The FTC Identity Theft Affidavit form serves as a crucial tool for victims of identity theft, enabling them to officially report incidents and dispute unauthorized transactions with credit bureaus and creditors. This voluntary document, which takes about 10 minutes to complete, is the first step towards reclaiming your financial integrity and security. Ready to take action? Click the button below to fill out your form.
In an era where data breaches seem to be a staple of daily news, the risk of identity theft looms large in the minds of many. To combat the ramifications of such a personal and financial invasion, the Federal Trade Commission (FTC) has provided a crucial tool—the Identity Theft Victim's Complaint and Affidavit form. This form, which averages a mere 10 minutes to complete, serves as a linchpin for individuals grappling with the aftermath of identity theft. It not only facilitates the reporting process with law enforcement but also aids in disputing fraudulent activities with credit reporting agencies and creditors. Prior to filling out this form, victims are advised to initiate a fraud alert on their credit reports and review them for suspicious activities, along with shutting down any compromised or illegitimately opened accounts. The form meticulously guides victims through detailing their encounter with identity theft—ranging from personal information used in unauthorized transactions to pinpointing the fraud's perpetrator if known. Furthermore, it demands documentation to verify the victim’s identity and outlines the steps to produce a comprehensive law enforcement report, which is instrumental in blocking identity theft-related information from polluting one's credit report. By laying out a structured path for redress and recovery, the FTC Identity Theft Affidavit form emerges as a beacon of hope for those navigating through the murky waters of identity theft.
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
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: ____________________________________________
(9)My address was: _________________________________________________
Number & Street Name
Apartment, Suite, etc.
Skip (8) - (10) if your information has not changed since the fraud.
(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)
receive any money, goods, services, or other benefit as a
result of the events described in this report.
(13)
am
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
don’t have
Address: __________________________________________________
complete
information).
__________________________________________________________
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 ($)
(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.
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.
_______________________________________
_________________________________________
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:
Printed Name
Date
Telephone Number
The FTC Identity Theft Affidavit form is a critical step for individuals who have fallen victim to identity theft and need to dispute fraudulent accounts or transactions. It aids in documenting the theft for law enforcement and helps in the removal of fraudulent information from credit reports. The process of filling out the form involves providing detailed personal information, describing the identity theft incident, and listing any fraudulent accounts or inquiries. Here are the detailed steps needed to complete the form.
Once the form is filled out, attach any necessary documentation, such as your identification documents and any available evidence of the fraud, like account statements or correspondence from creditors. Submitting this affidavit along with a police report can strengthen your identity theft claim and help ensure the removal of fraudulent information from your credit report.
What exactly is the FTC Identity Theft Affidavit Form?
The FTC Identity Theft Affidavit Form is a comprehensive document designed to help victims of identity theft formally report their ordeal. It aids in disputing fraudulent accounts and transactions with credit reporting agencies and creditors. This voluntary form, once filled, can be used to file a report with law enforcement and to challenge inaccuracies in your credit report due to identity theft.
How long does it take to complete the FTC Identity Theft Affidavit Form?
On average, it takes about 10 minutes to complete the FTC Identity Theft Affidavit Form, although this can vary based on the individual's specific circumstances and the details of the fraud encountered.
Where can I find the FTC Identity Theft Affidavit Form?
You can find and complete the FTC Identity Theft Affidavit Form online by visiting the FTC's official website at ftc.gov/idtheft. There, you can use a secure online version that also allows you to print copies for your records.
What should I do before filling out the FTC Identity Theft Affidavit Form?
Before you fill out the form, it's important to first place a fraud alert on your credit reports and review them for signs of fraudulent activity. Additionally, ensure you close any accounts that you believe have been tampered with or opened fraudulently.
Can I submit the form without including my Social Security Number?
Yes, you are advised to leave your Social Security Number blank until you are providing the form to a trusted entity with a legitimate business need, such as when filing a report at the police station or submitting a dispute to a credit reporting agency.
What documentation is required to verify my identity when submitting the form?
Your identity can be verified with a valid government-issued photo identification card (like a driver's license or passport). If you're under 16, a birth certificate or official school record showing your legal address may suffice. Additionally, include proof of residency for the period when the fraud occurred, such as a utility bill or lease agreement.
