Form DS-3077 Request for Entry into Children's Passport Issuance Aler

*OMB APPROVAL NO. 1405-0169
EXPIRATION DATE:
ESTIMATED BURDEN: 30 Minutes*

U.S. Department of State

REQUEST FOR ENTRY INTO
CHILDREN'S PASSPORT ISSUANCE ALERT PROGRAM
REQUEST FORM An alert request may be filed with respect to an unmarried child under the age of 18. This request
can be filed by concerned parents of U.S. citizen children, their appointed agents, or other persons having legal custody
of the child. Complete one form for each child, and submit the completed request along with proper documents to
Passport Services by e-mail, fax or mail. By signing this form you are affirming that your parental rights to this child have
not been terminated by court order.
1.

Please provide information about the child in order to make the alert system effective. Please print clearly or type
the information.
Date (mm-dd-yyyy) Place of Birth

Child's Full Name (Last, First, Middle)

Child's Sex

2.

U.S. Passport Number(s) , if any

Social Security Number

Female

Male

Please provide the following information about yourself so that we can acknowledge your request, and alert
you in the future.

Your Full Name (Last, First, Middle)

Documentation of Identity Provided
Other Form of Photo
Driver's License
Identification with
Passport

Relationship to Child
Shown Above

Signature

Documentation of Parentage, Guardianship, Legal Custody OR Authority to Act on Behalf of Parent or Legal Guardian, as
applicable
Birth Certificate
Current Custody/
Guardianship Court
Order(s)

Mailing Address

Consular Report of Birth Abroad (CRBA)

Adoption

Evidence of Authority to Act on
Behalf of Parent or Legal Custodian

Other

City

State or Country

Postal Code

NOTE: Since the Department will need to contact you, it is very important that you keep us informed in writing or by
telephone of any changes to your contact information. Failure to notify this office of your correct address and
phone number may result in passport issuance for your child without your knowledge.
Home Phone

3.

Work Phone

Cell Phone

Email Address(es)

I request that the U.S. Department of State notify me if it receives a U.S. passport application for the
above-mentioned child, or if an application is currently pending, or if there is any U.S. passport still valid for
the child's travel.
I Object to the Issuance of a U.S. Passport to the Aforementioned Child, but I understand that under
prescribed circumstances (see 22 CFR 51.28) the Department is authorized to issue the passport
nonetheless.

Signature

Date (mm-dd-yyyy)

Please read the Dual Nationality for Children information accompanying this form. It relates to a child who may have a foreign nationality in addition
to U.S. nationality.
Please submit via e-mail, fax, or mail the completed form along with the proper copies of the original documents to the U.S. Department of State's
Passport Services, Charleston Passport Center; Attn: Children's Passport Issuance Alert Program; 1269 Holland Street, Building D; Charleston, SC
29405; Fax: 843-746-1827; E-mail: [email protected].
DS-3077
XX-XXXX

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DUAL NATIONALITY FOR CHILDREN
Many children, born in the U.S. or born abroad to a U.S. citizen parent, are citizens of both the U.S. and another country. A child may acquire the
citizenship of a foreign country, for example, through the child's birth abroad, or through a parent. There is no requirement that a U.S. citizen
parent consent to a child's acquisition of another nationality. Even though U.S. law may prevent one parent from obtaining a U.S. passport for a
child (for example, because of the two-parent signature requirement), a parent may still be able to obtain a foreign passport for a dual national
child from the embassy or government of the other country. Under U.S. law, a United States citizen child is required to enter and depart the
United States on his or her United States passport. However, please be advised that, since there are currently no exit controls from the United
States, U.S. citizen children can still exit the United States undetected on foreign passports.
U.S. law and regulations concerning the issuance of U.S. passports do not apply to foreign governments when they issue passports to people
(including children) whom they consider to be citizens of their country, whether or not the foreign passport is issued in the United States and/or to
a person the United States considers to be a U.S. citizen. If you think there is a possibility that your child may have another nationality, you are
encouraged to contact the relevant country's embassy or consulate directly to inquire about the rules governing the issuance of that country's
passport to your child, including the possible availability of mechanisms to prevent the issuance to your child of that country's passport without
your consent. The addresses and telephone numbers for the embassies and consulates of foreign countries in the United States are listed on the
Consular Affairs Internet web page at: >>http://travel.state.gov << under Foreign Entry Requirements.

PRIVACY ACT STATEMENT
AUTHORITY: The information solicited on this form is requested pursuant to provisions in Titles 8 and 22
of the U.S. Code, as well as the corresponding federal regulations, including specifically 22 U.S.C. § 211a
and Public Law 106-113, Div. B, §1000(a)(7) [Div. A., Title II, §236] of the Admiral James W. Nance and Meg
Donovan Foreign Relations Authorization Act, Fiscal Years 2000 and 2001 and Executive Order 11295 (Aug.
5, 1966), and the regulations contained in 22 C.F.R. § 51.28.
PURPOSE: The primary purpose for soliciting the information is to enable the U.S. Department of State to
notify you of any pending U.S. passport applications for the child identified on the form and of any U.S.
passport held by the child that is still valid for travel. The child's social security number is requested
because that number is a unique identifier used to establish the identity of the passport holder. Filing a
request through the Children's Passport Issuance Alert Program and providing the information requested
on this form, including the child's social security number, is voluntary. Failure to complete the form may
result in a passport being issued to your child without your knowledge.
ROUTINE USES: The information solicited on this form may be made available as a routine use to other
government agencies, to assist the U.S. Department of State in adjudicating passport applications and
requests for related services, and for law enforcement and administrative purposes. It may also be
disclosed pursuant to court order. The information may be made available to foreign government agencies
to fulfill passport control and immigration duties. The information may also be provided to foreign
government agencies, international organizations and, in limited cases, private persons and organizations
to investigate, prosecute, or otherwise address potential violations of law or to further the Secretary's
responsibility for the protection of U.S. nationals abroad. This would include, among other entities and
agencies, disclosure to The National Center for Missing and Exploited Children, Central Authorities of
countries party to the Hague Convention on the Civil Aspects of International Child Abduction ("the
Convention"), attorneys of record and legal aid services to assist in facilitating operations under the
Convention; local police in connection with notification of next-of-kin and child custody disputes; social
services agencies; and parents involved in cases brought under the Convention. The information may also
be made available to private U.S. citizen 'wardens' designated by U.S. embassies and consulates. For a
more detailed listing of the routine uses to which this information may be put, see the Prefatory Statement
of Routine Uses and the listing of routine users set forth in the system description for Overseas Citizens
Services Records (State-05), found at http://foia.state.gov/issuances/priviss.asp.

PAPERWORK REDUCTION ACT STATEMENT
Public reporting burden for this collection of information is estimated to average 30 minutes per response,
including time required for searching existing data sources, gathering the necessary documentation,
providing the information and/or documents required, and reviewing the final collection. 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: A/GIS/DIR, Room 2400 SA-22, U.S. Department of State, Washington, DC 20522-2202.

DS-3077

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