Independent User Registration

To apply for an independent user ID, fill out the form below, and click Send Application when you are through. If you have already been assigned a user ID, you will be prompted to convert that ID to an Independent user ID. If you have not been assigned a user ID yet, an ID will be assigned and mailed to you. The password will not be disclosed, so make sure you remember it!!!

And remember:
Warning! Misuse of Federal Information at this Web site falls under the provisions of Title 18, United States Code, section 1030. This law specifies penalties for exceeding authorized access, alteration, damage or destruction of information residing on Federal Computers. 

First Name:
Middle Initial:
Last Name:

Social Security Number:

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Provide your e-mail address.
E-mail Address:

Choose a Password.
Re-enter Password for Verification:

Mother's Maiden Name.
Mother's Maiden Name: