How to Complete the DS-5525 Passport Form

How to Complete the DS-5525 Passport Form

 

The DS-5525 Passport Form is used for a minor child passport. This passport form is used if one of the parents or guardians is not available to give consent for a minor passport at the passport acceptance facility. You can submit Form DS-5525 Statement of Special Family Circumstances Passport Form if you are the applying parent and you want to explain why the non-applying parent/guardian’s consent could not be obtained. It is specifically for special circumstances. A child minor passport is for any passport applicant 15 or younger. The special circumstances may vary from case to case, but the DS-5525 is used for each situation. If a parent or guardian is currently incarcerated, living overseas, or simply just not a part of your life- the  DS-5525 Statement of Special Family Circumstances Passport Form is what you need. This page will explain how to complete the DS-5525 Passport Form.

The Form DS-5525 Statement of Special Family Circumstances Passport Form is NOT a guarantee so please approach this form as a special request. Each situation is reviewed individually.

What to Include

The statement will explain in detail the situation regarding the non-applying parent or guardian and why they are unavailable. The DS-5525 passport form will also need to state the efforts made to contact the non-applying parent or guardian. Please give thorough evidence, court information, letters from a lawyer, and anything you can provide. The DS-5525 passport form is not a guarantee, so the more information you have, the better!

Evidence should be given, which may include custody orders, incarceration orders, or a restraining order. These documents will help for the Form DS-5525: Statement of Exigent/Special Family Circumstances to be approved.

You can also complete the DS-5525 Statement of Special Family Circumstances Passport Form on the US State Dept website.

Download the DS-5525 Statement of Special Family Circumstances Passport Form.

How to Complete the DS-5525 Passport Form

1. Minor’s Name

(Last, First, Middle)

2. Minor’s Date of Birth

(mm/dd/yyyy)

3. Non-Applying Parent/Guardian’s Name

(Last, First, Middle)

4. Other Names of Non-Applying Parent/Guardian

OMB CONTROL NO. 1405-0216

OMB EXPIRATION DATE: 08-31-2016

ESTIMATED BURDEN: 30 Minutes

Signature of Parent

or Legal Guardian: Date

(mm/dd/yyyy)

5. Non-Applying Parent/Guardian’s Date of Birth

(mm/dd/yyyy)

First

Middle

Last

If yes, please provide any documentation with this form, such as

a letter from the convicting criminal court, a copy of the incarceration

court order, or a copy of the on-line inmate locator page.

6. Non-Applying Parent/Guardian’s Last Known Contact Information

City

ZIP Code

State

Apartment

Street

7. Has any court either in the United States or abroad ever issued an order/decree that references the custody

or travel of the minor child in question? (Examples include a divorce decree, custody order, protection order,

stay away order, restraining order, etc.)

No

Yes

If yes, you must provide a complete, signed, and dated copy of the order(s)/decree(s) with this form.

Telephone Number: ( )

E-mail Address:

8. Is the non-applying parent/guardian currently incarcerated?

(consent from the incarcerated parent/guardian may be required)

Yes No

9. Please explain in detail the reason for your request to issue a U.S. passport book and/or card without the

non-applying parent/guardian’s consent. If you cannot locate the non-applying parent/guardian, please

describe the number of attempts made to contact him or her, exact or approximate dates, the types of attempts

(i.e., by letter, phone, e-mail, or in-person), and the outcome of each attempt. Please include the non-applying

parent/guardian’s last known address, telephone number(s), and place of employment.

10. Have you attempted to contact the non-applying parent/guardian through any third party? If yes, please list

the name of the person contacted, the relationship of the person contacted to the non-applying parent/guardian,

the dates of the attempts to contact, and the

address and/or telephone number of the contact.

DS-5525 08-2013

U.S. Department of State

Country

OATH: I declare under penalty of perjury that all statements made in this supporting document are true and correct.

STATEMENT OF EXIGENT/SPECIAL FAMILY CIRCUMSTANCES

FOR ISSUANCE OF A U.S. PASSPORT TO A MINOR UNDER AGE 16

DS-5525 Passport Form