Fillable Form 1- Registration Fillable (Selective Service System)

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Form 1- Registration Fillable (Selective Service System)

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SELECTIVE SERVICE SYSTEM
PO BOX 94637
PALATINE IL 60094-4637
Postage
Required
Place Stamp
Here
From:
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, 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 Innovation and
Opportunity Act (formerly 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.
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 classification. (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 five years and/or a fine
of not more than $250,000.
SELECTIVE SERVICE SYSTEM REGISTRATION FORM
Register online at sss.gov
or complete this form
SSS FORM 1 (Expires 09-30-2024)
OMB APPROVAL 3240-0002
SIGNATURE
INT
I AFFIRM THE FOREGOING STATEMENTS ARE TRUE
TODAY’S DATE: (MM-DD-YYYY)
CURRENT MAILING ADDRESS: STREET ADDRESS & APARTMENT NUMBER
CITY STATE ZIP CODE
LAST NAME
4
6
5
FIRST NAME & MIDDLE NAME PHONE NUMBER
E-MAIL
OTHER SUFFIXSUFFIX: (Mark with “X”)
JR III
DATE OF BIRTH: (MM-DD-YYYY) SOCIAL SECURITY NUMBERSEX: (Mark with “X”)
Male Female
PRINT ONLY IN BLACK INK AND IN CAPITAL LETTERS ONLY
1
7
8
2
3
9
DO NOT WRITE IN THIS SPACE
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 Ocer (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.
AGENCY USE
SELECTIVE SERVICE SYSTEM REGISTRATION FORM
WHO MUST REGISTER?
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.
WHY REGISTER?
AFTER REGISTRATION
Within 90 days, you should receive a Registration Acknowledgement containing your Selective Service Number. You can also verify your Selective Service
Number by going to sss.gov. MOVING - You are required, by Federal law, to submit an address change. You can do it online at www.sss.gov or at your local
Post Oce.
IT’S THE LAW
Virtually all Men living in the United States and U.S. citizens living abroad must register at 18 with Selective Service. Men may pre-regis-
ter at 17 years and 3 months and when they turn 18, they will automatically be registered. Men 18 - 25 years old remain in a database for
national emergencies, requiring a future rapid expansion of our Armed Forces.
PROTECT ELIGIBILITIES FOR FUTURE BENEFITS
By registering, a young man stays eligible for:
-U.S. Citizenship for male immigrants
-Student financial aid (federal and most states) and even admission to some state schools
-Job training benefits
-Most federal jobs and jobs with the U.S. Postal Service
FAIRNESS AND EQUALITY
By registering all eligible young men, the Selective Service System ensures a fair and equitable draft, if ever required; however, there
has not been a draft since 1973.
CIVIC DUTY
It’s your responsibility to ensure that young men, 18 - 25, understand the law so they can make an informed decision about registra-
tion compliance. Currently, more than 90 percent of eligible young men are registered. It’s a civic duty of every young man to comply
with the law.
INSURANCE FOR THE NATION
By registering, a man’s voluntary participation helps provide a hedge against unforeseen threats. It is a relatively low-cost insurance
policy for our Nation.
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Completed 25 January 2022

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