If you are applying for a new U.S. passport book and/or card, please submit this form with a new DS-11 U.S. passport application to any
designated acceptance facility , U.S. passport agency, U.S. embassy, or U.S. consulate abroad.
If you are not currently applying for a new U.S. passport book and/or card, send this form or a recovered lost or stolen U.S.
passport book and/or card to the following address:
U.S. Department of State
Consular Lost/Stolen Passport Unit
600 19th Street, NW
Washington, DC 20522
To report a lost or stolen U.S. passport by telephone, call: 1-877-487-2778,
For more information, please visit our website: www. travel.state.gov
AUTHORITIES: We are authorized to collect this information by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; 26 U.S.C. 6039E; 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 U.S. passport book and one U.S. passport card at any one
time, except as authorized by the U.S. Department 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 passport and no other
purpose unless authorized by law.
ROUTINE USES: This information may be disclosed to another domestic government agency, a private contractor, a foreign government agency,
or to a private person or private employer in accordance with certain approved routine uses. These routine uses include, but are not limited to, law
enforcement activities, employment verification, fraud prevention, border security, counterterrorism, litigation activities, and 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 system can be found in System of Records Notices State-05, Overseas Citizen Services Records and
State-26, Passport Records.
DISCLOSURE: Providing your Social Security number and other information on this form is voluntary, but failure to provide the information on this
form may, given the form's purpose of verification of your identity, result in processing delays or the denial of your passport applicat ion.
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. law, including the prov isions 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 imprisonment under the provisions of 18 U.S.C. 1543. The use of a U.S. passport in
violation of the restrictions contained therein or of the passport regulations is punishable by fine and/or imprisonment under 18 U.S.C. 1544. All
statements and documents submitted are subject to verification.
PRIVACY ACT STATEMENT
PAPERWORK REDUCTION ACT STATEMENT
Public reporting burden for this collection of information is estimated to average ten minutes per response, including time required for searching
existing data sources, gathering the necessary data, providing the information and/or documents required, and reviewing the final collection. You
do not have to supply this information u nless this collection displays a currently valid OMB control number. If you hav e 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 Program Management and Operational Support, 2201 C Street NW, Washington, D.C. 20520.
The address should only be used to submit this form or other correspondence about lost/sto len passports. It should not be used for
general inquiries that are unrelated to lost/stolen passports.
HOW TO REPORT YOUR LOST OR STOLEN U.S. PASSPORT BOOK AND/OR PASSPORT CARD
U.S. Department of Stat e
STATEMENT RE GARDING A LOST OR STOLEN U.S. PASSPORT BOOK AND/OR CARD
If you are submitting this form without also submitting a passport application, please provide a copy of a
government-issued photo identification, such as a driver's license or a state-issued identification card.
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U.S. Department of State
44132 Mercure Cir
P.O. Box 1227
Sterling, Virginia 20166-1227
Protect yourself against identity theft! Report a lost or stolen U.S. passport book or passport card!