Request Registration/Absentee Ballot
Fill out the Voter Registration/Absentee Ballot Request
You may not need to fill out this entire form. Check out the instructions below to see what information your state requires.
Open Voter Registration/Absentee Ballot Request
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What do I fill in?
Only the following blocks are required:
Block 1: Select the category that describes you.
Block 2.a: Name (Last, First, Middle); Block 2.c: Sex; Block 2.e: Date of Birth
Blocks 2.f and 2.g: Your valid American Samoa Driver's License number or your Social Security number is required for voter registration. If you do not possess either of these identification numbers, American Samoa shall assign a number that will serve to identify you for voter registration purposes.
Block 3.a through 3.e: Complete street address of your American Samoa voting residence. A post office box is not sufficient. If your address includes a rural route, describe its location in Block 6. This address must be different from the one provided in Block 4 and must be within the county where you claim legal voting residence.
Block 4.a: Complete address where you want your ballot sent – usually your current mailing address. It must be different from the address you provided in Block 3.
Block 4.c: American Samoa does not allow you to receive your ballot by fax or email.
Block 6: Enter your age, current place of employment, and a statement that the residence listed in Block 3 was acquired with the intent to make American Samoa your legal residence. Submission of this form serves as a request to receive ballots for all Federal elections held through the next two regularly scheduled general elections. If you do not wish to receive ballots for that length of time, you may request a ballot for each election for Federal office held in the next election year OR a ballot for only the next scheduled election for Federal office by noting your choice here. Provide any additional comments for your election official here.
Block 7: Sign and date. This form must be sworn to by a notary public, consular officer, or other authorized person.
Submission Options
Mail the form to:
Chief Election Officer
P.O. Box 3970
Pago Pago, AS 96799
Don't know your county? Go to the county finder. Don't know your zip code? Go to the United States Postal Service website.
Optional: You may be able to use the Postage-Paid Envelope Template.
Open Postage-Paid Envelope Template
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The postage-paid envelope may be used if mailed in the U.S. Postal System which includes all U.S. military post offices (APO/FPO) overseas or through the diplomatic pouch available at U.S. embassies/consulates. Affix appropriate postage if using international mail. Template must be printed on a number 10 or larger envelope.
If you choose to fax, you MUST also sign and mail your request
Fax
If you choose to fax, it is recommended that you fax the form directly to your local election official (fax numbers can be found on American Samoa Election website). You may also use our toll-free fax service:
Inside the U.S.? Fax to:
1-800-368-8683
(703)-693-5527
DSN 223-5527
Outside the U.S.? Show me a list of toll-free fax numbers.
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Follow-up
- Check the "Important Dates" section at the top of this page for registration, ballot request, and voted ballot return deadlines.
- If you have not received your absentee ballot in a timely manner use the Federal Write-In Absentee Ballot.