Form RD 3550-1
0MB No. 0575-0172
United States Department of Agriculture
Rural Housing Service
AUTHORIZATION TO RELEASE INFORMATION
Account or Other Identifying Number
Name of Customer
I, and/or adults in my household, have applied for or obtained a loan or grant from the Rural Housing Service (RHS), part of the Rural
Development mission area of the United States Department of Agriculture. As part of this process or in considering my household for
interest credit, payment assistance, or other servicing assistance on such loan, RHS may verify information contained in my request for
assistance and in other documents required in connection with the request.
I, or another adult in my household, authorize you to provide to RHS for verification purposes the following applicable information:
Other consumer credit references.
If the request is for a new loan or grant, I further authorize RHS to order a consumer credit report and verify other credit information.
I understand that under the Right to Financial Privacy Act of 1978, 12 U.S.C. 3401, et seq., RHS is authorized to access my financial
records held by financial institutions in connection with the consideration or administration of assistance to me. I also understand that
financial records involving my loan and loan application will be available to RHS without further notice or authorization, but will not be
disclosed or released by RHS to another Government agency or department or used for another purpose without my consent except as
required or permitted by law.
This authorization is valid for the life of the loan.
The recipient of this form may rely on the Government's representation that the loan is still in existence.
The information RHS obtains is only to be used to process my request for a loan or grant, interest credit, payment assistance, or other
servicing assistance. I acknowledge that I have received a copy of the Notice to Applicant Regarding Privacy Act Information. I
understand that if I have reque