USE OF THIS FORM
This form is used with a U.S. passport application (Form DS-11) when one or both legal parents and/or legal guardians cannot appear in person with their minor child to apply for their child’s U.S. passport. Both legal parents/legal guardians may also use this form to authorize a third party to apply for a child's passport on the parents/guardians’ behalf. A separate notarized written statement with all details in this form may be submitted in lieu of this form.
•Children Under Age 16: Both legal parents/legal guardians must appear in person with their minor child to apply for a U.S. passport. If one or both parent/guardian(s) cannot appear in person with their child, they must submit this form or a separate statement consenting to passport issuance which must be signed and sworn under oath before a passport authorizing officer or notary.
•Children Ages 16 and 17: Parental awareness is required by one legal parent/legal guardian to issue the child a U.S. passport. In many cases, the passport authorizing officer may be able to ascertain parental awareness of the passport application. However, the passport authorizing officer retains discretion to request the legal parent/legal guardian’s written consent to passport issuance. Visit travel.state.gov for more details.
•Institutions or Entities Granted Guardianship to Child: Submit the documents below with this form or a separate statement and ensure the documents have no conditions placed on the passport’s validity period and where the child may travel. If there are conditions in the consent, new consent is required.
1.A certified court order granting guardianship to the institution/entity. Photocopies are not acceptable.
2.A signed statement on the institution's/entity's letterhead authorizing a specific person to apply for the child’s passport on the child's behalf. The statement must include the child's name and the name of the individual(s) authorized to apply for the passport.
3.The authorized individual’s photocopied employee photo identification verifying employment with the institution/entity.
NOTE: Consent may not be required if the legal parent/legal guardian submits evidence of sole authority to apply for the child’s passport such as the other parent’s death certificate (if said parent is deceased), court order granting sole legal custody, or birth certificate listing only one parent. The parent may also submit for consideration Form DS-5525 or written statement (made under penalty of perjury) explaining, in detail, why the second parent cannot be reached. Visit www.travel.state.gov for more details.
HOW TO COMPLETE THIS FORM
Sections 1, 2, and 3 are completed by the child’s non-applying legal parent(s)/legal guardian(s) also known as the “affiant(s)”. Consent is valid for both passport book and card unless specified by writing “issue passport book only” or “issue passport card only” in Section 3.
Stop at Section 4. The affiant(s) must wait to sign in front of a passport authorizing officer or notary. The signed date of the affiant(s) and passport authorizing officer or notary must match. The passport authorizing officer or notary must not be related to the affiant(s).
The affiant(s) must attach with this form a photocopy of the front and back of the valid government-issued photo identification presented and notated on this form or statement by the passport authorizing officer or notary.
Consent is valid for 90 days from the passport authorizing officer or notary’s signed date. If this consent expires before submitting the U.S. passport application for the said-named child, new consent is required.
Notaries Outside the United States: In certain countries, this form or statement must be notarized at a U.S. embassy or consulate and cannot be notarized by a local notary public. Go to the U.S. embassy or consulate webpage for more information.
CONTACT INFORMATION FOR PASSPORT SERVICES AND INTERNATIONAL PARENTAL CHILD ABDUCTION
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Website |
Email |
Phone |
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Passport Services |
travel.state.gov |
[email protected] |
1-877-487-2778 |
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National Passport Information Center (NPIC) |
(TDD/TTY 1-888-874-7793) |
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International Parental Child Abduction |
travel.state.gov/childabduction |
[email protected] |
1-888-407-4747 |
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Office of Children's Issues |
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WARNING
False statements made knowingly and willfully on passport applications, including affidavits or other supporting documents submitted therewith, may be punishable by fine and/or imprisonment under U.S. law, including the provisions of 18 U.S.C. 1001, 18 U.S.C. 1542, and/or 18 U.S.C. 1621.
PRIVACY ACT STATEMENT
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: The primary purpose for soliciting the information is to establish two-parent consent for applicants under the age of 16, or one-parent consent when requested by the Department for applicants ages 16 or 17, consistent with Public Law 106-113, Section 236.
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-26, Passport Records, and State-05, Overseas Citizen Services Records and Other Overseas Records.
DISCLOSURE: Providing information on this form is voluntary. Failure to provide the information requested on this form may cause delays in processing.
PAPERWORK REDUCTION ACT
Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the 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 unless this collection displays a currently valid OMB control number. If you have 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, Attn: Passport Forms Officer, 44132 Mercure Cir, PO Box 1199, Sterling, Virginia 20166-1199.