FSA- 2004 Date of Modification 12-31-2007
AUTHORIZATION TO RELEASE INFORMATION |
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INSTRUCTIONS FOR PREPARATION |
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Purpose: This form is completed by the applicant to authorize employers, financial institutions, and creditors to verify and provide employment, income or other financial information in connection with the submission of an application for a loan or servicing assistance.
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Handbook Reference: 3-FLP |
Number of Copies: Original |
Signatures Required: Applicant |
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Distribution of Copies: Original in case file. |
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Automation-Related Transactions: N/A |
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Please read Items (1) through (4) and the Privacy Act Statement. Applicant must complete Items (5A), (5B), and (5C).
Fld Name /
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Instruction |
(1) – (4) General |
Please read. |
(5A) Name |
Enter the applicant’s name. |
(5B) Signature |
Enter the applicant’s signature
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(5C) Date |
Enter the date the applicant signed. |
Page
| File Type | application/msword |
| File Title | Template Users: Select the text for each of the instruction components below and type over it without changing the font type, |
| Author | Preferred Customer |
| Last Modified By | maryann.ball |
| File Modified | 2010-07-01 |
| File Created | 2010-07-01 |