Ds 2004 Form – Fill Out and Use This PDF

The DS-2004 form is an essential document for notifying the U.S. Department of State about the appointment of foreign government employees, excluding diplomatic and consular officers. It serves as a comprehensive notification tool, ensuring that all relevant employee information is accurately relayed for the administration of privileges and immunities. This process necessitates careful attention to detail to avoid delays or discrepancies, especially concerning benefits like identification cards, tax exemptions, and more. Ready to start the process? Click the button below to fill out your form.

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Ds 2004 Form PDF Details

Navigating the complexities of international diplomacy and the administration of foreign government personnel in the United States requires meticulous adherence to procedural protocols. At the heart of this process lies the Form DS-2004, a critical document designed for the notification of appointment of foreign government employees, excluding diplomatic and consular officers. This form, which requires thorough and accurate completion, serves as a foundational step in ensuring that employees of foreign missions are properly documented and eligible for the privileges and immunities accorded to them by the United States. It outlines detailed instructions for reporting not just the appointment, but also any subsequent changes in the employment status of members of the administrative, technical, and service staffs of embassies, along with consular employees and members of the service staff of consular posts. The form underscores the necessity of precise information, from personal identifiers to residential and official addresses, emphasizing the critical nature of accuracy to avoid delays in processing identification cards, tax exemption cards, and other essential documentation. Moreover, it delineates specific conditions under which the United States extends privileges and immunities, linking these to the obligations of the sending state towards the employee. Through its comprehensive instructions and detailed itemization, Form DS-2004 embodies the meticulous balance between diplomatic courtesy and the regulatory framework that governs the presence of foreign government employees on U.S. soil, ensuring that every appointment is acknowledged and processed within the ambit of international agreements and U.S. law.

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Form Name	Ds 2004 Form
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
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INSTRUCTIONS FOR COMPLETING FORM DS-2004,

NOTIFICATION OF APPOINTMENT

OF FOREIGN GOVERNMENT EMPLOYEE

Please read all instructions before completing this form.

This form is to be completed for all employees of foreign missions except diplomatic and consular officers. All questions should be answered completely and accurately. If a question does not apply, please type N/A.

Any changes in the information provided on this form should be reported as soon as possible using the Notification of Change, Form DS-2006.

In the case of members of the administrative and technical and service staffs of embassies and consular employees and members of the service staff of consular posts, the United States does not extend privileges and immunities to persons unless documentation is provided to indicate that the sending state: (1) pays the cost of the employee's transportation to the U.S. from the employee's normal place of residence; (2) transfers the employee and his or her immediate family out of the United States within a specific time frame consistent with the sending state's transfer policy; and (3) pays the cost of the employee's transportation from the United States to the employee's normal place of residence or to the country of the employee's next assignment.

NOTE: It is important that all information provided to the Office of Protocol and the Office of Foreign Missions be consistent. Discrepancies, such as in the spelling of the name, the residence address, date of birth, etc., may delay processing applications for identification cards, tax exemption cards, drivers' licenses, and automobile registrations.

The instructions below are numbered to correspond to the numbered items on the form.

PLEASE TYPE ALL ANSWERS.

If employee is a U.S. citizen, the following items do not need to be completed: 8, 9, 10, 16, 17, 18, 20, 21, 22, (unless family member also is employed

by a foreign government or international organization), or 23.

1Enter the name of the Embassy or Mission submitting the form. Give telephone number and email address of office which can be contacted for further information, if necessary.

2Enter "X" in the box to indicate if the employee works at an embassy, consulate, miscellaneous foreign government office, or mission to an international organization, or is a personal or domestic employee of a foreign government official. For personal or domestic employee, check box corresponding to employer's status (e.g. Embassy, Consular).

3Enter the officer's full name in the order specified:

(a) surname; (b) given name;

military rank, or title; (d) suffix, such as Jr. or Sr.; and (e) maiden name. Type "X" to indicate if

male or female.

NOTE: The abbreviated name, if used, will appear in all publications and documents issued by the U.S. Department of State.

