Form DS-4024 Smart Traveler Enrollment Program (STEP)

U.S. Department of State

OMB APPROVAL NO. 1405-0152
EXPIRATION DATE: xx/xx/xxxx
ESTIMATED BURDEN: 20 Minutes

SMART TRAVELER ENROLLMENT PROGRAM

The Smart Traveler Enrollment Program is a free service provided by the U.S. Government to U.S. nationals who are traveling to, or living in, a foreign
country. Enrollment allows you to record information about your upcoming trip abroad that the U.S. Department of State can use to assist you in case
of an emergency. To enroll your trip or foreign residence, please fill out the form below and return to the U.S. Department of State.
Personal Information: Fill out your Personal Information
Full Name (Last, First, Middle)

Email Address

Date of Birth (mm-dd-yyyy) Citizenship

Gender

U.S. Passport Information
Passport or Passport Card Number

Emergency Contact Information: Fill out your Emergency Contact Information. Your Emergency Contact should be someone who is not traveling or
living with you.
Full Name (Last, First, Middle)

Address

City

U.S. State or Foreign Province

Country

Postal Code

Phone Number

Email Address

Relationship to Primary Traveler/Resident

PAPERWORK REDUCTION ACT
Public reporting burden for this collection of information is estimated to average 20 minutes per response, including time required for searching
existing data sources, gathering the necessary documents, providing the information or documents required, and reviewing the final collection. You
do not have to supply this information unless this collection displays a valid Office of Management and Budget (OMB) number. If you have comments
on the accuracy of this burden estimate or recommendations for reducing it, please send them to: Bureau of Consular Affairs, Overseas Citizens
Services (CA/OCS/PMO), U.S. Department of State, SA-17, 10th Floor, Washington, DC 20036.
PRIVACY ACT STATEMENT
Fill out your Privacy Act information. You must check the check box to indicate that you have read the Privacy Act Statement.
AUTHORITY: The information solicited on this form is requested pursuant to provisions in 22 U.S.C. § 2715 and 22 U.S.C. § 4802(b) of the U.S.
Code and 22 C.F.R. § 71.1 and 22 C.F.R. § 71.6 of the Code of Federal Regulations.
PURPOSE: To notify U.S. nationals in the event of a disaster, emergency or other crisis, and for evacuation coordination.
ROUTINE USES: The information solicited on this form may be made available as a routine use to appropriate agencies whether federal, state, local,
or foreign, to assist the Department in the evacuation or provision of emergency service to U.S. nationals, or for law enforcement and administration
purposes or pursuant to court order. The information is also made available to private U.S. nationals, known as wardens, designated by U.S.
embassies to assist in communicating with the American community in an emergency. More information on the Routine Uses for the system can be
found in System of Records Notice, State-05, Overseas Citizens Services Records.
DISCLOSURE: Providing the information requested on this form is purely voluntary. Failure to provide the requested information on the form could
make it more difficult for the Department to notify the U.S. national respondent in the event of an emergency.

I have read the terms of the Privacy Act Notice.
I do not authorize the U.S. Department of State to disclose my information to anyone except as authorized by law.
OR
I agree to allow the U.S. Department of State to disclose my information to:
Family Members

Friends

Media

Legal Representative

Medical Representative

Members of Congress

Other

Waiver Comments
Please use this space below to specify individuals, explain, or clarify your response or describe your selection of "Other".

DS-4024
xx-2016

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Destination
Itinerary
Please provide enough information about your Destination or Overseas Residence to help a U.S. consular officer contact you in case of an
emergency. The Type of Visit, Date of Arrival at Destination, Date of Departure from Destination (except for Indefinite Stay visits), and Country must
be entered. For example, providing the hotel name, the city, and the country will be useful, even if you can not provide the hotel phone number.
Please provide the dates you will be in that location, even if approximate.
Date of Arrival (mm-dd-yyyy) Date of Departure from Destination (mm-dd-yyyy) Purpose of Visit
My departure date is
unknown or indefinite

Address

City

Country

Postal Code

U.S. State or Foreign Province

Phone Number

Email Address

Additional Travelers/Members of Household
If you are traveling or residing with one or more travelers/members of household, please fill out their Personal Information below. Attach additional
copies of this form if you need more space.
Additional Traveler/Member of Household #1
Full Name (Last, First, Middle)

Address

City

Country

Date of Birth (mm-dd-yyyy)

Postal Code

U.S. State or Foreign Province

Phone Number

Citizenship

Email Address

Relationship to Primary Traveler/Resident

Comments

Passport or Passport Card Number

Additional Traveler/Member of Household #2
Full Name (Last, First, Middle)

Address

City

Country

Date of Birth (mm-dd-yyyy)

Postal Code

U.S. State or Foreign Province

Phone Number

Citizenship

Email Address

Relationship to Primary Traveler/Resident

Comments

Passport or Passport Card Number

Additional Traveler/Member of Household #3
Full Name (Last, First, Middle)

Address

City

Country

Date of Birth (mm-dd-yyyy)

Comments

DS-4024

Postal Code

Citizenship

U.S. State or Foreign Province

Phone Number

Email Address

Relationship to Primary Traveler/Resident

Passport or Passport Card Number

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Additional Destination Information
If you are visiting more than one city or country during your trip, enter details about your destination that could help a consular officer contact you in
case of an emergency. Attach additional copies of this form if you need more space.
Additional Destination #1
Date of Arrival (mm-dd-yyyy) Date of Departure from Destination (mm-dd-yyyy) Purpose of Visit
My departure date is
unknown or indefinite

Address

City

Country

Postal Code

U.S. State or Foreign Province

Phone Number

Email Address

Additional Destination #2
Date of Arrival (mm-dd-yyyy) Date of Departure from Destination (mm-dd-yyyy) Purpose of Visit
My departure date is
unknown or indefinite

Address

City

Country

Postal Code

U.S. State or Foreign Province

Phone Number

Email Address

Additional Destination #3
Date of Arrival (mm-dd-yyyy) Date of Departure from Destination (mm-dd-yyyy) Purpose of Visit
My departure date is
unknown or indefinite

Address

Country

City

Postal Code

U.S. State or Foreign Province

Phone Number

Email Address

If there are any additional destinations, please attach the required information on a separate sheet of paper.
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