CONSENT: I authorize and direct any Federal, State, or local agency, organization, business, or individual to release to Lower Brule Housing any information needed to complete and verify my application for participation, and/or to maintain my continued assistance under HUD Development of South Dakota, and/or other housing assistance programs. I understand and agree that this authorization of the information obtained with its use may be given to and used by the Department of Housing and Urban Development (HUD) in administering and enforcing program rules and policies. INFORMATION COVERED: I Understand that, depending on program policies and requirements, previous or current information regarding my household or me may be needed. Verifications and inquiries that may be requested, include but are not limited to: Identify and Marital Status Medical or Child Care Allowances Residence and Rental Activity Employment, Income and Assets Credit and Criminal Activity I understand that this authorizations cannot be used to obtain any information about me that is not pertinent to my eligibility and for continued participation in a housing assistance program. GROUPS OR INDIVIDUALS THAT MAY BE ASKED: The groups or individuals that may b e asked to release the above information (depending on program requirements) includes but are not limited to: Previous Landlords (including Public Housing Agencies) Courts and Post Offices Schools and Colleges Law Enforcement Agencies Support and Alimony Providers Retirement System Welfare Agencies Past and Present Employers Credit Providers and Credit Bureaus State Unemployment Agencies Social Security Administration Medical and Child Care Providers Veterans Administration Banks and Financial Institutions Utility Companies CONDITIONS: I agree that a photocopy of this authorization may be used for the purpose stated above. The original of the authorization is on file with Lower Brule Housing and will stay in effect for a year and one month from the date signed. I understand that I have a right to review my file and correct any information that I can prove is incorrect. WARNING: TITLE 18, SECTION 1001 OF THE United States CODE, STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OR AGENCY OF THE United States.