Selective Service Number:
**Required Field

Social Security Number:
(No dashes or spaces)**Required Field

Last Name:
**Required Field

Date of Birth:
(mmddyyyy)  **Required Field

Street or PO Box or RFD:
**Required Field

City:
**Required Field

State:
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Zip Code:
**Required Field

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SSS FORM 2, OMB APPROVAL: 3240-0003

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 (3240-0003), 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.