OMB control number
Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16
OMB 1405-0216 · STATE/AFA.
OMB 1405-0216
The Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor under Age 16 (DS-5525) is used in conjunction with the Application for a U.S. Passport (DS-11). This form is only for use if the written consent of the non-applying parent or guardian cannot be obtained. The statement must explain in detail the non-applying parent or guardian's unavailability, and recent efforts made to contact the non-applying parent/guardian. This form is not to be used if the non-applying parent/guardian refuses, or claims it is inconvenient, to provide notarized consent for the minor applicant.
The latest form for Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16 expires 2028-12-31 and is listed under ICR 202312-1405-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form DS-5525 Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Child under Age 16 | Form and Instruction |
| Form DS-5525 Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16 | Form and Instruction |
 DS-5525_Expires 113023_OMB No. 1405 0216_30-Day FRN_Legal Authorities.docx | Supplementary Document |
| Justification for Nonsubstantive ICR.docx | Justification for No Material/Nonsubstantive Change |
| DS-5525_30day_2019_Legal Authorities_FINAL.docx | Supplementary Document |
| DS-5525_Expires 113023_OMB No. 1405 0216_30-Day FRN_ PRA Supporting Statement.docx | Supporting Statement A |
 Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Child under Age 16 |
Form and Instruction |
| Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16 |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202312-1405-001 | Reinstatement without change of a previously approved collection | 2023-12-08 | ||
| 202101-1405-011 | No material or nonsubstantive change to a currently approved collection | 2021-01-28 | Approved without change | |
| 201908-1405-004 | Revision of a currently approved collection | 2019-08-27 | Approved without change | |
| 201607-1405-004 | Revision of a currently approved collection | 2016-07-08 | Approved without change | |
| 201306-1405-004 | New collection (Request for a new OMB Control Number) | 2013-06-20 | Approved without change |
OMB Details
Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16
Federal Enterprise Architecture: Homeland Security - Border and Transportation Security
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form DS-5525 | STATEMENT OF EXIGENT/SPECIAL FAMILY CIRCUMSTANCES FOR ISSUANCE OF A U.S. PASSPORT TO A MINOR UNDER AGE 16 | www.travel.state.gov | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.