RELEASE
Fair Credit Reporting Act of 1970, as amended
PLEASE TAKE NOTICE THAT ONE OR MORE CONSUMER CREDIT REPORTS MAY BE OBTAINED FOR EMPLOYMENT PURPOSES PURSUANT TO THE FAIR CREDIT REPORTING ACT, AS AMENDED, 15 U.S.C. § 1681, ETSEQ. SHOULD A DECISION TO TAKE ANY ADVERSE ACTION AGAINST YOU BE MADE, BASED IN WHOLE OR IN PART ON THE CONSUMER CREDIT REPORT, THE CONSUMER REPORTING AGENCY THAT PROVIDED THE REPORT PLAYED NO ROLE IN THE AGENCY’S DECISION TO TAKE SUCH ADVERSE ACTION.
Information provided by you on this form will be furnished to the consumer reporting agency in order to obtain information in connection with an investigation to determine your (1) fitness for Federal employment, (2) clearance to perform contractual service of the Federal Government, and/or (3) security clearance or access. The information obtained may be redisclosed to other Federal agencies for the above purposes and in fulfillment of official responsibilities to the extent that such disclosure is permitted by law.
I hereby authorize the U. S. Department of Agriculture to obtain such report(s) from any consumer/credit reporting agency for employment purposes.
(Print Name) __________________________ (SSN) __________________
(Signature) ___________________________ (Date) __________________
Your Social Security Number is needed to keep records accurate, because other people may have the same name.
Executive Order 9397 also asks Federal agencies to use this number to help identify individuals in agency records.
Para informacion en
espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response Center, Room 130-A 600
Pennsylvania Ave. N.W., Washington, D.C. 20580.
A Summary of Your Rights Under the Fair
Credit Reporting Act
The federal Fair Credit Reporting Act
(FCRA) promotes the accuracy, fairness, and privacy of information in the files
of consumer reporting agencies. There
are many types of consumer reporting agencies, including credit bureaus and
specialty agencies (such as agencies that sell information about check writing
histories, medical records, and rental history records). Here is a summary of your major rights under
the FCRA. For more information,
including information about additional rights, go to www.ftc.gov/credit or write to: Consumer
Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave.
N.W., Washington, D.C. 20580.
·
You must
be told if information in your file has been used against you. Anyone who uses a credit report or
another type of consumer report to deny your application for credit, insurance,
or employment – or to take another adverse action against you – must tell you,
and must give you the name, address, and phone number of the agency that
provided the information.
·
You have
the right to know what is in your file. You may request and obtain all the information about you in
the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper
identification, which may include your Social Security number. In many cases,
the disclosure will be free. You are
entitled to a free file disclosure if:
·
a person has taken
adverse action against you because of information in your credit report;
·
you are the
victim of identify theft and place a fraud alert in your file;
·
your file
contains inaccurate information as a result of fraud;
·
you are on
public assistance;
·
you are
unemployed but expect to apply for employment within 60 days.
In addition, by September 2005 all consumers will be entitled to
one free disclosure every 12 months upon request from each nationwide credit
bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit
for additional information.
·
You have
the right to ask for a credit score. Credit scores are
numerical summaries of your credit-worthiness based on information from credit
bureaus. You may request a credit score
from consumer reporting agencies that create scores or distribute scores used
in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will
receive credit score information for free from the mortgage lender.
·
You have
the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or
inaccurate, and report it to the consumer reporting agency, the agency must
investigate unless your dispute is frivolous.
See www.ftc.gov/credit for an explanation of
dispute procedures.
·
Consumer reporting
agencies must correct or delete inaccurate, incomplete, or unverifiable
information. Inaccurate, incomplete
or unverifiable information must be removed or corrected, usually within 30
days. However, a consumer reporting
agency may continue to report information it has verified as accurate.
·
Consumer
reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative
information that is more than seven years old, or bankruptcies that are more
than 10 years old.
·
Access
to your file is limited. A consumer reporting agency may provide
information about you only to people with a valid need -- usually to consider
an application with a creditor, insurer, employer, landlord, or other
business. The FCRA specifies those with
a valid need for access.
·
You must
give your consent for reports to be provided to employers. A consumer reporting agency may not give
out information about you to your employer, or a potential employer, without
your written consent given to the employer.
Written consent generally is not required in the trucking industry. For more information, go to www.ftc.gov/credit.
·
You may
limit “prescreened” offers of credit and insurance you get based on information
in your credit report. Unsolicited
“prescreened” offers for credit and insurance must include a toll-free phone
number you can call if you choose to remove your name and address from the
lists these offers are based on. You may opt-out with the nationwide credit
bureaus at 1-888-5-OPTOUT (1-888-567-8688).
·
You may
seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer
reports or a furnisher of information to a consumer reporting agency violates
the FCRA, you may be able to sue in state or federal court.
·
Identity
theft victims and active duty military personnel have additional rights. For more information, visit www.ftc.gov/credit.
States may enforce the FCRA and many states have
their own consumer reporting laws. In
some cases, you may have more rights under state law. For more information, contact your state or local consumer
protection agency or your state Attorney General. Federal enforcers are:
|
TYPE OF
BUSINESS: |
CONTACT: |
|
Consumer reporting agencies,
creditors and others not listed below |
Federal Trade Commission: Consumer
Response Center - FCRA |
|
|
Washington, DC 20580 1-877-382-4357 |
|
National banks, federal
branches/agencies of foreign banks (word |
Office of the Comptroller of the
Currency |
|
"National" or initials
"N.A." appear in or after bank's name) |
Compliance Management, Mail Stop
6-6 |
|
|
Washington, DC 20219 800-613-6743 |
|
Federal Reserve System member banks
(except national banks, |
Federal Reserve Board |
|
and federal branches/agencies of
foreign banks) |
Division of Consumer &
Community Affairs |
|
|
Washington, DC 20551 202-452-3693 |
|
Savings associations and federally
chartered savings banks (word |
Office of Thrift Supervision |
|
"Federal" or initials
"F.S.B." appear in federal institution's name) |
Consumer Complaints |
|
|
Washington, DC 20552 800-842-6929 |
|
Federal credit unions (words
"Federal Credit Union" appear in |
National Credit Union
Administration |
|
institution's name) |
1775 Duke Street |
|
|
Alexandria, VA 22314 703-519-4600 |
|
State-chartered banks that are not
members of the Federal Reserve |
Federal Deposit Insurance
Corporation |
|
System |
Consumer Response Center, 2345
Grand Avenue, Suite 100 |
|
|
Kansas City, Missouri
64108-2638 1-877-275-3342 |
|
Air, surface, or rail common
carriers regulated by former Civil |
Department of Transportation ,
Office of Financial Management |
|
Aeronautics Board or Interstate
Commerce Commission |
Washington, DC 20590 202-366-1306 |
|
Activities subject to the Packers
and Stockyards Act, 1921 |
Department of Agriculture |
|
|
Office of Deputy Administrator -
GIPSA |
|
|
Washington, DC 20250 202-720-7051 |
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