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If you believe the report contains inaccurate, incomplete, or outdated information, you may contact the reporting agency or source directly to dispute the information.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]