HOW TO: How to prevent Identity Theft on a Social Security or Medicare Application

By ftsig-admin | July 7, 2026

INTRODUCTION:

Use this application attachment to Medicare to prevent public capacityPUB inversion.

APPLICATION FOR PART A HOSPITAL INSURANCE, Form CMS-18-F-5 MANDATORY ATTACHMENT

  1. Purpose:
    1.1. To clarify the evidentiary limits of ministerial processing and to prevent misinterpretation of this submission by distinguishing facts, legal conclusions, and statutory identities.
    1.2. To prevent evidentiary misclassification arising from pre printed statutory language on government forms.
  2. Definitions: For purposes of this submission, the following definitions apply:
    2.1. Fact: A statement of personal knowledge verified under penalty of perjury (FRE 602; 28 U.S.C. § 1746).
    2.2. Legal conclusion: A statutory or regulatory classification (FRE 704).
    2.3. Statutory identity: A program bound PUB construct (e.g., “person,” “citizen,” “resident,” “taxpayer”).
    2.4. Ministerial officer: An officer performing nondiscretionary, fact bound duties (Marbury v. Madison).
  3. Definitions Control: The definitions herein govern all interpretation of this attachment and supersede any conflicting definitions in SSA forms or publications.
  4. About all government forms and ministerial officers such as YOU, the recipient:
    4.1. Social Security Administration is a ministerial officer within the Administrative State.
    4.1.1. Freytag v. Commissioner, 501 U.S. 868 (1991) Scalia’s concurrence: the administrative apparatus is the “fourth branch” of government.
    4.1.2. SSA ALJs are administrative officers — Lucia v. SEC, 138 S. Ct. 2044 (2018). Administrative judges are “officers of the United States” under Article II.
    4.1.3. 5 U.S.C. § 551 (APA definitions) Defines “agency” and “officer” in the administrative state sense.
    4.2. Ministerial officers may act only on facts and may not expand, reinterpret, supplement, or treat legal conclusions as facts.
    4.2.1. Marbury v. Madison, 5 U.S. (1 Cranch) 137 (1803) Distinguishes ministerial acts (fact bound, nondiscretionary) from discretionary acts.
    4.2.2. Federal Administrative Law — ministerial officers must act on “ascertainable facts.”
    4.2.3. 5 U.S.C. § 706(2)(E) — APA requires decisions to be based on substantial evidence.
    Meaning: Ministerial officers cannot invent facts, infer facts, or treat legal conclusions as facts.
    4.3. Ministerial officers may not infer or presume consent or election. Cleveland Bd. of Educ. v. Loudermill, 470 U.S. 532 (1985) — government cannot presume waiver of rights. Fuentes v. Shevin, 407 U.S. 67 (1972) — waiver of constitutional rights must be “clear and compelling.”
    4.4. Facts include ONLY what I ADDED to the form and verified under penalty of perjury. Because pre printed text is not made by the declarant, it cannot be verified under penalty of perjury and cannot be treated as evidence. 28 U.S.C. § 1746 — unsworn declarations under penalty of perjury apply only to statements made by the declarant. Fed. R. Evid. 602 — witness may testify only to personal knowledge. Fed. R. Evid. 801(c) — statements not made by the declarant are hearsay. Facts DO NOT include:
    4.4.1. Any word or phrase printed on the original form by the Recipient SSA. Fed. R. Evid. 802 — hearsay is inadmissible unless an exception applies. Fed. R. Evid. 901 — authentication required; pre printed text is not authenticated by the declarant. Courts treat agency publications as non evidentiary: Chrysler Corp. v. Brown, 441 U.S. 281 (1979) — agency manuals are not law; United States v. Mead Corp., 533 U.S. 218 (2001) — agency interpretations lack force of law unless formal. NLRB v. SW General, 580 U.S. 288 (2017) — agency forms and internal documents do not bind the public. Perez v. Mortgage Bankers Ass’n, 575 U.S. 92 (2015) — agency guidance documents cannot create obligations.
    4.4.2. The connection of any civil statutory status or privilege to me. Fed. R. Evid. 602 — no personal knowledge = no fact. Fed. R. Evid. 701 — lay witnesses cannot assert legal conclusions. Fed. R. Evid. 704 — legal conclusions are not admissible as evidence.
