Ds 2004 Form PDF Details

The Ds 2004 form is an important document when it comes to estate planning. This form helps to outline the details of your estate and can help ensure that your assets are distributed in the way you want after you pass away. Make sure to consult with an estate planning attorney to make sure that your Ds 2004 form is complete and accurate. Doing so can help avoid any confusion or problems after your death.

Listed here, you'll discover quite a few specifics about ds 2004 form PDF. It is suggested that you read through this information before you decide to start fiddling with the file.

QuestionAnswer
Form NameDs 2004 Form
Form Length4 pages
Fillable?Yes
Fillable fields85
Avg. time to fill out18 min 4 sec
Other namesform fs 240, how to download fs 240, federal form fs 240, fs 240 form

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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;

(c) prefix such as Mr., Mrs., Ms., or Miss,

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.

4

5

6

7

8

9

10

11

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.

DS-2004

Instruction page 1 of 2

11-2017

 

12

13

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

22

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,

23

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

and 23 attach family status justification form), for consular officers

 

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

 

 

 

 

 

 

 

 

 

 

 

NOTIFICATION OF APPOINTMENT

P

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

OF FOREIGN GOVERNMENT EMPLOYEE

A

 

 

 

T

 

 

 

 

 

 

 

 

 

 

 

 

PID

 

 

 

 

 

 

 

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

(c) Prefix or Rank

(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

 

 

 

 

 

 

 

 

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

No

If Yes, give position and duty office:

 

 

 

 

 

 

government in the United States?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

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)

Date (mm-dd-yyyy)

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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form 240 empty fields to fill out

Write the asked information in the CitizenshipatBirth, TypeofPassport, Diplomatic, Official, Regular, Other, LastArrivalinUSA, Datemmddyyyy, PortofEntry, EmployingOffice, PlaceofBirth, CityCountry, TypeofVISA, OtherG, and Specifytype area.

part 2 to finishing form 240

You have to write particular information within the segment CityTelephoneJobTitle, DateofEntryonDutymmddyyyy, ExpectedDateofDeparture, mmyyyy, mmddyyyy, Yes, IfYesgivepositionanddutyoffice, Yes, IfYesgivenamesanddutyoffice, and Pageof.

step 3 to filling out form 240

Be sure to record the rights and responsibilities of the parties inside the aSurname, bGivenName, cPrefix, dSuffix, eMaiden, fOther, gRelationship, Male, Female, DateofBirthmmddyyyy, PlaceofBirthCityCountry, Citizenship, and VISAStatus box.

Filling in form 240 stage 4

Finish by reviewing the next sections and completing the required information: ForEmployee, Yes, ForDependents, Yes, Datemmddyyyy, Datemmddyyyy, Datemmddyyyy, and EmbassySeal.

Finishing form 240 stage 5

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