Outline
Identity theft can be a distressing experience, leaving victims feeling vulnerable and unsure of how to regain control over their personal information. The FTC Identity Theft Affidavit form serves as a crucial tool for those who have fallen victim to such crimes. This voluntary form allows individuals to file a report with law enforcement, as well as dispute inaccuracies with credit reporting agencies and creditors stemming from identity theft. Completing the affidavit typically takes about ten minutes and requires basic personal information, such as your name, address, and Social Security number. It also includes sections where you can describe the fraud, list any affected accounts, and provide information about the identity thief if known. Before diving into the details of the form, it’s important to first place a fraud alert on your credit reports and review them for any signs of unauthorized activity. The affidavit not only helps document your experience but also assists in the process of clearing your name and restoring your credit. For those who prefer a digital format, a secure online version of the form is available at ftc.gov/idtheft, which can be printed for your records. By understanding how to effectively use this form, victims can take significant steps toward reclaiming their identity and financial well-being.
Sample - Ftc Identity Theft Affidavit Form
Leave (3)
blank until
you provide
this form to
someone with
a legitimate
business need,
like when you
are filing your
report at the
police station
or sending
the form
to a credit
reporting
agency to
correct your
credit report.
Skip (8) - (10)
if your
information
has not
changed since
the fraud.
Now
About You (the victim)
Identity Theft Victim’s Complaint and Affidavit
A voluntary form for filing a report with law enforcement, and disputes with credit reporting agencies and creditors about
identity theft-related problems. Visit ftc.gov/idtheft to use a secure online version that you can print for your records.
Before completing this form:
Place a fraud alert on your credit reports, and review the reports for signs of fraud.1.
Close the accounts that you know, or believe, have been tampered with or opened fraudulently.2.
(1) My full legal name: ________________________________________________
First Middle Last Suffix
(2) My date of birth: __________________
mm/dd/yyyy
(3) My Social Security number: ________-______-__________
(4) My driver’s license: _________ ___________________
State Number
(5) My current street address:
____________________________________________________________________________
Number & Street Name Apartment, Suite, etc.
_______________________________________________________________
City State Zip Code Country
(6) I have lived at this address since ____________________
mm/yyyy
(7) My daytime phone: (____)___________________
My evening phone: (____)___________________
My email: ______________________________________
At the Time of the Fraud
(8) My full legal name was: ____________________________________________
First Middle Last Suffix
(9) My address was: _________________________________________________
Number & Street Name Apartment, Suite, etc.
_______________________________________________________________
City State Zip Code Country
The Paperwork Reduction Act requires the FTC to display a valid control number (in this case, OMB control #3084-0047)
before we can collect – or sponsor the collection of – your information, or require you to provide it.
Average time to complete: 10 minutes
(10) My daytime phone: (____)_________________ My evening phone: (____)_________________
My email: _____________________________________
(11) I did OR did not authorize anyone to use my name or personal information to
obtain money, credit, loans, goods, or services — or for any
other purpose — as described in this report.
(12) I did OR did not receive any money, goods, services, or other benefit as a
result of the events described in this report.
(13) I am OR am not willing to work with law enforcement if charges are brought
against the person(s) who committed the fraud.
(14) I believe the following person used my information or identification
documents to open new accounts, use my existing accounts, or commit other
fraud.
Victim’s Name _______________________________ Phone number (____)_________________ Page 2
Declarations
About You (the victim) (Continued)
(14):
Enter what
you know
about anyone
you believe
was involved
(even if you
don’t have
complete
information).
Name: ___________________________________________________
First Middle Last Suffix
Address: __________________________________________________
Number & Street Name Apartment, Suite, etc.
__________________________________________________________
City State Zip Code Country
Phone Numbers: (____)_______________ (____)________________
Additional information about this person: _____________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
About the Fraud
Victim’s Name _______________________________ Phone number (____)_________________ Page 3
(15) Additional information about the crime (for example, how the identity thief
gained access to your information or which documents or information were
used):
________________________________________________________________
________________________________________________________________
________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
About the Information or Accounts
(17) The following personal information (like my name, address, Social Security number, or date of
birth) in my credit report is inaccurate as a result of this identity theft:
(A) __________________________________________________________________________
(B) __________________________________________________________________________
(C) __________________________________________________________________________
(18) Credit inquiries from these companies appear on my credit report as a result of this identity
theft:
Company Name: _______________________________________________________________
Company Name: _______________________________________________________________
Company Name: _______________________________________________________________
(14) and (15):
Attach
additional
sheets as
needed.