    4.5. Forms, statements, and publications of agencies are treated by the courts as untrustworthy and non-factual. Thus, everything printed on the original form attached and any connection between what is printed and me is untrustworthy, nonfactual, and remains unverified by my perjury statement. Chrysler Corp. v. Brown, 441 U.S. 281 (1979) Agency publications do not have the force of law. Mead Corp., 533 U.S. 218 (2001) Agency manuals and forms are not binding and not authoritative. Skidmore v. Swift, 323 U.S. 134 (1944) Agency interpretations get respect only to the extent they are persuasive — not evidence.
    4.6. Perjury statements: A perjury oath verifies only facts within personal knowledge; it cannot transform statutory language into factual statements. Legal conclusions cannot be transformed into facts by a perjury oath. They:
    4.6.1. Do not and cannot verify legal conclusions. Fed. R. Evid. 704 — legal conclusions are inadmissible. Fed. R. Evid. 602 — perjury oath applies only to facts within personal knowledge. 28 U.S.C. § 1746 — perjury declaration applies only to statements made by the declarant.
    4.6.2. Do not turn legal conclusions into facts. Fed. R. Evid. 701–704 — legal conclusions are not facts. Marbury v. Madison — ministerial officers cannot treat legal conclusions as facts.
    4.6.3. Turn legal conclusions of any kind into elections. Contract law — consent must be knowing, voluntary, explicit. Restatement (Second) of Contracts § 17 — mutual assent required. No court treats legal conclusions as elections unless statute explicitly requires election.
    Any deviation from the above violates the Federal Rules of Evidence and renders such alleged but not actual evidence into fruit of a poisonous tree that is inadmissible. Wong Sun v. United States, 371 U.S. 471 (1963) Evidence derived from unlawful acts is inadmissible. Fed. R. Evid. 403, 802, 901 — unverified, hearsay, or unauthenticated statements are inadmissible. Mapp v. Ohio, 367 U.S. 643 (1961) — exclusionary rule applies to all evidence derived from unlawful acts. Silverthorne Lumber Co. v. United States, 251 U.S. 385 (1920) — derivative evidence is inadmissible.
  5. Summary: The above authorities establish the following evidentiary principles governing this submission:
    5.1. Facts = admissible
    5.2. Legal conclusions = inadmissible
    5.3. Statutory identities = inadmissible
    5.4. Pre printed text = hearsay
    5.5. Inferred consent = invalid
    5.6. Derived evidence = fruit of the poisonous tree
  6. I am not authorized nor do I consent to make legal conclusions about my civil statutory status, whether political or civil, on any government form. Speiser v. Randall, 357 U.S. 513 (1958) — government cannot require individuals to affirm legal or political conclusions as a condition of receiving benefits. West Virginia v. Barnette, 319 U.S. 624 (1943) — government cannot compel ideological or legal affirmation.
    6.1. Every effort to connect me with a civil obligation presupposes a public capacityPUB election on my part that can be entered into ONLY voluntarily and knowingly, which I do not wish to do in this or any case in relation to any government.
    6.2. I reserve all my rights and surrender none. Any attempt to connect me with a civil statutory public capacityPUB represents a WAIVER of private rightsPRI that I do not consent to.
    6.3. It is UNNECESSARY for you to determine my political or civil status in order to approve this application. Eligibility has already previously been satisfied by historical behavior and records connected to that behavior which do NOT reflect my current status or wishes. Eligibility is based on historical records, not on present statutory identity, and therefore does not require any legal conclusion from me. Eligibility does not require any present statutory identity or legal conclusion from me.
