Form DS-5504 at a glance
| Official title | Application for a U.S. Passport for Eligible Individuals (Correction, Name Change to Passport Issued 1 Year Ago or Less, and Limited Passport Replacement) |
| Issued by | U.S. Department of State |
| Edition | 04-2025 |
| Pages | 6 |
| Fillable fields | 78: 60 text fields, 15 checkboxes, 3 radio groups |
| OMB number | 1405-0160 |
| Official PDF | ds5504_pdf.PDF on eforms.state.gov |
| Cost with FillWise | 1 fill |
Counted on Oct 11, 2026 from the official PDF, with the same engine FillWise fills it with.
What Form DS-5504 asks for
- Pages 5-6: City, Zip Code, Countries to be Visited, Name Last, First, Middle, Date of Birth (MM/DD/YYYY), Sex, Place of Birth (State or Country) (the same boxes on each of these pages).
The captions printed next to the first fields of each page, as the PDF gives them.
Fields to watch on Form DS-5504
- 6 questions answered with a Yes box. FillWise ticks one only when your notes answer it; the rest stay empty for you.
- 14 boxes with a fixed number of characters, such as Social Security Number (3), Zip Code (6). Long numbers are split across them, so check the digits.
How to fill Form DS-5504 with FillWise
- Open the official PDF from eforms.state.gov in Chrome.
- In the FillWise side panel, paste your notes or attach a photo of a document, and press Fill form.
- Check all 6 pages of the downloaded PDF before anyone signs.
Without the extension: Fill a PDF in your account.
How FillWise handles Form DS-5504
FillWise fills this form the regular way: the AI reads each field's printed caption, its tooltip and its options, and answers from your notes.
What to check before you file
- The edition. Agencies replace their forms with new editions. This page describes the 04-2025 edition; check that your copy is still the current one on eforms.state.gov.
- It applies only if one of the three statements in Section A of the instructions is true; for a lost, stolen or damaged passport you apply on Form DS-11 instead. Send your most recent passport and one 2x2 inch photo with it.
- Names and numbers character by character; signatures, fees and supporting documents stay with you.
Filling Form DS-5504 for many people
Bulk fill in your FillWise account takes Form DS-5504 and a CSV or Excel sheet with one person per row. It fills the first one and stops so you can check the result, then fills the rest and hands back one zip. Each copy costs 1 fill, the same as filling it on its own. How it works step by step: bulk PDF form filling guide.
Cost
Form DS-5504 has 6 pages, but its fields are on pages 1, 5-6 only, so filling it costs 1 fill: FillWise charges a PDF fill by the pages it fills, one fill per started 5 pages. The free plan starts with 20 fills and then tops back up to 5 fills a week, no card required. Paid plans are on the pricing page.
Privacy
The PDF is filled in your browser; only its field list and your data go to our server for the AI, and nothing is stored. Details: privacy and security.