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Pre-Adverse Action Notice Template
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Pre-Adverse Action Notice Template
[Sender Name or Company Name]
[Sender Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
Date: [Date]
To: [Recipient Full Name]
[Recipient Address]
[City, State, ZIP Code]
Subject: Pre-Adverse Action Notice
Dear [Recipient Name],
1. Notice of Potential Adverse Action
This letter is to inform you that [Company Name / Employer Name / Landlord Name / Other] is considering taking adverse action regarding your [job application / employment / rental application / credit application / other] based in whole or in part on information contained in a [consumer report / background check / credit report / screening report / other report].
At this time, no final adverse action has been taken.
2. Report Information
The report or information reviewed in connection with this matter is described as follows:
Report Type: [Consumer Report / Background Check / Credit Report / Other]
Date of Report: [Date]
Reporting Agency or Source: [Name of Agency or Source]
Agency Address: [Address]
Agency Phone Number: [Phone Number]
Agency Website, if applicable: [Website]
3. Basis for Potential Action
The potential adverse action is being considered because of the following information appearing in the report:
[Describe the relevant information in general terms, if appropriate]
This notice is being provided so that you have an opportunity to review the information and respond before any final decision is made.
4. Opportunity to Respond
If you believe the report contains inaccurate, incomplete, or outdated information, you may contact the reporting agency or source directly to dispute the information.
You may also provide us with any explanation, clarification, correction, or supporting documentation you would like us to consider before a final decision is made.
Please provide any response no later than [Date] or within [Number] days from the date of this notice.
5. Enclosures
The following documents are enclosed with this notice, if applicable:
☐ Copy of the report
☐ Summary of rights under applicable law
☐ Copy of background screening results
☐ Other: [Describe]
6. No Final Decision Yet
Please note that this is a pre-adverse action notice only. No final decision has been made at this time.
Any final decision, if made, will be communicated separately after you have had an opportunity to review and respond to the information described above.
7. Contact Information for Response
If you would like to submit a response or supporting information to us, please use the following contact details:
Contact Person: [Name]
Title: [Title]
Email: [Email]
Phone: [Phone Number]
Mailing Address: [Address]
8. Reservation of Rights
Nothing in this notice guarantees any particular outcome. Any final determination will be made after review of any timely response received and any other relevant information.
9. Signatures
Sincerely,
Signature: __________________________
Name: [Sender Name]
Title: [Title]
Company: [Company Name]
Date: [Date]
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Pre-Adverse Action Notice Template
Pre-Adverse Action Notice Template FAQ
What is a pre-adverse action notice?
A pre-adverse action notice is a written notice sent before an employer, landlord, lender, or other party takes negative action based on information found in a consumer report or similar third-party report. It gives the person a chance to review the information and respond before the decision becomes final. This notice is commonly used when a background check, credit report, or screening report may affect employment, housing, or another application.
Why do you need a pre-adverse action notice?
You need a pre-adverse action notice to give the affected person fair notice and an opportunity to review potentially harmful information before a final decision is made. In many situations, especially where consumer reporting laws apply, sending this notice helps support compliance and proper procedure. It also helps reduce disputes by showing that the person was informed and given time to respond.
When should you use a pre-adverse action notice?
Use a pre-adverse action notice before denying employment, housing, credit, or another opportunity based in whole or in part on a background check, consumer report, credit report, or similar screening information. It is typically used after the report is reviewed but before the final adverse action is taken. This gives the person time to dispute errors, explain the information, or provide additional context.
How to write a pre-adverse action notice?
Start by identifying the sender and the recipient, then state that adverse action is being considered based on information from a report. Identify the report type, the reporting agency or source if applicable, and explain that no final decision has yet been made. You should also state how long the recipient has to respond, what documents are enclosed, and where the recipient can send corrections or explanations before the final decision is made.
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