Form DS-5504 PDF Template

What is a Form DS-5504?

Form DS-5504, officially known as the "Application for a U.S. Passport for Eligible Individuals," is issued by the U.S. Department of State. It is used for correcting information, changing names due to marriage or court order, or replacing a limited passport issued within the last year. Eligible applicants must meet specific criteria, such as having had their passport issued less than one year ago. This form is not applicable to those residing outside the U.S. and Canada, who should instead contact their nearest U.S. embassy or consulate. The form is free unless expedited service is requested, and it requires the applicant to send their current passport, a new photo, and any necessary documentation to the National Passport Processing Center.

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How to Fill in Our Form DS-5504 PDF Template

Follow these steps to fill in the Form DS-5504 template:

General Information:

U.S. Department of State
Application for a U.S. Passport for Eligible Individuals
0MB Control No. 1405-0160
Expiration Date: 11-30-2022
Estimated Burden: 40 minutes

Purpose:

Correction of information
Name change within one year of passport issuance
Replacement of a limited passport

Eligibility Criteria:

Name change by marriage or court order within one year of passport issuance
Incorrect identifying information on the current passport
Passport issued for less than two years (not due to multiple losses or damage)

Instructions:

Visit travel.state.gov for more information or contact the National Passport Information Center at 1-877-487-2778 or NPIC@state.gov.
Applicants residing outside the U.S. and Canada should visit usembassy.gov for procedures.

Fees:

No fee unless expedited service is requested
Expedited service available for a fee (check travel.state.gov for details)
Enclose a check or money order payable to "U.S. Department of State"
Do not send cash

Mailing Instructions:

Complete, sign, and date the form
Include your most recent passport, a new color photo, and any required documents
For routine service, mail to:

National Passport Processing Center
Post Office Box 90107
Philadelphia, PA 19190-0107

For expedited service (write "Expedite" on the envelope):

National Passport Processing Center
Post Office Box 90907
Philadelphia, PA 19190-0907

Use trackable mailing service
For 1-2 day delivery (only for passport books), include appropriate postage fee

Additional Information:

Providing your email address on the form allows the Department to contact you for any issues or additional information required.
For up-to-date fees, processing times, and application status, visit travel.state.gov.