Request Registration/Absentee Ballot

You may not need to fill out this entire form. Check out the instructions below to see what information your Territory 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.

Blocks 2.h through 2.j: Recommended but not required. Provide your contact information to allow your local election official to follow up if more information is required.

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 within the county where you claim legal voting residence.

Block 4.a: Complete address where you want your ballot sent, usually where you live now.

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. The Federal Post Card Application registers you to vote and requests absentee ballots for all regularly scheduled Federal elections for the calendar year in which it is submitted. 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. Provide any information that may assist the local election official in accepting this application.

Block 7: Sign and date. This form must be sworn to by a notary public, consular officer, or other authorized person. (Note: There will be no notary requirements for the 2010 general election or any election for Federal office thereafter)

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.

Open Fax Coversheet

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• If you have not received your absentee ballot in a timely manner use the Federal Write-In Absentee Ballot.