Consent for disclosure of records protected under the Privacy Act

This form may be used to provide consent and authorize the CFPB to disclose your records to another person or entity. Please provide the information requested below and submit.

This form may be used if you are:

Providing consent and authorizing the CFPB to disclose your records to another person or entity
A parent consenting to and authorizing the disclosure of the records of a minor
A legal guardian consenting to and authorizing disclosure of the records of an incompetent

If you have any questions, please contact the CFPB’s FOIA Office at FOIA@cfpb.gov or at (855) 444-3642.

Information used for identity-proofing and authentication

Please provide the following information to assist the CFPB in verifying your identity:

Required

Full name
Electronically signed statement (at the bottom of this form) that affirms your identity and the fact that you understand penalties associated with requesting information under false pretenses

Optional

A photocopy of two forms of identification, including one form of identification that bears your photograph, and one form of identification that bears your signature; or
A photocopy of a single form of identification that bears both your photograph and signature

For requests by parent or legal guardian

If you are the parent consenting to and authorizing disclosure of the records of a minor or the legal guardian consenting to and authorizing disclosure of the records of an incompetent, you will be required to provide adequate proof of your legal relationship before action will be taken on any request. If you have any questions, please contact the CFPB’s FOIA Office at FOIA@cfpb.gov or at (855) 444-3642.

The term guardian means the legal guardian of any individual who has been declared to be incompetent due to physical or mental incapacity or age by a court of competent jurisdiction.

Information required to locate the records

This information is required for the CFPB to be able to match the individual's information provided in this request with the record that pertains to that individual.

About us

We're the Consumer Financial Protection Bureau (CFPB), a U.S. government agency that makes sure banks, lenders, and other financial companies treat you fairly.