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 Approved

Exp. Date: 11/30/2027

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

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):

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: Present one of the following valid, unexpired forms of ID:

• Driver’s license, temporary license, or ID issued by a U.S. State or Territory (paper documents NOT accepted)

• U.S. Passport or passport card

• Foreign Passport or passport card

• Consular ID Card/Matricula Consular

• U.S. Border Crossing Card

• U.S. Military ID Card (front and back) or U.S. Military’s dependent ID card

• Native American Tribal ID

• Permanent Resident Card (form I-551) “green card”

• Government-issued Personal Identity Verification (PIV) card

• Common Access Card (CAC)

• Transportation Worker Identification Credential (TWIC)

• U.S. Certificate of Naturalization (Form-550 or Form N-570)

• DHS/ICE Miramar Check-in Paperwork – must have a photo and seal.

• U.S. Certificate of Citizenship (form N-560 or Form N-561)

• Prison ID with picture, name, and date of birth

• US Citizenship and Immigration Services Employment Authorization Document (EAD) (I-766)

• US Merchant Mariner Credential

• Veteran Health Identification Card (VHIC)

• Documents reflecting TPS (Temporary Protected Status) eligibility

Group B: If cannot provide the documents from list one, present two of the following. The documents must be valid and unexpired unless otherwise noted below. At least one document submitted must be a photo ID:

• Social Security Card

• Birth certificate or document issued by a foreign country or U.S. state, jurisdiction, or territory

• Foreign driver’s license

• Marriage license or divorce decree

• U.S. Individual Taxpayer Identification Number (ITIN) provided on official letter awarding the ITIN or an official renewal ITIN letter from the U.S. Internal Revenue Service (IRS).

• Municipal identification card (such as those issued by city ID program)

• Community ID

• Voter registration card

• U.S. or foreign passport or passport card that expired within the previous 2 years.

• Consular ID from applicant’s country of citizenship that expired within the previous 2 years.

• Credit card/debit card statement

• Mortgage statement

• Financial institution account statement

• Utility bill

• Federal or State tax return

• W-2

• Insurance documents, including medical, dental, vision, life, home, rental, or vehicle

• Rental or lease agreement with signature of landowner and tenant

• Property tax bill or statement or deed or title to residential property

• Pay stubs

• Car registration

• Foreign or U.S. School-issued or college ID card

• Employee identification card

• Union or worder center identification card

• Foreign border crossing card (example: ECOWAS is accepted)

• Foreign Military ID Card (front and back)

• Foreign federal electoral photo card

• Foreign national or federal government-issued ID cards (from individual’s home country)

• Other foreign federal government-issued identification documents

• U.S. Prison ID missing picture, name, or DOB can be accepted with 2nd form of ID or official document (letter or other) from prison.

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 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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