Form Rd 3550-1 - Authorization To Release Information - United States Department Of Agriculture Rural Development Rural Housing Servicing
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1Form RD 3550-1
Form Approved
(Rev. 7-00)
OMB No. 0575-0172
United States Department of Agriculture
Rural Development
Rural Housing Servicing
AUTHORIZATION TO RELEASE INFORMATION
TO: _____________________________________
RE: _____________________________________
Account or Other Identifying Number
_____________________________________
Name of Customer
I 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 the process, RHS may verify information contained
in my request for assistance and in other documents required in connection with the request.
I authorize you to provide to RHS for verification purposes the following applicable information:
• Past and present employment or income records.
• Bank account, stock holdings, and any other asset balances.
• Past and present landlord references.
• 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.
The information RHS obtains is only to be used in the processing of my request for assistance.
A copy of this authorization may be accepted as an original.
Your prompt reply is appreciated.
_______________________________________
_____________________________
Signature
Date
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 0575-0172. The time required to complete this information collection
is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintain-
ing the data needed, and completing and reviewing the collection of information.
RHS Is An Equal Opportunity Lender
SEE ATTACHED PRIVACY ACT NOTICE
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