WHEN TO USE THIS FORM Use this form only if you cannot ...

STATEMENT OF EXIGENT/SPECIAL FAMILY CIRCUMSTANCES FOR ISSUANCE OF A U.S. PASSPORT TO A CHILD UNDER AGE 16 OMB CONTROL NO. 1405-0216 EXPIRATION DATE: 11-30-2023 ESTIMATED BURDEN: 30 Minutes Please print legibly using black ink only. If you make an error, complete a new form. Do not correct. DS -5525 11- 2020 Page 1 of 2 . WHEN TO USE THIS FORM

  Family, Testament, Special, Circumstances, Exigent, Statement of exigent special family circumstances