Fillable Form DS 86: Statement of Non-Receipt of a U.S. Passport

What is Form DS-86?

In case a passport is lost, it should be immediately reported to the authorities. However, if the passport is lost while in transit to the applicant Form DS 86 should be filed. Form DS-86 or Statement of Non-receipt of a Passport is used to protect people from identity theft. A United States citizen could fill out this form if they applied for a passport book or a passport card and have not received it in the mail ever since the documents have been issued. A U.S. citizen may not normally bear more than one valid or potentially valid U.S. passport book and one valid U.S. passport card at a time.

The statement must be sent within 90 days since the passport was issued. If you do not report the non-receipt of your U.S. passport document(s) within 90 days of the issue date, you will be required to reapply and submit the full passport fee.

The information that is provided on the DS-86, Statement of Non-Receipt of a Passport, will be placed into the Consular Lost or Stolen Passport System. Anyone using the U.S. passport book or U.S. passport card reported on the DS-86 may be detained. In case the document gets received it should be reported as non-received at a later time, report it as found and submit it for cancellation. It has been invalidated. It cannot be used for travel.

Again, the primary purpose of this form is for soliciting the information is to establish the need for a replacement U.S. passport for customers who have not received the passport for which they originally applied.

How to fill out Form DS-86?

This application must be submitted with a clear photocopy of an identification containing a photo. Providing the information requested on this form is voluntary. Failure to provide the information requested may result in processing delays or the denial of your U.S. passport application. Type or print legibly in black ink in the white areas only.

• Select which document is being reported.
  • Choose between U.S. Passport Book and U.S. Passport Card.
  • Pick which one applies to the applicant.
• Enter the full name of the applicant.
  • Last, First, Middle
• Date of Birth of the applicant.
  • MM-DD-YYYY
• Primary Telephone Number
• Secondary Telephone Number
• Mailing Address
  • Street Address
  • Apartment /Unit
  • City
  • State
  • ZIP Code
• Sign and date the document
  • The area for signature is different for Applicant's Signature who is age 16 and older which is found on the left side, while on the right side it should contain the Parent's/Legal Guardian's Signature
  • Before signing, make sure the applicant has read this:
    • I, the undersigned, certify that I have not received the U.S. passport book and/or U.S. passport card for which I applied for. I declare under penalty of perjury that the statements made on this form are true and correct. I request that a new U.S. passport book and/or U.S. passport card be issued to me and certify that if I receive the U.S. passport book and/or U.S. passport card previously applied for, I will immediately contact the National Passport Information Center at 1-877-487-2778 (TDD: 1-888-874-7793) and return the recovered passport to the U.S. Department of State.

The next part of the form is to only be used by the passport office only.

Be mindful of false statements made knowingly and willfully in passport applications or in affidavits or other supporting documents submitted therewith are punishable by fine and/or imprisonment under the provisions of 18 U.S.C 1001, 18 U.S.C. 1542, and/or 18 U.S.C. 1621. Alteration or mutilation of a U.S. passport issued pursuant to this application 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 are subject to verification.

Where to file Form DS-86?

Form DS-86 or Statement of Non-receipt of a Passport must be mailed to the passport agency that originally processed the application. To obtain the address of that agency please call the National Passport Information Center at 1-877-487-2778 (TDD: 1-888-874-7793).

The information solicited on this form may be made available as a routine use to other government agencies and private contractors to assist the U.S. Department of State in adjudicating U.S. passport applications and requests for related services, and for law enforcement, fraud prevention, border security, counterterrorism, litigation activities, and administrative purposes.

The information may be made available to foreign government agencies to fulfill passport control and immigration duties. The information may also be provided to foreign government agencies, international organizations and, in limited cases, private persons and organizations to investigate, prosecute, or otherwise address potential violations of law or to further the Secretary's responsibility for the protection of U.S. citizens and non-citizen nationals abroad.

For a more detailed listing of the routine uses to which this information may be put see the Department of State's Prefatory Statement of Routine Uses relative to the Privacy Act (Public Notice 6290 of July 15, 2008) and the listing of routine users set forth in the System of Records Notices for Overseas Citizen Services Records (State-05) and Passport Records (State-26) published in the Federal Register.