Complete Back-up Federal Write-In Absentee Ballot

If you requested an absentee ballot but have not yet received it, you can still vote by using the back-up Federal Write-In Absentee Ballot (FWAB).

In order to be eligible to use this back-up ballot, you must:

• You must be a registered voter; AND
• Have applied for a regular ballot so the request is received by your local election official by the State deadline; or 30 days before the general election; AND
• Have not received the requested regular absentee ballot from the State.

American Samoa allows you to use the FWAB for voting in general elections for Federal office.

Open Back-up Federal Write-In Absentee Ballot

(Opens in a new window and requires Adobe Reader 7)

What do I fill in?

Only the following blocks of the Voter's Declaration/Affirmation are required:

Block 1: American Samoa does not allow you to use this form for registration. Do not check the registration block.

Block 2: Select the category that describes you.

Block 3: Name (Last, First, Middle)

Block 4: Sex

Date of Birth

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 5: Recommended but not required. Provide your contact information to allow your local election official to follow up if more information is required.

Block 7: 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 9. This address must be within the county where you claim legal voting residence.

Block 8: Complete address where you want your ballot sent, usually where you live now.

Block 9: Provide any information that may assist the local election official in accepting this ballot or application.

Affirmation: Sign and date. No witness or notary required.

Once the ballot is complete, fold and place it in the security envelope and seal. Place only the voted ballot in the security envelope and do not write on the security envelope. Insert the sealed security envelope and the Voter's Declaration/Affirmation into the mailing envelope and seal.

Envelope Templates

Open Security Envelope Template

Open Postage-Paid Envelope Template

(Opens in a new window and requires Adobe Reader 7)

The postage-paid envelope may be used 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

Mail

You must mail your back-up Federal Write-In Absentee Ballot to:

Chief Election Officer
P.O. Box 3970
Pago Pago, AS 96799

• If you receive your State absentee ballot after submitting your Federal Write-In Absentee Ballot, fill it out and return it. The State absentee ballot will be counted instead of the back-up ballot if it's received in time.