Can I sign the application electronically?

Electronic signatures are generally acceptable under the ESIGN Act (15 U.S.C. §7001) and state UETA laws, but each state ACP may require specific consent disclosures or authentication methods. Verify the program's eSubmission rules before relying solely on eSignature.

What identity documents are required?

Most programs request a government-issued photo ID and supporting documentation of eligibility such as a protective order, police report, or a letter from a victim-service provider. Requirements vary by state and may include notarized attestations.

How do I update my forwarding address?

Notify the ACP office promptly according to program procedures. Some programs require a signed change request and updated verification; failure to update can interrupt mail forwarding and critical communications.

What happens if a submission is incomplete?

The ACP office will typically request missing items, which delays processing. Keep copies of all submissions and respond quickly to requests for additional evidence to avoid denial.

How do I revoke enrollment or cancel protections?

Contact the state ACP office for the program-specific revocation process. Revocation steps often require a signed withdrawal and confirmation of identity; consider consulting an advocate or attorney if safety concerns are involved.

Who can I contact for help completing the form?

Victim-advocate organizations, legal-aid programs, and the state ACP office can provide assistance. For questions about electronic tools or HIPAA-covered data handling, consult the receiving agency's privacy officer or legal counsel.

Electronic Signature
Templates
Other
Address Confidentiality Program Application

Address Confidentiality Program Application

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

ADDRESS CONFIDENTIALITY PROGRAM APPLICATION

Section 40-15-117 MCA

Please mail completed application to:

ACP
PO Box 201410
Helena, MT 59620-1410

For ACP Use only

ACP # Filed:

Type of application:

New Reinstatement Renewal New Name

APPLICANT'S LEGAL NAME (First, Middle, Last)

Mr. Ms.

DATE OF BIRTH (mm/dd/yyyy)

Has applicant ever participated in a confidential address program in Montana or in another state?

YES NO If yes, in what state?

CO-APPLICANT NAMES (First, MI, Last) - Use additional paper if needed

Name

DATE OF BIRTH (mm/dd/yyyy)

Relationship to applicant

A.

B.

C.

RESIDENTIAL ADDRESS (Participant's actual residential address/physical location is required to participate in ACP)

Street Address: Apt/Suite#:

City: MT ZIP: County:

DAY TELEPHONE

EVENING TELEPHONE

MESSAGE/OTHER TELEPHONE

BUSINESS NAME AND ADDRESS (Fill out only if applicant owns a business)

Business Name: Address:

City: MT ZIP:

I am (or the applicant for whom I am the parent/guardian is) a victim of:

sexual assault or domestic violence or stalking.

I am a resident of the State of Montana and have recently relocated to a place unknown to the abuser. I have determined that the Address Confidentiality Program (ACP) should be part of my safety plan. I understand that knowingly providing the ACP with false or incorrect information is punishable under 45-7-202, MCA or other applicable statutes and may jeopardize my participation in the program. To my knowledge, the information contained on this form is true and accurate.

I hereby designate the Montana Attorney General as my agent for service of process pursuant to 40-15-117, MCA. I understand that moving from the above residential address or changing my mailing address without first notifying the ACP may result in the cancellation of my participation in the ACP.

Signature of Applicant or Parent/Guardian

Date

State of )

County of )

On this day of in the year 2 , before me , a notary public, personally appeared

proved on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument, and

acknowledged (he/she/they) executed the same. Witness my hand and official seal.

NOTARY PUBLIC

My Commission Expires:

Questions? Call ACP at (406) 444-5803

OVS 3/07

What the Address Confidentiality Program Application Is and why it exists

The Address Confidentiality Program Application is the official form used to request enrollment in a state-run program that provides a substitute mailing address to eligible individuals. Applicants typically include victims of domestic violence, stalking, sexual assault, or other crimes who need to keep their physical address confidential for safety reasons. The program assigns a secure redirect address or agent address that accepts mail and forwards it to the participant's true location, shielding the residential address from public records and routine disclosures. Completing the application initiates verification, establishes forwarding instructions, and records program terms.

Why completing this application matters for personal safety and privacy

Enrollment replaces public address records with a program address, reducing the risk that an abuser or third party can locate the participant. Programs often include mail forwarding, identity-protection guidance, and coordination with state agencies to suppress address disclosure.

Who typically applies and who helps with the process

The application is used by individuals seeking to prevent public disclosure of their residential address and by organizations that support them during enrollment.

Survivors and petitioners seeking safe mail forwarding and suppression of public address records
Legal aid and victim-advocate organizations assisting documentation, ID verification, and follow-up
State or local agencies that update records and coordinate forwarding with courts and registries

Support from legal, advocacy, or government representatives can streamline verification steps and reduce common errors during submission.

Step-by-step: completing the Address Confidentiality Program Application

Follow these sequential steps to prepare, verify, and submit a complete application to a state program office.

01

Gather documents: Collect ID, proof of residency, and any protective orders required by your state.
02

Complete form: Enter applicant data, contact info, and forwarding preferences accurately.
03

Attach verification: Include copies of government ID and supporting evidence of eligibility.
04

Submit: Send to the state ACP office by the accepted method (mail, in-person, or eSubmission).