Enter present nationality.

Enter employee's date of birth (mm-dd-yyyy).

Enter nationality at birth, even if the same as Number 4.

Enter employee's place of birth - city and country or state.

Enter"X" in box indicating type of passport, if any.*

Enter "X" in box indicating type of United States visa held in passport, or if permanent resident, give alien registration "A" number.

Enter date (mm-dd-yyyy), of arrival in the United States and port of entry.

Enter residence address (not duty address unless actually living and working at the same location), in the United States where employee currently resides. If temporary (hotel, etc.), use Form DS-2006 to notify the Department of State when officer moves to a permanent address.

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11-2017

Enter the name, address, and telephone number of foreign mission

consulate, or office where the employee will be assigned. NOTE: For domestic employees, give the name, Personal

Identification Number (PID), and title of the employer, and his/her complete office address.

Enter the name, address, and telephone number of the actual office or annex where the employee will be working, if different from Number 12. NOTE: For domestic employees, give the residence address where domestic duties will be performed.

NOTE: All addresses must be street addresses, including type,

e.g. Street, Ave., Blvd., etc., not post office box numbers, and must include ZIP codes and telephone area codes.

Enter names of all eligible family members residing in the household in the United States, following the same format as in Number 3 above. Use Form DS-2007 for additional names. Give date of birth (mm-dd-yyyy), place of birth, (city country), current citizenship, and relationship to principle employee. Enter type of United States visa (A-1, B-2, etc.) currently held, or copy of Permanent Resident Alien card.

Enter "X" in appropriate boxes for an identification card. For embassy A&T staff (a) principals (who are not U.S. citizens,

permanent resident aliens or determined to be "permanently resident in the U.S.), (b) spouses (except U.S. citizens, spouses of persons

14Enter person's title or position, e.g. secretary, clerk, driver, cook, etc. Do not use any diplomatic or consular title reserved for officer.

15Enter the date (mm-dd-yyyy), employee assumed present official duties in the United States.

determined to be "permanently resident in" the U.S., and permanent

resident aliens), (c) dependents of persons determined to be "permanent resident aliens and dependents of person determined to be "permanent resident in" the U.S.)

who are unmarried children between 16 and 21 years who reside with their parents or are full-time students, or unmarried children

16	Enter the date (mm-yyyy) (approximate) that employee will terminate	under 23 years who are full-time students (for students between 21
16		and 23 attach family status justification form), for consular officers
	duties in the United States.*
	duties in the United States.*
		only the consular employees and embassy service staff, principals

17Enter name, title and (PID), if available, of the person the employee is replacing. Enter date (mm-yyyy), of termination of predecessor. If new position, so state. (Not applicable for domestic workers.)*

18If employee will serve in any official capacity other than that that listed in Number 14, enter position title and mission. Separate notification will be required.*

19If a family member (spouse or dependent) is or will be employed in the United States by a foreign government or international organization, please identify and indicate position or title, relationship and where the person is working. The person must be notified separately to the Office of Protocol using the appropriate form.

20If not listed in item 21, enter dates (mm-yyyy), nature of all previous assignments (including study and training) and place (city and state) in the United States. List To/From month/Year (mm-yyyy)*.

21Enter the dates (mm-yyyy), nature of employment (job title and employer), and place (city and country) of academic study or other activities for previous 5 years, starting from the most recent assignment prior to this one. List to/From--Month/Year (mm-yyyy). (NOTE: For Numbers, 20, 21, attach additional sheet, if necessary.)*

(who are not U.S. citizens, permanent resident aliens or determined to be "permanently resident in" the U.S.) unless the sending state

and the U.S. have entered into a bilateral agreement extending immunity to family members. Other employees and family members do not receive identification cards.* The employee must sign and date (mm-dd-yyyy) the form. In case of domestic employees, the official employers must also sign and date the form. The form must be signed and dated (mm-dd-yyyy) by the designated approving embassy official and the official embassy seal must

be affixed.

*Not required if person being registered is U.S. Citizen or Permanent Resident Alien

Submit forms and attachments to

U.S. Department of State

3507 International Place, NW

Washington, DC 20008-3034

ANY CHANGES IN THE INFORMATION PROVIDED ON THIS FORM SHOULD BE REPORTED AS SOON AS POSSIBLE USING THE NOTIFICATION OF CHANGE,

FORM DS-2006.

DS-2004

Instruction page 2 of 2

					OMB APPROVAL NO. 1405-0105
					EXPIRATION DATE: 12-31-2021
					ESTIMATED BURDEN: 20 MINUTES *
		U.S. Department of State		FOR OFFICIAL USE ONLY
		U.S. Department of State		FOR OFFICIAL USE ONLY
		NOTIFICATION OF APPOINTMENT	P		R
		NOTIFICATION OF APPOINTMENT	P		R
		OF FOREIGN GOVERNMENT EMPLOYEE	A		T
		OF FOREIGN GOVERNMENT EMPLOYEE	A		T
			PID
TO: Secretary of State, Attention - Department of State
TO: Secretary of State, Attention - Department of State
1.From (Name of Embassy/Mission)			2. Type of Officer
			Embassy	Mission to International Organization
			Consular	Private Domestic		EMB.	MISC.
			Miscellaneous	International		CON.	MISSION TO INTL.
				Organization

	Contact Name, Telephone Number and Email Address

3.Full Name

(a)Surname (Last)

(b) Given Name

(d) Suffix

(e) Maiden

Male

Female

4. Current Citizenship

5. Date of Birth (mm-dd-yyyy)

6. Citizenship at Birth

7. Place of Birth (City, Country)

8. Type of Passport
Diplomatic	Official	Regular	Other

9. Type of VISA

A1	A2	A3	Other
				(Specify type)
G1	G2	G3	G4
				G5

Permanent Resident: A

For A3 & G5, Give I-94 Expiration Date (mm-dd-yyyy)

10.

Last Arrival in U.S.A.

11. Residence Address

Temporary

Permanent

Date (mm-dd-yyyy)

Number

Street (Ave., Blvd., Place, Etc.)

Apt.

Port of Entry

City

State

ZIP

Telephone

(FOR DOMESTIC EMPLOYEES: See instructions for item #12.)

(FOR DOMESTIC EMPLOYEES: See instructions for item #13.)

12.

Employing Office

13. Duty Office (If different from employing office)

Name of Office

Number

Street (Ave., Blvd., Place, Etc.)

Suite

Number

Street (Ave., Blvd., Place, Etc.)

Suite

City

State

Zip

City

State

Zip

Telephone

Ext.

Telephone

Ext.

14.

Job Title

15. Date of Entry on Duty (mm-dd-yyyy)

16.

Expected Date of Departure (mm-yyyy)

17. Name, Title and PID (If Available) of Predecessor and

Date (mm-dd-yyyy) of Termination

18.

Will Officer serve in another official capacity?

19. Are there any immediate family member employed by a foreign

Yes

If Yes, give position and duty office:

government in the United States?

Yes

If Yes, give names and duty office:

Each person must submit a separate notification of appointment.

DS-2004

Page 1 of 2

11-2017

20.All previous foreign assignments within the United States. (If not listed in item 21 below, including study and training) (List To/From (mm-yyyy))

(Not applicable for International organizational personnel)

21.All assignments/positions/academic studies/other activities within past five years

(Dates, nature of activity, and location - beginning with most recent) (List To/From (mm-yyyy))

(Not applicable for International organizational personnel)

22.Family Members Residing in Household in The United States (Use DS-2007 continuation sheet if necessary; staple to this form.)

(a) Surname			(b) Given Name

(c) Prefix	(d) Suffix	(e) Maiden	(f) Other	(g) Relationship

Male

Female

Date of Birth (mm-dd-yyyy)

Place of Birth (City, Country)

Citizenship

VISA Status

23. Please indicate if requesting identification cards
For Employee:	Yes	No	For Dependents:	Yes	No

I understand that, if I am at present engaged in, or proposed to engage in, any activity on behalf of a foreign government as a public relations counsel, publicity agent, or information service employee, I must register with the Attorney General in accordance with 22 U.S.C. 612.

Intentional provision of false information on this form violates United States law (Title 18 U.S. Code, Section 1001) and will be considered a violation of the international legal obligation of foreign missions and their personnel to respect the laws of the receiving state (Vienna Convention on Diplomatic Relations, 1961, Article 41; Vienna Convention on Consular Relations, 1963, Article 55).

Signature of Applicant

Employer's Signature (For Private Domestic Employees)

Typed Name and Signature of Chief of Mission or Authorized Deputy

Date (mm-dd-yyyy)

(Embassy Seal)

PRIVACY ACT and PAPERWORK REDUCTION ACT STATEMENTS

The Privacy Act of 1974, as amended, 5 U.S.C. 552a, contains provisions regarding the maintenance, collection, use, and dissemination of information about United States citizens and aliens lawfully admitted for permanent residence in the United States. The following information is provided in accordance with subsection (e)(3) of the Privacy Act. AUTHORITIES: The information is sought pursuant to Vienna Convention on Diplomatic Relations of 1961; Vienna Convention on Consular Relations of 1963; Diplomatic Relations Act (22 U.S.C. 254a-e); and International Organizations Immunities Act (22 U.S.C. 288e (a)).

PURPOSE: The principal purpose for the collection of this information is to notify the U.S. Department of State of the appointment of foreign government employees so the Department can therefore extend various privileges and benefits granted by the above-cited authorities which are predicated upon review and acceptance of this information by the U.S. Department of State.

ROUTINE USES: The principal users of this information are offices within the U.S. Department of State, including but not limited to, the Office of Protocol, the Office of Foreign Missions, and the Office of Visa Services. In response to inquiries from law enforcement agencies, the Office of Protocol may confirm status as recognized by the U.S. Department of State as covered under STATE 36, Security Records. Information may also be provided to other government agencies having statutory or other lawful authority to maintain such information. Names of the members of diplomatic staff, office addresses, titles, and names of spouses are published quarterly in the Diplomatic List, U.S. Department of State Publication 10424. Names of Consular Officers, titles, and office addresses are published semi-annually in Foreign Consular Offices in the United States, U.S. Department of State Publication 10277.

DISCLOSURE: Providing this information is mandatory. Failure to provide the information requested on this form may prevent acceptance and the extension of benefits to principals or family members as provided in the above-cited authorities.

ANY CHANGES IN THIS INFORMATION MUST BE REPORTED IMMEDIATELY TO THE DEPARTMENT OF STATE (USE FORM DS-2006, NOTIFICATION OF CHANGE)

*Public reporting burden for this collection of information is estimated to average 20 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, 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: M/OFM, 3507 International Place NW, Washington, DC 20008.

DS-2004

Page 2 of 2

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Write the asked information in the Citizenship at Birth, Type of Passport, Diplomatic, Official, Regular, Other, Last Arrival in USA, Date mmddyyyy, Port of Entry, Place of Birth, City Country, Type of VISA, Other, Specify type, and Permanent Resident A area.

You have to write particular information within the segment Expected Date of Departure, mmyyyy, Name Title and PID If Available, mmddyyyy, Will Officer serve in another, Yes, If Yes give position and duty, Are there any immediate family, Yes, If Yes give names and duty office, Each person must submit a separate, and Page of.

Be sure to record the rights and responsibilities of the parties inside the All previous foreign assignments, Not applicable for International, All assignmentspositionsacademic, Not applicable for International, Family Members Residing in, a Surname, b Given Name, c Prefix, d Suffix, e Maiden, f Other, g Relationship, Male, and Female box.

Finish by reviewing the next sections and completing the required information: Date of Birth mmddyyyy, Place of Birth City Country, Citizenship, VISA Status, Please indicate if requesting, For Employee, Yes, For Dependents, Yes, I understand that if I am at, Intentional provision of false, Signature of Applicant, Employers Signature For Private, Date mmddyyyy, and Date mmddyyyy.

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