The FTC Identity Theft Affidavit form serves as a crucial tool for victims of identity theft to report unauthorized use of their personal information. It facilitates the reporting process with law enforcement and the contesting of fraudulent transactions with both credit reporting agencies and creditors. Recognizing the importance of swift action, the form comes with guidelines on the initial steps to take before completion, including placing a fraud alert on credit reports and closing compromised accounts. For detailed guidance on filling out this form effectively, click the button below.
In today's digital age, the incidences of identity theft are on the rise, making it crucial for individuals to have a way to report and dispute fraudulent activities associated with their personal information. The Federal Trade Commission (FTC) provides a vital tool in this fight against identity theft: the Identity Theft Victim’s Complaint and Affidavit form. This document is designed for victims to detail unauthorized transactions, thereby streamlining the process of disputing fraudulent accounts and transactions with credit reporting agencies and creditors. It is a comprehensive, voluntary form that takes approximately 10 minutes to complete and is available in a secure online format at the FTC’s official website, ensuring ease of access and confidentiality. Before filling out this affidavit, individuals are advised to place a fraud alert on their credit reports and close any accounts that they suspect have been tampered with or fraudulently opened. Additionally, the form requires personal details, instances of fraud, and allows for law enforcement engagement, emphasizing its role as a multifaceted tool in addressing the challenges of identity theft. The FTC also mandates the display of a valid control number on the form, in adherence to the Paperwork Reduction Act, highlighting the form’s legitimacy and the importance of submitting accurate and truthful information. With sections dedicated to personal information, details about the fraud, and a requirement for documentation verification, the FTC Identity Theft Affidavit form is an essential step in reclaiming one’s financial security and personal peace of mind after the occurrence 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
Being a victim of identity theft can feel overwhelming, but taking action quickly is critical to regaining control. The FTC Identity Theft Affidavit is a comprehensive form designed to help you report fraudulent activity. It's not just a simple form; it's a tool that paves the way for rectifying the misuse of your identity. Here's how to complete the affidavit step by step.
After completing the form, attach any supporting documents necessary to substantiate your claims, such as a copy of your ID and evidence of residency. Submitting this affidavit to the appropriate agencies and creditors will help in not only removing fraudulent information from your credit report but also in guarding against further misuse of your identity.
What is the FTC Identity Theft Affidavit?
The FTC Identity Theft Affidavit is a document designed to help victims of identity theft report the situation to law enforcement agencies, as well as dispute fraudulent accounts and transactions with credit reporting agencies and creditors. It serves as a comprehensive statement from victims about the details of the identity theft incident, providing crucial information needed to investigate and resolve the fraud.
How long does it take to complete the FTC Identity Theft Affidavit?
On average, completing the FTC Identity Theft Affidavit takes about 10 minutes. This timeframe can vary depending on the complexity of the identity theft case and how much information the victim can provide.
What should I do before filling out the FTC Identity Theft Affidavit?
Before filling out the affidavit, you should first place a fraud alert on your credit reports and review them for any signs of fraudulent activity. Additionally, close any accounts that you believe have been tampered with or opened fraudulently. These steps are crucial in preventing further misuse of your personal information.
Do I need to provide sensitive information such as my Social Security number on the affidavit?
Yes, the form requires sensitive information, including your Social Security number, to accurately report and investigate the identity theft. However, you are advised to leave the Social Security number field blank until you are providing the form to a trusted entity, such as a police department or a credit reporting agency, that needs this information to assist you.
Can I complete the FTC Identity Theft Affidavit online?
Yes, there is a secure online version of the FTC Identity Theft Affidavit available at ftc.gov/idtheft. This enables you to fill out the form electronically and print it for your records or to submit to relevant agencies and organizations.
What documentation should I attach to the FTC Identity Theft Affidavit?
When submitting the affidavit, you should attach copies of documents that verify your identity, such as a government-issued photo ID (driver's license, passport, etc.) or, if under 16, a birth certificate or school record. Additionally, provide proof of residency for the time the fraud occurred, like a utility bill or rental agreement.
How do I report that someone used my information for identity theft?
In the affidavit, you’ll provide details about the identity theft, including any information you have about the perpetrator and the unauthorized accounts or transactions they conducted. Additional sheets may be attached if more space is needed. This information is crucial for law enforcement and credit reporting agencies to take action.
What if I discover more frauds after submitting the FTC Identity Theft Affidavit?
If you identify additional fraudulent activities after submitting the affidavit, you should file an updated form or additional documentation detailing the new discoveries to the relevant agencies and organizations previously notified.
How do I submit an Identity Theft Report to a credit reporting agency?