(16): Reminder:
Attach copies
of your identity
documents
when sending
this form to
creditors
and credit
reporting
agencies.
(16) I can verify my identity with these documents:
A valid government-issued photo identification card (for example, my driver’s
license, state-issued ID card, or my passport).
If you are under 16 and don’t have a photo-ID, a copy of your birth certificate or
a copy of your official school record showing your enrollment and legal address is
acceptable.
Proof of residency during the time the disputed charges occurred, the loan
was made, or the other event took place (for example, a copy of a rental/lease
agreement in my name, a utility bill, or an insurance bill).
Documentation
___________________________________________________________________
Name of Institution Contact Person Phone Extension
___________________________________________________________________
Account Number Routing Number Affected Check Number(s)
Account Type: Credit Bank Phone/Utilities Loan
Government Benefits Internet or Email Other
Select ONE:
This account was opened fraudulently.
This was an existing account that someone tampered with.
___________________________________________________________________
Date Opened or Misused (mm/yyyy) Date Discovered (mm/yyyy) Total Amount Obtained ($)
___________________________________________________________________
Name of Institution Contact Person Phone Extension
___________________________________________________________________
Account Number Routing Number Affected Check Number(s)
Account Type: Credit Bank Phone/Utilities Loan
Government Benefits Internet or Email Other
Select ONE:
This account was opened fraudulently.
This was an existing account that someone tampered with.
___________________________________________________________________
Date Opened or Misused (mm/yyyy) Date Discovered (mm/yyyy) Total Amount Obtained ($)
___________________________________________________________________
Name of Institution Contact Person Phone Extension
___________________________________________________________________
Account Number Routing Number Affected Check Number(s)
Account Type: Credit Bank Phone/Utilities Loan
Government Benefits Internet or Email Other
Select ONE:
This account was opened fraudulently.
This was an existing account that someone tampered with.
___________________________________________________________________
Date Opened or Misused (mm/yyyy) Date Discovered (mm/yyyy) Total Amount Obtained ($)
Victim’s Name _______________________________ Phone number (____)_________________ Page 4
(19) Below are details about the different frauds committed using my personal information.
(19):
If there were
more than three
frauds, copy this
page blank, and
attach as many
additional copies
as necessary.
Enter any
applicable
information that
you have, even if
it is incomplete
or an estimate.
If the thief
committed two
types of fraud at
one company,
list the company
twice, giving
the information
about the two
frauds separately.
Contact Person:
Someone you
dealt with, whom
an investigator
can call about this
fraud.
Account Number:
The number of
the credit or
debit card, bank
account, loan, or
other account
that was misused.
Dates: Indicate
when the thief
began to misuse
your information
and when you
discovered the
problem.
Amount Obtained:
For instance,
the total amount
purchased with
the card or
withdrawn from
the account.
Victim’s Name _______________________________ Phone number (____)_________________ Page 5
(20) One way to get a credit reporting agency to quickly block identity theft-
related information from appearing on your credit report is to submit a
detailed law enforcement report (“Identity Theft Report”). You can obtain
an Identity Theft Report by taking this form to your local law enforcement
office, along with your supporting documentation. Ask an officer to witness
your signature and complete the rest of the information in this section. It’s
important to get your report number, whether or not you are able to file in
person or get a copy of the official law enforcement report. Attach a copy of
any confirmation letter or official law enforcement report you receive when
sending this form to credit reporting agencies.
Select ONE:
I have not filed a law enforcement report.
I was unable to file any law enforcement report.
I filed an automated report with the law enforcement agency listed
below.
I filed my report in person with the law enforcement
officer and agency listed below.
____________________________________________________________________
Law Enforcement Department State
____________________________ _____________________
Report Number Filing Date (mm/dd/yyyy)
____________________________________________________________________
Officer’s Name (please print) Officer’s Signature
____________________________ (____)_______________
Badge Number Phone Number
Did the victim receive a copy of the report from the law enforcement officer? Yes OR No
Victim’s FTC complaint number (if available): ________________________
Your Law Enforcement Report
(20):
Check “I have
not...” if you have
not yet filed a
report with law
enforcement or
you have chosen
not to. Check “I
was unable...” if
you tried to file
a report but law
enforcement
refused to take it.
