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Applying: Authorization for the Release of Information - HCV

Richmond Housing Authority Logo

Phone: 765.966.2687 | Fax: 765.962.1143
58 S. 15th Street - Richmond, IN 47374
RichmondHousingIndiana.org

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


Purpose:
The Richmond Housing Authority 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
    • Child Care
    • Child Support
  • Schools and Colleges