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The FTC Identity Theft Affidavit form serves as a crucial tool for individuals who have fallen victim to identity theft. This voluntary form allows victims to report their experiences to law enforcement and to dispute fraudulent activities with credit reporting agencies and creditors. Completing the form typically takes around ten minutes, making it a manageable task for those in distress. Before filling it out, victims are advised to place a fraud alert on their credit reports and review those reports for any signs of unauthorized activity. The affidavit requires personal information, including the victim's full legal name, date of birth, and Social Security number, as well as details about the fraudulent activities they have encountered. It also prompts victims to provide information about any individuals they suspect may have been involved in the identity theft. Additionally, supporting documentation, such as government-issued identification and proof of residency, is necessary to verify identity and substantiate claims. By utilizing this form, victims can take significant steps toward reclaiming their identity and addressing the consequences of identity theft.

Sample - Ftc Identity Theft Affidavit Form

Average time to complete: 10 minutes

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:

1.Place a fraud alert on your credit reports, and review the reports for signs of fraud.

2.Close the accounts that you know, or believe, have been tampered with or opened fraudulently.

About You (the victim)

Now

(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 NameApartment, 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: ______________________________________

Leave (3) blank until you provide this form to someone with

alegitimate 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.

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.

Skip (8) - (10) if your information has not changed since the fraud.

_______________________________________________________________

City

State

Zip Code

Country

(10)My daytime phone: (____)_________________ My evening phone: (____)_________________

My email: _____________________________________

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.

Victim’s Name _______________________________ Phone number (____)_________________ Page 2

About You (the victim) (Continued)

Declarations

(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.

About the Fraud

(14) I believe the following person used my information or identification

(14):

Enter what

documents to open new accounts, use my existing accounts, or commit other

you know

fraud.

 

 

 

about anyone

 

 

 

 

you believe

Name: ___________________________________________________

was involved

(even if you

First

Middle

Last

Suffix

don’t have

 

 

 

 

Address: __________________________________________________

complete

information).

Number & Street Name

Apartment, Suite, etc.

 

__________________________________________________________

 

City

State

Zip Code

Country

 

Phone Numbers: (____)_______________ (____)________________

Additional information about this person: _____________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

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):

________________________________________________________________

________________________________________________________________

________________________________________________________________

(14)and (15): Attach additional sheets as needed.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Documentation

(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).

(16): Reminder: Attach copies of your identity documents when sending this form to creditors

and credit reporting agencies.

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: _______________________________________________________________

Victim’s Name _______________________________ Phone number (____)_________________ Page 4

(19)Below are details about the different frauds committed using my personal information.

___________________________________________________________________

Name of InstitutionContact 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 InstitutionContact 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 InstitutionContact 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 ($)

(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

Your Law Enforcement Report

(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 DepartmentState

____________________________

_____________________

Report Number

Filing Date (mm/dd/yyyy)

(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:

Alaw 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.

____________________________________________________________________

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): ________________________

 

 

Victim’s Name _______________________________ Phone number (____)_________________ Page 6

Signature

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)

Your Affidavit

(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

File Specs

Fact Name Details
Average Completion Time The average time to complete the FTC Identity Theft Affidavit form is about 10 minutes.
Purpose of the Form This form serves as a complaint and affidavit for identity theft victims to file reports with law enforcement and dispute issues with creditors.
Online Access Individuals can visit ftc.gov/idtheft to access a secure online version of the form that can be printed for personal records.
Fraud Alert Requirement Before completing the form, it is advised to place a fraud alert on credit reports and review them for any signs of fraud.
Documentation Needed Victims must provide valid government-issued ID and proof of residency during the time of the disputed events.
Law Enforcement Report Submitting a law enforcement report can help block identity theft-related information from appearing on credit reports.
Control Number The form displays a valid control number (OMB control #3084-0047) as required by the Paperwork Reduction Act.
Victim Information The form requires detailed information about the victim, including their full name, address, and contact information.
State-Specific Forms Each state may have its own laws regarding identity theft. It's important to check local regulations for specific requirements.

Ftc Identity Theft Affidavit - Usage Guidelines

If you believe you have been a victim of identity theft, filling out the FTC Identity Theft Affidavit form is a crucial step in addressing the situation. This form will help you report the identity theft to law enforcement and assist in disputing fraudulent charges with credit reporting agencies. Follow the steps below carefully to ensure you provide all necessary information.

