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Blank Ftc Identity Theft Affidavit PDF Form

The FTC Identity Theft Affidavit form serves as a vital tool for individuals who have fallen victim to identity theft. This voluntary form allows victims to report their situation to law enforcement and dispute inaccuracies with credit reporting agencies and creditors. Completing this form is an essential step in reclaiming control over one's personal information and mitigating the effects of identity theft; start the process by filling out the form below.

Article Guide

Identity theft is an increasingly prevalent issue, and for victims, navigating the aftermath can feel overwhelming. The Federal Trade Commission (FTC) provides a vital resource in the form of the Identity Theft Affidavit, a tool designed to assist individuals in reporting their experiences to law enforcement and disputing fraudulent activity with credit reporting agencies. This voluntary form takes approximately ten minutes to complete and serves as a structured way for victims to document their claims. By filling out the affidavit, individuals can provide crucial information about their identity and the nature of the fraud, including personal details such as their full legal name, Social Security number, and the specifics of the fraudulent activity. Importantly, the form also prompts users to take preliminary steps, like placing a fraud alert on their credit reports and closing compromised accounts, before submission. Once completed, the affidavit can be printed for personal records or submitted online through the FTC’s secure portal. This article will delve into the nuances of the FTC Identity Theft Affidavit, outlining its components, the process of completion, and the essential role it plays in helping victims reclaim their identities and restore their financial standing.

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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
Name: ___________________________________________________				(even if you
First	Middle	Last	Suffix	(even if you
First	Middle	Last	Suffix	don’t have
				don’t have
Address: __________________________________________________				complete
Address: __________________________________________________				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: _______________________________________________________________

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

➤ PDF File

Form Specifications

Fact Name	Fact Details
Average Completion Time	The form takes about 10 minutes to complete.
Purpose	This form helps victims report identity theft to law enforcement and dispute issues with credit agencies.
Online Version	A secure online version is available at ftc.gov/idtheft for easy access and printing.
Fraud Alert Requirement	Before filling out the form, place a fraud alert on your credit reports.
Documentation Needed	Victims must provide proof of identity and residency, such as a driver’s license or utility bill.
Affidavit Declaration	Victims declare whether they authorized the use of their information or received benefits from the fraud.
Law Enforcement Report	Victims can obtain a detailed law enforcement report to help block identity theft-related information.
Control Number	The FTC must display a valid control number (OMB control #3084-0047) for information collection.
State-Specific Forms	Some states may have specific forms or laws governing identity theft reporting.
Additional Information	Victims can attach extra sheets if more details about the fraud are necessary.

Ftc Identity Theft Affidavit: Usage Guidelines

Filling out the FTC Identity Theft Affidavit form is a crucial step for individuals who have experienced identity theft. Completing this form allows victims to report the incident to law enforcement and helps in disputing fraudulent activities with credit reporting agencies. After filling out the form, it is essential to submit it to the appropriate authorities and keep copies for your records.

Begin by placing a fraud alert on your credit reports and reviewing them for any signs of fraud.
Close any accounts that you suspect have been tampered with or opened fraudulently.
In the section labeled "About You (the victim)," provide your full legal name, date of birth, Social Security number, driver’s license information, current address, and contact numbers. Leave the Social Security number blank until you provide the form to someone who needs it.
If your information has changed since the fraud, fill in your previous full legal name, address, and contact numbers in the "At the Time of the Fraud" section.
Indicate whether you authorized anyone to use your personal information and whether you received any benefits from the fraud.
Provide details about the individual you believe used your information, including their name, address, and any additional information you may have.
Describe how the identity thief accessed your information and which documents were used in the fraud.
List any documents you can provide to verify your identity, such as a government-issued photo ID or proof of residency.
In the "About the Information or Accounts" section, note any inaccurate personal information on your credit report and list companies that made inquiries as a result of the identity theft.
Detail the different frauds committed using your personal information, including the name of the institution, account number, and any relevant dates.
If you have filed a law enforcement report, provide the details of the agency, report number, and filing date. If not, indicate your status regarding filing a report.
Ask a law enforcement officer to witness your signature and complete their section of the form.
Keep copies of the completed form and any supporting documents for your records before submitting them to the relevant authorities.

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 to law enforcement and dispute inaccuracies with credit reporting agencies and creditors. It serves as a formal complaint and provides a structured way for individuals to document their experiences and the fraud they have encountered.

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 the individual's situation and the amount of information they need to provide.