How can I use the FTC Identity Theft Affidavit Form to correct my credit report?
Alongside the affidavit, submit copies of your identity verification documents to the credit reporting agencies. Clearly outline any inaccuracies in your credit report that resulted from identity theft, including fraudulent accounts or transactions, to have them addressed.
What if I need to report multiple instances of fraud?
If your identity was compromised in more than three specific instances, you can attach additional copies of the pertinent section(s) of the form. Make sure to provide as much detailed information as possible for each instance, even if incomplete, to assist in the investigation and resolution process.
When people fill out the FTC Identity Theft Affidavit form, common mistakes can hinder their efforts to resolve their identity theft issues efficiently. Understanding these pitfalls can significantly improve the accuracy and effectiveness of the affidavit, thus facilitating a smoother recovery process.
First, a prevalent mistake is not placing a fraud alert on credit reports before completing the form. The form advises individuals to alert the three major credit bureaus about potential fraud. This step is crucial because it not only warns potential creditors to verify anyone's identity before issuing new credit but also helps victims catch unauthorized activities early on.
Second, inaccurately reporting personal information, such as incorrect Social Security numbers, dates of birth, or addresses, can lead to significant delays. The section "About You" on the form requires precise details since discrepancies can complicate the verification of one's identity and, by extension, the resolution of the identity theft.
Third, many overlook the instruction to leave certain fields, like the Social Security number, blank until they're providing the form to a legitimate business need. This is a safeguard to protect sensitive information, but neglecting this advice can expose victims to further risks of identity theft if the form is intercepted or mishandled.
Fourth, failure to attach additional documentation as recommended can slow down the process. The form suggests attaching identification documents such as a government-issued photo ID and proof of residency during the time the fraud occurred. These documents are crucial for verifying the victim's identity and substantiating the claim.
Lastly, not submitting a detailed law enforcement report alongside the affidavit is a missed opportunity. Such a report is instrumental in getting the fraudulent information blocked from appearing on your credit report quickly. It strengthens the case against the perpetrators and is a vital step in the recovery journey.
By avoiding these common mistakes, individuals can ensure their FTC Identity Theft Affidavit is comprehensive and effective, leading to a more streamlined process in mitigating the effects of identity theft.
When dealing with identity theft, the FTC Identity Theft Affidavit form is a crucial document for victims to start reclaiming their identity and addressing fraudulent activities. However, this form often works in conjunction with other important documents and forms to build a comprehensive approach for resolution. Below is a list of accompanying documents and forms commonly used alongside the FTC Identity Theft Affidavit:
Working with these documents helps victims of identity theft cover all bases, ensuring they can effectively dispute fraudulent charges, protect their credit, and prevent future breaches of their personal information. It's important to keep copies of all documents and correspondence safe and to follow up regularly on disputes and reports to ensure resolution.
The Uniform Victim Assistance Form mirrors the FTC Identity Theft Affidavit form in its purpose to assist victims in reporting a crime. Just as the FTC form provides a structured way for victims of identity theft to report incidents and dispute fraudulent accounts, the Uniform Victim Assistance Form serves those affected by various crimes, offering a pathway to communicate details to law enforcement and obtain supportive services. Both forms gather comprehensive personal, crime-related, and, if applicable, financial details from the victim to facilitate investigations and corrective actions.
Consumer Credit Dispute Form shares similarities with the FTC Identity Theft Affidavit particularly in the area of disputing erroneous information on credit reports. Where the FTC affidavit allows victims of identity theft to outline fraudulent accounts and activities for correction, the Consumer Credit Dispute Form specifically targets inaccuracies on credit reports, such as unauthorized charges or accounts. Both documents are critical tools in the process of restoring one's financial health and credit status after instances of fraud or identity theft.
The Police Report Form, like the FTC Identity Theft Affidavit, is instrumental in formally recording an illicit activity with law enforcement. While the FTC form is tailored towards identity theft, providing a comprehensive layout for victims to detail the fraudulent use of their information, Police Report Forms serve a broader range of incidents. Nonetheless, both documents play a crucial role in initiating legal action and investigations, making it possible to track and address the crime effectively.