  1. Gather your personal information, including your full legal name, date of birth, Social Security number, and driver’s license number.
  2. Write down your current street address, including city, state, zip code, and country.
  3. Indicate how long you have lived at your current address.
  4. Provide your daytime and evening phone numbers, along with your email address. Leave the Social Security number blank until you submit the form to a legitimate entity.
  5. If your information has changed since the fraud, fill in your full legal name, previous address, and phone numbers at the time of the fraud.
  6. Answer the declarations regarding whether you authorized anyone to use your personal information and if you received any benefits as a result of the fraud.
  7. Provide information about the person you believe used your information, including their name and address, if known.
  8. Describe how the identity thief gained access to your information and any relevant documents or information used.
  9. List the documents you can provide to verify your identity, such as a government-issued photo ID or proof of residency.
  10. Identify any inaccuracies in your credit report that resulted from the identity theft.
  11. List the companies that made credit inquiries on your report due to the identity theft.
  12. Detail the fraudulent accounts, including the name of the institution, account numbers, and whether the accounts were opened fraudulently or tampered with.
  13. If applicable, copy the fraud details page for additional accounts and fill it out as needed.
  14. Complete the section regarding your law enforcement report, including the department, report number, and filing date. If you haven’t filed a report yet, indicate that on the form.
  15. Have a law enforcement officer witness your signature and complete their section of the form.

After completing the form, ensure you keep a copy for your records. You may need to submit this affidavit to law enforcement and credit reporting agencies to resolve any issues related to the identity theft. Act quickly to protect your identity and financial well-being.

Your Questions, Answered

What is the FTC Identity Theft Affidavit form?

The FTC Identity Theft Affidavit form is a voluntary document that helps victims of identity theft report their situation. It can be used to file a report with law enforcement and to dispute issues with credit reporting agencies and creditors. This form is designed to streamline the process of addressing identity theft-related problems.

How long does it take to complete the form?

On average, completing the FTC Identity Theft Affidavit form takes about 10 minutes. The time may vary depending on how much information you need to provide. Having your personal information and documentation ready can help speed up the process.

What should I do before filling out the form?

Before you start filling out the form, it’s important to take a few preliminary steps. First, place a fraud alert on your credit reports. This will notify potential creditors to take extra steps to verify your identity. Next, review your credit reports for any signs of fraud. Finally, close any accounts that you believe have been tampered with or opened fraudulently.

What documents do I need to provide with the affidavit?

You will need to verify your identity with certain documents. A valid government-issued photo ID, like a driver’s license or passport, is required. If you are under 16 and do not have a photo ID, you can provide a copy of your birth certificate or an official school record. Additionally, proof of residency during the time the disputed charges occurred is necessary. This could be a utility bill, rental agreement, or insurance bill.

How do I submit the FTC Identity Theft Affidavit form?

You can submit the completed form to law enforcement and credit reporting agencies. If you file a report with law enforcement, ask an officer to witness your signature on the affidavit. Attach any supporting documentation, including a copy of the law enforcement report, when sending the form to credit reporting agencies. For added convenience, you can also use the secure online version available at ftc.gov/idtheft.

Common mistakes

  1. Incomplete Personal Information: Failing to provide all necessary details about yourself, such as your full legal name, date of birth, or Social Security number, can lead to delays in processing your affidavit.

  2. Incorrect Contact Information: Entering wrong phone numbers or email addresses may hinder communication with law enforcement or credit reporting agencies.

  3. Neglecting to Place a Fraud Alert: Not placing a fraud alert on your credit reports before filling out the affidavit can result in missed opportunities to prevent further identity theft.

  4. Omitting Documentation: Failing to attach necessary documents, such as proof of identity or residency, can weaken your case and lead to rejection of your affidavit.

  5. Inaccurate Information About the Fraud: Providing incorrect details about the fraudulent activity, including names or account numbers, can complicate investigations.

  6. Not Following Up with Law Enforcement: After submitting the affidavit, neglecting to obtain a law enforcement report or confirmation can hinder your ability to dispute fraudulent charges effectively.

  7. Ignoring Additional Information: Failing to provide all relevant details about how the fraud occurred or additional individuals involved can limit the effectiveness of your report.