What should I do before filling out the form?

Before completing the FTC Identity Theft Affidavit, it is important to take a few preliminary steps. First, place a fraud alert on your credit reports to notify creditors of potential identity theft. Next, review your credit reports for any signs of fraudulent activity. Finally, close any accounts that you believe have been tampered with or opened fraudulently.

Who should fill out the form?

The form should be filled out by the victim of identity theft. This includes anyone whose personal information has been misused to obtain money, credit, or services without their consent. It is essential for the victim to provide accurate and complete information to support their case.

What information do I need to provide on the form?

The form requires various personal details, including your full legal name, date of birth, Social Security number, and current address. Additionally, you will need to provide information about the fraudulent activities, any individuals you believe were involved, and documentation to verify your identity.

What if my information has changed since the fraud occurred?

If your personal information has changed since the fraud occurred, you should provide your previous information in the designated sections of the form. This helps law enforcement and credit agencies understand the timeline and context of the identity theft.

How can I verify my identity when submitting the form?

You can verify your identity by providing a valid government-issued photo identification card, such as a driver's license or passport. If you are under 16 and do not have a photo ID, a copy of your birth certificate or school record can suffice. Be sure to attach copies of these documents when sending the form to creditors and credit reporting agencies.

What should I do after completing the form?

After completing the FTC Identity Theft Affidavit, you should submit it to your local law enforcement agency to file a report. It is also advisable to send copies of the form to credit reporting agencies and creditors to dispute any fraudulent charges or accounts. Keep a copy for your records and note any report numbers or confirmation letters you receive.

Is there a way to expedite the process with credit reporting agencies?

Yes, submitting a detailed law enforcement report, known as an Identity Theft Report, can expedite the process. When you take the FTC Identity Theft Affidavit to your local law enforcement office, ask an officer to witness your signature and complete the necessary information. This report can help you quickly block identity theft-related information from appearing on your credit report.

Common mistakes

Incomplete Personal Information: Failing to provide all necessary personal details can lead to delays. Ensure that your full legal name, date of birth, and Social Security number are accurately filled out.
Missing Contact Information: Omitting your daytime and evening phone numbers, as well as your email address, can hinder communication. Make sure to include all contact details.
Not Attaching Documentation: Forgetting to attach copies of required documents, such as a government-issued ID or proof of residency, can result in your form being rejected. Always include these essential documents.
Failure to Indicate Authorization: Not clearly stating whether you authorized someone to use your personal information can create confusion. Be specific in your declarations about authorization.
Skipping Relevant Sections: Ignoring sections that ask for details about the fraud or the identity thief can weaken your case. Complete all relevant sections, even if some information is incomplete.
Incorrect or Incomplete Fraud Details: Providing inaccurate information about the fraud, such as the name of the institution or account numbers, can complicate your situation. Double-check all details before submission.
Not Following Up: Failing to obtain a copy of the law enforcement report or confirmation can leave you without necessary documentation. Always ensure you have a copy for your records and follow up if needed.

Documents used along the form

When dealing with identity theft, it's essential to have the right documentation to support your case. The FTC Identity Theft Affidavit is a crucial starting point, but several other forms and documents can help you navigate the recovery process more effectively. Here’s a list of important documents you might consider using alongside the affidavit.

Law Enforcement Report: This report is created when you file a complaint with your local police department. It serves as an official record of the crime and can be used to support your claims with creditors and credit reporting agencies.
Fraud Alert Request: By placing a fraud alert on your credit reports, you notify creditors to take extra steps to verify your identity before opening new accounts in your name. This alert can last for one year and can be renewed.
Credit Report: Obtaining your credit report is vital to identify any accounts or inquiries that you did not authorize. You can request a free report annually from each of the three major credit bureaus.
Dispute Letters: These letters are sent to creditors or credit reporting agencies to dispute any inaccuracies on your credit report. They should clearly outline the errors and request corrections.
Identity Theft Report: This is a more detailed report that combines the FTC Identity Theft Affidavit and your law enforcement report. It can help you to prove that you are a victim of identity theft when dealing with creditors.
Proof of Identity Documents: These can include a government-issued ID, Social Security card, or utility bills showing your name and address. They help verify your identity during the recovery process.
Account Statements: Collecting statements from affected accounts can provide evidence of unauthorized transactions. This documentation is crucial when disputing charges or accounts.
Identity Theft Protection Services Documentation: If you are using a service to monitor your identity, keep records of any alerts or reports they provide. This information can support your case and help track any ongoing issues.

