You can open the FCRA Adverse Action Letter Template in multiple formats, including PDF, Word, and Google Docs.
FCRA Adverse Action Letter Template Printable | Editable FormSample
Examples
[Your Company Name]
[Your Company Address]
[City, State, Zip Code]
[Your Phone Number]
[Your Email]
[Date]
[Name of the Consumer]
[Consumer’s Address]
[City, State, Zip Code]
Notice of Negative Action Resulting from a Consumer Report
We regret to inform you that we have taken an adverse action regarding your application for [specify purpose, e.g., credit, employment, etc.], based in part on information provided in your consumer report.
As a result of this decision, we are unable to offer you [details of the action taken, e.g., credit, employment], effective [date].
The specific reasons for this adverse action include:
1. [Reason 1, e.g., poor credit history]
2. [Reason 2, e.g., delinquent accounts]
3. [Reason 3, if applicable]
You have the right to:
– Obtain a free copy of your consumer report from [Credit Reporting Agency] within 60 days.
– Dispute the accuracy of any information in your report by contacting [Credit Reporting Agency].
– Request a free copy of your credit report from [Credit Reporting Agency] once a year.
If you believe this adverse decision was made in error, you may contact us at [Your Contact Information] for further review of your application.
[Your Name]
[Your Title]
[Your Company Name]
[Your Company Name]
[Your Company Address]
[City, State, Zip Code]
[Your Phone Number]
[Your Email]
[Date]
[Name of the Consumer]
[Consumer’s Address]
[City, State, Zip Code]
Adverse Action Notification
We are writing to inform you that we have made an adverse decision regarding your application for [specify purpose, e.g., credit, housing, etc.], based on the information contained in your consumer report.
As a result of this information, we are unable to provide you with [explain specific action taken].
The decision was significantly influenced by the following factors:
1. [Reason 1, e.g., insufficient credit history]
2. [Reason 2, e.g., high debt-to-income ratio]
3. [Reason 3, if applicable]
You have the right to:
– Request a free copy of your consumer report from [Credit Reporting Agency].
– Dispute any inaccuracies found in your report by contacting [Credit Reporting Agency].
– Seek any additional information regarding your rights under the Fair Credit Reporting Act.
If you wish to discuss this decision further or believe that your report contains errors, please contact us at [Your Contact Information]. We are committed to assistance and clarity.
[Your Name]
[Your Title]
[Your Company Name]
Format
Please complete the form below to create the FCRA Adverse Action Letter Template. All fields must be filled out to ensure compliance with the Fair Credit Reporting Act (FCRA) and to provide the recipient with a clear understanding of their rights. We provide examples to guide you through each step. FCRA Adverse Action Letter Template 1. Sender Information 2. Recipient Information 3. Adverse Action Details 4. Date of Adverse Action 5. Reason for Adverse Action 6. Consumer Reporting Agency Information 7. Rights Information 8. Signature and Date 9. Acknowledgment
PDF
WORD
Google Docs
FCRA Adverse Action Letter Template Printable | Editable FormPrintable
