United States Application for a U.S. Passport for Eligible Individuals — Correction, Name Change, and Limited Passport Replacement (Form DS-5504)

This file is the source-review record for this document version, per the manual-source-review-v1 practice. It documents the provenance of the published fields and flow, records a mock-data check of the field set, and states the current verification claim honestly.

Current claim

• status: draft
• verification.method: manual-source-review-v1
• verification.lastVerifiedAt: 2026-07-02

The document was derived from and cross-checked against two independent live sources (the process page and the fillable form PDF, itself extracted two independent ways — see below), but the full field-by-field comparison the practice requires has not yet been re-confirmed by a second, independent reviewer pass. It therefore remains draft, not verified. Consumers SHOULD treat this as an accurate, source-grounded structural reference, not a load-bearing description of the live process.

Why this document (GOV-678, plan GOV-664 §2 F1.8)

GOV-664's approved federal passport/immigration wave names Form DS-5504 as completing the U.S. Department of State passport form family: us/dos/passport-application-ds11 (first-time/replacement), us/dos/passport-renewal-ds82 (routine mail-in renewal), and us/dos/lost-or-stolen-passport-ds64 (lost/stolen report) were already published; DS-5504 (name change / data correction / limited replacement) was the one remaining sibling in this family.

Sources examined

• Document (id, version): us/dos/passport-name-change-ds5504 / 1.0.0
• Spec version: GovSchema 0.3.0
• Authority: U.S. Department of State, Bureau of Consular Affairs (DOS)
• Primary source URL: https://travel.state.gov/content/travel/en/passports/have-passport/change-correct.html ("Change or Correct a Passport") — retrieved 2026-07-02. States the eligibility windows (name change within one year of both events; data/print correction; limited-replacement) and the required attachments (current passport, name-change document or error evidence, one photo, no fee).
• Official form id: Form DS-5504 (DS-5504 04-2025), OMB Control No. 1405-0160, expiration 06/30/2028.
• Form PDF: https://eforms.state.gov/Forms/ds5504_pdf.PDF — fetched directly with a plain curl request; HTTP 200, no access block, consistent with the sibling us/dos/passport-application-ds11, us/dos/passport-renewal-ds82, and us/dos/lost-or-stolen-passport-ds64 documents also sourced from eforms.state.gov. Extracted two independent ways, following the same method us/dos/passport-renewal-ds82 v2.0.0 used:
  • Page text, via pdfjs-dist's getTextContent() (all 6 pages: 4 instruction pages + 2 application pages), giving the printed wording of Section A's three eligibility statements and Section C's numbered field instructions (items 1–9).
  • AcroForm field structure, via pdf-lib's form-field API (79 named widgets: text fields, checkboxes, and radio groups), further cross-referenced by widget page number and rectangle position (which page and where on the page each widget sits) to resolve fields the printed instructions do not itemize by number.
• Retrieved / reviewed: 2026-07-02
• Reviewer: GovSchema Engineering (Standards Engineer)

Not a time-versioned (edition) form

A name change / data correction / limited replacement is a one-time filing tied to a specific passport and a specific error or life event, not filed "for" a recurring period — applying the GSP-0005 §2 coexistence test, there is no scenario where two editions of the DS-5504 data model need to coexist for the same applicant. This document is therefore authored at the plain (non-edition) registry path, registry/us/dos/passport-name-change-ds5504/1.0.0/, the same as its sibling us/dos/lost-or-stolen-passport-ds64.

What was confirmed against the source

• Eligibility gate is "any of three", not "all of". Unlike us/dos/passport-renewal-ds82's six-statement "answer Yes to ALL" gate, Form DS-5504 Section A reads "You are eligible to use this form if you can answer 'Yes' to any of the statements below" — confirmed against the printed instruction text and modeled as three independent boolean fields (fieldRole: eligibility) rather than a single combined condition, since an applicant may qualify via exactly one statement while answering "No" to the other two.
• The three eligibility statements are each echoed a second time on Application Page 2 (items 20/22/23, as Name Change/Printed Incorrectly/Limited checkboxes) purely to route the applicant to the matching correction sub-section. Confirmed via widget position (all three Page-2 checkboxes sit directly above their respective correction fields; the Page-1 radio groups are the Section A eligibility statements themselves). Modeled as the same logical field, not duplicated — the same reasoning us/dos/passport-renewal-ds82 v2.0.0 applied to its own page-2 identity repeat fields.
• Full applicant identity, address, contact, and physical-description field set (Application Page 1 and 2) — transcribed from the AcroForm widget set and cross-checked against the numbered Section C instructions where they exist (items 1–9: name, DOB, sex, place of birth, SSN, mailing address, other names used, email, phone). The Permanent Address, Emergency Contact, Travel Plans, and physical description (height/hair/eye color/occupation/employer) blocks have no corresponding printed instruction — the same gap us/dos/passport-renewal-ds82 v2.0.0 found in its own AcroForm review — and are modeled from the AcroForm field names and their on-page position alone.
• The six-field correction block (Application Page 2, item 22): each of last name, first name, middle name, date of birth, place of birth, and sex marker has its own "needs correction" checkbox (Misprinted Last Name / First Name / Middle Name / DOB / POB / Sex) paired with its own corrected-value widget. Modeled as six independent misprinted*/corrected* field pairs, each corrected* field's requiredWhen referencing its own misprinted* checkbox — this is a more granular structure than DS-64's simple "list what changed" free-text approach, and reflects what the live AcroForm actually enumerates.
• The name-change sub-section (item 21, Changed Last/First/Middle Name) is required only when nameChangedWithinOneYear is true, per the printed instruction ("If yes, and your submitted passport book and/or card is less than one year old, please complete this section with your new name").
• The "Acts or Conditions" attestation (Instruction Page 4) — the sex-offender-registration / federal-drug-offense / outstanding-warrant declaration the applicant agrees to by signing — has no dedicated AcroForm widget (this is a print-and-sign paper form; the declaration is bound to the wet-ink signature, not a checkbox). Modeled as a single required boolean field, actsOrConditionsDeclarationConfirmed, with the declaration's exact text quoted in the field description, following the same pattern used for us/dos/passport-application-ds11's acceptanceFacilityAcknowledged and sg/ica/identity-card-reregistration's declarationConfirmed.

