Survivors of Human Trafficking Form

Instructions for Submitting a Request to Block Adverse Items Resulting from Human Trafficking

If you are a survivor of human trafficking, you have the right to request that adverse information resulting from the trafficking be blocked from your consumer report. We are committed to making this process as simple and secure as possible.

You may submit your request by secure web form, email, or mail. If you have any questions, please call our toll-free number at 877-747-2104.

Name*

First NameMiddle NameLast NameSuffix

Please list any other or previously used name(s) (First, Middle, Last, Suffix)

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Social Security Number*

ex. xxx-xx-xxxx

Date of Birth*

ex. 01/10/2025

If needed, you may be contacted by a member of our team to provide additional proof of identity, such as

A copy of a government-issued ID (driver’s license, passport, etc.)
A recent utility bill or other document that confirms your identity

What is your preferred method of contact?*

EmailMail

Email Address

example@example.com

Trafficking Documention

Your request must include victim determination from one of the following sources:

A Federal, State, or Tribal government entity
A court of competent jurisdiction (including certain documents filed in court)
A non-governmental organization or human trafficking task force authorized by a Federal, State, or Tribal entity
A self-attestation signed or certified by one of the above

Your request must also include identification of the items you believe resulted from human trafficking. Examples include, but are not limited to:

Payment delinquencies or defaults
Coerced debt
Criminal arrests or convictions
Evictions or non-payment of rent

How to Submit Your Request

Please upload your trafficking documentation and list of adverse item(s) to be blocked below. If you have any questions regarding what to provide, please call our toll-free number at 877-747-2104.

Upload documents here*

Additional Resources

The Consumer Financial Protection Bureau (CFPB)’s final rule amended the FCRA to add Section 605(c), allowing survivors of human trafficking to block adverse information from consumer reports. You can read more about this amendment here: https://files.consumerfinance.gov/f/documents/cfpb_fcra-trafficking_fast-facts.pdf

On behalf of all of us at Atlantic Employee Screening, we look forward to doing all that we can to help you succeed, thrive and get a fresh start along your journey forward. If you are a human trafficking victim in search for an advocate, we implore you to get in touch with our contact, Kym Kurey, at http://www.anewinternational.org.