Guarantor Authorization to Obtain Consumer Credit Report

Guarantor Authorization to Obtain Consumer Credit Report and Conduct a
Credit Inquiry
I authorize the National Marine Fisheries Service, Fisheries Finance Program (FFP) to obtain a
consumer credit report and conduct a credit investigation on me. The FFP will use this
information to evaluate my offer to guarantee debt for
_________________________________.
This authorization is valid for purposes of verifying information given pursuant to any lawful
purpose covered by the Fair Credit Reporting Act.
Upon request, the FFP will provide me with the name and address of the Consumer Reporting
Agency contacted to supply the report. I understand that credit inquiries have the potential to
impact my credit score.

Signature: ____________________________________

Name: ________________________________________________________________________
Social Security Number: __________________________________________________________
Date of Birth: __________________________________________________________________
Current Address: _______________________________________________________________
Previous Addresses (last seven years): ______________________________________________

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other suggestions for reducing this burden to Brian Summers, Financial
Services Division, NOAA Fisheries, 1315 East West Highway, Silver Spring, MD 20910. Confidential name and address information will be
released via a NOAA website for informational purposes. All other data submitted will be handled as confidential material in accordance with
NOAA Administrative Order 216-100, Protection of Confidential Fishery Statistics. Notwithstanding any other provisions of the law, no person is
required to respond to, nor shall any person be subjected to a penalty for failure to comply with, a collection of information subject to the
requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number
Privacy Act Notice:
Authority: The collection of this information is authorized by Title 46 U.S.C. 1271-1279 and 50 CFR Part 253, Subpart B.
Purpose: The data will primarily be used for the evaluation of financial condition in connection with application for financing under the
Fisheries Finance Program. Financing will not be considered unless all requested information is furnished.
Routine Uses: The Department will use this information to determine eligibility for financing. Disclosure of this information is permitted under
the Privacy Act of 1974 (5 U.S.C. Section 552a) to be shared among Department staff for work-related purposes. Disclosure of this information
is also subject to all of the published routine uses as identified in the Privacy Act System of Records Notice COMMERCE/NOAA-21, Financial
Services Division.
Disclosure: Furnishing this information is voluntary; however, failure to provide accurate information will prevent full evaluation of the
application.