Fillable Form DS-5504

What is a DS-5504 Form?

Form DS-5504 is a U.S. passport application used for:

• Name changes within one year of passport issuance.
• Correcting printing errors on a passport.
• Replacing a passport issued for two years or less (excluding lost or damaged passports).

Where to send the DS-5504 Form?

Submit and mail this accomplished form along with your latest US passport book and/or passport card and any documentary evidence requested to:

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

What documents do I need with my DS-5504?

When submitting a DS-5504, make sure to bring the following documents with you:

• Current passport
• Passport photo
• Proof of Name Change or Data Correction
• Proof of passport error

How to Fill Out DS-5504?

Before filling out this form, make sure that DS-5504 is the right form for you by answering these questions:

1. I changed my name, by marriage or court order, less than one year after my most recent US passport book and/or card was issued and my US passport book and/or card was issued less than one year ago.
   1. Yes
   2. No
2. My identifying information in my most recent US passport book and/or card was printed incorrectly.
   1. Yes
   2. No
3. My most recent US passport book was limited to two years or less for a reason other than multiple losses or a seriously damaged/mutilated passport.
   1. Yes
   2. No

If you answered no to ALL of the three statements above, then you cannot use this form. Instead, you will need a form DS-82 or DS-11 depending on your circumstances.

Section 1: Personal Information

This section contains personal information about the applicant.

1. Name

Provide your Last Name, First Name, and Middle Name.

2. Date of Birth

Provide the date of your birth in the following format: MM/DD/YYYY.

3. Sex

Check “M” if you are male. If not, check “F” if you are female.

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 were you born.

5. Social Security Number

Provide your social security number.

6. Email

Provide your email address.

7. Primary Contact Phone Number

Provide your phone number which you can primarily be reached.

8. Mailing Address

Provide your mailing address.

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.

10. US Passport Book and/or Passport Card Information
    1. Provide your name as printed on your latest US passport book and/or passport card.
    2. Provide your latest US passport book number and its book issuance date (MM/DD/YYYY).
    3. Provide your latest US passport card number and its card issuance date (MM/DD/YYYY).
    4. Staple a recent 2”x2” photo of yourself beside this line on the box provided.
    5. Provide your signature (parent or legal guardian’s signature if you are a minor).
    6. Provide the date of when this form was accomplished.
11. Height

Provide your height.

12. Hair Color

Provide your hair color,

13. Eye Color

Provide your eye color,

14. Occupation

Provide your occupation if you are 16 or older.

15. Employer or School

Provide your employer or school if applicable.

16. Additional Contact Phone Numbers

Provide additional contact numbers if any.

17. Permanent Address

If your place of residence is different from your mailing address, provide your permanent address.

18. Emergency Contact

Provide the name, address, phone number, and your relationship with the person who should be contacted in case of an emergency.

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.

Section 2: Signatures

This section contains the signatures of the applicant and guardian, if applicable.

1. Applicant’s Legal Signature (If applicant 16 y/o or older)

If you are above the age of 16, input your signature in the provided field.

2. Guardian’s Signature (If minor)

If you are a minor, then have your guardian input his/her signature in the provided field.

3. Date Signed

Enter the date when this form was signed.

Section 3: Additional Questions

This section contains additional questions regarding your current passport book and/or passport card.

1. Has your name changed by marriage or court order less than one year after your US passport book and/or card was issued?

If yes, and your submitted passport book and/or card is less than one year old, provide your new name.

2. Was your identifying information printed incorrectly in your US passport book and/or card?

If yes, check the box(es) next to the field(s) that need correction and provide the correct information.

3. Was your most recent US passport book limited for two years or less?

If yes, submit evidence of your US citizenship.

Frequently Asked Questions (FAQs)

How do I correct a mistake on my US passport?

If there is a mistake on your US passport, then you will need to fill up a DS-5504 form.

What is the DS-5504 form for?

Form DS-5504 is a U.S. passport application used for name changes, error corrections, and limited passport replacements.

What’s the fastest you can replace a lost passport?

Typically, it takes 4-6 weeks to replace a lost passport. However, you can expedite it and get it in 2-3 weeks. If you’re looking for something faster, then you should have a reason for urgent travel and make an appointment.

What is the best way to pay passport fees?

Pay U.S. passport fees by mail with a check or money order, at acceptance facilities with check, money order, or card (varies), or at passport agencies with cash, check, money order, or card.

Where can I get a DS-5504 Form?

You can get and fill up a DS-5504 Form from PDFRun.