Confirmation of Eligibility for a Reclaimed Name Change Gratis Replacement Document Under Call to Action 17 (IRM 0004)

Download the form

Help to download and save this form

  • Use your computer. The form may not open on tablets or mobile phones.
  • For most Internet browsers, clicking on the link above will ask you what you would like to do with the form.
    • You must save the form on your computer in a place you can remember.
    • If you try to open the form in your Internet browser’s PDF viewer, viewing or saving the form will not work.
  • You must open the form using Acrobat Reader.

How to open this form in Acrobat Reader

  1. Open Acrobat Reader
  2. Select “File” from the top menu
  3. Click "Open
  4. Find the location where you saved the form, click on the file and click “Open

Page details

Date modified: