OMB control number

Certification of Identity

OMB 1103-0016 · DOJ/DOJADM.

OMB 1103-0016

This form is used to identity individuals requesting records on self or another individual under the Privacy Act, 5 U.S.C. Section 552a(i)(3) and in accordance with the provisions of 28 C.F.R., Section 16.41(d).

The latest form for Certification of Identity expires 2027-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DOJ-361 Certification of Identity Form
1103-0016 Supporting Statement A (2023) + OIP.docx Supporting Statement A
Electronic Code of Federal Regulations Title 28 Judicial Adminstration.pdf Supplementary Document
Certification of Identity Form

All Historical Document Collections

202401-1103-002 Approved without change	Reinstatement without change of a previously approved collection	2024-01-17
202306-1103-005 Comment filed on proposed rule and continue	Revision of a currently approved collection	2023-06-28
202005-1103-001 Approved without change	Extension without change of a currently approved collection	2020-05-26
201703-1103-001 Approved without change	Extension without change of a currently approved collection	2017-03-09
201310-1103-001 Approved without change	Extension without change of a currently approved collection	2014-01-15
201005-1103-001 Approved with change	Revision of a currently approved collection	2010-10-28
200707-1103-001 Approved without change	Extension without change of a currently approved collection	2007-07-27
200405-1103-002 Approved without change	Revision of a currently approved collection	2004-05-20
200012-1103-002 Approved without change	Revision of a currently approved collection	2000-12-22
199801-1103-003 Approved without change	Reinstatement without change of a previously approved collection	1998-01-12
199411-1103-003 Approved without change	Reinstatement with change of a previously approved collection	1994-11-18
199411-1103-001 Approved without change	Revision of a currently approved collection	1994-11-18