FPI-LOM
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FULL
NAME
(Last) (First) (Middle)
DATE
OF
BIRTH
(Mo) (Day) (Yr)
DO NOT WRITE IN THE ABOVE SPACE
SOCIAL
SECURITY
ACCOUNT
NUMBER
SELECTIVE
SERVICE
NUMBER
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MAILING
ADDRESS
ON FILE
(Number) (Street) (Apt. No.)
CURRENT
MAILING
ADDRESS
(Number) (Street) (Apt. No.)
(City) (State or Foreign Country) (Zip Code)
(City) (State or Foreign Country) (Zip Code)
NAME
CHANGE
(Last) (First) (Middle) (Suffix)
TODAY’S
DATE
SIGNATURE OF REGISTRANT
SSS Form 2 (Expires Feb 2021) OMB APPROVAL: 3240-0003
SELECTIVE SERVICE SYSTEM
Change of Information Form
PRIVACY ACT STATEMENT
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.
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, classication, induction, and examination of registrants and for identication of prospects for recruiting.
DEPARTMENT OF LABOR - to assist veterans in need of data concerning reemployment rights, and for determining eligibility for benets under the Workforce Innovation and Opportunity Act (formerly Workforce Investment Act).
DEPARTMENT OF EDUCATION - to determine eligibility for student nancial 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.
U.S. CENSUS BUREAU - 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 classication. (Military Selective Service Act, 50 U.S.C. 3806(h))
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 ve years and/or a ne of not more than $250,000.
CHANGE OF INFORMATION FORM INSTRUCTIONS
EIGHT steps to fill out this form.
NOTE: Selective Service must already have your record on file to complete this Change of Information Form. Please send update whenever you legally
change your name or change your address previously supplied to Selective Service. (For a quick way to change your address only, go online to the Selective
Service Web site at www.sss.gov.)
Blocks through
Print your full name, your date of birth, your Social Security Account Number, Selective Service Number, and mailing adress as shown on your latest
Selective Service Acknowledgment form regardless of the type of change being submitted.
Block
If you legally changed your name, print your new name in Block and provide a copy of the legal court order document as proof of the change.
Block
Print the address of your current residence if different from Block .
Block
Sign and date your Change of Information Form.
If you need to register,
use SSS Form 1 (UPO).
Tell your friends they can register online at
www.sss.gov
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THIS IS NOT A REGISTRATION FORM
TO MAIL: PEEL THE SEAL STRIPS OFF, SEAL THE CARD, AFFIX POSTAGE, THEN MAIL.
Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number.
