AUTHORITIES: The information solicited on this form is requested pursuant to provisions in Titles 8 and 22 of the United States Code (U.S.C.), whether or not codified, including specifically 22 U.S.C. 2705 and predecessor statutes; 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; and by regulations issued pursuant to E.O. 11295 (August 5, 1966), including Parts 50, 51, and 53, Title 22 Code of Federal Regulations (CFR).
PURPOSE: We are requesting this information in order to schedule your appointment for a service, including applying for a Consular Report of Birth Abroad and/or a U.S. passport, and notarial services.
ROUTINE USES: This information may be disclosed to another domestic government agency, a private contractor, a foreign government agency, or to a private person or private employer in accordance with certain approved routine uses. These routine uses include, but are not limited to, law enforcement activities, employment verification, fraud prevention, border security, counterterrorism, litigation activities, and activities that meet the Secretary of State's responsibility to protect U.S. citizens and non-citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices State-05, Overseas Citizen Services Records other Overseas Records, and State-26, Passport Records.
DISCLOSURE: Providing information on this form is voluntary. Be advised, however, that failure to provide the information requested on this form may cause delays in scheduling and/or providing the requested service.
For U.S citizens and legal permanent residents, the applicant’s information is protected under the Privacy Act of 1974, as amended, 5 U.S.C. 552a; Federal Information Security Modernization Act of 2014, Public Law 113- 283, 44 USC Chapter 35; and OMB Circular No. A-130, revised July 28, 2016.