Having these documents on hand can streamline the process of resolving identity theft issues. They not only strengthen your claims but also help you stay organized as you navigate this challenging situation. Remember, each document plays a role in ensuring that your rights are protected and that you can reclaim your identity.

Similar forms

Fraud Alert Request Form: Similar to the FTC Identity Theft Affidavit, this form allows individuals to notify credit reporting agencies about potential identity theft. It helps in placing alerts on credit reports, making it harder for identity thieves to open accounts in the victim's name.
Credit Report Dispute Form: This document enables individuals to dispute inaccuracies in their credit reports. Like the affidavit, it serves as a formal request to correct information that may have been altered due to identity theft.
Identity Theft Report: This report is filed with law enforcement to document identity theft. It is crucial for victims to have this report when disputing fraudulent transactions, similar to how the FTC affidavit supports claims of identity theft.
Affidavit of Forgery: This document is used to report forged signatures or documents. It functions similarly to the FTC affidavit by providing a sworn statement about the fraudulent use of one's identity or financial information.
Consumer Financial Protection Bureau (CFPB) Complaint Form: This form allows individuals to file complaints against financial institutions regarding identity theft issues. It shares similarities with the FTC affidavit in that both serve as formal mechanisms to address grievances related to identity theft.

Dos and Don'ts

When filling out the FTC Identity Theft Affidavit form, it’s crucial to approach the process carefully. Here are four things you should and shouldn't do:

Do place a fraud alert on your credit reports before completing the form. This step helps protect your identity.
Do provide accurate and complete information about yourself and the fraudulent activity. This ensures that your case is taken seriously.
Do keep copies of all documents you submit. This documentation may be needed for future reference.
Do submit the affidavit to law enforcement and credit reporting agencies promptly. Timeliness can help mitigate damage.

Don't leave any required fields blank. Incomplete information may delay the processing of your affidavit.
Don't provide false information. Misrepresentation can lead to legal consequences.
Don't forget to attach necessary documentation, such as proof of identity. This is essential for verifying your claims.
Don't hesitate to ask for help if you are unsure about any part of the form. Seeking assistance can clarify the process.

Misconceptions

Here are seven common misconceptions about the FTC Identity Theft Affidavit form:

It is mandatory to use the form. Many people think they must use the FTC Identity Theft Affidavit to report identity theft. However, while it is a helpful tool, it is not legally required. You can report identity theft directly to law enforcement without this form.
Filing the form guarantees resolution. Some believe that submitting the affidavit will automatically resolve their identity theft issues. In reality, it serves as a record of the theft and aids in disputing fraudulent charges, but resolution depends on follow-up actions with creditors and credit reporting agencies.
The form is only for financial fraud. Many assume the affidavit is only for financial identity theft. In fact, it can be used for various types of identity theft, including medical identity theft and criminal identity theft.
You must file a police report to use the form. Some think they cannot use the affidavit without first filing a police report. While a police report can strengthen your case, you can still use the affidavit to document the theft and dispute charges.
It is a lengthy process. Many fear that completing the form will take a lot of time. In truth, the average time to complete the FTC Identity Theft Affidavit is about 10 minutes, making it a relatively quick task.
You need to provide extensive personal information. Some believe they must share a lot of sensitive information on the form. While you do need to provide essential details, you can leave certain fields blank if you are uncomfortable or if the information is not relevant.
The affidavit is only useful for credit reporting agencies. Many think the form is only for dealing with credit reporting agencies. However, it can also be used to file reports with law enforcement and to communicate with creditors about fraudulent accounts.

Key takeaways

Here are key takeaways about filling out and using the FTC Identity Theft Affidavit form:

Time Commitment: Completing the form typically takes around 10 minutes.
Purpose: This affidavit serves as a voluntary report to law enforcement and can help in disputes with credit reporting agencies and creditors regarding identity theft issues.
Fraud Alert: Before filling out the form, it is advisable to place a fraud alert on your credit reports and review them for any signs of fraudulent activity.
Document Verification: You will need to provide personal identification documents, such as a government-issued photo ID or proof of residency, to verify your identity.
Law Enforcement Report: Obtaining a law enforcement report can expedite the process of blocking identity theft-related information from your credit report.
Accuracy of Information: Ensure that all personal information is accurate and up to date, especially if there have been changes since the fraud occurred.
Attachments: It is important to attach any relevant documentation when sending the affidavit to creditors or credit reporting agencies.