Authorization for Release of Information
(To be completed by all
household members over the age of 18 years)
the above named individual, have authorized the Attleboro Housing Authority to
verify the accuracy of the information, which I have provided to the Housing
Authority, from the following sources:
Criminal Offenders Records
Information Employer / D.E.T.
Welfare Social Security
Credit Report Physician
Revenue Service; Department of
hereby give you my permission to release this information to the Attleboro
Housing Authority subject to the condition that it be kept confidential. I would appreciate your prompt attention in
supplying the information requested on the attached page to the Attleboro
Housing Authority within five (5) days of receipt of this request.
understand that a photocopy of this Authorization is as valid as the original.
you for your assistance and cooperation in this matter.
Fair Information Practices Act – Statement of Rights
The Attleboro Housing Authority collects
information about applicants and tenants for its housing programs as required
by law in order to determine eligibility, amount of rent and correct apartment
size. The information collected is used
to manage the housing programs, to protect the public’s financial interest and
to verify the accuracy of information submitted. When permitted by law, it may be released to government agencies,
other housing authorities and to civil or criminal investigators and
prosecutors. Otherwise, the information
will be kept confidential and only used by Housing Authority staff in the
course of their duties.
The Fair Information
Practices Act established requirements governing housing authorities’ use and
disclosure of the information it collects.
Applicants and tenants may give or withhold their permission when
requested by the Housing Authority to provide information; however, failure to
permit the Housing Authority to obtain the required information may result in
delay, ineligibility for programs or termination of tenancy or housing subsidy. The provision of false or incomplete
information is a criminal offense punishable by fines and/or imprisonment. As an applicant or tenant, you have the
following rights in regard to the information collected about you. No information may be used for any purpose
other than those described above without your consent.
No information may be disclosed to any person other than those
described above without your consent.
If we receive legal order to release the information, we will notify
or your authorized representative has a right to inspect and copy any
information. However, the Housing
Authority reserves the right for a 24-hour notice in such cases in order to
have someone available to assist you.
may ask questions and receive answers from the Housing Authority about how we
collect and use information.
may object to the collection, maintenance, dissemination, use, accuracy,
completeness or type of information we hold about you. If you object, we will investigate your
objection and will either correct the problem or make your objection part of
your file. If you are dissatisfied, you
may appeal to The Department of Housing and Community Development.
I have read and understand
this Fair Information Practices Statement of Rights.