RFP 283-22-0568_Attach19b Credit Release Form.pdf
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- Solicitation number
- 283-22-0568
About this file
This document includes a credit release form and details of a solicitation for national survey services. The credit release form allows the Department of Health and Human Services to obtain consumer credit reports for employment purposes under the Fair Credit Reporting Act.
The solicitation is for the 2023-2027 National Surveys on Drug Use and Health. The selected contractor will design multi-mode data collection methods, provide sufficient field staff to screen dwelling units and conduct interviews, develop training programs, employ statistical expertise in sample design and small area estimation, and perform technical writing and analyses. The surveys will support annual prevalence estimates for substances use and mental health for the US civilian population aged 12 and older at the national, state, and territory levels. The Department of Health and Human Services Substance Abuse and Mental Health Services Administration is the issuing agency.
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Text version
HHS Credit Release
(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 EITHER 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 for 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 Department of Health and Human Services (HHS) 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 records.
Office of Security and Drug Testing For Official Use Only 1
RFP No. 283-22-0568 Attachment 19b
File details come from the government source that posted it. Updated .