Sensitive data fields on the application

Applicant Name: Full legal name

Residential Address: Physical street address

Forwarding Address: Confidential mail delivery address

Government ID: Driver's license or passport number

Eligibility Evidence: Protective orders, police reports

Contact Information: Phone and email for program correspondence

Common mistakes that delay or invalidate an application

Submitting incomplete proof of eligibility, such as an unsigned protective order or an undated police report, which causes verification delays and requests for additional documents.
Entering inconsistent name or address details that do not match government ID, triggering identity-verification rejections or the need for notarized affidavits.
Using a P.O. box for the protected physical address when the program requires a verifiable residential address, resulting in denial or follow-up documentation requests.
Failing to follow the program's signature or consent requirements for electronic submission, including missing the required consumer disclosure under ESIGN when applicable.

Risks and potential penalties for incorrect or fraudulent applications

False Statements: May lead to denial or criminal penalties

Misuse of Address: Program removal for unauthorized use

Privacy Breach: Exposure risk if records mishandled

Perjury Consequences: Criminal charges in some jurisdictions

Mail Delivery Issues: Delayed essential notices or benefits

Program Revocation: Loss of protections if rules violated

Where to file the application and how it moves through the program

Applications are routed to a state-designated ACP office or agent and then processed according to program procedures.

Submit Application: Send completed form and documents to the state ACP office
Verification: Program verifies identity and eligibility documentation
Address Assignment: Program issues substitute mailing address for public records
Mail Forwarding: Incoming mail to the program address is forwarded per participant instructions

Digital submission formats and platform considerations

Many states accept scanned or electronically signed applications; confirm each program's permitted formats and authentication requirements before eSubmission.

Accepted Formats: PDF and DOCX are commonly accepted for scanned or uploaded documents
Authentication: Email verification, SMS codes, or platform 2FA are typical signer controls
Integrations: Platforms integrate with systems like Salesforce and Google Workspace for secure document routing

When using a commercial eSignature provider, verify compliance with ESIGN/UETA and any program-specific rules; platforms that support secure PDF, audit trails, and HIPAA-ready configurations simplify compliance for sensitive filings.

Typical timelines and processing expectations

Processing times and renewal intervals vary by state; check program materials for exact deadlines and required renewals.

Initial Processing Time:

Varies by program; expect state-specific timelines from a few weeks to several months

Renewal Interval:

Many programs require annual renewal or periodic re-certification

Change Notifications:

Notify the ACP office promptly of forwarding-address changes or program exits

Proof Updates:

Some states request updated eligibility evidence during renewal

Emergency Requests:

Contact victim-advocate or program office for expedited processing in urgent cases

Practical tips for accurate and efficient completion

Apply these best practices to reduce processing delays, protect privacy, and maintain program eligibility.

Prepare supporting documents

Assemble clear, legible copies of government ID, orders, or police reports before you start. Scan or photocopy originals and redact nonessential sensitive data where allowed; this prevents multiple requests and speeds verification.

Match names exactly

Ensure the name on your application matches your government ID and other submitted documents. If you use multiple names, include legal documentation (court order or marriage certificate) to reconcile differences to avoid identity verification failures.

Choose forwarding address carefully

Designate a secure forwarding location—trusted third-party address or agent—that can reliably receive mail. Confirm acceptance and update the forwarding contact if circumstances change to avoid missed correspondence.

Document submissions

Keep dated copies of every submission and receipt. Track mail, email confirmations, and any program correspondence to support appeals or re-certification requests if needed.

Frequently asked questions and troubleshooting for the Address Confidentiality Program Application

Answers to common questions about electronic submission, identity requirements, updates, and program limits.

Need help? Contact support

Can I sign the application electronically?
Electronic signatures are generally acceptable under the ESIGN Act (15 U.S.C. §7001) and state UETA laws, but each state ACP may require specific consent disclosures or authentication methods. Verify the program's eSubmission rules before relying solely on eSignature.
What identity documents are required?
Most programs request a government-issued photo ID and supporting documentation of eligibility such as a protective order, police report, or a letter from a victim-service provider. Requirements vary by state and may include notarized attestations.
How do I update my forwarding address?
Notify the ACP office promptly according to program procedures. Some programs require a signed change request and updated verification; failure to update can interrupt mail forwarding and critical communications.
What happens if a submission is incomplete?
The ACP office will typically request missing items, which delays processing. Keep copies of all submissions and respond quickly to requests for additional evidence to avoid denial.
How do I revoke enrollment or cancel protections?
Contact the state ACP office for the program-specific revocation process. Revocation steps often require a signed withdrawal and confirmation of identity; consider consulting an advocate or attorney if safety concerns are involved.
Who can I contact for help completing the form?
Victim-advocate organizations, legal-aid programs, and the state ACP office can provide assistance. For questions about electronic tools or HIPAA-covered data handling, consult the receiving agency's privacy officer or legal counsel.

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