(DO NOT WRITE IN THE ABOVE SPACE.)
SELECTIVE SERVICE NUMBER SOCIAL SECURITY NUMBER SEX DATE OF BIRTH
NAME AND CURRENT MAILING ADDRESS
SSS Digital Acknowledgment SSS Form 3B (Feb-21)
Change of Information Form
If any information shown is incorrect, make corrections, sign and return this top portion to:
Selective Service System, P.O. Box 94636, Palatine, Illinois 60094-4636
LAST ACTION DATE
Dear Registrant:
Please keep this letter or wallet sized acknowledgment card as legal proof of your registration.
Please review this letter carefully, and use the top portion of this letter to update and/or correct your
information. Line through any mistakes and write in the correct information.
IF YOU MADE CHANGES: Cut off the top portion of this letter, and mail it to Selective Service
System, P.O. Box 94636, Palatine, Illinois 60094-4636. If your information is correct, do not return this form. However, if
any of your information changes, you are required to notify the Selective Service System within 10 days. If changing only
your address, you may make the changes at https://www.sss.gov/verify/update-info.
For Non-Immigrants: If you are on a valid visa and believe that you were registered in error, send this entire form and
proof of your immigration status to: Selective Service System, P.O. Box 94638, Palatine, Illinois 60094-4638. A complete
list of acceptable documentation may be found at https://www.sss.gov/wp-content/uploads/2020/02/
DocumentationList.pdf.
Thank you for your cooperation, and please call us at 1-847-688-6888 if you have any additional
questions/concerns.
We estimate the public reporting burden for this collection will vary from 1 - 2 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 the burden to: Selective Service System, SSS Forms Officer (3240-0003), Arlington, VA 22209-2425. The OMB control number
3240-0003, is currently valid. Persons are not required to respond to this collection unless it displays a valid OMB control number.
SELECTIVE SERVICE NUMBER SOCIAL SECURITY NUMBER
DATE OF BIRTH LAST ACTION DATE
Registration Acknowledgment SSS Form 3A (Feb-21)
NAME AND CURRENT MAILING ADDRESS
(Fold on line.)
The Selective Service System thanks you for registering.
This form is your official Registration Acknowledgment.
Cut it out and safeguard it as your proof of having registered.
ACTING DIRECTOR
Here's your official
Registration Acknowledgment
Cut it out and safeguard it as your proof of having
registered.
Joel C. Spangenberg
SIGNATURE OF REGISTRANT
SIGNATURE OF REGISTRANTTODAY'S DATE
First explore your interest,
then decide which career path
is right for you. Visit
todaysmilitary.com/ssb2 or fill
out and return the enclosed
reply card for more
information.
THIS IS NOT AN OFFICIAL FORM OF IDENTIFICATION
THIS IS NOT AN OFFICIAL FORM OF IDENTIFICATION
04-1185537-2
ON FILE
M
10-14-2004
03-24-2023
04-1185537-2
ON FILE
10-14-2004
03-24-2023
TONY MICHAEL BAISLEY
CROSSVILLE, TN 38571
04-1185537-2
4184 HIGHWAY 70 N
TONY MICHAEL BAISLEY
CROSSVILLE, TN 38571
4184 HIGHWAY 70 N
