I/We authorize the above named agency to obtain information about me or my household that is pertinent to eligibility for participation in assisted housing programs.
This may include rental history, financial and credit reports, private or public benefit information, criminal activity reports, employment verification , medical or child care expenses, family composition, or handicapped assistance expenses.
I/ We agree this Authorization may be photocopied and used up to one year from the date above for the following items: recertification for public housing or rental assistance programs.
I/We authorize NPHA and its staff to share and/or obtain any pertinent and/or necessary information with the Ponca Tribe of Nebraska’s agents and/or assigns.
I/We authorize NPHA and its staff and/or assigns to share any information obtained regarding anyone on the composition, including prospective additions to the composition, with the head of household, as signed below.
If I/we do not sign this Authorization, I/we also understand that my/our program assistance may be denied or terminated.
