AUTHORIZATION FOR RELEASE OF INFORMATION
**EVERYONE THE AGE OF 18 AND OLDER MUST SIGN THIS FORM**
CONSENT: I authorize and direct any Federal, State, or local agency, organization, business, or individual to release to Northwest Minnesota Multi-County HRA any information or materials needed to complete and verify my application for particiapnt, and/or maintain my continued assistance under the Section 8, Rental Rehabilitation, Public Housing, Family Self Sufficiency, Resident Opportunities for Self Sufficiency, and/or other housing assistance programs. I understand and agree that this authorization or the information obtained with its use may be given to and used by the Department of Housing and Urban Development (HUD) in administering and enforcing program rules and policies.
INFORMATION COVERED: I understand that, depending on program policies and requirements, previous or current information regarding me or my household may be needed. Verifications and inquires that may be requested, include byt are not limited to:
| - Identity & Marital Status |
- Employment, Income, & Assets |
- Residences & Rental Activity |
| - Medical or Child Care Allowances |
- Credit & Criminal Activity |
- Compliance w/ Program Requirements & Obligations |
I understand that this authorization cannot be used to obtain any information about me that is not pertinent to my eligibility for and continued participation in a housing assistance program.
GROUP OR INDIVIDUALS THAT MAY BE ASKED: The groups or individuals that may be asked to release the above information (depending on program requirements) include, but are not limited to:
| - Previous Landlords (Including Public Housing Agencies) |
- Past & Present Employers |
- Veterans Administration |
| - Credit Providers & Credit Bureaus |
- Courts & Post Offices |
- Welfare Agencies |
| - Banks & Other Financial Institutions |
- Schools & Colleges |
- Retirement Systems |
| - State Unemployment Agencies |
- Utility Companies |
- Law Enforcement Agencies |
| - Social Security Administration |
- Support & Alimony Providers |
- Medical & Child Care Providers |
COMPUTER MATCHING NOTICE AND CONSENT: I understand and agree that HUD or the Public Housing Authority may conduct computer matching programs to verify the information supplied for my application or recertification. If a computer match is done, I understand that I have a right to notification of any adverse information found and a chance to disprove that information. HUD may in the course of its duties exchange such automated information with other Federal, State, or local agencies, including but not limited to: State Employment Security Agencies; Department of Defense; Office of Personal Management; the U.S. Postal Service; the Social Security Administration; and State Welfare Agencies.
CONDITIONS: I agree that a photocopy of this authorization may be used for the purposes stated above. This authorization will stay in effect for a year and one month from the date it was signed.