To have identity theft-related information removed from your credit report, submit the completed FTC Identity Theft Affidavit along with any relevant law enforcement report to the credit reporting agency. This action urges the agency to block fraudulent information from appearing on your report.
What should I do if I am unable to file a law enforcement report?
If you encounter difficulties in filing a law enforcement report, document your attempt and notify the credit reporting agencies and creditors involved in your identity theft case. Check the appropriate box on the affidavit indicating that you were unable to file a report and provide this information when disputing fraudulent accounts and transactions.
Filling out the FTC Identity Theft Affidavit form is a critical step towards resolving identity theft issues. However, it's common for individuals to make mistakes during this process. Here are four frequently encountered errors:
Addressing these mistakes can streamline the process of disputing fraudulent activities and restoring one's credit history. It's always advisable to carefully read and follow the instructions provided with the form to ensure that all necessary information and documentation are correctly submitted.
When dealing with identity theft, submitting the FTC Identity Theft Affidavit form is a crucial step in alerting authorities and securing one's financial health. However, this form is often just one part of a broader set of documents needed to fully confront and resolve issues arising from identity theft. Understanding these additional forms and documents is essential for a comprehensive approach to addressing identity theft.
Equipped with the FTC Identity Theft Affidavit and these companion documents, victims can take a thorough and organized approach to reclaim their financial integrity and protect their identity. It's important that individuals safely store all documentation related to their case and follow up regularly with credit bureaus, creditors, and law enforcement to ensure resolution.
Police Report for Theft: Similar to the FTC Identity Theft Affidavit, this document reports an unlawful incident, detailing the victim's information and circumstances surrounding the theft. Both serve as formal notices to authorities but focus on different types of theft.
Credit Freeze Request: Requests to freeze credit reports are similar as they aim to protect individuals from the consequences of identity theft. Like the affidavit, they involve providing personal details and explaining one's circumstances to secure financial information.
Credit Report Dispute Form: Used to correct inaccuracies on one's credit report, it parallels the affidavit's function of disputing false information resulting from identity theft. Both require detailed descriptions of what is incorrect and why.
Data Breach Notification Letter: This informs individuals of unauthorized access to their personal information, similar to the affidavit’s role in alerting authorities and businesses about identity theft, albeit from the perspective of the entity experiencing the breach.
Fraud Alert Placement Request: Forms to place a fraud alert on credit reports are similar, as they alert credit bureaus to potential fraud, akin to how the affidavit notifies about identity theft, serving to protect one's financial integrity.
Bank Fraud Complaint Form: Similar to the FTC affidavit, this form is filed with a bank to report unauthorized transactions. Both involve the reporting of financial fraud and require detailed account and transaction information.
Identity Theft Passport Application: Certain states issue "Identity Theft Passports" to victims, serving as evidence of one's status as an identity theft victim, similar to how the affidavit can be used to assert one's case when dealing with credit and legal issues.
Consumer Complaint Form: Like the FTC Identity Theft Affidavit, consumer complaint forms are used to report misconduct or unsatisfactory business practices, although these forms are more general and not solely focused on identity theft.
Insurance Claim Form for Theft: While this form pertains to claiming insurance benefits for theft, it shares the affidavit's function of officially reporting an incident, requiring detailed information about the victim and the event.
Privacy Complaint Form: Filed with privacy commissioners or relevant bodies, these focus on breaches of privacy similar to identity theft scenarios. The primary parallel is in the protection of individuals' personal information and the pursuit of remedial action.
When filling out the FTC Identity Theft Affidavit form, it's crucial to approach the task with attention to detail and honesty to ensure the process contributes effectively to resolving the identity theft issues. Here are essential do's and don'ts to consider:
Things You Should Do
Review your credit report carefully before completing the form to identify all fraudulent activities and accounts. Placing a fraud alert on your credit reports is a vital first step in this process.
Provide accurate and complete information about yourself and the identity theft incident. Inaccuracies can delay the recovery process, and completeness helps law enforcement and creditors fully understand the situation.
Attach copies of any documentation that can verify your identity (such as a government-issued photo ID) and support your claim (like statements from affected accounts or law enforcement reports).
Sign the form in the presence of a law enforcement officer if filing a law enforcement report and ensure you receive a copy of the official report for your records.
Things You Shouldn't Do
Do not leave sections blank that are applicable to your situation. If a section is not applicable, indicate with "N/A" (not applicable) or "None" to show that you did not overlook the section.
Avoid guessing dates and amounts. If you're unsure, it's better to note that the information is an estimate rather than provide inaccurate data.
