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Information Release Authorization Form

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