Automated report:
A law
enforcement
report filed
through an
automated
system, for
example, by
telephone, mail,
or the Internet,
instead of a
face-to-face
interview with a
law enforcement
officer.
As applicable, sign and date IN THE PRESENCE OF a law enforcement officer, a notary, or
a witness.
(21) I certify that, to the best of my knowledge and belief, all of the information on and attached to
this complaint is true, correct, and complete and made in good faith. I understand that this
complaint or the information it contains may be made available to federal, state, and/or local
law enforcement agencies for such action within their jurisdiction as they deem appropriate. I
understand that knowingly making any false or fraudulent statement or representation to the
government may violate federal, state, or local criminal statutes, and may result in a fine,
imprisonment, or both.
_______________________________________ _________________________________________
Signature Date Signed (mm/dd/yyyy)
Signature
(22) If you do not choose to file a report with law enforcement, you may use this form as an Identity
Theft Affidavit to prove to each of the companies where the thief misused your information that
you are not responsible for the fraud. While many companies accept this affidavit, others require
that you submit different forms. Check with each company to see if it accepts this form. You
should also check to see if it requires notarization. If so, sign in the presence of a notary. If it
does not, please have one witness (non-relative) sign that you completed and signed this Affidavit.
_______________________________________
Notary
Witness:
_______________________________________ _________________________________________
Signature Printed Name
_______________________________________ _________________________________________
Date Telephone Number
Your Affidavit
Victim’s Name _______________________________ Phone number (____)_________________ Page 6
Form Information
| Fact Name | Details |
|---|---|
| Average Completion Time | 10 minutes |
| Purpose of the Form | This form allows victims to report identity theft to law enforcement and dispute fraudulent charges with creditors and credit reporting agencies. |
| Online Access | Victims can complete a secure online version of the form at ftc.gov/idtheft and print it for their records. |
| Fraud Alert Requirement | Before completing the form, victims should place a fraud alert on their credit reports and review them for signs of fraud. |
| Documentation Needed | Victims must provide a valid government-issued ID and proof of residency during the time of the fraud. |
| Law Enforcement Report | Victims can obtain an Identity Theft Report by visiting local law enforcement, which helps in blocking identity theft-related information from credit reports. |
Detailed Guide for Filling Out Ftc Identity Theft Affidavit
Filling out the FTC Identity Theft Affidavit form is an important step in addressing identity theft issues. After completing the form, you can use it to file a report with law enforcement and to dispute any fraudulent charges with credit reporting agencies and creditors. It is crucial to provide accurate information to ensure proper handling of your case.
- Start by entering your full legal name in the designated section, including your first, middle, last name, and suffix if applicable.
- Provide your date of birth in the format mm/dd/yyyy.
- Fill in your Social Security number, ensuring you follow the format provided.
- Input your driver’s license number and the state it was issued in.
- Write your current street address, including apartment or suite number, city, state, zip code, and country.
- Indicate how long you have lived at this address by entering the date in mm/yyyy format.
- List your daytime and evening phone numbers, along with your email address. Leave the Social Security number and email sections blank until you provide the form to someone with a legitimate business need.
- If your information has changed since the fraud, provide your full legal name and address at the time of the fraud.
- State whether you authorized anyone to use your personal information and whether you received any money or benefits as a result of the fraud.
- Identify the person you believe used your information, providing their name, address, and any additional information you have.
- Describe how the identity thief gained access to your information and which documents were used.
- List the documents you can provide to verify your identity, such as a government-issued photo ID or proof of residency.
- Identify any inaccurate personal information in your credit report due to the identity theft.
- List the companies that made credit inquiries as a result of the identity theft.
- Detail any fraudulent accounts or tampered accounts, including the name of the institution, account numbers, and the type of fraud committed.
- Indicate whether you have filed a law enforcement report, and provide the necessary details if applicable.
Obtain Answers on Ftc Identity Theft Affidavit
-
What is the FTC Identity Theft Affidavit form?
The FTC Identity Theft Affidavit is a voluntary form that helps individuals report identity theft. It serves multiple purposes, including filing a report with law enforcement and disputing issues with credit reporting agencies and creditors. By using this form, victims can document their experiences and take steps to resolve the problems caused by identity theft.
To access a secure online version of the affidavit that you can print for your records, visit ftc.gov/idtheft.
