SSS Form 1 Registration Form

From:

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IN
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DEPARTMENT OF JUSTICE - for review and processing of suspected
violations of the Military Selective Service Act, or for perjury, and for defense
of a civil action arising from administrative processing under such Act.
DEPARTMENT OF STATE & U.S. CITIZENSHIP AND IMMIGRATION
SERVICES - for collection and evaluation of data to determine a person’s
eligibility for entry/reentry into the United States and for U.S. citizenship.
DEPARTMENT OF DEFENSE & U.S. COAST GUARD - for exchange of data
concerning registration, classification, induction, and examination of registrants
and for identification of prospects for recruiting.
DEPARTMENT OF LABOR - to assist veterans in need of data concerning
reemployment rights, and for determining eligibility for benefits under the
Workforce Investment Act.
DEPARTMENT OF EDUCATION - to determine eligibility for student financial
assistance.
OFFICE OF PERSONNEL MANAGEMENT & U.S. POSTAL SERVICE - to
determine eligibility for employment.
DEPARTMENT OF HEALTH AND HUMAN SERVICES - to determine a
person’s proper Social Security Account Number and for locating parents
pursuant to the Child Support Enforcement Act.
STATE AND LOCAL GOVERNMENTS - to provide data which may constitute
evidence and facilitate the enforcement of state and local law.
BUREAU OF CENSUS - for the purposes of planning or carrying out a census
or survey or related activity pursuant to the provisions of Title 13.
ALTERNATIVE SERVICE EMPLOYERS - for exchange of information with
employers regarding a registrant who is a conscientious objector for the
purpose of placement and supervision of performance of alternative service
in lieu of induction into military service.
GENERAL PUBLIC - Registrant’s name, Selective Service registration
number, date of birth, and classification. (Military Selective Service Act,
Section 56, U.S.C. App. 456h)

The Military Selective Service Act, Selective Service regulations, and the
President’s Proclamation on Registration require that you provide the indicated
information, including your Social Security Account Number if you have one.
The principal purpose of the requested information is to establish or verify
your registration with the Selective Service System. This information may
be furnished to other government agencies for the stated purposes on a
selective basis.

PRIVACY ACT STATEMENT

MEN

H
T

Failure to provide the required information may violate the Military Selective
Service Act. Conviction for such a violation may result in imprisonment for
up to five years and/or a fine of not more than $250,000.

18 through 25

REGISTER
HERE

PLACE STAMP

REQUIRED

POSTAGE

It’s Quick - It’s Easy
- It’s The Law -

SELECTIVE SERVICE SYSTEM
P.O. BOX 94739
PALATINE, IL 60094-4739

SELECTIVE SERVICE SYSTEM

IG
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DO

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TODAY’S

D-YY
DATE: (MM-D

6

RE

SIGNATU

ARE TRUE

UPO

3
DO NOT WRITE IN THIS SPACE

SOCIAL SECURITY ACCOUNT NUMBER

SUFFIX: (Mark with “X”)

III

OTHER SUFFIX

ZIP CODE

5

UPO

You should receive a Selective Service Acknowledgment with your
Selective Service Number. Keep your acknowledgment in a safe place
for future reference. You can also verify your Selective Service Number by
going to www.sss.gov to “Check a Registration”. If you move, you are
required by Federal law to provide address changes to Selective Service,
which can be done at www.sss.gov to “Report a Change of Address Online”, or
by filling out and mailing a SSS Form 2 (Change of Information) at the post office.

STATE

What About After I Register?

JR

Fill Out
This Card

SIGNATURE

How Do I Register? Please print
all the requested information
– including your Social Security
Account Number if you have one;
sign your name; peel the seal strips
off, seal the card, put a stamp on the
front, and mail the sealed card. Or,
register online at www.sss.gov.

Female

0002
OVAL 3240OMB APPR

I AFFIRM THE FOREGOING STATEMENTS ARE TRUE

4

1M (Mar 07)

EMENTS

GOING STAT

THE FORE

7

SSS FORM

I AFFIRM

7

Register online (www.sss.gov)
or complete this form.

CITY

3

ZIP CODE

STATE

SELECTIVE SERVICE SYSTEM REGISTRATION FORM

5

TMENT NUMB
ESS & APAR

STREET ADDR

PRINT ONLY IN BLACK INK AND IN CAPITAL LETTERS ONLY

CURR

ADDRESS:

SEX: (Mark with “X”)

SA

ER

ING
ENT MAIL

Male U.S. citizens and
immigrants, documented
and undocumented, residing
in the U.S. and its territories
must register if they are age
18 through 25.

DATE OF BIRTH: (MM-DD-YYYY)

NAME

“X”)

III

JR

Male

& MIDDLE

(Mark with

Who Must Register?
IX

OTHER SUFF

We estimate the public reporting burden for this collection will vary from two minutes per response, including time for reviewing instructions, searching existing data sources, gathering data, and completing and reviewing the information. Send comments regarding the
burden statement or any other aspects of the collection of information, including suggestions for reducing this burden to: Selective
Service System, SSS Forms Officer (3240-0002), Arlington, VA 22209-2425. The OMB control number 3240-0002, is currently valid.
Persons are not required to respond to this collection unless it displays a valid OMB control number.

LAST NAME

FIRST NAME

LE

3

Female

SUFFIX:

1

4

“X”)

MP

Male

2

with
SEX: (Mark

2

1

ONLY

LETTERS

LAST NAME

IN CAPITAL

D-YYYY)

4

INK AND

: (MM-D
OF BIRTH

SPACE

NUMBER

FIRST NAME & MIDDLE NAME

DATE

IN BLACK

ACCOUNT

CURRENT MAILING ADDRESS: STREET ADDRESS & APARTMENT NUMBER

PRINT ONLY

RITY
SOCIAL SECU

5

SELECTIVE

E IN THIS

DO NOT WRIT

2

CITY

.sss.gov)
line (www
Register on
e this form. REGISTRATION FORM
or complet
SYSTEM
SERVICE

Not registering is
a felony. Young men
prosecuted and convicted of
failure to register may be fined
up to $250,000, imprisoned
for up to five years, or both.
Failure to register also may
cause men to permanently lose eligibility
for student financial aid, government
employment, job training, and U.S.
citizenship for male immigrants.

OMB APPROVAL 3240-0002

Registration is the process by
which the U.S. Government
collects
names
and
addresses of men age 18
through 25 to use in case of a
national emergency, determined
by Congress and the President,
which would require rapid
expansion of the Armed Forces.
Men are required to register
within 30 days of their 18th birthday.
Once men reach their 26th birthday, they
can no longer register, as stated in the
Military Selective Service Act.

TODAY’S DATE: (MM-DD-YYYY)

1

What Happens If I
Don’t Register?

SSS FORM 1M (UPO) (August 2011)

What is Selective Service
Registration?

6

You Must Register With Selective
Selective Service
Service