Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card

OMB 1405-0014

OMB 1405-0014

This form is used in conjunction with a DS-11, "Application for a U.S. Passport", or submitted separately to report loss or theft of a U.S. passport. Passport Services collects the information when a U.S. citizen or non-citizen national applies for a new U.S. passport and has been issued a previous, still valid U.S. passport that has been lost or stolen, or when a passport holder independently reports it lost or stolen. Passport applicants can either download the form from the internet or obtain one at any Passport Agency or Acceptance Facility.

The latest form for Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card expires 2021-11-30 and can be found here.

All Historical Document Collections
Revision of a currently approved collection 2021-09-10
Approved without change
Reinstatement with change of a previously approved collection 2018-07-19
Approved with change
No material or nonsubstantive change to a currently approved collection 2017-11-08
Improperly submitted and continue
No material or nonsubstantive change to a currently approved collection 2015-07-30
Approved without change
Extension without change of a currently approved collection 2015-05-26
Approved with change
Revision of a currently approved collection 2013-03-13
Approved with change
Extension without change of a currently approved collection 2011-03-16
Approved without change
Revision of a currently approved collection 2009-02-11
Approved without change
No material or nonsubstantive change to a currently approved collection 2008-08-04
Approved without change
Revision of a currently approved collection 2005-11-21
Approved without change
Extension without change of a currently approved collection 2002-10-11
Approved without change
Reinstatement with change of a previously approved collection 2001-09-07
Approved without change
Reinstatement without change of a previously approved collection 1997-12-31
Approved without change
Reinstatement with change of a previously approved collection 1994-09-27
Approved without change
Reinstatement with change of a previously approved collection 1991-08-01
Approved without change
Reinstatement with change of a previously approved collection 1984-08-14
Approved with change
No material or nonsubstantive change to a currently approved collection 1981-07-17
Approved without change
Reinstatement without change of a previously approved collection 1979-02-14
Approved without change
Reinstatement without change of a previously approved collection 1978-12-31
Approved with change
No material or nonsubstantive change to a currently approved collection 1973-07-25

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