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Request For Official Passport And/or Visa Form

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U.S. Department of the Interior Request for Official Passport and/or Visa

Please type the following information to obtain an Official Passport and/or visa. Completed forms can be

sent to: Office of International Affairs, Attn: Passport Office, Room 3555, 1849 C. Street, N.W.

Washington, DC 20240, or via fax at 202-219-9822. (Please do not email completed forms).

Full Name

__________________________________________________________

Date of Birth

__________________________________________________________

Place of Birth

__________________________________________________________

Grade and Title

__________________________________________________________

DOI Bureau

___________________________________________________________

Business Address

(Please provide physical address for Federal Express delivery. No P.O. Box.)

__________________________________________________________

Email Address

____________________________________________________

Phone and Fax

___________________________________________________________

Destination

___________________________________________________________

Date of Departure

_____________________________ Return

_____________________

Trip Purpose

_________________________________________________________

Choose from the following list:

I have never had any type of passport.

I have a tourist Passport, Passport Number _________, which expires/expired on

________________.

I have an Official or Diplomatic Passport (circle one), Passport Number __________, which

expires/expired on _________________.

My Official Passport is already on file with the Office of International Affairs Passport Division.

Please obtain necessary visa(s), if needed.

(Note: The employee’s most recent passport (Official, Diplomatic, or tourist) must be physically

presented as proof of citizenship. Even if it has expired, and is more than 15 years from the date of

issue, please list here.)

PLEASE NOTE: YOUR OFFICIAL PASSPORT IS U.S. GOVERNMENT PROPERTY AND

MUST BE STORED AT THE U.S. DEPARTMENT OF THE INTERIOR ACCORDING TO

CONTROLS ESTABLISHED BY THE STATE DEPARTMENT. IT MUST BE RETURNED TO

THE OFFICE OF INTERNATIONAL AFFAIRS/PASSPORT OFFICE ONCE YOUR TRIP IS

COMPLETED.

Questions? Please call us at (202) 208-5292 or email us at passports@ios.doi.gov

Request For Official Passport And/or Visa Form

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