Form DS-2029 Application for Consular Report of Birth Abroad of a Cit

ATTENTION
DS-2029
and SSN
APPLICATION FOR SOCIAL
SECURITY NUMBER CARD
(page 3 of this form package)
CAN BE COMPLETED ONLY AT
THE SAME TIME THE CONSULAR
REPORT OF BIRTH APPLICATION IS
COMPLETED
REFER TO 7 FAM
SUBCHAPTER 1440

U.S. DEPARTMENT OF STATE

APPLICATION FOR CONSULAR REPORT OF BIRTH ABROAD
OF A CITIZEN OF THE UNITED STATES OF AMERICA
(Middle)

1. NAME OF CHILD IN FULL (First)

18.

Please Type or Print Neatly in Blue or Black Ink.
See Instructions on Reverse Side.

A. THIS SECTION TO BE COMPLETED BY APPLICANT.

(Last)

Serial No.

2. SEX

Date Issued (mm-dd-yyyy)

M
3. DATE OF BIRTH (mm-dd-yyyy)

4. HOUR

AM

OMB NO. 1405-0011
EXPIRES: 09/30/2006
Estimated Burden: 20 Minutes*

F

5. PLACE OF BIRTH IN FULL (City, State, Country)

Approved by
FS Post

PM

THE FOLLOWING ITEMS PERTAIN TO THE NATURAL PARENTS. COMPLETE FOR BOTH FATHER AND MOTHER.
FATHER

ITEM

MOTHER

6. FULL NAME
(Include mother's maiden name)
7. DATE OF BIRTH
(Month, day, year)
8. PLACE OF BIRTH
(City, State, Country)
9. PRESENT ADDRESS
(Street No., City, State)
10. ADDRESS IN UNITED STATES
(Street No., City, State)
11. EVIDENCE OF U.S. CITIZENSHIP
IF ALIEN, SHOW NATIONALITY
FROM (mm-dd-yyyy)

FROM (mm-dd-yyyy)

TO (mm-dd-yyyy)

TO (mm-dd-yyyy)

BRANCH OF SERVICE

12. PRECISE PERIODS OF PHYSICAL
PRESENCE IN UNITED STATES
(Do not list individual States. Use
additional paper, if necessary)
13. PRECISE PERIODS ABROAD IN
U.S. ARMED FORCES, IN OTHER
U.S. GOVERNMENT EMPLOYMENT,
WITH QUALIFYING INTERNATIONAL
ORGANIZATION, OR AS DEPENDENT
OF SUCH PERSON (Specify)

FROM (mm-dd-yyyy)

FROM (mm-dd-yyyy)

TO (-mm-dd-yyyy)

TO (mm-dd-yyyy)

BRANCH OF SERVICE

14. PREVIOUS MARRIAGES
(Show dates and manner of termination of all)

15. DATE AND PLACE OF PRESENT MARRIAGE (mm-dd-yyyy)

(City, State, Country)

B. THIS SECTION TO BE COMPLETED BY CONSULAR OFFICER, NOTARY PUBLIC OR OTHER PERSON QUALIFIED TO ADMINISTER OATH
16. AFFIRMATION:

I SOLEMNLY SWEAR (OR AFFIRM) THAT THE STATEMENTS MADE ON THIS APPLICATION ARE TRUE TO THE
BEST OF MY KNOWLEDGE AND BELIEF.

NAME OF PERSON PROVIDING INFORMATION

SUBSCRIBED TO: TYPED NAME AND TITLE OF OFFICIAL

SIGNATURE

SIGNATURE OF OFFICIAL

RELATIONSHIP TO CHILD

CITY

DATE (mm-dd-yyyy)

(SEAL)

C. THIS SECTION TO BE COMPLETED BY CONSULAR OFFICE
17. DOCUMENTS PRESENTED:

18. (See upper right corner)
DS-2029
* The response time is an estimated average including the time needed to look for, get, and provide the information required. You do not have to provide the information requested
if the OMB approval has expired. We would appreciate any comments on the estimated response burdens, and recommendations for reducing them. Please send your comments to
(SSN)
A/RPS/DIR, U.S. Department of State, Washington, DC 20520.
09-2003

