ssf3230a.pdf
PDF 24 KB Posted
- Attached to
- CELL PHONE FORENSIC SERVICES SUPPORT
- Solicitation number
- HSSS01-13-R-0028
About this file
Disclosure and Authorization pertaining to Consumer Reports pursuant to the Fair Credit Reporting Act
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Text version
DEPARTMENT OF HOMELAND SECURITY
United States Secret Service
DISCLOSURE AND AUTHORIZATION
PERTAINING TO CONSUMER REPORTS
PURSUANT TO THE FAIR CREDIT REPORTING ACT
This is a release for the United States Secret Service (or other component of the Department of Homeland Security) to obtain one or more consumer credit reports about you in connection with your employment (or application for employment) with the Department of Homeland Security or one of its components, including as a contract employee. One or more consumer credit reports about you may be obtained for employment purposes, including evaluating your fitness for employment, promotion, reassignment, retention or access to classified information.
I, , hereby authorize the United States Secret Service (or other component of the
Department of Homeland Security) to obtain such report(s) from any consumer credit reporting agency for employment purposes. Copies of this authorization that show my signature are as valid as the original signed by me.
Signature
Date
Social Security Number
Additional information regarding the credit bureaus that report credit history can be obtained via their home pages at:
www.experian.com www.transunion.com www.equifax.com
Please retain this information to assist you with any credit issues.
PRIVACY ACT STATEMENT: YOUR SOCIAL SECURITY NUMBER (SSN) IS SOLICITED UNDER THE AUTHORITY OF EXECUTIVE ORDER 9397. THIS INFORMATION WILL BE USED TO IDENTIFY AND SEPARATE INDIVIDUALS WITH SIMILAR OR IDENTICAL NAMES OR INITIALS. DISCLOSURE OF YOUR SOCIAL SECURITY NUMBER AND OTHER REQUESTED INFORMATION IS VOLUNTARY; HOWEVER, FAILURE TO PROVIDE YOUR SSN AND OTHER INFORMATION REQUESTED MAY PROHIBIT PROCESSING AND CAUSE DENIAL OF ACCESS TO SECURE AREAS OR SENSITIVE MATERIAL PROTECTED BY THE UNITED STATES SECRET SERVICE.
SSF 3230A (11/2003) Page 1 of 1 http:www.equifax.com http:www.transunion.com http:www.experian.com
| Social Security Number: |
| FullName: |
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