Resident: Authorization Release of Information

Arkansas County Housing Authority
P 870.946.2622
Monday - Friday • 8:00 am - 4:30 pm
105 W. 4th Street • P.O. Box 447 • DeWitt AR, 72042
[email protected]

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I hereby grant permission to any Federal, State, local, or private agency, organization, business, or individual to release to the Arkansas County Housing Authority [ACHA] any information or materials, including any criminal history or financial information, needed to complete and verify my application for participation, or for continued assistance, in the Section 8 Voucher Rental Assistance Program and/or the Low Rent Public Housing Program administered by the Arkansas County Housing Authority.

I understand that the U.S. Department of Housing and Urban Development [HUD] may conduct computer matching programs to verify the information supplied on my application for participation or re-certification.
I agree that the ACHA and/or HUD may release information from my file concerning my rental history, including, but not limited to, my payment history, lease violations, or policy violations, to credit bureaus, collection agencies, or current and prospective landlords.

I further agree that a photocopy of this signed authorization may be used for the above purposes.

Fields marked with * must be completed or form will not submit.

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