Form Ds-4085 - Application For Additional Visa Pages Page 2
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4FEDERAL TAX LAW
Section 6039E of the Internal Revenue Code (26 U.S.C. 6039E) requires you to provide your Social Security Number (SSN), if you have one,
when you apply for a U.S. passport or renewal of a U.S. passport. If you have not been issued a SSN, enter zeros in box #5 of this form. If
you are residing abroad, you must also provide the name of the foreign country in which you are residing. The Department of State must
provide your SSN and foreign residence information to the Department of Treasury. If you fail to provide the information, you are subject
to a $500 penalty enforced by the IRS. All questions on this matter should be directed to the nearest IRS office.
NOTICE TO CUSTOMERS MAKING PAYMENT BY CHECK
If you send us a check, it will be converted into an electronic funds transfer (EFT). This means we will copy your check and use the account
information on it to electronically debit your account for the amount of the check. The debit from your account will usually occur within 24
hours, and will be shown on your regular account statement.
You will not receive your original check back. We will destroy your original check, but we will keep the copy of it. If the EFT cannot be
processed for technical reasons, you authorize us to process the copy in place of your original check. If the EFT cannot be completed be-
cause of insufficient funds, we may try to make the transfer up to two times and we will charge you a one–time fee of $25, which we will
also collect by EFT.
REMITTANCE OF FEES
31 U.S.C. 7701 requires persons “doing business” with a federal agency to provide their Social Security Numbers to that agency. Because
the Department of State collects fees for the provision of passport services to you, you are considered a person “doing business” with the
Department. Passport service fees are established by law and regulation (see 22 U.S.C. 214, 22 CFR 22.1, and 22 CFR 51.50–56) and are
collected at the time you apply for the passport service. If the Department fails to receive full payment of the applicable fees, because, for
example, your check is returned for any reason or you dispute a passport fee charge to your credit card, the Department of State will take
action to collect the delinquent fees from you under 22 CFR Part 34 and the Federal Claims Collection Standards (see 31 CFR Parts 900–904).
In accordance with the Debt Collection Improvement Act (Pub.L. 104–134), if the fees remain unpaid after 180 days and no repayment ar-
rangements have been made, the Department will refer the debt to the Department of Treasury for collection. Debt collection procedures
used by Treasury may include referral of the debt to private collection agencies, reporting of the debt to credit bureaus, garnishment of private
wages and administrative offset of the debt by reducing or withholding eligible Federal payments (e.g. tax refunds, social security payments,
federal retirement, etc.) by the amount of your debt, including any interest penalties or other costs incurred. In addition, non–payment of
passport fees may result in the invalidation of your passport. An invalidated passport cannot be used for travel.
OTHER USES OF SOCIAL SECURITY NUMBERS
In addition to reporting your Social Security Number to Treasury and using it in connection with debt collection, the Department checks Social
Security Numbers against lists of persons ineligible or potentially ineligible to receive a U.S. passport.
PAPERWORK REDUCTION STATEMENT
You are not required to provide the information requested on this form unless the form displays a currently valid OMB number. We try to
create forms and instructions that can be easily understood. Often this is difficult to do because our citizenship laws are very complex. The
estimated burden time for this information collection is 20 minutes, which includes the time required to search existing data sources, gather
the necessary data, complete and review this form, and provide and submit the form and any additional information required. If you have
comments concerning the accuracy of this time estimate or suggestions for making this form simpler, we would be happy to hear from you.
You can write to us at: U.S. Department of State (A/ISS/DIR) Washington, DC 20520.
IMPORTANT NOTICE TO APPLICANTS WHO HAVE LOST OR HAD A PREVIOUS PASSPORT BOOK
AND/OR PASSPORT CARD STOLEN
A United States citizen may not normally bear more than one valid or potentially valid U.S. passport book or more than one valid or potentially
valid U.S. passport card at a time. Therefore, when a valid or potentially valid U.S. passport book or U.S. passport card cannot be presented
with a new application, it is necessary to submit a Form DS-64, Statement Regarding a Lost or Stolen Passport. Your statement must detail
why the previous U.S. passport book or U.S. passport card cannot be presented.
The information you provide regarding your lost or stolen U.S. passport book or passport card will be placed into our Consular Lost or Stolen
Passport System. This system is designed to prevent the misuse of your lost or stolen U.S. passport book or passport card. Anyone using
the passport book or passport card reported as lost or stolen may be detained upon entry into the United States. Should you locate the
U.S. passport book or passport card reported lost or stolen at a later time, report it as found and submit it for cancellation. It has been
invalidated. You may not use that passport book or passport card for travel.
PROTECT YOURSELF AGAINST IDENTITY THEFT
REPORT YOUR LOST OR STOLEN PASSPORT BOOK OR PASSPORT CARD!
For more information or to report your lost or stolen passport book or passport card by phone, call NPIC or visit our website at
travel.state.gov.
DS–4085
Instruction Page 2 of 3
02-2010
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