-
How long does it take to complete the form?
On average, it takes about 10 minutes to complete the FTC Identity Theft Affidavit form. This time may vary depending on the complexity of your situation and the amount of information you need to provide. It’s essential to gather all necessary documents and details beforehand to streamline the process.
-
What should I do before filling out the form?
Before you start filling out the FTC Identity Theft Affidavit, take the following steps:
- Place a fraud alert on your credit reports to warn creditors that your information may have been compromised.
- Review your credit reports for any signs of fraud or unauthorized activity.
- Close any accounts that you know or suspect have been tampered with or opened fraudulently.
These actions will help protect your identity and make the affidavit process more effective.
-
How can I verify my identity when submitting the form?
To verify your identity when submitting the FTC Identity Theft Affidavit, you will need to provide certain documents. Acceptable forms of identification include:
- A valid government-issued photo ID, such as a driver's license, state-issued ID card, or passport.
- If you are under 16 and do not have a photo ID, you can use a copy of your birth certificate or an official school record showing your enrollment and legal address.
Additionally, you should provide proof of residency during the time the disputed charges occurred. This could include a rental or lease agreement, a utility bill, or an insurance bill. Remember to attach copies of these documents when sending the form to creditors and credit reporting agencies.
Common mistakes
Filling out the FTC Identity Theft Affidavit form can be a crucial step in addressing identity theft. However, there are common mistakes that individuals often make, which can hinder their ability to resolve issues effectively. Understanding these pitfalls can help ensure that the process goes smoothly.
One significant mistake is not placing a fraud alert on credit reports before completing the form. This step is essential because it alerts creditors to take extra precautions when verifying identity. Failing to do this can lead to further fraudulent activity while the affidavit is being processed.
Another error is leaving required fields blank. Each section of the form is designed to gather specific information that helps law enforcement and credit agencies understand the situation. Omitting details such as your full legal name, Social Security number, or contact information can delay the investigation and resolution.
People also often skip providing documentation to verify their identity. The form requires proof, such as a government-issued ID or proof of residency, to substantiate claims. Without these documents, agencies may not take the report seriously, which could prolong the resolution process.
Inaccurate information about the fraud itself is another common mistake. When detailing how the identity thief gained access to personal information, individuals sometimes provide vague or incomplete descriptions. This lack of clarity can lead to misunderstandings and ineffective responses from law enforcement or credit agencies.
Additionally, failing to attach supporting documents can significantly weaken a case. The affidavit encourages individuals to include any relevant paperwork, such as bank statements or correspondence with creditors. Without these attachments, the claim may lack the necessary evidence to support it.
Another frequent oversight is not following up on the law enforcement report. After submitting the affidavit, individuals should ensure they have a copy of the report and any confirmation letters. This documentation is vital for communicating with credit reporting agencies and can expedite the blocking of fraudulent information.
Lastly, some individuals mistakenly do not keep copies of the completed affidavit. Retaining a copy for personal records is essential, as it serves as a reference for future communications with law enforcement or creditors. Not having this information readily available can complicate the process of resolving identity theft issues.
Documents used along the form
When dealing with identity theft, completing the FTC Identity Theft Affidavit form is just one step in a larger process. Several other forms and documents often accompany this affidavit to help victims navigate the complexities of restoring their identity and securing their financial future. Below is a list of essential documents that can aid in this effort.
- Police Report: This document is generated when you report the crime to law enforcement. It serves as an official record of the identity theft incident and is often required by creditors and credit reporting agencies to verify the claim.
- Credit Report: Obtaining a copy of your credit report is crucial. It allows you to review your accounts and identify any fraudulent activity. You are entitled to one free report per year from each of the major credit bureaus.
- Fraud Alert Request: Placing a fraud alert on your credit reports notifies creditors to take extra steps to verify your identity before opening new accounts. This request can typically be made online or by phone with the credit bureaus.
- Identity Theft Report: This is a more detailed report that combines the FTC affidavit and the police report. It is essential for disputing fraudulent accounts and can help in recovering losses.
- Dispute Letters: These letters are sent to creditors and credit reporting agencies to dispute fraudulent charges or accounts. They should include details about the fraudulent activity and a request for correction.
- Proof of Identity Documents: These may include copies of your driver’s license, Social Security card, or utility bills. They help verify your identity when filing reports or disputing charges.