Page 1 of 4

APPLICATION FOR A CONSULAR REPORT OF BIRTH
A Consular Report of Birth may be issued for any U.S. citizen child
under age 18 who was born abroad and who acquired U.S. citizenship
at birth. Only the child's parent or legal guardian may make application
on the child's behalf. The application generally must be signed before a
U.S. consular officer, a consular agent or, in the case of children born in
U.S. military hospitals, a designated military official. In certain
circumstances, the application may be executed before a notary public
overseas. (Contact the nearest American Embassy or Consulate for
guidance in such cases.)
DOCUMENTARY EVIDENCE
A. For children who have never been documented as U.S. citizens:
When an application is made for a Consular Report of Birth for a child
who has never been documented as a U.S. citizen, the documentary
evidence listed below should be presented. Provisions may be made for
documents that are not available. In certain instances, additional
evidence may be required to insure full compliance with citizenship law.
All documentation submitted must be originals or certified copies of the
originals.
1. Child's birth certificate.
2. Evidence of the parent(s) U.S. citizenship. This may consist of a
U.S. passport, Consular Report of Birth, Naturalization Certificate,
Certificate of Citizenship or U.S. birth certificate. For other forms of
acceptable U.S. citizenship evidence, contact the U.S. consul.
3. Parents' marriage certificate.
4. Evidence of the termination of any previous marriages of the parents
(divorce decree, annulment decree, or death certificate).
B. For children who have previously been documented as U.S.
citizens: When an application is made for a child who has previously
been documented as a U.S. citizen, the application need only be
accompanied by the documentation issued to the child and the original or
a certified copy of the child's birth certificate.
COMPLETION OF THE APPLICATION FOR A CONSULAR
REPORT OF BIRTH
Complete Section A, items 1-15 on the first page of this form in
accordance with the corresponding numbers below.
1. Enter the name of the child as it is recorded on the local birth
certificate. Translations of foreign names are acceptable. If an erroneous
name is shown on the birth certificate, an explanatory affidavit from the
parent must be presented regarding the correct name. When a child's
name has been changed by adoption or certain other legal action
amending the child's name retroactive to birth, the new name may be
recorded on the application when the legal action has been substantiated
by an adoption decree or other documentary evidence, respectively.
Note, however, that information provided in items 6-14 must relate to
natural, not adoptive parents.
2. Check (X) box to indicate whether male or female.
3. Write the month in full. Do not abbreviate. (Example: October 2,
1984).
4. Strike out either A.M. or P.M. (whichever is inapplicable), and enter
the conventional local time as shown on the birth certificate. (Example:
3:00 P.M.) If the time of birth is not shown on the birth certificate, enter
the time from memory if known. If time is not known, write "not
known".
5. Enter only the name of the city, state, or province (if applicable), and
country.
DS-2029
(SSN)

6. Enter the names of the natural parents including the maiden name of
mother. The names of adoptive parents may not be used.
7. Write the month in full. Do not abbreviate.
8. Enter only the city, state, and country.
9. Use address at the time the application is executed.
10. Enter either address at which parents will be residing or receiving
mail upon arrival or return to the United States, or the last address in the
U.S. The address should be written out in every instance. Do not write
"same" or "same as husband".
11. List the type of document, document number, date and place of
issuance, and name of individual as recorded on the document if different
than item 6 above. For a list of permissible documents, see instructions
on documentary evidence. If parent is not a U.S. citizen, show
nationality.
12. List periods of physical presence in the U.S. prior to the child's birth
in exact detail. Do not include periods that will be mentioned in item 13.
Vacation trips abroad, schooling in foreign countries, and any other brief
absences cannot be counted as periods of a physical presence in the U.S.
13. List periods in detail. Official written evidence from the appropriate
governmental department or international organization must be presented
to support any periods shown. For names of qualifying organizations,
see consul.
14. List all prior marriages in the following manner: Date of marriage,
manner of termination, date of termination. If no previous marriages,
write "none".
15. Show date and place of marriage of child's parents. If the parents are
not married to each other, write "not married".
PRIVACY ACT STATEMENT
The information solicited on this form is requested pursuant to provisions
in titles 8 and 22 of the United States Code (U.S.C.), whether or not
codified, including specifically 22 U.S.C. 2705, and predecessor statutes.
and by regulations issued pursuant to E.O. 11295 (August 5, 1966),
including Part 50, Title 22 Code of Federal Regulations (CFR). The
primary purpose for soliciting the information is to establish citizenship,
identity, and entitlement to issuance of a Consular Report of Birth and to
properly administer and enforce the laws pertaining thereto.
The
information may also be used in connection with issuing other evidence
of citizenship, and in furtherance of the Secretary's responsibility for the
protection of U.S. nationals abroad.
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 possible violations of law or to further the Secretary's
responsibility for the protection of U.S. nationals abroad.
The
information may be made available to private U.S. citizen 'wardens'
designated by the U.S. Embassies and consulates
Failure to provide the information requested on this form may result in
the denial of a Consular Report of Birth, related document or service to
the individual seeking such report, document or service.

NOTE TO APPLICANTS: IT IS NOT NECESSARY TO APPLY FOR A SOCIAL SECURITY CARD AT THIS TIME.
THE ATTACHED APPLICATION IS PROVIDED AS A CONVENIENCE SHOULD YOU CHOOSE TO DO SO.

Page 2 of 4

U.S. SOCIAL SECURITY ADMINISTRATION

APPLICATION FOR SOCIAL SECURITY NUMBER CARD

18.

COMPLETE ONLY IF APPLICANT HAS NEVER BEFORE APPLIED FOR OR RECEIVED A SOCIAL SECURITY NUMBER CARD AND IS UNDER AGE 5.
UNLESS THE REQUESTED INFORMATION IS PROVIDED, WE MAY NOT BE ABLE TO ISSUE A SOCIAL SECURITY NUMBER. PLEASE READ PRIVACY ACT
STATEMENT ON REVERSE.

