Official Federal Forms > US Department Of State > Passport
Application For Additional Visa Pages DS-4085 - Official Federal Forms
| Application For Additional Visa Pages Form. This is a national form and can be used in Passport US Department Of State . |
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APPLICATION FOR ADDITIONAL VISA PAGES OR MISCELLANEOUS PASSPORT SERVICES PLEASE DETACH AND RETAIN THIS INSTRUCTION SHEET FOR YOUR RECORDS Date of Application:__________________________ FOR INFORMATION, QUESTIONS, AND INQUIRIES: Please visit our website at travel.state.gov. In addition, you may contact the National Passport Information Center (NPIC) toll-free at 1-877-487-2778 (TDD:1-888-874-7793) or by email at NPIC@state.gov. Customer Service Representatives are available Monday-Friday 8:00a.m.-10:00p.m. Eastern Time (excluding federal holidays). Automated Information is available 24/7. HOW DO I APPLY FOR ADDITIONAL VISA PAGES? 1. Complete, sign, and date this form. 2. Send this form with your valid U.S. passport book and your fee for additional visa pages. Please visit our website at travel.state.gov for detailed information regarding current fees. THE CURRENT PASSPORT FEE. Enclose the fee in the form of personal check or money order. MAKE CHECKS PAYABLE TO "DEPARTMENT OF STATE." THE FULL NAME AND DATE OF BIRTH OF THE APPLICANT MUST BE TYPED OR PRINTED ON THE FRONT OF THE CHECK. DO NOT SEND CASH. Passport Services cannot be responsible for cash sent through the mail. By law, the fees are non-refundable. NOTE: Because of the sensitivity of the enclosed documents, Passport Services recommends using trackable mailing service when submitting your application. MAIL FORM TO: FOR ROUTINE SERVICE: National Passport Processing Center Post Office Box 90106 Philadelphia, PA 19190-0106 FOR EXPEDITED SERVICE (Additional Fee): National Passport Processing Center Post Office Box 90906 Philadelphia, PA 19190-0906 OVERNIGHT DELIVERY SERVICE: if you desire overnight delivery for the return of your passport, please include the appropriate fee with your application. FASTER PROCESSING: For an additional fee, you may request expedited service. Please include this fee with your application and mail to the appropriate address. Please write "Expedite" ON OUTER ENVELOPE WHEN MAILING. TO ENSURE MINIMAL PROCESSING TIME for expedited applications, Passport Services recommends using overnight delivery when submitting the application AND including the appropriate postage fee for return overnight delivery for the completed passport book. Expedited service is available only in the United States. Please consult our website for updated fee information and processing times. HOW WILL MY PASSPORT BOOK BE MAILED BACK TO ME? Your U.S. passport book will be returned to you by priority mail. To check the status of your passport application online please visit travel.state.gov. NOTE REGARDING MAILING ADDRESSES: Passport Services will not mail a passport to a private address outside the United States. If you do not live at the address listed in the "mailing address" then you must put the name of the person and mark it as "In Care Of." If your mailing address changes prior to receipt of your new passport, please contact the National Passport Information Center. FAILURE TO PROVIDE INFORMATION REQUESTED ON THIS FORM, INCLUDING YOUR SOCIAL SECURITY NUMBER, MAY RESULT IN SIGNIFICANT PROCESSING DELAYS AND/OR THE DENIAL OF YOUR APPLICATION. NOTICE TO APPLICANTS RESIDING ABROAD United States citizens residing abroad CANNOT submit the form to the domestic addresses listed above. Such applicants should contact the nearest U.S. embassy or consulate for procedures to be followed when applying overseas. WARNING: False statements made knowingly and willfully in passport applications, including affidavits or other documents submitted to support this application, are punishable by fine and/or imprisonment under U.S. law including the provisions of 18 USC 1001, 18 USC 1542, and/or 18 USC 1621. Alteration or mutilation of a passport issued pursuant to this application is punishable by fine and/or imprisonment under the provisions of 18 USC 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 USC 1544. All statements and documents are subject to verification. If you choose to provide your email address in Item #6 on this application, Passport Services will use that information to contact you in the event there is a problem with your application or if you need to provide information to us. DS-4085 12-2010 American LegalNet, Inc. www.FormsWorkFlow.com Instruction Page 1 of 3 FEDERAL TAX LAW Section 6039E of the Internal Revenue Code (26 USC 6039E) requires you to provide your Social Security Number (SSN), if you have one, when you apply for a U.S. passport or renewal of a U.S. passport. If you have not been issued a SSN, enter zeros in box #5 of this form. If you are residing abroad, you must also provide the name of the foreign country in which you are residing. The Department of State must provide your SSN and foreign residence information to the Department of Treasury. If you fail to provide the information, you are subject to a $500 penalty enforced by the IRS. All questions on this matter should be directed to the nearest IRS office. NOTICE TO CUSTOMERS APPLYING OUTSIDE A STATE DEPARTMENT FACILITY If you send us a check, it will be converted into an electronic funds transfer (EFT). This means we will copy your check and use the account information on it to electronically debit your account for the amount of the check. The debit from your account will usually occur within 24 hours and will be shown on your regular account statement. You will not receive your original check back. We will destroy your original check, but we will keep the copy of it. If the EFT cannot be processed for technical reasons, you authorize us to process the copy in place of your original check. If the EFT cannot be completed because of insufficient funds, we may try to make the transfer up to two times and we will charge you a one-time fee of $25, which we will also collect by EFT. REMITTANCE OF FEES Passport service fees are established by law and regulation (see 22 USC 214, 22 CFR 22.1, and 22 CFR 51.50-56) and are collected at the time you apply for the passport service. If the Department fails to receive full payment of the applicable fees because, for example, your check is returned for any reason or you dispute a passport fee charge to you credit card, the Department of State will take action to collect the delinquent fees from you under 22 CFR Part 34 and the Federal Claims Collection Standards (see 31 CFR Parts 900-904). In accordance with the De
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