Supplemental Questionnaire Form PDF Details

At times, applying for a U.S. passport reveals an unexpected hurdle: insufficient evidence of identity. To navigate this problem, the Supplemental Questionnaire serves as a vital tool, intended to reinforce an application when primary evidence falls short. It demands a blend of detailed personal information, from biographical details to family ties, spanning across a person’s schooling, employment history, and residential timeline. This exhaustive approach allows applicants to provide a comprehensive portrait of their identity, especially when conventional documents like a driver's license or a previous passport do not suffice. Filling out the Supplemental Questionnaire with thoroughness, accuracy, and candor not only aids the authorities in affirming one's identity but also helps in speeding up the passport issuance process. Crucially, the form casts a wide net, requesting data that includes, but is not limited to, past addresses, employment records, and familial backgrounds. Such exhaustive information collection underscores the importance of transparency in the process while simultaneously reminding applicants of the legal repercussion tied to falsification. With a streamlined guide available online and support through various customer service channels, applicants are well-equipped to fulfill these requirements, ensuring they can surmount the challenge of insufficient identity evidence and proceed towards securing their passport.

QuestionAnswer
Form NameSupplemental Questionnaire Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesseq, False, DS-5520, ds 5520

Form Preview Example

SUPPLEMENTAL QUESTIONNAIRE TO DETERMINE

IDENTITY FOR A U.S. PASSPORT

USE OF SUPPLEMENTAL QUESTIONNAIRE TO DETERMINE IDENTITY FOR A U.S. PASSPORT

This form is intended to supplement an application for a U.S. passport in the event insufficient evidence of identity is provided. In addition to completing this form, you may be asked to provide further documentary evidence to support your identity claim. Documentary evidence should contain your full name/photograph (with issue date) or full name/signature (with issue date). For more information on proof of identity, please refer to page two of the instructions for the DS-11, Application for a U.S. Passport, or visit travel.state.gov.

FORM INSTRUCTIONS

1.To assist us in establishing your identity for a U.S. passport, please fill out this supplemental questionnaire and return it to the requesting passport office. If you have been asked for additional information and/or documentation, please submit the information and/or documentation requested with this supplemental questionnaire.

2.If you are unable to provide primary evidence of identity such as a previously issued U.S. passport, naturalization certificate, valid driver's license, valid government-issued identification or another form of primary evidence of identity, please submit secondary evidence. For lists of primary and secondary evidence of identity, go to http://travel.state.gov/passport and click on the link to information for first time applicants.

3.Please complete the questions on this form to the best of your knowledge. Generally, the more information you are able to provide, the faster we may be able to process your U.S. passport application.

4.If you are unsure of the answer to a question, please provide a response to the best of your knowledge. For example, if you are unsure of an exact address, please provide the city, state and street name if you can recall them. Passport Services will consider all the information derived from the form in its entirety.

5.Failure to answer every question will not necessarily preclude passport issuance, as the form is considered in its entirety.

6.If you have no knowledge of the answer to a question, please write "I don't know." If you believe a particular question does not apply to you or your circumstances, please write "not applicable" or "N/A."

7.If you need more space to respond to a question, please write the rest of your response on a separate sheet of paper.

FOR INFORMATION AND/OR QUESTIONS

Please visit our website at travel.state.gov. In addition, contact the National Passport Information Center (NPIC) toll-free at 1-877-487-2778 (TDD 1-888-874-7793) or by e-mail at NPIC@state.gov. Customer Service Representatives are available Monday-Friday, 8:00 a.m.-10:00 p.m. Eastern Time (excluding federal holidays). Automated information is available 24/7.

WARNING

False statements made knowingly and willfully in passport applications or in affidavits or other supporting documents submitted therewith 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 therein 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.

PRIVACY ACT STATEMENT

AUTHORITIES: We are authorized to collect this information by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; 26 U.S.C. 6039E; Executive Order 11295 (August 5, 1966); and 22 C.F.R. parts 50 and 51.

PURPOSE: We are requesting this information in order to determine your entitlement to be issued a U.S. passport. The collection of the Social Security number will be used for identity /entitlement to passport verification only and no other purpose unless authorized by law.

ROUTINE USES: This information may be disclosed to another domestic government agency, a private contractor, a foreign government agency, or to a private person or private employer in accordance with certain approved routine uses. These routine uses include, but are not limited to, law enforcement activities, employment verification, fraud prevention, border security, counterterrorism, litigation activities, and activities that meet the Secretary of State's responsibility to protect U.S. citizens and non-citizen nationals abroad.

More information on the Routine Uses for the system can be found in System of Records Notices State-05, Overseas Citizen Services Records and State-26, Passport Records.

DISCLOSURE: Providing your Social Security number and the other information on this form is voluntary, but failure to provide the information on this form may, given the form's purpose of verification of your identity or entitlement, result in processing delays or denial of your passport application.

PAPERWORK REDUCTION ACT STATEMENT

Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time required for searching existing data sources, gathering the necessary data, providing the information and/or documents required, and reviewing the final collection. Responding to this collection of information is voluntary. 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: U.S. Department of State, Bureau of Consular Affairs, Passport Services, Office of Program Management and Operational Support, 2201 C Street NW, Washington, D.C. 20520.

DS-5520 06-2013

Page 1 of 3

U.S. Department of State

OMB Approval No.: 1405-xxxx

SUPPLEMENTAL QUESTIONNAIRE TO DETERMINE Expiration Date: xx-xx-xxxx

Estimated Burden: 45 minutes

IDENTITY FOR A U.S. PASSPORT

Section A: Biographical Information

1. Full Name:

(First, Middle, Last)

2. Date of Birth:

 

 

-

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

(month)

 

 

 

(day)

 

 

 

(year)

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Social Security Number:

4. Place of Birth (City, State/Country):

Section B: Information About Your Family (Living and Deceased)

Relationship

Full Name

Place of Birth

(City, State, Country)

Date of Birth

Current Address

 

Example

Example

Example

Example

Example

 

 

 

 

 

 

 

 

 

Brother

Joe Smith

Anytown,

12-25-1980

123 Elm St. Anytown,

 

 

Anystate, USA

Anystate

 

 

 

 

 

 

 

 

 

 

 

 

 

Father/Parent

Stepfather/Parent

Mother/Parent

Stepmother/Parent

Sibling

Sibling

Sibling

Sibling

Section C: Employment

Please list your last three places of employment (if applicable)

If self-employed or a contractor working remotely, provide your home addresses.

If active duty military, provide 3 most recent duty stations.

Company Name

Example

ABC

Industries

Address

Example

1001 West Elm Drive

City, State

Example

Anytown, Anystate

Country

Example

USA

Time Employed

Example

2004-2008

DS-5520 06-2013

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Section D: Schools

Please list all schools that you attended inside and outside of the United States (or as many as possible)

Name of School

City

State

Country

Dates of Attendance

Example

Example

Example

Example

Example

Washington Elementary

Anytown Anystate

USA

08-1990 to 06-1994

Section E: Residences

Please list your five most recent permanent residences (or as many as possible)

Temporary residences of less than 90 days may be omitted

Street

Example

City

Example

State

Example

Zip Code

Example

Country

Example

Time of

Residence

Example

123 First St.

Anytown

Anystate

11011

USA

03-1990 to

06-2002

Section F: Signature

I declare under penalty of perjury that all responses contained in this document are true and correct to the best of my knowledge.

Signature

Date

DS-5520 06-2013

Page 3 of 3

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