OMB control number

Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16

OMB 1405-0216 · STATE/AFA.

OMB 1405-0216

The Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor under Age 16 (DS-5525) is used in conjunction with the Application for a U.S. Passport (DS-11). This form is only for use if the written consent of the non-applying parent or guardian cannot be obtained. The statement must explain in detail the non-applying parent or guardian's unavailability, and recent efforts made to contact the non-applying parent/guardian. This form is not to be used if the non-applying parent/guardian refuses, or claims it is inconvenient, to provide notarized consent for the minor applicant.

The latest form for Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16 expires 2028-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DS-5525 Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Child under Age 16 Form and Instruction
Form DS-5525 Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16 Form and Instruction
DS-5525_Expires 113023_OMB No. 1405 0216_30-Day FRN_Legal Authorities.docx Supplementary Document
Justification for Nonsubstantive ICR.docx Justification for No Material/Nonsubstantive Change
DS-5525_30day_2019_Legal Authorities_FINAL.docx Supplementary Document
DS-5525_Expires 113023_OMB No. 1405 0216_30-Day FRN_ PRA Supporting Statement.docx Supporting Statement A
Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Child under Age 16 Form and Instruction
Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16 Form and Instruction

All Historical Document Collections

202312-1405-001	Reinstatement without change of a previously approved collection	2023-12-08
202101-1405-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-01-28
201908-1405-004 Approved without change	Revision of a currently approved collection	2019-08-27
201607-1405-004 Approved without change	Revision of a currently approved collection	2016-07-08
201306-1405-004 Approved without change	New collection (Request for a new OMB Control Number)	2013-06-20

OMB Details

Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16

Federal Enterprise Architecture: Homeland Security - Border and Transportation Security

Form DS-5525

STATEMENT OF EXIGENT/SPECIAL FAMILY CIRCUMSTANCES FOR ISSUANCE OF A U.S. PASSPORT TO A MINOR UNDER AGE 16

www.travel.state.gov

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.