DS-86: Statement of Non-Receipt of a U.S. Passport

Select the product(s) you are reporting as not received: U.S. Passport Book and Card, Book Only or Card Only.

Enter your Middle Name, First Name and Last Name.

Enter your Social Security Number.

Enter your Telephone Number and your Date of Birth (MM/DD/YYYY).

Enter your Travel Date (MM/DD/YYYY).

Enter the Mailing Address (as listed on original application): Street Address, Apartment/Unit, City, State and ZIP Code.

Fill in the Current Mailing Address (if different than address on original application): Street Address, Apartment/Unit, State, City and ZIP Code.

Please explain what you have done to find the passport book/card (ex: Called NPIC, Called Delivery Service, etc.) Attach a separate sheet of paper if more space is needed.

Check Yes or No. Were the supporting documents that you submitted with your original passport application returned to you? If you answered "No", describe any/all documents not received (Example: birth certificate, naturalization certificate, adoption decree, etc.)

You must sign and date the application. Enter the Date (MM/DD/YYYY).

By signing you certify that you have not received the U.S. passport book and/or U.S. passport card for which you applied, and you declare under penalty of perjury that the statements made on this form are true and correct.

You request that a new U.S. passport book and/or U.S. passport card be issued to you, and certify that if you receive the U.S. passport book and/or U.S. passport card you reported as not received, you will immediately contact the National Passport Information Center at 1-877-487-2778 (TDD/TTY: 1-888-874-7793) or your local U.S. embassy or consulate if you applied outside of the United States and return the recovered passport to the U.S. Department of State.

False statements made knowingly and willfully in passport applications, including affidavits or other supporting documents submitted to support this application, are punishable by fine and/or imprisonment under the provisions of 18 U.S.C. 1001, 18 U.S.C. 1542, and/or 18 U.S.C. 1621. Alteration or mutilation of a passport issued pursuant to this application is punishable by fine and/or imprisonment under the provisions of 18 U.S.C. 1543. The use of a passport in violation of the restrictions contained herein or of the passport regulations is punishable by fine and/or imprisonment under 18 U.S.C. 1544. All statements and documents are subject to verification.

If you applied for your U.S. passport book or card while outside of the United States, please contact your local U.S. embassy or consulate for instructions on where to send your passport.

Once your statement is received, the U.S. passport book or card that was reported as not received will be cancelled and cannot be used for travel. If the U.S. passport book or card reported in this statement arrives at a later time, call the National Passport Information Center at 1-877-487-2778 for instructions on where to send that passport.

Form DS-86 is the Statement of Non-Receipt of a U.S. Passport. The information that you provide on this form will be entered into the Consular Lost and Stolen Passport System. This system is designed to prevent the misuse of the U.S. passport book or card that you did not receive in the mail. Passport(s) reported as not received will be cancelled and cannot be used for travel. Anyone using the U.S. passport book or card reported on this form, including yourself, may be detained upon entry into the Unites States.

This form is used when you do not receive your U.S. passport in the mail. You have 120 days from the date that your U.S. passport book or card was issued to report that you have not received it in the mail. If you do not report non-receipt of your passport within 120 days of the issue date, you will be required to reapply and submit the full passport fee(s). Unless you have immediate travel plans, it is recommended that you wait 14 days from the date your passport was issued before you submit this statement.

Mail this statement and photocopy of your photo identification to the passport agency that issued the passport you did not receive.