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Get DS-86 2020-2024

Applicant s Signature age 16 and older Mother/Father/Parent/Legal Guardian s Signature if applicant is under age 16 Date mm-dd-yyyy ISSUING OFFICE USE ONLY Was the passport mailed to the correct mailing address Was delivery confirmed Tracking Number Vendor Previous U.S. Passport Book Number Issuing Agency DS-86 05-2017 UPS Fed Ex DHL Date Issued mm-dd-yyyy Date Mailed mm-dd-yyyy Special Postage if used Page 1 of 2 HOW TO USE THIS FORM To determine how and when to use and submit this form please call the National Passport Information Center NPIC at available Monday-Friday 8 00a.m.-10 00p.m. and Saturday 10 00a.m.-3 00p.m. Eastern Time excluding federal holidays. U*S* Department of State STATEMENT OF NON-RECEIPT OF A U*S* PASSPORT Attention Read WARNING on Page 2 OMB Approval No* 1405-0146 Expiration Date 10-31-2020 Estimated Burden 15 Minutes IMPORTANT NOTICE Except when authorized a U*S* citizen may not bear more than one valid U*S* passport book and one valid U*S* passport card at a time. You have 90 days from the date that your passport document s was issued to report that you have not yet received it in the mail* 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 s. To check the status of your U*S* passport application please visit travel*state. gov or contact our National Passport Information Center NPIC 1-877-487-2778 TDD 1-888-874-7793. Protect yourself against identity theft Report the non-receipt of your U*S* passport book or U*S* passport card The information that you provide on this form will be entered into the Consular Lost or Stolen Passport System* Upon submission of this form you may not use the passport s reported as not received for travel as the passport s will be invalidated* Anyone using the U*S* passport book or U*S* passport card reported on this form including yourself may be detained* Should you receive the passport s you reported as not received at a later time report it as found and submit it for cancellation* See page two of this form for additional information* This application must be accompanied by a clear photocopy of the front and back of a government-issued identification document containing your photograph. Type or print legibly in black ink in the white areas only. Select the product s which you are reporting as not received* Book Only U*S* Passport Book and Card Last Name Card Only Middle Name First Name Social Security Number Date of Birth mm-dd-yyyy Primary Telephone Number Secondary Telephone Number Travel Date mm-dd-yyyy Mailing Address as listed on original application Apartment /Unit Street Address ZIP Code State City Please explain what steps have been taken to locate the passport product s Attach a separate sheet of paper if more space is needed. Yes Was the documentary evidence that you submitted with your original passport application returned to you No If no please describe which document s was not received Example birth certificate naturalization certificate adoption decree etc* Attach a separate sheet of paper if more space is needed.

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