Process for FSA ID Account Creation for Individuals without a Social Security Number in Connection with Person Authentication Service (PAS)

Attestation & Validation of Identity

OMB No. 1845-New
Form Under Review
Exp. Date: xx/xx/xxxx

WARNING/IMPORTANT: Any person who knowingly makes a false statement or misrepresentation
on this form or on any accompanying document is subject to penalties that may include fines,
imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097

Section 1: Description
Complete this form only if you do not have a Social Security number (SSN) and need to verify your
identity to access the U.S. Department of Education’s Systems. You must contact Federal Student
Aid Information Center (FSAIC) at 1-800-433-3243 prior to completing and submitting this form and
providing documentation of identity. After calling FSAIC, you will receive an email from FSA with your
case number and instructions.
Complete this form and provide documentation of identity if one of the following statements is
true for you:
1. I am a parent or spouse of a student who is applying for aid, and I do not have an SSN.
2. I am a citizen of the Freely Associated States and need to complete the FAFSA® form online.

Section 2: Instructions
1. Read and Sign Statement of Identity
2. Provide Documentation of Identity (See table below)
3. Submit this statement and copies of documents to Federal Student Aid for processing.
4. Submit this form and the required documentation to: [email protected]
5. Next Step – Within 1-3 business days, FSA will provide an email confirming that your identity
has been verified

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Section 3: Personal & Contact Information
Full Name (First, Middle, Last):
Address:
City:

State:

Zip Code:

Date of Birth (MM/DD/YYYY):
Email Address:
Case Number (see e-mail from FSAIC): MANVER#

Section 4: Attestation & Signature
I certify that I, (Print name)

, am the

individual signing this Statement and Documentation of identity for purposes of obtaining login
credentials (FSA ID) to access the U.S. Department of Education’s Systems to contribute to a
FAFSA® form. I acknowledge and understand this Attestation Form is not an application for federal
student financial aid under Title IV of the Higher Education Act (HEA), as amended. I further
understand and acknowledge that I must abide by the U.S. Department of Education’s code of
conduct, terms of service, and rules of behavior when accessing and using the U.S. Department of
Education’s Systems (refer to September 10, 2021 Federal Register Notice for more information).
By signing below, I consent and certify under penalty of perjury under the laws of the United States of
America, that the foregoing is true and correct. I understand that any falsification of this statement is
punishable under the provisions of 18 U.S.C. § 1001 by a fine, imprisonment of not more than five
years, or both, and that the knowing and willful request for or acquisition of records pertaining to an
individual under false pretenses is a criminal offense under the Privacy Act of 1974, subject to a fine
of not more than $5,000 fine (5 U.S.C. § 552(a)(i)(3)). By signing and submitting this form, my
request for login credentials will be logged in the U.S. Department of Education’s Person
Authentication Service (PAS) System of Record (18-11-12).
Name (Printed):
Signature:
Date (MM/DD/YYYY):

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Section 5: Acceptable Identification Documents
All acceptable documents submitted for verification or proof of identity must be valid (current and
unexpired). The name of the individual and address on the utility bill must match the information
provided on this form. Only one (1) document is required from Group A or two (2) documents from
Group B.
Group A

Group B: Utility Bill [1] plus one (1) of the following:

•

U.S. State/Territory Driver’s License

•

Municipal identification card

•

U.S. State or City Identification Card

•

Community ID

•

Foreign Passport

•

Consular identification card

A utility bill is generally defined as a monthly statement that details an amount owed by an individual(s)of a household for
basic services that keep a residence operable. Such as: electricity, water/sewer, gas, trash/ recycling, television, internet,
or phone bill.
1

Section 6: Privacy Act Statement
Authority: Title IV of the Higher Education Act of 1965, as amended (HEA) (20 U.S.C. 1070 et seq.),
authorizes the U.S. Department of Education (Department) to ask the questions set forth in this
Attestation & Validation of Identity form.
Purpose: We use the information provided on this form to process the Attestation & Validation of
Identity to generate authentication and log-on credentials for those individuals wishing to access
Departmental student financial assistance systems, online applications, websites and services, and to
update security challenge questions and their corresponding answers, and to allow electronic
signature on student aid forms and applications, including, but not limited to, the consent/affirmative
approval for the Department to disclose records to the Internal Revenue Service (IRS) to obtain
Federal Tax Information (FTI) and for the disclosure and redisclosure of the FTI, revocation of such
consent/ affirmative approval, the Free Application for Federal Student Aid (FAFSA®), Direct Loan
Master Promissory Notes, loan benefit program forms, deferments, or forbearances through
StudentAid.gov and other Department websites, as applicable. An individual’s personally identifiable
information, is used to verify identity and retrieve records to process this form. We also may verify the
accuracy of the information provided to the Department.
Routine Uses: The information provided on this form will only be disclosed outside of the Department
with prior written consent or as otherwise allowed by the Privacy Act of 1974, as amended (Privacy
Act) (5 U.S.C. 552a). The Privacy Act’s requirement for prior written consent has an exception for
“routine uses” that the Department publishes in our System of Records Notices (SORNs). The
Department may disclose, without consent, the information provided on this form pursuant to the
routine uses identified in the Person Authentication Servicer (PAS) (18-11-12) SORN, which is
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available on the Department’s Privacy Act System of Record Notice Issuances (SORN) webpage
located at https://www2.ed.gov/notices/ed-pia.html.
These routine uses include the following:
•

To validate the personally identifiable information (PII) entered by the current, former, or
prospective aid applicant or aid recipient (or their third-party preparer) or endorser, who
records indicate is applying for, has applied for, has endorsed, or has received an HEA Title IV
loan and/or grant, or the PII entered by a participant of such an application (including the
spouse of an independent aid applicant or recipient or the parent[s] of a dependent aid
applicant or recipient), disclosures may be made to: guaranty agencies; educational and
financial institutions; federal loan (including Federal Perkins Loan) servicers; federal, state,
local, or tribal agencies; private parties such as relatives, business and personal associates,
and present and former employers; creditors; consumer reporting agencies; adjudicative
bodies; and the individual whom the records identify as the endorser or the party obligated to
repay the debt.

•

To permit the Department to disclose information on aid applicants and recipients to the IRS
for the IRS to disclose federal tax information (FTI) under subsection 494(a) of the HEA (20
U.S.C. 1098h(a)) and section 6103(l)(13)(A) and (C) of the Internal Revenue Code (IRC) to the
Department as part of a matching program to determine their eligibility under Title IV of the
HEA and to permit the Department to redisclose the FTI of individuals pursuant to section
6103(l)(13)(D)(iv) of the IRC and the revocation of such consent/affirmative approval for IDR,
disclosures may be made to federal loan servicers.

Effects of Not Providing Information: Providing information on this form is voluntary; however, if
not enough information is provided to process an Attestation & Validation of Identity form, the request
may be delayed or denied.
The Paperwork Reduction Act of 1995: According to the Paperwork Reduction Act of 1995, no
persons are required to respond to a collection of information unless such collection displays a valid
Office of Management and Budget (OMB) control number. The valid OMB control number for this
information collection is 1845-NEW. Public reporting burden for this collection of information is
estimated to average .33 hours (20 minutes) per response, including time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. The obligation to respond to this collection is voluntary. If you
have comments or concerns regarding the status of your individual submission of this form, write
directly to the Federal Student Aid Information Center, P.O. Box 84, Washington,
D.C. 20044. (Note: Do not return the completed form to this address.)

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