Information Release Authorization Form

Phone: 606.285.3833 | Fax: 606.285.3835
402 John M. Stumbo Drive, Langley, KY 41645
FCHA-KY.org

Purpose:

The Floyd County Housing Authority (FCHA) may use this authorization and the information obtained with it to administer and enforce program rules and policies.

Information covered inquires may be:

Child Care Expenses
Credit History
Criminal Activity
Educational Programs and Resources
Employment History
Family Composition
Identity and Marital Status
Job Search and Job History
Probation/Parole
Family Contributions
Pension & Retirement
Medical Information

Individuals or Organizations that may release information:

Any individual or organization including any government organizations may be asked to release information. For example, information may be requested from:

Banks and other Financial Institutions
Courts
Department of Social Services
Drug Store and Pharmacies
Educational Providers
Alcohol and Drug Service Providers
Law Enforcement Agencies
Landlords
Utility Companies
Credit Bureaus
Providers of Alimony
Providers of Child Care
Providers of Child Support
Schools and Colleges

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