Form Ds-5504 - Us Passport Re-Application Form (Page 3 of 6) in pdf

FEDERAL 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

because 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.

PAYMENT 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 51.61-66) 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 arrangements 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 30 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/RPS/DIR) Washington, DC

20520.

IMPORTANT NOTICE TO APPLICANTS REGARDING LOST AND STOLEN PASSPORTS

The Consular Lost or Stolen Passport System contains information provided by applicants regarding their lost or stolen U.S. passports

and is designed to prevent the misuse of lost or stolen U.S. passports. Anyone using a passport book reported as lost or stolen may

be detained upon entry into the United States. Should you locate a U.S. passport previously reported as lost or stolen, immediately

report the book as found and submit it for cancellation. It has been invalidated. You may not use that passport for travel.

PROTECT YOURSELF AGAINST IDENTITY THEFT—REPORT YOUR LOST OR STOLEN PASSPORT!

For more information or to report your lost or stolen passport by phone, call NPIC or visit our website at travel.state.gov.

DS-5504

Instruction Page 3 of 4

Form Ds-5504 - Us Passport Re-Application Form Page 3

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