Documents used along the form

The FTC Identity Theft Affidavit form is an essential tool for individuals who have experienced identity theft. It serves as a formal complaint to law enforcement and helps victims dispute fraudulent activity with credit reporting agencies and creditors. In addition to this affidavit, there are several other documents that can assist in addressing the aftermath of identity theft. Below is a list of related forms and documents commonly used in conjunction with the FTC Identity Theft Affidavit.

  • Law Enforcement Report: This document is created when you file a report with local law enforcement about the identity theft. It provides official documentation of the crime and can be used to support your claims with creditors and credit reporting agencies.
  • Credit Report Dispute Letter: This letter is sent to credit reporting agencies to formally dispute inaccuracies on your credit report resulting from identity theft. It details the specific errors and requests corrections.
  • Fraud Alert Request Form: This form is used to place a fraud alert on your credit report. A fraud alert warns creditors to take extra steps to verify your identity before opening new accounts in your name.
  • Credit Freeze Request Form: A credit freeze restricts access to your credit report, making it more difficult for identity thieves to open accounts in your name. This form is submitted to credit bureaus to initiate the freeze.
  • Identity Theft Report: Similar to the law enforcement report, this document can be generated through the FTC's online platform. It serves as an official record of the identity theft incident and can be used for disputes.
  • Affidavit of Identity Theft: This is a sworn statement that provides details about the identity theft incident. It can be used in conjunction with the FTC affidavit to reinforce your claims.
  • Victim Impact Statement: This document outlines the emotional and financial impact of identity theft on the victim. It can be useful in legal proceedings or when seeking restitution.

These documents collectively support the victim's efforts to regain control over their identity and rectify any damage caused by identity theft. Having them on hand can streamline the process of resolving issues with creditors and credit reporting agencies.

Similar forms

The FTC Identity Theft Affidavit form shares similarities with the police report. A police report serves as an official document that records the details of a crime, including identity theft. Like the affidavit, it requires the victim to provide personal information and details about the incident. Both documents can be used to support claims with credit reporting agencies and creditors. A police report is often necessary to initiate investigations and can help victims in disputing fraudulent charges.

Another document that resembles the FTC Identity Theft Affidavit is the credit dispute letter. This letter is sent to credit reporting agencies when a consumer identifies inaccuracies in their credit report. Similar to the affidavit, it requires the victim to provide personal details and specifics about the disputed information. Both documents aim to rectify credit report errors stemming from identity theft, ensuring that victims can reclaim their financial standing.

The identity theft report is another document akin to the FTC affidavit. This report is generated when a victim files a complaint with law enforcement regarding identity theft. It includes details about the crime and serves as a formal record. Like the affidavit, it is used to assist in disputing fraudulent accounts and can be submitted to credit bureaus to expedite the process of clearing the victim’s credit history.

The fraud alert request is similar in purpose to the FTC Identity Theft Affidavit. When a victim places a fraud alert on their credit report, it notifies creditors to take extra steps to verify identity before issuing credit. This document requires personal information and serves as a proactive measure to prevent further identity theft. Both the alert and the affidavit work together to protect the victim’s financial identity.

The credit freeze request form also parallels the FTC Identity Theft Affidavit. A credit freeze prevents new creditors from accessing a consumer's credit report, making it more difficult for identity thieves to open accounts in the victim's name. Like the affidavit, it requires personal information and serves to protect the victim from ongoing fraud. Both documents are crucial tools for managing the aftermath of identity theft.

The identity theft protection service agreement is another related document. This agreement is established when a victim enrolls in a service that monitors their credit and personal information. Similar to the affidavit, it requires personal details and outlines the services provided to help mitigate the effects of identity theft. Both documents aim to safeguard the victim’s identity and restore their financial security.

The credit monitoring service report is comparable to the FTC Identity Theft Affidavit as well. This report provides ongoing updates about changes in the victim's credit report, alerting them to potential fraudulent activity. Like the affidavit, it focuses on identifying and addressing issues related to identity theft. Both documents are essential for maintaining awareness and taking action against fraud.

The statement of unauthorized use is another document that shares similarities with the FTC Identity Theft Affidavit. This statement is often submitted to financial institutions when a victim identifies transactions made without their consent. It requires personal information and details about the unauthorized use, just as the affidavit does. Both documents are used to dispute fraudulent charges and protect the victim's financial interests.

