passport Book” checkbox if you are intending to apply for a US passport book only.
Mark the “US Passport Card” checkbox if you are intending to apply for a US passport card only.
Mark the “Both” checkbox if you are intending to apply for both a US passport book and a US passport card.
Mark the “Regular Book (Standard)” checkbox if you are intending to apply for a regular US passport book.
Mark the “Large Book (Non-Standard)” checkbox if you are intending to apply for a large US passport book.
Line 1: Name
Provide your full legal name.
Line 2: Date of Birth
Provide the date of your birth in the following format: MM/DD/YYYY.
Line 3: Sex
Check “M” if you are male.
Check “F” if you are female.
Line 4: Place of Birth
If you were born in the US, provide the city and state where you were born.
If you were born outside of the US, provide the city and country where you were born.
Line 5: Social Security Number
Provide your social security number.
Line 6: Email
Provide your email.
Line 7: Primary Contact Phone Number
Provide your phone number which you can primarily be reached.
Line 8: Mailing Address
Provide your mailing address.
Line 9: List of All Other Names You Have Used
Provide all other names you have ever used such as birth name, maiden name, previous marriage, legal name change. Provide additional pages if necessary.
Line 10: US Passport Book and/or Passport Card Information
Line 11: Height
Provide your height,
Line 12: Hair Color
Provide your hair color,
Line 13: Eye Color
Provide your eye color,
Line 14: Occupation
Provide your if you are 16 or older.
Line 15: Employer or School
Provide your employer or school if applicable.
Line 16: Additional Contact Phone Numbers
Provide additional contact numbers if any.
Line 17: Permanent Address
If your place of residence is different from your mailing address, provide your permanent address.
Line 18: Emergency Contact
Provide the name, address, phone number, and your relationship with the person who should be contacted in case of an emergency.
Line 19: Travel Plans
Provide the departure date, return date, and countries to be visited. For the dates, provide them in the following format: MM/DD/YYYY.
Questions regarding your current passport book and/or passport card:
If your name has changed by marriage or court order less than one year after your U.S. passport book or passport card was issued and your submitted passport book and/or passport card is less than one year old, mark the appropriate “Yes” checkbox. Then, provide your current name, and submit evidence documenting your name change. Otherwise, check “No.”
If your identifying information was printed incorrectly in your U.S. passport book or passport card, mark the appropriate “Yes” checkbox. Then, provide your name, date of birth, sex, and place of birth, and submit evidence documenting your correct identifying information. Otherwise, check “No.”
If your latest US passport was limited for two years or less, mark the appropriate “Yes” checkbox and submit evidence of your US citizenship. Otherwise, check “No.”
What do I submit with Form DS-5504?
Submit the following requirements with your Form DS-5504:
Where to submit Form DS-5504?
Mail Form DS-5504 with the required documents to:
For Routine Service:
National Passport Processing Center
Post Office Box 90107
Philadephia, PA 19190-0107
For Expedited Service (Requires a Fee):
National Passport Processing Center
Post Office Box 90907
Philadelphia, PA 19190-0907
Note: All fees must be submitted in the form of a personal check or money order. Expedited service is only available for passports mailed in the United States and Canada.