Guarantor Authorization to Obtain Consumer Credit Report & Conduct a Credit Inquiry (Individual)

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OMB APPROVED NO. 0648-0012

Expires 10/31/2026

Guarantor Authorization to Obtain Consumer Credit Report and Conduct
a Credit Inquiry

I authorize the National Marine Fisheries Service, Fisheries Finance Program (FFP) to obtain a
credit report and conduct a credit investigation on
(Guarantor). The FFP will use this information to evaluate my offer to guarantee debt for
(Applicant).
This authorization is valid for purposes of verifying information given pursuant to any lawful
purpose covered by the Fair Credit Reporting Act.
Upon request, the FFP will provide me with the name and address of the Reporting Agency
contacted to supply the report. I understand that credit inquiries have the potential to impact
my credit score.

Signature: ____________________________________

Name:
Social Security Number:
Date of Birth:
Current Address:
Previous Mailing Addresses (last seven years):

Phone Number:
Mobile Number:
Email Address:
Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other suggestions for reducing this burden to Brian Summers, Financial Services
Division, NOAA Fisheries, 1315 East West Highway, Silver Spring, MD 20910. Confidential name and address information will be
released via a NOAA website for informational purposes. All other data submitted will be handled as confidential material in accordance with
NOAA Administrative Order 216-100, Protection of Confidential Fishery Statistics. Notwithstanding any other provisions of the law, no person
is required to respond to, nor shall any person be subjected to a penalty for failure to comply with, a collection of information subject to the
requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number
Privacy Act Notice:
Authority: The collection of this information is authorized by Title 46 U.S.C. 1271-1279 and 50 CFR Part 253, Subpart B.
Purpose: The data will primarily be used for the evaluation of financial condition in connection with application for financing under the Fisheries
Finance Program. Financing will not be considered unless all requested information is furnished.
Routine Uses: The Department will use this information to determine eligibility for financing. Disclosure of this information is permitted under the
Privacy Act of 1974 (5 U.S.C. Section 552a) to be shared among Department staff for work-related purposes. Disclosure of this information is also
subject to all of the published routine uses as identified in the Privacy Act System of Records Notice COMMERCE/NOAA-21, Financial Services
Division.
Disclosure: Furnishing this information is voluntary; however, failure to provide accurate information will prevent full evaluation of the application.