2 Fair Credit Release

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. Census Bureau 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.
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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:
•
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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.
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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.

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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.

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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.

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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
"Federal" or initials "F.S.B." appear in federal institution's name)

Office of Thrift Supervision
Consumer Complaints
Washington, DC 20552 800-842-6929

Federal credit unions (words "Federal Credit Union" appear in
institution's name)

National Credit Union Administration
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

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

Kansas City, Missouri 64108-2638

Activities subject to the Packers and Stockyards Act, 1921

1-877-275-3342

Department of Agriculture
Office of Deputy Administrator - GIPSA
Washington, DC 20250 202-720-7051