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
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