Intentionally not modeled

• Selection (3 widgets, Application Page 1) and Additional # / Additional # 2 (2 checkboxes each, Application Page 2). Their purpose could not be confidently determined from the widget name, the surrounding page text, or position relative to labelled fields — the same class of ambiguous checkbox us/dos/passport-renewal-ds82 v2.0.0 found on its own form (Additional # 1/Additional # 2, identically named) and left unmodeled rather than guessed at. A future reviewer with a rendered view of the form should resolve what these represent.
• Fees, processing times, and mailing addresses for submission remain deliberately excluded as data (SPEC's guidance on fee/policy volatility), consistent with every other DOS document in this registry.

Mock-data check

A representative filled-out application was checked field-by-field against every type/required/requiredWhen/validation constraint in schema.json:

``json { "nameChangedWithinOneYear": true, "identifyingInfoPrintedIncorrectly": false, "passportLimitedForOtherReason": false, "nameOnMostRecentPassport": "Maria Alejandra Ruiz", "requestedNameLast": "Torres", "requestedNameFirst": "Maria", "requestedNameMiddle": "Alejandra", "dateOfBirth": "1990-03-14", "sexMarker": "F", "placeOfBirth": "San Diego, California", "socialSecurityNumber": "123456789", "mailingAddressLine1": "482 Harbor View Drive, Suite 210", "mailingAddressCity": "San Diego", "mailingAddressState": "CA", "mailingAddressPostalCode": "92101", "mostRecentPassportBookNumber": "123456789", "passportBookIssueDate": "2025-11-01", "changedNameLast": "Torres", "changedNameFirst": "Maria", "changedNameMiddle": "Alejandra", "actsOrConditionsDeclarationConfirmed": true } ``

This models the same Maria Alejandra Torres scenario used across this registry's other U.S. mock scenarios (e.g. us/dos/lost-or-stolen-passport-ds64), here applying for DS-5504 to update her married surname on a passport book issued eight months ago (within the one-year window on both edges), exercising the nameChangedWithinOneYear: true → changedNameLast/changedNameFirst (both requiredWhen-gated) path while leaving the correction (misprinted*) and limited-replacement branches at their unrequired defaults. Every populated field satisfies its type/validation constraint; every field made required by a true requiredWhen condition (changedNameLast, changedNameFirst) is present.

Both registry validators were run against the schema document itself and pass:

``` $ node tools/validate.mjs registry/us/dos/passport-name-change-ds5504/1.0.0/schema.json ok registry/us/dos/passport-name-change-ds5504/1.0.0/schema.json

$ node tools/validate-ajv.mjs registry/us/dos/passport-name-change-ds5504/1.0.0/schema.json ok registry/us/dos/passport-name-change-ds5504/1.0.0/schema.json [v0.3] ```

What is NOT yet independently verified

• The Selection/Additional # checkboxes noted above.
• Constraint patterns (SSN, ZIP code, E.164 phone, 2-letter state) are reasonable encodings consistent with the sibling DOS documents in this registry, not citations of a published DOS validation rule.
• mailingAddressState/mailingAddressPostalCode are modeled required: true even though mailingAddressCountry is optional (implying a foreign address is possible) — the same latent inconsistency already present in us/dos/passport-renewal-ds82 v2.0.0, carried here for consistency rather than independently resolved; a future reviewer should decide the correct shape for both documents together.
• The online/e-Service submission channel, if the U.S. Department of State later exposes one for this form, was not observed; this document is sourced entirely from the paper/PDF Form DS-5504.

Path to a verified claim (next step)

To advance this document to status: verified, a reviewer applies manual-source-review-v1 (Procedure step 2 field-by-field comparison, step 3 flow comparison) as an independent second pass against the live Form DS-5504 PDF, resolves the Selection/Additional # ambiguity and the mailing-address-country inconsistency (ideally alongside us/dos/passport-renewal-ds82), confirms the sources are still authoritative, ships any discrepancy as a new schema version (immutability — VERSIONING §3), and records the outcome here plus sets status: verified with a current verification.lastVerifiedAt/nextReviewBy. This v1.0.0 record stays as the authoring provenance.

Re-verification

Per the practice's Cadence, nextReviewBy is set to 2027-01-01 (6 months). Re-check the source on or before that date, on any source.url change, or when the U.S. Department of State publishes a new Form DS-5504 revision.