### To vote in primary elections, your State may require you to specify a political party:

Email 

# Federal Post Card Application (FPCA)

Voter Registration and Absentee Ballot Request

County Previous name (if applicable)

5

7 

# Identification

Some States require your

full SSN. Check your State’s

pages in the Voting Assistance

Guide on FVAP.gov

.



# Contact

information

Include international

prefixes. No DSN number.



# Political Party

Ballot receipt 2

6 4

– – 

### Last name

First name Suffix

Apt. # 3 

# My legal name

City/Town/Village Street Address (not P.O. Box) 

# My voting residence

address

Usually your last U.S.

residence or your legal U.S.

residence. See instructions.



# Where to send my

ballot

This is your current mailing

address and should be

different from above. If

required, place a forwarding

address in Box 9. 8

9

This information is for official use only. Any unauthorized release may be punishable by law. 

### Please print in black ink.

1 

# Classification

Make only 1 selection.

(In most States, you must be

absent from your voting district

to use this form). 

### I am an activated National Guard member on State orders.

I prefer to receive my ballot, as permitted by my State, by:

(rank from 1 -3 in order of preference; be sure appropriate contact information is provided above) I am a member of the Uniformed Services or Merchant Marine on active duty OR

Standard Form 76 (Rev. 03-2013 ), OMB No. XXXX-XXXX 

### M F Birth date

D D / /

M M Y Y Y Y



# Additional

requirements

for your State

Such as: mail forwarding

address, additional phone,

or other State required

information. See Voting

Assistance Guide.

/ / 

### You must sign and send in. 

# Affirmation (REQUIRED): I swear or affirm, under penalty of perjury, that:



## • The information on this form is true, accurate, and complete to the best of my knowl

- edge. I understand that a material misstatement of fact in completion of this document may constitute grounds for conviction of perjury. • I am a U.S. citizen, at least 18 years of age (or will be by the day of the election), eligible to vote in the requested jurisdic

- tion, and • I am not disqualified to vote due to having been convicted of a felony or other disqualifying offense, nor have I been adjudicated mentally incompetent; or if so, my voting rights have been reinstated; and • I am not registering, requesting a ballot, or voting in any other jurisdiction in the U.S., except the jurisdiction cited in this voting

form. Witness signature / date if required by your State.

See the Voting Assistance Guide on FVAP.gov. Middle name I am an eligible spouse or dependent.

Email/Online Sex

Telephone

Fax

State Zip Code Social Security Number

OR State Driver’s License or ID

Mail Fax

–



### Signature

Date For any questions about this form, consult the Voting

Assistance Guide available in hard copy or on

FVAP.gov or your Voting Assistance Officer.

Race See instructions 

### I am a U.S. citizen residing outside the U.S., and my return is not certain. I am a U.S. citizen residing outside the U.S., and I intend to return. I request an absentee ballot for all elections in which I am eligible to vote AND:

I am a U.S. citizen and have never resided in the United States.

Signature

M M D D Y Y Y Y Today’s date

### The gray numbers and instructions below correspond to the gray numbered boxes on the

face of the form.

1 The classification you choose determines in which election(s) you will be allowed to vote.

Choose the one that best represents your current situation.

2 If you want to vote in primary elections, most States require you to specify a political party.

Check your State’s pages in the Voting Assistance Guide on FVAP.gov to see if your State

requires you to specify a political party.

3 The information you enter for your name should match the information you normally put on

legal or official forms. For example, it should be the same name that appears on your driver’s

license or other government-issued ID.

4 While most States allow you to enter either your driver’s license number or the last 4 digits of

your Social Security Number, some will invalidate this form without your full SSN. Check your

State’s pages in the Voting Assistance Guide on FVAP.gov to see if your State requires the

full SSN.

Also, many States ask that you provide your race or ethnic group in order to demonstrate that

they are complying with the Voting Rights Act and the National Voter Registration Act.

5 If there are questions or problems with your form, local election officials will use this

information to contact you. An email address is the simplest and fastest way for them to do so.

Your voting materials will be sent to the email address(es) that you provide here if you request

it and your State allows it. Include an alternate phone number in Box 9 if necessary.

6 Indicate your preferred method for receiving your ballot by ranking each box 1, 2, or 3. All

States and jurisdictions must send absentee ballots to military and overseas voters by at least

one of the following: email, online download, or fax if requested. Check your State’s pages in

the Voting Assistance Guide on FVAP.gov to learn what your State allows. You can always

get your absentee ballot by mail.

7 This determines the jurisdiction where you vote. For military voters the voting address is your

legal U.S. residence. For overseas citizens this is usually the U.S. address where you last

lived. You do not need to have any current physical ties to this address

. Do not use a post

office box number. If the area has no street names, enter the route number and box number.

8 Enter the address where you want voting materials to be sent to you. Voting materials will be sent to this address unless you enter a forwarding address in Box 9.

9 Enter anything here that would help ensure that your ballot is accepted. Check your State’s

pages in the Voting Assistance Guide on FVAP.gov for anything your State may specifically

require here. For example, some States require last date of residency in the U.S., previous

location of registration, overseas employer, or witness address.

If you want your voting materials to be sent somewhere other than where you live now, enter

that alternate (forwarding) address here. Provide an alternate phone number here.

Affirmation. Read this carefully. It is what you are agreeing to under oath and penalty of perjury by

filling out and sending in this form. Some States require that your form be witnessed. Check

the Voting Assistance Guide on FVAP.gov for your State’s requirements. 

# Federal Post Card Application (FPCA)

Instructions

From

(Your name and current complete military or overseas mailing address)



## To

(Your local election office in the United States. Check your State’s pages in the Voting

Assistance Guide on FVAP.gov for contact information.) International airmail postage is required if not mailed in the

U.S. Postal Service, APO/FPO system, or diplomatic pouch. 

## U.S. Postage Paid

39 USC 3406



## OFFICIAL ABSENTEE BALLOTING MATERIAL

– FIRST CLASS MAIL PAR AVION

NO POSTAGE NECESSARY IN THE U.S. MAIL

– DMM 703.8.0 

# Privacy Act Statement

Authority: The authority to collect your personal information on this form comes from 42

USC 1973ff, “Uniformed and Overseas Citizens Absentee Voting Act (UOCAVA).”

Principal Purpose: This form serves as an application for registration and/or request for

absentee ballot for all persons covered by UOCAVA.

Disclosure: Your disclosure of personal information is voluntary. However, failure to

provide the requested personal information may keep the pertinent jurisdiction from

processing this request and may prevent you from voting absentee. 

### For any questions about this form, consult the Voting Assistance

Guide available in hard copy or on FVAP.gov or your Voting

Assistance Officer. Standard Form 76 (Rev. 03-2013)



# Agency Disclosure Statement

The public reporting burden for this collection of information is estimated to average 15 minutes

per response, including the time for reviewing instructions, gathering and maintaining the data

needed, and completing and reviewing the collection of information. Send comments regarding

this burden estimate or any other aspect of this collection of information, including suggestions for

reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive

Services Directorate, Information Management Division, 4800 Mark Center Drive, East Tower,

Suite 02G09, Alexandria, VA 22350-3100. [OMB CONTROL #]. Respondents should be aware

that notwithstanding any other provision of law, no person shall be subject to any penalty for failing

to comply with acollection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ADDRESS ABOVE.