8 FAM 403.3
(Office of Origin: CA/PPT/S/A)
8 FAM 403.3-1 Summary
a. This subchapter provides policy and procedures that passport specialists and consular officers ("you") must follow when an applicant indicates a gender on the "sex" line on the passport application with information different from the one reflected on some or all of the submitted citizenship and/or identity evidence, including a prior passport.
b. This policy explains the need for medical certification from a licensed physician who has treated the applicant or reviewed and evaluated the medical history of the applicant regarding the change in gender, as well as the need for accurate identification and a photograph reflecting the applicant’s current appearance. It is based on standards and recommendations of the World Professional Association for Transgender Health (WPATH), recognized as the authority in this field by the American Medical Association (AMA).
c. A passport is defined by INA 101(a)(30) (Immigration and Nationality Act) (8 U.S.C. 1101(a)(30)) as "any travel document issued by competent authority showing the bearer's origin, identity, and nationality if any, which is valid for the entry of the bearer into a foreign country." An individual's gender is an integral part of that person's identity.
d. Sex reassignment surgery is not a prerequisite for passport issuance based on gender change.
e. Medical certification of gender transition from a licensed physician as described in 8 FAM 403.3-2 is the only documentation of gender change required. Other medical records must not be requested.
f. A form DS-11 “Application for U.S. Passport” must be used the first time an applicant applies for a passport in reassigned gender, as personal appearance for execution is required, even if the applicant has a previous passport. A change in gender is a change in the identity of the applicant, and evidence of identity in the new name (if applicable) and gender must be presented. Subsequent applications in the same gender may be submitted on a form DS-82 if the applicant is eligible (see 8 FAM 702.2 regarding eligibility to apply on a form DS-82 and 8 FAM 403.3-3(D) regarding resumption of the birth gender).
8 FAm 403.3-2 Documentation Requirements
8 FAM 403.3-2(A) Documents to be Submitted with the Form DS-11
a. Evidence of U.S. citizenship/non-citizen U.S. nationality. The applicant must submit acceptable evidence of U.S. citizenship or non-citizen U.S. nationality. The applicant is not required to obtain an amended birth record, amended Consular Report of Birth (CRBA), or to request that the U.S. Citizenship and Immigration Services (USCIS) issue a replacement Certificate of Naturalization/Citizenship reflecting the change of gender. State law in the United States and the laws of other countries vary on whether an amended birth certificate may be issued reflecting a gender change;
NOTE: An amended birth certificate in the new gender is not acceptable evidence of gender change (as opposed to amending a birth certificate to correct a typographical error--see 8 FAM 403.3-7). See also 8 FAM 403.3-5 regarding form FS-240, "Consular Report of Birth of a U.S. Citizen Abroad."
b. Evidence of identity. As with all applications, the applicant must be asked to submit acceptable Identification Document(s) (IDs) in the new gender, and name, if applicable (see 8 FAM 401.3). However, state law and foreign laws vary as to whether a driver’s license or other State or foreign government ID may be issued reflecting a gender change. So, the applicant may document her/his identity by submitting any of the following ID documents:
(1) Primary ID in the new gender;
(2) Secondary ID in the new gender; or
(3) Acceptable primary ID in the birth gender if it readily identifies the applicant.
NOTE: Some form of photographic ID must be presented; You cannot use the doctor’s certification as the only evidence to identify an applicant.
c. Photograph. A recent photograph that is a good likeness of the applicant, and satisfactorily identifies the applicant must be submitted. The photograph must agree with the submitted ID and reflect the applicant’s current and true appearance (see also 8 FAM 402.1 "Passport Photographs");
d. Passport Fee. All necessary passport fees must be submitted (see 8 FAM 602.2 "Passport Fees"); and
e. Name Change. If the applicant’s name has been changed, either by court order or by customary usage, she/he must present satisfactory evidence of the material name change (see 8 FAM 403.1 "Names and Name Usage"). Both names must be cleared (see 8 FAM 501.3).