1.NAME OF CHILD IN FULL (First)
TO BE SHOWN ON CARD

(Middle)

(Last)

2. SEX

SEX

Date Issued (mm-dd-yyyy)

F

M

NAA

3. DATE OF BIRTH (mm-dd-yyyy)

4. HOUR

DOB

5. PLACE OF BIRTH IN FULL (City, State, Country)

AM

PLB

6.

Serial No.

FCI

Approved By
FS Post

PM

FATHER'S NAME

7.
FATHER'S FULL NAME
MOTHER'S FULL NAME AT BIRTH

FNA

Father's Social Security Number
9.

MOTHER'S NAME

Mother's Social Security Number

8.
SOCIAL SECURITY NUMBER

-

MNA

-

-

PNA

NO

HAS THE PERSON IN ITEM 1 EVER APPLIED FOR OR RECEIVED A SOCIAL SECURITY NUMBER BEFORE?
FULL MIDDLE NAME
10.
FIRST
LAST
NAB
NAME OF CHILD
FULL NAME AT BIRTH
IF OTHER THAN ABOVE
STREET ADDRESS, APT. NO., P.O. BOX, RURAL ROUTE NO.

11.
STT

MAILING ADDRESS
DO NOT ABBREVIATE
STATE OR FOREIGN COUNTRY

CITY/PROVINCE

CTY

STE

POSTAL/ZIP CODE

ZIP

12.
RACE/ETHNIC
ETB
DESCRIPTION
(Check one only-Voluntary)

Asian, Asian American
or Pacific Islander

13. NAME OF PERSON PROVIDING
INFORMATION

Black (Not
Hispanic)

Hispanic

North American
Indian or Alaskan
Native

White (Not Hispanic)

14. I declare under penalty of perjury that I have examined all the information on this form, and on any
accompanying statements or forms, and it is true and correct to the best of my knowledge.

SIGNATURE
15. RELATIONSHIP TO CHILD
16. TODAY'S DATE (mm-dd-yyyy)

17. DAYTIME TELEPHONE NUMBER (Including Area Code)

DON

DO NOT WRITE BELOW THIS LINE (FOR SSA USE ONLY)
NPN

PBC

DOC

EVI

EVIDENCE SUBMITTED

EVA

NTI

EVC

PRA

CAN

NWR

ITV

DNR

UNIT

SIGNATURE AND TITLE OF EMPLOYEE(S) REVIEWING EVIDENCE

DATE (mm-dd-yyyy)
DCL

SSN
(DS-2029)
09-2003

DATE (mm-dd-yyyy)
Page 3 of 4

THE PRIVACY ACT/PAPERWORK ACT AND YOUR APPLICATION

The Privacy Act of 1974 requires us to give each person the following notice when applying for a Social Security
number.
Sections 205(c) and 702 of the Social Security Act allow us to collect the facts we ask for on this form.
We use the facts you provide on this form to assign you a Social Security number or to issue you a Social Security
card. You do not have to give us these facts, however, without them we cannot issue you a Social Security number or
a card. Without a number, you may not be able to get a job and could lose Social Security benefits in the future.
The Social Security number is also used by the Internal Revenue Service for tax administration purposes as an
identifier in processing tax returns of persons who have income which is reported to the Internal Revenue Service and
by persons who are claimed as dependents on someone's Federal income tax return.
We may disclose information as necessary to administer Social Security programs, including to appropriate law
enforcement agencies to investigate alleged violations of Social Security law; to other government agencies for
administering entitlement, health, and welfare programs such as Medicaid, Medicare, veterans benefits, military
pension, and civil service annuities, black lung, housing, student loans, railroad retirement benefits, and food stamps;
to the Internal Revenue Service for Federal tax administration; and to employers and former employers to properly
prepare wage reports. We may also disclose information as required by Federal law, for example, to the Department
of Justice, Immigration and Naturalization Service, to identify and locate aliens in the U.S.; to the Selective Service
System for draft registration; and to the Department of Health and Human Services for child support enforcement
purposes. We may verify Social Security numbers for State motor vehicle agencies that use the number in issuing
drivers licenses, as authorized by the Social Security Act. Finally, we may disclose information to your
Congressional representative if they request information to answer questions you ask him or her.
We may use the information you give us when we match records by computer. Matching programs compare our
records with those of other Federal, State, or local government agencies to determine whether a person qualifies for
benefits paid by the Federal government. The law allows us to do this even if you do not agree to it.
Explanations about these and other reasons why information you provide us may be used or given out are available in
the U.S. Social Security offices, U.S. Embassies or consulates, or the VARO in Manila. If you want to learn more
about this, contact any U.S. Social Security office, U.S. Embassy or consulate, or VARO in Manila.
This information collection meets the requirements of 44 U.S.C. section 3507, as amended by Section 2 of the
Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of
Management and Budget control number. We estimate that it will take you about 8.5 to 9 minutes to read the
instructions, gather the necessary facts and answer the questions. You may send comments on our time estimate to:
SSA, 1338 Annex Building, Baltimore, MD 21235-0001. Send only comments relating to our time estimate to
this address, not the completed form.

SSN
(DS-2029)

Page 4 of 4