The victim impact statement can also be compared to the FTC Identity Theft Affidavit. This document allows victims to express the emotional and financial toll of identity theft. While it serves a different purpose, it still requires personal details and relates to the broader context of the victim’s experience. Both documents highlight the consequences of identity theft and support the victim’s case in seeking justice or restitution.

Lastly, the consumer complaint form filed with the FTC is similar to the FTC Identity Theft Affidavit. This form allows victims to report identity theft and other consumer issues directly to the Federal Trade Commission. It requires personal information and details about the fraudulent activity. Both documents serve to notify authorities and provide a record of the victim’s experience, facilitating further action against identity theft.

Dos and Don'ts

When filling out the FTC Identity Theft Affidavit form, there are several important guidelines to follow. The following list outlines what you should and should not do to ensure the process goes smoothly.

  • 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 on the form.
  • Do attach copies of necessary documents to verify your identity.
  • Do keep a copy of the completed affidavit for your records.
  • Do include any relevant details about the fraud, such as how your information was accessed.
  • Do follow up with law enforcement to obtain your report number.
  • Don’t leave any sections of the form blank unless instructed to do so.
  • Don’t submit the form without verifying that all information is correct.

By adhering to these guidelines, you can help ensure that your affidavit is processed efficiently and effectively.

Misconceptions

Misconceptions about the FTC Identity Theft Affidavit form can lead to confusion and hinder the process of addressing identity theft. Here are eight common misconceptions, along with clarifications:

  • The affidavit is mandatory for all identity theft cases. Many believe that completing the affidavit is a requirement for all identity theft situations. In reality, it is a voluntary form that aids in filing a report with law enforcement and disputing fraudulent activity.
  • Filing the affidavit guarantees a quick resolution. Some individuals expect immediate results after submitting the affidavit. However, the process can take time, as law enforcement and credit agencies need to investigate and process the information provided.
  • The affidavit can only be submitted in person. There is a misconception that the affidavit must be delivered in person. The form can also be submitted online or via mail, providing flexibility for victims.
  • All personal information must be filled out completely. Victims may feel pressured to provide every detail. If certain information has not changed since the fraud, it is acceptable to skip those sections.
  • The affidavit replaces the need for a police report. Some think that completing the affidavit eliminates the need for a law enforcement report. In fact, a law enforcement report is often necessary for creditors and credit reporting agencies to take action.
  • Only one affidavit is needed for multiple incidents. Victims may assume that one affidavit suffices for all cases of identity theft. Each incident may require separate documentation and details to ensure proper handling.
  • The affidavit is only for financial fraud. Many believe the affidavit only addresses credit-related issues. However, it can also be used for various types of identity theft, including medical fraud and criminal identity theft.
  • Once submitted, the affidavit cannot be amended. There is a belief that the affidavit is final once submitted. Victims can amend or add information if new details arise or if they realize they omitted something important.

Key takeaways

Filling out the FTC Identity Theft Affidavit form can be a crucial step in reclaiming your identity and addressing the consequences of identity theft. Here are some key takeaways to keep in mind:

  • Understand the Purpose: This form serves as a voluntary report for law enforcement and helps you dispute fraudulent charges with creditors and credit reporting agencies.
  • Time Commitment: Expect to spend about 10 minutes completing the form, so set aside a quiet moment to focus.
  • Start with a Fraud Alert: Before filling out the form, place a fraud alert on your credit reports and review them for any signs of unauthorized activity.
  • Document Your Identity: Be prepared to provide your full legal name, date of birth, Social Security number, and current address. Accurate information is essential.
  • Include Previous Information: If your personal information has changed since the fraud occurred, include both your previous and current details in the form.
  • Specify Authorizations: Clearly indicate whether you authorized anyone to use your personal information. This helps clarify the situation for law enforcement.
  • Gather Supporting Documents: Attach copies of documents that verify your identity, such as a government-issued ID and proof of residency, when submitting the form.
  • Provide Detailed Information: Include as much detail as possible about the fraud, including how the thief accessed your information and any fraudulent accounts opened in your name.
  • Follow Up with Law Enforcement: Consider obtaining a law enforcement report, as it can help expedite the process of blocking fraudulent information from your credit report.

Completing the FTC Identity Theft Affidavit form is an important step in protecting your identity and financial future. By following these takeaways, you can navigate the process more effectively and take control of your situation.