8 FAM 403.3-2(B) Medical Certification for Gender Change/Transition
a. A full validity U.S. passport will be issued reflecting a new gender upon presentation of a signed, original certification or statement, on office letterhead, from a licensed physician who has treated the applicant for her/his gender-related care or reviewed and evaluated the gender-related medical history of the applicant.
b. Licensed physicians include:
(1) A doctor of osteopathy (D.O.) (not to be confused with a doctor of optometry (O.D.), whose certification is not acceptable); or
(2) A medical doctor (M.D.). M.D.s may specialize in various medical fields including, but not limited to, internists, endocrinologists, gynecologists, urologists, surgeons, psychiatrists, pediatricians, and family practitioners.
c. Medical certifications from persons who are not licensed physicians are not acceptable. They include, but are not limited to:
(2) Physician Assistants;
(3) Nurse practitioners;
(4) Health practitioners;
(5) Licensed vocational nurses;
(6) Registered nurses;
(7) Chiropractors; or
d. The medical certification must include the following information (see 8 FAM 403.3-8):
(1) Licensed physician’s full name;
(2) Medical license or certificate number;
(a) Licensed physicians in foreign countries must have a comparable foreign license or certificate registration number;
(b) For all foreign licensed physician gender change requests, passport agencies/centers must scan copies of the form DS-11 and attach all submitted documents to Passport Services’ Adjudication Policy Division (CA/PPT/S/A/AP) at AskPPTAdjudication@state.gov. CA/PPT/S/A/AP works with post to verify the bona fides of the foreign-based licensed physician with the applicable post abroad. CA/PPT/S/A/AP will advise the passport agency/center of the outcome of post's verification as soon as possible; and
NOTE: This is not a public-facing e-mail address and public inquiries will not be replied to.
(c) Posts must verify their own foreign-based licensed physicians or, if the statement is from a physician in another country, contact the post which covers that country for verification.
(3) Address and telephone number of the licensed physician;
(4) Language stating that she/he has treated the applicant or has reviewed and evaluated the medical history of the applicant and that she/he has a doctor/patient relationship with the applicant;
(5) Language stating the applicant has had appropriate clinical treatment for gender transition to the new gender of either male or female; and
(6) Language stating “I declare under penalty of perjury under the laws of the United States that the forgoing is true and correct.”
e. If the applicant has not submitted the requested medical certification, use the appropriate letter (or similar language for overseas posts) available in information request letter (IRL) 706 in corresponding with the passport applicant. (See 8 FAM 801.2 “Information Request Letters and Information Notices.”)
f. For applicants who have just begun and may be in the initial stages of the gender transition process, a two year limited validity passport using endorsement 46 (see 8 FAM 505.2) reflecting the new gender will be issued upon presentation of a medical certification described in paragraph a above that includes the following:
(1) Information listed in above;
(2) Language stating the applicant is in the process of gender transition to the new gender of either male or female; and
(3) Language stating “I declare under penalty of perjury under the laws of the United States that the forgoing is true and correct.”
g. Faxed, e-mailed, or scanned photocopies of medical certifications are not acceptable for full validity U.S. passports. In emergency circumstances, you may issue a limited validity passport in the new gender using endorsement 46.
8 FAM 403.3-3 Adjudicating Gender Change or Transition
8 FAM 403.3-3(A) Adjudicating Gender Change Cases
a. You must annotate the reason for issuing the full validity passport in the new gender in the "For Issuing Office Only" block of the form DS-11:
b. You must annotate and attach the medical certification to the form DS-11:
NOTE: You must not ask for additional specific clinical details regarding the gender change from the applicant.
NOTE: If the applicant requests that the original medical certification be returned, you may attach a clear photocopy of the medical certification, clearly annotate that the original medical certification was seen and returned, and return the original medical certification to the applicant.
8 FAM 403.3-3(B) Adjudicating Gender Transition Cases
a. You must annotate the reason for issuing the limited validity passport in the new gender in the "For Issuing Office Only" block of the form DS-11:
b. You must annotate and attach the medical certification to the form DS-11:
c. You must add an appropriate endorsement to limit the validity period of the passport:
(2) Use endorsement code 109 in emergency photo-digitized passports for urgent overseas cases where the applicant must travel immediately (see also 8 FAM 505.2)
8 FAM 403.3-3(C) Replacement of Passport Limited Because of Gender Transition
a. An applicant who received a limited passport book because of a gender transition will receive a replacement, fully-valid passport without further fee (except for expedited service, if requested), if she/he:
(1) Applies for the new passport within two years of issuance using form DS-5504, "Application for a U.S. Passport: Name Change, Data Correction, and Limited Passport Book Replacement;"
(2) Meets the requirements of 8 FAM 403.3-2; and
(3) Presents a new medical certification that meets the requirements for a fully-valid passport in 8 FAM 403.3-2(B).
b. If, after two years, the applicant applies for a new passport and her/his gender transition has not been completed, the applicant must submit a new physician’s statement, following the same information and licensure requirements in 8 FAM 403.3-2, reflecting that the applicant still is in the process of gender transition. The applicant must also submit a new form DS-11, with appropriate identity, citizenship, and passport fees submitted (see 8 FAM 403.3-2(A)). Another two-year limited validity passport will be issued.
