Ds-5542 Request For Overseas U.s. Citizen Vital Records Services

OMB Control No. 1405-xxxx
Expiration Date: XX/XX/20XX
Estimated Burden: 40 minutes

U.S. Department of State

REQUEST FOR OVERSEAS U.S. CITIZEN
VITAL RECORDS SERVICES
Please Print Legibly Using Black Ink Only

ABOUT THIS FORM

This form is used to request certified or authenticated copies of overseas U.S. citizen vital records such as Consular Reports of Birth/Death Abroad, Certificates of
Witness to Marriage, and Panama Canal Zone documents. You may also use this form to request correction or amendment to a Consular Report of Birth Abroad.
NOTE: If the subject of the record(s) you are requesting is a minor and you are not the minor’s parent, you must submit written authorization such as a court
order with your request. For more information regarding requests for vital records, please visit our website at travel.state.gov.

INSTRUCTIONS

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1. Birth Records - Select if requesting a Consular Report of Birth Abroad of a U.S. Citizen or Panama Canal Zone Birth Certificate, indicate how many copies you
need, and complete the requested information regarding the subject/document holder (i.e., full name, other names used, date of birth – month/day/year, place of
birth, parent(s)/guardian(s) full name and citizenship status at the time of the subject’s birth, U.S. passport book/card information, and the Consular Report of Birth
Abroad document number, if known). NOTE: If the subject was not born a U.S. citizen but later naturalized, PLEASE STOP, and contact U.S. Citizenship
and Immigration Services (USCIS).
2. Death Records - Select if requesting a Consular Report of Death Abroad of a U.S. Citizen or Panama Canal Zone Death Certificate, indicate how many copies
you need, and complete the requested information regarding the deceased (i.e., full name, date of birth and death – month/day/year, and place of death). Third
party requests for death records must be supported by evidence of a valid need for the record per 22 CFR 71.5 and72.6(c). NOTE: Consular Reports of Death
Abroad issued prior to 1975 are maintained by the National Archives and Records Administration (NARA) and may not be requested on this form.
3. Marriage Records - Select if requesting a Certificate of Witness to Marriage Abroad, indicate how many copies you need, and complete the requested
information regarding the couple (i.e., full name of bride/groom/spouse, date of marriage – month/day/year, and place of marriage).
4. Other Services - Select if requesting an apostille or amendment to a Consular Report of Birth Abroad. For apostilles indicate the country for intended use and
how many documents need an apostille. Note: The country for intended use must be a member of the 1961 Hague Convention on Apostilles. For amendments,
indicate the change(s) you are requesting. Note: You must present original or certified copies of evidence to support the amendment(s) you are requesting. (All
supporting documents will be returned to you). Visit travel.state.gov for more information.
5. Requestor’s Information – The person requesting the record or other service must complete this section (i.e., provide your full name, mailing address, contact
information and relationship to the document holder/subject).
6. Shipping Options – Select how you want to receive your documents. The fee for overnight service must be included with this form. Visit travel.state.gov for
current shipping fee information.
7. Oath – Do not sign this section until you appear before a person authorized to administer the oath/affirmation.
• Vital Records Fee: The vital records fee is $50.00 per copy. We accept U.S. Postal Service money orders, checks (personal, corporate, certified, cashier’s,
travelers) made payable to the U.S. Department of State.
• Check Status: You may check the status of your request by emailing [email protected] or by calling 202-485-8300.

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WARNING

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False statements made knowingly and willfully in this form or otherwise in connection with your request, are punishable by fine and/or imprisonment under U.S.
law including the provisions of 18 U.S.C. 1001. Pursuant to 22 CFR§ 131.2, the Department of State will not certify to a document when it has good reason to
believe that the certification is desired for an unlawful or improper purpose.

PRIVACY ACT STATEMENT

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AUTHORITIES: Collection of the information solicited on this form is authorized by the Titles 8 and 22 of the United States Code (U.S.C.), and other applicable
laws and regulations including, 8 U.S.C. 1104, Powers and Duties of the Secretary of State; 8 U.S.C. 1401, Nationals and Citizens of United States at Birth; 8
U.S.C. 1403, Persons Born in the Canal Zone or Republic of Panama on or after February 26, 1904; 8 U.S.C. 1408, Nationals but not Citizens of the United
States at Birth; 8 U.S.C. 1409, Children Born Out of Wedlock; 8 U.S.C. 1504(b), Consular Report of Birth Abroad; 22 U.S.C. 2705, Documentation of citizenship;
22 U.S.C. 2715b, Notification of next of kin; reports of death; 22 C.F.R. 50.2, Determination of U.S. nationality of persons abroad; 22 C.F.R. 50.5, Application for
registration of birth abroad; 22 C.F.R. 50.7, Consular Report of Birth Abroad of a Citizen of the United States of America; 22 C.F.R. 72.4 -72.6, Reporting Deaths
of United States Nationals; 12 Stat. 72, Ch. 179, Sec. 31, June 22, 1860 Marriage Abroad in Presence of Consular Officer; restated in R.S. 4082, repealed in R.S.
5596; and 104 Stat. 27, Pub. Law 101-246, Sec. 123, February 16, 1990 Consular Officer Duties; repealed Sec. 31 of 12 Stat. 72; 22 U.S.C. 4192.
PURPOSE: The information requested on this form is collected to validate and process authorized requests for records services.

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ROUTINE USES: The information solicited on this form may be made available as a routine use to other government agencies and private contractors to assist
the U.S. Department of State in issuing certificates under the Seal of the U.S. Department of State and requests for related services, and for law enforcement,
fraud prevention, border security, counterterrorism, litigation activities, and administrative purposes. 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 of State’s responsibility to protect U.S. citizens and non-citizen nationals abroad. The information may be made available to the Department of
Homeland Security and private employers for employment verification purposes. For a more detailed listing of the routine uses to which this information may be
put, see the Department of State's Prefatory Statement of Routine Uses relative to the Privacy Act (Public Notice 6290 of July 15, 2008) and the listing of routine
users set forth in the System of Records Notices for Overseas Citizens Services Records and Other Overseas Records (State-05) and Passport Records (State26) published in the Federal Register.
CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: Providing the information requested on this form is voluntary, but if you do not provide the
information requested on this form or in connection with this form, we may deny your request for records services.

PAPERWORK REDUCTION ACT (PRA) STATEMENT

Public reporting burden for this collection of information is estimated to average 40 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: Attn: Passport Forms Officer, U.S. Department of State, Bureau of Consular Affairs, Passport Services,
Office of Program Management and Operational Support, 44132 Mercure Circle, PO Box 1199, Sterling, Virginia 20166-1199.
DS-5542 XX-20XX

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OMB Control No. 1405-xxxx
Expiration Date: XX/XX/20XX
Estimated Burden: 40 minutes

U.S. Department of State

REQUEST FOR OVERSEAS U.S. CITIZEN
VITAL RECORDS SERVICES
Please Print Legibly Using Black Ink Only
For Official Use Only
Payment Amount

$

Payment Type

Clerk’s Initials

LABEL

Cashier’s Initials
To complete the sections below, please follow the instructions provided on Page 1.

1. Birth Records

Consular Report of Birth Abroad (FS-240)

Copy Total:

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a. Full Name of Subject at Birth

First

Middle

Last

Panama Canal Zone Birth Certificate
Suffix

b. Other Names Used by Subject

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c. Date of Birth (mm-dd-yyyy)

d. Place of Birth (City, State/Country)

First

e. Full Name Parent/Legal Guardian 1

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f. Citizenship Parent/Legal Guardian 1

First

g. Full Name Parent/Legal Guardian 2

h. Citizenship Parent/Legal Guardian 2

Middle

Last

Suffix

Middle

Last

Suffix

Book Number

i. U.S. Passport Book Information

Card Number

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j. U.S. Passport Card Information

Issued Date
(mm-dd-yyyy)
Issued Date
(mm-dd-yyyy)

k. Document Control Number (If Known)
2. Death Records
Copy Total:

159-

First

Consular Report of Death Abroad
Middle

b. Date of Birth (mm-dd-yyyy)

Last

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a. Full Name of Deceased

Expired Date
(mm-dd-yyyy)
Expired Date
(mm-dd-yyyy)

Panama Canal Zone Death Certificate

Suffix

c. Date of Death (mm-dd-yyyy)

d. Place of Death (City, State/Country)
3. Marriage Records Copy Total:

First

a. Full Name of Groom/Spouse
b. Full Maiden Name of
Bride/Spouse

First

Certificate of Witness to Marriage Abroad (Pre 1989)
Middle

Last

Suffix

Middle

Last

Suffix

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5. Requestor’s Information

b. Mailing Address

Note: If the subject of the record(s) you are requesting is a minor and you are not the minor’s parent, you must include a copy of
supporting evidence of custody, such as a court order with this form.

First, Middle, Last, Suffix
Number/Street/PO Box

c. Contact Information
Telephone
d. Relationship to Document Subject

City

Parent

State/Country

Legal Guardian

Email

Legal Representative

USPS First Class 1-2 weeks. No additional cost.

Zip Code

Other (Specify)

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6. Shipping Options (check one)

Self

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a. Requestor’s Full Name

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c. Date of Marriage (mm-dd-yyyy)
d. Place of Marriage (City/State/Country)
4. Other Services
Apostille
Amendment to Consular Report of Birth Abroad Must submit proof to support some change(s) requested. Visit travel.state.gov for more details.
Which country do you
Select all that apply: Name Change
Adoption
Gender Change
Paternity
Error Correction
need the apostille?
Other (Explain):

UPS Overnight Delivery - Visit travel.state.gov for current shipping fees.

7. Oath/Affirmation. STOP HERE. This section must be signed before a notary public or other person authorized to administer oaths.

Subject/Document Holder’s Signature (Must be 18 years or older)
Subscribed and Sworn to (Affirmed) before me this

ATTACH TO THIS REQUEST:

1.
2.
3.

Requestor’s Signature (If other than the document holder/self)
day of

Name and Title of Administering Official

Requestor’s Photocopied Government Issued Photo ID (front and
back)
Payment ($50 per copy)
Other evidence as requested on this form. (e.g., court order of
guardianship) (Visit travel.state.gov for more information)

DS-5542 XX-20XX

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OATH: I solemnly swear (or affirm) that the above information given by me is true and correct to the best of my knowledge and belief.

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(SEAL)

WHERE DO I MAIL THIS REQUEST?

U.S. Department of State
Passport Vital Records
44132 Mercure Circle
PO Box 1213
Sterling, VA 20166-1213

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