The Data Breach Notification Form, though primarily used by organizations to report a breach of personal information, aligns with the FTC Identity Theft Affidavit in its focus on protecting individuals’ personal data. The affidavit empowers individuals to report and remedy the unauthorized use of their data, while the Data Breach Notification Form is designed to alert consumers about exposures that could lead to similar misuse. Both forms contribute to a broader infrastructure of accountability and remedy concerning personal data protection.
Finally, the Credit Freeze Request Form parallels the FTC Identity Theft Affidavit by offering a preventative measure against identity theft. After submitting the FTC affidavit to dispute unauthorized activities and correct credit reports, individuals often follow up with a Credit Freeze Request to prevent future fraud. This form restricts access to one's credit reports, thereby thwarting attempts to open new accounts fraudulently. Although serving different functions—one reactive and the other proactive—both forms are essential to safeguarding one's financial integrity against identity theft.
When completing the FTC Identity Theft Affidavit form, there are several best practices to ensure your report is accurate and effective. Here are four essential do’s and don’ts to follow:
Do:
Don’t:
When dealing with identity theft, many people turn to the Federal Trade Commission's (FTC) Identity Theft Affidavit form. However, there are several misconceptions about this form and its use. Let’s dispel some of these myths to provide clear guidance for those grappling with identity theft.
Myth 1: The FTC Identity Theft Affidavit is the only form you need to resolve identity theft. While the affidavit is an important tool in disputing fraudulent accounts and transactions, it's usually just the first step. Victims also need to file a police report and contact all affected creditors individually.
Myth 2: Completing the affidavit is a quick process. Although the form states that the average completion time is about 10 minutes, preparing to complete the form—by gathering necessary information, understanding the details of the fraud, and correctly filling out the form—can take significantly longer.
Myth 3: You must fill out every section of the affidavit before submitting. Some sections of the affidavit might not apply to every case of identity theft. Moreover, it's crucial to leave the Social Security number field blank until you are submitting the form to a legitimate party to protect your information.
Myth 4: The FTC Identity Theft Affidavit is only useful for disputes with credit reporting agencies. This affidavit can also assist in disputing fraudulent charges with creditors and file a report with law enforcement, making it a versatile tool in identity theft cases.
Myth 5: The affidavit will immediately clear your credit report of fraudulent transactions. While it's an important step in disputing fraudulent activity, the process of removing unauthorized transactions from your credit report often requires additional steps, including follow-up with credit bureaus and creditors.
Myth 6: Everyone responds the same way to receiving an FTC Identity Theft Affidavit. Different creditors and institutions may have their own procedures for handling identity theft claims, even when you provide them with an affidavit. Some may request additional information or documentation.
Myth 7: Filing an affidavit guarantees that thieves will be caught and prosecuted. While the affidavit helps in documenting the theft for law enforcement, catching and prosecuting the perpetrator involves additional investigative work and evidence beyond the affidavit itself.
Myth 8: There's no need to monitor your credit after submitting the affidavit. Continuous monitoring of your credit reports is crucial after identity theft to ensure no new fraudulent activity occurs and that all disputed transactions have been removed.
Myth 9: The FTC Identity Theft Affidavit is only for recent fraud. You can use this form to dispute fraudulent activities, regardless of when they happened. However, acting quickly can help in resolving issues more efficiently.
Myth 10: Once completed, the affidavit is automatically sent to creditors and credit bureaus. After finishing the affidavit, it’s your responsibility to send it to the appropriate parties. The FTC does not automatically distribute the form on your behalf.
Understanding the truth behind these misconceptions can help victims of identity theft navigate their recovery process more effectively. While the FTC Identity Theft Affidavit is a powerful tool, it's part of a broader strategy required to regain your financial health and security.
Filling out the FTC Identity Theft Affidavit is a crucial step in addressing and correcting the repercussions of identity theft. Here are eight key takeaways to ensure the process is as efficient and thorough as possible:
This form serves as a structured way to report identity theft, providing a clearer path to resolving issues and restoring your financial health. However, completing the affidavit is just one step in a comprehensive approach to tackling identity theft, including ongoing monitoring of your credit and accounts for any future discrepancies.
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