8 FAM 403.3-3(D) Resumption of the Birth Gender
If an applicant who already has been issued a passport in a new gender requests issuance of a passport in the birth gender, a medical certification of the transition back to the birth gender is required (see 8 FAM 403.3-2(B) regarding medical certifications). The same procedures for adjudication and issuance of full validity (gender change) or limited validity (gender transition) passports apply if the applicant is returning to the birth gender (see also 8 FAM 403.3-3(A) and 8 FAM 403.3-3(B)).
8 FAM 403.3-4 CONVERSATIONS WITH PASSPORT APPLICANTS SEEKING TO DOCUMENT GENDER Change/TRANSITION
a. As with all passport applicants, you must be sensitive and respectful at all times.
b. Refer to the applicant by the pronoun appropriate to her/his new gender even if the transition is not complete.
c. Ask only appropriate questions regarding information necessary to determine citizenship and identity of the applicant.
8 FAM 403.3-5 AMENDING GENDER IN Consular REPORTS OF BIRTH Abroad
a. The form FS-240, "Consular Report of Birth Abroad of Citizen of the United States of America," can be amended by Passport Services' Office of Technical Operations, Record Services division (CA/PPT/S/TO/RS) to reflect the change in gender. The documentary requirements specified in this Appendix for passport services are the same for amending gender on a form FS-240. See Bureau of Consular Affairs Internet Information on amending a form FS-240. Inquirers are directed to contact Passport Services' Record Services Division, using the below dual addresses, both physical and P.O. box address, and the nine-digit zip code.
U.S. Department of State
Telephone (public): 202-485-8300
b. An amended form FS-240 is acceptable evidence of a gender change for a subsequent passport application.
8 FAM 403.3-6 INTERSEX CONDITIONS (DISORDERS OF SEX DEVELOPMENT)
a. “Intersex” is a condition in which a person is born with a reproductive or sexual anatomy and/or chromosomal pattern that does not fit typical definitions of male or female.
b. Birth documentation is often not updated to reflect corrected gender. When the passport application indicates a sex different from the one reflected on the birth documentation, the applicant, or her/his applying parents in the case of a minor child, must provide medical certification that meets the requirements in 8 FAM 403.3-2(B), adjusting the language to reflect the intersex condition and specify the gender correction to either male or female. In the case of a minor child, the applying parent(s) also must submit a signed statement confirming the gender correction to either male or female. These statements must be attached to the passport application.
c. Unless the applicant, or her/his applying parent, provides the statements described above, the gender listed on her/his birth documentation will determine the gender to be listed in the passport.
8 FAM 403.3-7 GENDER ERRORS IN ORIGINAL BIRTH CERTIFICATE
a. If an applicant advises that the gender on her/his birth document mistakenly lists the wrong gender due to typographical error, and there is sufficient time before the listed departure date, refer the applicant to the appropriate issuing vital records office to have the error corrected (IRL 875-33).
b. If the departure date is imminent, you may issue a limited one year validity passport, listing the applicant's requested gender, using endorsement code 46 (see 8 FAM 505.2.) A corrected certified copy of the amended birth document will be required before issuance of a full validity passport in the requested gender.
8 FAM 403.3-8 MODEL LETTER FOR LICENSED PHYSICIAN CERTIFYING TO THE APPLICANT'S GENDER CHANGE/TRANSITION
Licensed Physician’s Letterhead
(Physician’s Address and Telephone Number)
I, (physician’s full name), (physician’s medical license or certificate number), (issuing U.S. State/Foreign Country of medical license/certificate), am the physician of (name of patient), with whom I have a doctor/patient relationship and whom I have treated (or with whom I have a doctor/patient relationship and whose medical history I have reviewed and evaluated).
(Name of patient) has had appropriate clinical treatment for gender change to the new gender (specify new gender male or female).
(Name of patient) is in the process of gender transition to the new gender (specify new gender male or female). (NOTE TO PHYSICIAN ONLY: Use this sentence only when the patient has just begun or is in the early stages of his or her gender transition.)
I declare under penalty of perjury under the laws of the United States that the forgoing is true and correct.
Signature of Physician
Typed Name of Physician