Do not send the affidavit without first placing a fraud alert on your credit reports and closing compromised accounts, as this can leave you vulnerable to further fraud.
Do not provide your Social Security number or other sensitive personal information in sections of the form meant to be left blank or until you are providing it to a legitimate party with a need to know, such as a law enforcement officer or credit reporting agency.
Understanding the process and implications of filling out the FTC Identity Theft Affidavit form is crucial for victims of identity theft. Misconceptions abound, potentially complicating a situation already fraught with stress and confusion. Clarification of these misconceptions ensures victims are better equipped to safeguard their rights and navigate the recovery process more smoothly.
A common misunderstanding is that completing the FTC Identity Theft Affidavit form immediately resolves identity theft issues. In reality, this form is just the first step in a comprehensive process that involves reporting the identity theft to various agencies, including credit reporting agencies and creditors, to dispute fraudulent transactions and accounts created in the victim's name.
Some believe that the information provided in the FTC Identity Theft Affidavit is shared with all necessary parties by the FTC. However, victims are responsible for sending the completed form to credit bureaus, creditors, and law enforcement agencies. The FTC does not distribute this information on behalf of individuals.
There's a misconception that once the affidavit is completed, there's no need for further action, such as filing a police report. Contrary to this belief, filing a police report is a critical step that often needs to be taken in conjunction with submitting the FTC affidavit to strengthen one's case against the identity thief.
Some victims are wary of completing the affidavit due to concerns over its complexity and time consumption. While the form is thorough, it is designed to be user-friendly, with an average completion time of just 10 minutes, making it an accessible tool for victims to assert their rights.
Another misconception is that the form requires highly sensitive information that could further jeopardize one’s security. While it does ask for personal details, these are necessary for the purpose of disputing fraudulent activity and are shared only with trusted entities involved in the investigation and remediation process.
There's also confusion regarding the necessity of the affidavit for those who notice fraudulent accounts but are not experiencing immediate financial loss. Regardless of immediate loss, completing the affidavit is crucial in preventing future fraud and disputing unauthorized accounts and inquiries.
Many believe that the FTC Identity Theft Affidavit is the only document needed to clear their name. In actuality, it is often used in conjunction with other documents, such as a police report and documentation of fraudulent transactions, to provide a comprehensive account of the identity theft.
Lastly, there is a notion that the affidavit is a one-time solution. In fact, recovering from identity theft is an ongoing process. Victims may need to provide additional information and follow up with credit bureaus, creditors, and law enforcement over time.
In sum, navigating the aftermath of identity theft requires a clear understanding of the purpose and limitations of the FTC Identity Theft Affidavit. Dispelling common misconceptions empowers victims to take effective actions towards reclaiming their financial wellbeing and security.
When dealing with identity theft, the FTC Identity Theft Affidavit form plays a crucial role in reporting and resolving issues stemming from such incidents. Below are key takeaways essential for individuals looking to navigate the aftermath of identity theft effectively:
Before completing the FTC Identity Theft Affidavit, individuals should first place a fraud alert on their credit reports and review them for any signs of fraudulent activity. This preemptive step is essential for protecting one's credit while the affidavit is processed.
Filling out the affidavit requires providing detailed personal information, including full legal name, contact details, Social Security number, and information about any affected accounts. However, sensitive details like the Social Security number should be left blank until they are securely provided to a legitimate entity that requires it.
The affidavit includes a section for declaring whether the victim authorized anyone to use their information, received any benefits from the fraud, and is willing to work with law enforcement. Honest responses here are crucial for the investigation and resolution process.
Victims can list out accounts affected by the identity theft, specifying whether these were fraudulently opened in their name or if existing accounts were tampered with. This information aids in disputing unauthorized transactions or accounts with credit bureaus and financial institutions.
Attaching identification and proof of residency documents, such as a government-issued photo ID and utility bills, is necessary when submitting the affidavit to creditors and credit reporting agencies. These documents help verify the identity of the complainant and the validity of their claims.
The affidavit allows victims to provide details about any individual they suspect has used their information fraudulently, although this section can be completed with as much or as little information as the victim has available.
To further support their case, victims are encouraged to file a detailed law enforcement report, which can then be attached to the affidavit when disputing fraudulent information on credit reports or with creditors.
The FTC provides a secure online version of the affidavit, which can be filled out and printed for records. Utilizing this online resource ensures that the information is submitted accurately and efficiently.
In summary, the FTC Identity Theft Affidavit form is a powerful tool for victims of identity theft, offering a structured way to report and rectify issues caused by fraudulent activity. Following the structured process and providing detailed, accurate information can significantly aid in the recovery process.
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