Form DS-4283 Courier Drop-Off List for U.S. Passport Applications

U.S. Department of State

Courier Drop-Off List for U.S. Passport Applications
USE OF THIS FORM
We use the information collected on this form to track U.S. passport applications submitted by private courier
companies to U.S. Department of State passport agency drop-off boxes. This form identifies the courier
company, the courier employee, the receiving U.S. Department of State passport agency, and the applications
received.

INSTRUCTIONS
1. Please provide all required information on this form. Submit one drop-off list for each service type.
2. Attach this form, instruction-side facing up, to each sealed group of applications when submitting to the U.S.
Department of State passport agency's drop-off box.
3. If you are submitting documentation in response to the agency's request for more information (“applicant
response” or “AR”) or to correct a passport containing inaccurate information (“rewrite”), please check the
appropriate box in one of the three spaces provided per drop-off list.

INFORMATION OR QUESTIONS
For more information, please visit our website at travel.state.gov. If you have any questions regarding this form,
please contact the National Courier Liaison by email at [email protected] or by phone at
202-485-6532 Monday - Friday 8:00 a.m. - 5:00 p.m. Eastern Time. You may also send correspondence to
the following address:
U.S. Department of State
CA/PPT/S/PMO/CS
ATTN: National Courier Liaison
44132 Mercure Cir
P.O. Box 1199
Sterling, VA 20166-1199

PAPERWORK REDUCTION ACT STATEMENT
We estimate the public reporting burden for this collection to average 10 minutes per response, including the time
required for searching existing data sources, gathering the necessary data, 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: U.S. Department of State, Bureau of
Consular Affairs, Passport Services, Office of Program Management and Operational Support, 44132 Mercure Cir,
P.O. Box 1199 Sterling, Virginia 20166-1199.

DS-4283

09/2020

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RESET

U.S. Department of State

Courier Drop-Off List
For U.S. Passport Applications

OMB Control No: 1405-0222
Expiration Date: 01-31-2022
Estimated Burden Time: 10 Minutes

Note: Application limits and service types are set by each U.S. Department of State passport agency. Couriers must abide by each
passport agency's guidelines.

Passport Agency:

Date:

Courier Company:

Service
Type:

Applicant's Last Name
Example: Doe

Applicant's
DOB
1/1/2000

Same Day
Two Day

Three Day
Mail Out

Form

Departure
Date

Foreign
Visa (Y/N)

DS-82

1/8/2022

No

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Type

Applicant's Last Name

Application Number

Departure Date

AR
Rewrite
AR
Rewrite
AR
Rewrite

I, the undersigned, have delivered passport applications and/or related documents for the above listed applicants on the date
written at the top of this form.

Name of Courier
Employee:
Department of State Use Only:
Intake:

DS-4283

Signature:
Initial and Date

Mail Open:
09/2020

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