Providing this information is voluntary, but without it the Department may find it more difficult to assist you in a manner consistent with your wishes.
Individuals: for particular individuals to whom you would like the Department of State to provide information, provide name(s), relationship, and contact details.
Other parties: please check all that apply: family, friends, employer, attorney/representative, congressional offices, media, other parties in a position to assist you.
Minor: if you are completing this form on behalf of a minor, please check the box and state the minor's full name and your legal relationship.
Signature: electronic signature is as acceptable as signing with pen/ink and paper.
| Question | Answer |
|---|---|
| Form Name | DS-5505 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 32 |
| Avg. time to fill out | 6 min |
| Edition | 04-2024 |
| Issuing agency | U.S. Department of State |
| Matches the agency's file | Yes, checked October 1, 2026 |
| Other names | DS-5505, DS5505, DS 5505, Form 5505, Written Consent to Release of Personal Information Under the Privacy Act |
| Official source | DS-5505 (Rev 04-2024), U.S. Department of State |
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