Notice

TXR 2212Adverse Action Notice and Credit Score Disclosure

This form provides the required notice to a rental applicant when the landlord takes an adverse action (such as denying the application) based in whole or in part on information from a consumer report or credit score. It complies with the Fair Credit Reporting Act (FCRA) by informing the applicant of the action taken and the reason(s), identifying the Consumer Reporting Agency (name, mailing address, toll-free number) when the action was based on the consumer report, stating the applicant's rights to obtain the file, dispute it and request a free copy within 60 days, and — when the report contained a credit score — disclosing the score, the date it was created, the score range and the key factors that adversely affected it. Signed by the landlord or by the broker under a written property management agreement or power of attorney.

Source: TXR
Form Number: 2212
Category: Notice
Revised: January 1, 2012

Used For

Residential Sales, RESIDENTIAL_LEASING

Form Outline

The TXR 2212 form is organized into the following sections:

  1. Notice Header
    Identifies the applicant, landlord, date, and property address associated with the denied rental application. "To: ___ (Applicant) / From: ___ (Landlord) / Date: ___ / Re: Application for Lease concerning the Property at ___" (the property blank continues on a second line).
  2. Adverse Action Description and Reasons
    "Landlord has taken the following adverse action (description of action taken): ___ for the following reason(s) (select one or more): ❑ (1) You failed to meet the rental criteria for this Property. This adverse action is not based upon your consumer report or credit score. ❑ (2) This adverse action is based in whole or in part on the information contained in your consumer report." If (2), identifies the Consumer Reporting Agency (name, mailing address, toll-free telephone number); the FCRA rights paragraphs are printed.
  3. Information about Your Credit Score
    "(Complete the following information only if the consumer report contained the Applicant's credit score)": the credit score, the date on which it was created, the range (low / high) and, on page 2, the key factors that adversely affected the score (four lines).
  4. Signatures
    Page 2: "Landlord ___ Date"; "Or signed for Landlord under written property management agreement or power of attorney: By: ___ Date"; then Broker's Associate's Printed Name, Broker's Printed Name / License No. and Firm Name. Signature lines and their dates are e-sign tabs placed when the document is sent.

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