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. 1845-0179

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 create a StudentAid.gov account prior to completing and submitting this form and providing documentation of identity. After creating your account, you will receive an email from Federal Student Aid (FSA) with your case number and further instructions. If you do not receive this email or case number, you may contact Federal Student Aid Information Center (FSAIC) at 1-800-433-3243.

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

Complete this form only if you do not have a Social Security Number and need to verify your identity to access the U.S. Department of Education’s System (e.g., Completing the FAFSA^® Form); and after you have created a Studentaid.gov account AND received your case number:

1. Provide Personal and Contact Information (Page 2, Section 3)

Note: Full name MUST match identity documentation provided.

2. Read and Sign Statement of Identity (Page 2, Section 4)

3. Provide Documentation of Identity (Page 3, Section 5)

4. Submit this document (i.e., signed attestation of identity) and copies of identity documents to Federal Student Aid for processing at: [email protected].

5. Wait for E-mail Confirmation: FSA will provide an email confirming the status of your identity and your Studentaid.gov account (i.e., verified Studentaid.gov account or additional action required prior to account verification).

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 (Required): Date (MM/DD/YYYY):

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.

Acceptable Identification Documents
Group A	OR	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 identification card[2]
Foreign Passport		Consular identification card

¹A 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, cable television service provider, internet, or phone bill (e.g., mobile telephone bills and Voice over Internet Protocol (VoIP) plans).

²A community identification card generally includes, but is not limited to, a card that is issued and managed by a local nonprofit organization, often in partnership with a government agency (i.e., policy agency), business, or other community groups. This card may be one that is available to those who live or work in the community, not only to residents.

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 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 Income-Driven Repayment (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 1845-0179. 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.)

Federal Student Aid | StudentAid.gov

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