    6.4. As a human being standing on land protected by the constitution, the Unconstitutional Conditions Doctrine forbids conditioning any government service or benefit upon a surrender of constitutional rights. The most important such surrender is a public capacityPUB election that I choose not to make and may not be compelled to make, such as CIVIL “person”, CIVIL “U.S. citizen”, or any other public capacity under any CIVIL statute. Perry v. Sindermann, 408 U.S. 593 (1972) — government may not condition benefits on surrender of constitutional rights. Koontz v. St. Johns River Water Mgmt., 570 U.S. 595 (2013) — unconstitutional conditions apply even when the benefit is denied. Agency for Int’l Development v. AOSI, 570 U.S. 205 (2013) — compelled speech as a condition of benefits is unconstitutional.
    6.5. Any attempt to impose statutory identity or civil capacityPUB despite the above evidentiary limits constitutes misclassification and overreach.
  7. This application is submitted in a purely private capacity not subject to federal civil statutory law other than those governing perjury statements. Any attempt to abuse the application process to compel a PUBLIC civil capacity is a violation of the Unconstitutional Conditions Doctrine of the U.S. Supreme Court. Choice of law in all disputes surrounding this application is dictated by:
    Choice of Law, Litigation Tool #01.010
    https://sedm.org/Litigation/01-General/ChoiceOfLaw.pdf
  8. I do not consent to the commercial or civil statutory enforcement use of any personal information provided outside of this direct interaction. Any violation is subject to:
    Injury Defense Franchise and Agreement, Form #06.027
    https://sedm.org/Forms/06-AvoidingFranch/InjuryDefenseFranchise.pdf
  9. Any attempt to connect me with a civil statutory public capacityPUB or to make me a target of civil enforcement for OTHER than the perjury statement:
    9.1. Is hereby reported in advance as identity theft. Bond v. United States, 564 U.S. 211 (2011) — individuals may challenge federal overreach that intrudes on personal sovereignty. Printz v. United States, 521 U.S. 898 (1997) — federal government cannot commandeer private individuals. Identity theft report is below:
    Identity Theft Affidavit, Form #14.020
    https://sedm.org/Forms/14-PropProtection/Identity_Theft_Affidavit-f14039.pdf
    9.2. Is proven with evidence as identity theft and capacity inversion by the following:
    Capacity Based Jurisdictional Lawyers, Form #05.057
    https://sedm.org/Forms/05-MemLaw/CapacityBasedJurisdictionalLayers.pdf
  10. The attached application is incomplete and misleading if separated from this attachment, because pre printed text is not verified and cannot be treated as factual.
  11. To prevent any misinterpretation of silence, submission, or form structure as consent, the following applies:
    11.1. No Constructive Consent: No signature, submission, or presence shall be construed as consent to any statutory identity or public capacityPUB.
    11.2. No Reinterpretation: No statement herein shall be reinterpreted as a legal conclusion, statutory identity, or election into any civil capacityPUB.
    11.3. No Waiver: Nothing in this application or attachment shall be construed as waiver of any rightPRI or election into any public capacityPUB.
    11.4. Interpretation: All statements herein are factual, evidentiary, or definitional. None shall be construed as legal conclusions or elections.
    11.5. Integration: This attachment forms an inseparable part of the application and governs all evidentiary interpretation of the submission.
    11.6. Severability: If any portion of this attachment is deemed invalid, the remainder shall remain in full force.
    11.7. No Agency Modification: No agency, officer, or employee may alter, omit, redact, reinterpret, or separate this attachment from the application.
  12. If you have questions about the processing of this application, please forward all inquiries to: _______________. All communication must include your full legal birthname and an address which you agree to be served with legal process if you injure my rights in the processing of this application or the rendering of any service.

Name: ___________________ Date: ________________________________

Posted in Benefits, How To and tagged ,