- Identity Theft Recovery Plan: This is a personal document outlining the steps you plan to take to recover from identity theft. It may include timelines, contacts, and actions needed to restore your credit and identity.
Each of these documents plays a vital role in the process of recovering from identity theft. By gathering and organizing them, victims can better navigate the challenges ahead and work towards regaining control over their personal information and financial health.
Similar forms
- Identity Theft Report: This document serves as an official record of the identity theft incident. It is typically filed with law enforcement and can be used to support claims with credit reporting agencies, similar to the FTC Identity Theft Affidavit.
- Fraud Affidavit: This form is used to report fraudulent activity to financial institutions. Like the FTC affidavit, it helps victims dispute unauthorized charges and accounts.
- Credit Report Dispute Letter: This letter is sent to credit reporting agencies to dispute inaccuracies on a credit report. It functions similarly to the FTC affidavit by providing a formal mechanism to address identity theft-related discrepancies.
- Police Report: Filing a police report is essential for documenting the crime. It can be used alongside the FTC affidavit to establish proof of identity theft when dealing with creditors and credit bureaus.
- Fraud Alert Request: A request to place a fraud alert on a credit report is a proactive measure. This document notifies creditors to take extra steps to verify identity before granting credit, similar to the protective measures outlined in the FTC affidavit.
- Credit Freeze Request: This request prevents new credit accounts from being opened in the victim's name. It aligns with the FTC affidavit's purpose of safeguarding against further identity theft.
- Victim Impact Statement: This statement details the emotional and financial impact of identity theft on the victim. While not a formal legal document, it can accompany the FTC affidavit to provide context and support for claims made to creditors and agencies.
Dos and Don'ts
When filling out the FTC Identity Theft Affidavit form, it's essential to approach the process with care. Here are seven things you should and shouldn't do:
- Do place a fraud alert on your credit reports before completing the form.
- Do review your credit reports for any signs of fraudulent activity.
- Do close any accounts that you suspect have been tampered with.
- Do provide accurate and complete personal information as requested.
- Don't leave any required fields blank; ensure everything is filled out to the best of your ability.
- Don't forget to attach copies of your identity documents when submitting the form.
- Don't hesitate to seek assistance if you have questions about the form or the process.
By following these guidelines, you can help ensure that your affidavit is processed smoothly and effectively.
Misconceptions
There are several misconceptions regarding the FTC Identity Theft Affidavit form. Understanding these misconceptions can help individuals navigate the process more effectively. Below are eight common misunderstandings:
- Misconception 1: The affidavit is mandatory for all identity theft cases.
- Misconception 2: Completing the affidavit automatically resolves identity theft issues.
- Misconception 3: You must file a police report before submitting the affidavit.
- Misconception 4: The affidavit is only for financial identity theft.
- Misconception 5: You can only use the affidavit once.
- Misconception 6: The affidavit guarantees a quick resolution with credit reporting agencies.
- Misconception 7: You do not need to provide documentation when submitting the affidavit.
- Misconception 8: The affidavit can be completed without any personal information.
The FTC Identity Theft Affidavit is a voluntary form. While it is helpful for disputing fraudulent charges and filing reports, it is not legally required for every case of identity theft.
Filling out the affidavit does not guarantee that all issues will be resolved. It serves as a tool to assist in reporting and disputing fraud, but further action may be necessary.
The FTC Identity Theft Affidavit can be used for various types of identity theft, including medical identity theft and criminal identity theft, not just financial fraud.
The affidavit can be used multiple times. Individuals may need to submit it to different creditors or agencies as they address various aspects of the identity theft.
Key takeaways
Key Takeaways for Filling Out the FTC Identity Theft Affidavit Form:
- The average time to complete the form is approximately 10 minutes.
- This form serves as a voluntary report for law enforcement and assists in disputes with credit reporting agencies.
- Before filling out the affidavit, place a fraud alert on your credit reports and review them for any signs of fraud.
- It is crucial to close any accounts that may have been tampered with or opened fraudulently.
- Provide accurate personal information, including your full legal name, date of birth, and Social Security number.
- Document any fraudulent activity by detailing how your information was misused and what documents were involved.
- Attach copies of your identity verification documents when submitting the form to creditors and credit reporting agencies.
- Obtaining a law enforcement report can expedite the process of blocking fraudulent information from your credit report.