Statement of Exigent/Special Family Circumstances
This form is required for issuing a U.S. passport for children under age 16 without parental consent. It should be used only when notarized consent cannot be obtained due to exigent or special family circumstances. Completing this form does not guarantee passport issuance.
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How do I fill this out?
To fill out this form, print legibly using black ink only. Be sure to provide all necessary information to support your request for a passport. If needed, use additional sheets of paper for your answers.
How to fill out the Statement of Exigent/Special Family Circumstances?
1
Print the form using black ink and ensure clarity.
2
Fill in your child's information and the applying guardian's details.
3
Answer questions regarding consent and contact attempts with the non-applying parent.
4
Provide any relevant court orders or evidence of circumstances.
5
Sign the form and submit it along with the passport application.
Who needs the Statement of Exigent/Special Family Circumstances?
1
Single parents needing a passport for their child.
2
Guardians facing challenges in obtaining consent from a non-applying parent.
3
Parents in emergency situations requiring urgent travel with their child.
4
Custodial parents who cannot contact non-custodial parents.
5
Individuals with court orders regarding child custody or travel.
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What are the instructions for submitting this form?
To submit this form, include it with the child’s passport application and any supporting documents. For physical submissions, send it to the National Passport Processing Center at 44132 Mercure Cir, PO Box 1199, Sterling, VA 20166-1199. For further queries, contact the National Passport Information Center at 1-877-487-2778.
What are the important dates for this form in 2024 and 2025?
Important dates related to this form include the expiration date of OMB control number 1405-0216, which is 06-30-2024. Make sure to check regularly for any adjustments in the submission guidelines or forms required.
What is the purpose of this form?
The purpose of this form is to provide a mechanism for parents or guardians to apply for a passport for a child under 16 when obtaining consent from the other legal guardian is challenging. This could be due to emergencies or unique family situations. The form ensures that the necessity of travel does not compromise the child’s safety and well-being by allowing for exceptions to the usual consent requirements.
Tell me about this form and its components and fields line-by-line.
- 1. Child's Name: Enter the child's full name as it appears on the birth certificate.
- 2. Child's Date of Birth: Provide the DOB in the specified format (mm-dd-yyyy).
- 3. Applying Parent/Guardian's Name: Include the name of the parent or guardian applying for the passport.
- 4. Non-Applying Parent's Information: Complete the necessary details for the non-applying parent such as name, date of birth, and contact information.
- 5. Court Orders or Decrees: Indicate if any court orders referencing custody or travel have been issued.
- 6. Incarceration Status: Provide information regarding whether the non-applying parent is currently incarcerated.
- 7. Communication Attempts: Detail any communication attempts made with the non-applying parent.
- 8. Signed Declaration: The form must be signed by the applying parent or guardian under penalty of perjury.
What happens if I fail to submit this form?
Failure to submit this form may result in rejection of your child's passport application. It's crucial to provide all requested information accurately to avoid delays in processing.
- Passport Denial: If the form is incomplete or inaccurate, the passport application may be denied.
- Time Delays: Incorrect or missing information can lead to significant delays in processing.
- Legal Implications: Inaccurate statements made on the form can lead to legal penalties.
How do I know when to use this form?
- 1. Emergency Travel: Use the form in cases where immediate travel is needed for health or safety reasons.
- 2. Non-Contactable Parent: If the non-applying parent cannot be contacted due to incarceration or other issues.
- 3. Custody Issues: In situations where there is a complex custody arrangement.
Frequently Asked Questions
Who can use this form?
This form is for parents or guardians applying for a child's passport without the other parent's consent.
What is an exigent circumstance?
An exigent circumstance is a situation requiring immediate action, often due to emergencies.
Do I need a court order to use this form?
A court order can help validate your request but is not always necessary.
Can I edit this PDF?
Yes, you can easily edit this PDF form using PrintFriendly's tools.
How do I submit this form?
Submit the form along with your child's passport application at the designated address noted in the instructions.
What if I have questions while filling it out?
You can reach out to customer support for guidance while filling out the form.
Is there any charge to edit this PDF?
Editing this PDF on PrintFriendly is free of charge.
Can I save my edits?
Currently, you can download your edited PDF for submission but cannot save it on the site.
What if I make a mistake on the form?
If you make a mistake, simply start over with a new form, as corrections are not allowed.
Where can I find more information?
Additional details are available on the U.S. Department of State website.
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