Collection Authorisation Form Template for United States

Create a bespoke document in minutes, or upload and review your own.

4.6 / 5

4.8 / 5

Let's create your Collection Authorisation Form

1. Select your governing law:

2. Enter your key requirements:

3. Create your document to edit, review or download

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

Collection Authorisation Form

"I need a Collection Authorization Form for my medical practice that includes recurring payment authorization and HIPAA compliance provisions, to be used for collecting outstanding patient balances starting January 2025."

Your data doesn't train Genie's AI

You keep IP ownership of your information

Generate a Bespoke Document

1. Select your governing law:

2. Enter your key requirements:

3. Create your document to edit, review or download

Download a Standard Template

Get our United States-compliant Collection Authorisation Form

4.6 / 5

4.8 / 5

What is a Collection Authorisation Form?

The Collection Authorization Form is a crucial document used in the United States when a creditor needs formal permission to collect a debt or assign collection rights to a third party. This document is essential for compliance with the Fair Debt Collection Practices Act (FDCPA) and various state collection laws. It is typically used when initiating formal collection procedures, setting up payment plans, or engaging collection agencies. The form includes detailed information about the debt, authorized collection methods, consumer rights disclosures, and privacy notices. It serves multiple purposes: protecting the creditor's rights to collect, ensuring compliance with federal and state regulations, and informing debtors of their rights and the collection process. The document is particularly important in situations involving recurring payments, multiple debts, or when specific collection methods need to be authorized.

What sections should be included in a Collection Authorisation Form?

1. Parties: Identification of the creditor, debtor, and collection agency (if applicable), including full legal names and contact information

2. Debt Information: Details of the debt being authorized for collection, including original amount, current balance, account numbers, and date of origination

3. Authorization Statement: Clear statement of the debtor's authorization for collection activities, including specific permitted actions

4. Collection Methods: Specification of authorized collection methods (e.g., direct withdrawals, payment plans, communication channels)

5. Consumer Rights: Mandatory disclosures of consumer rights under FDCPA and applicable state laws

6. Privacy Notice: Statement regarding the handling and protection of personal information

7. Revocation Terms: Terms and process for revoking the collection authorization

8. Signature Block: Space for dated signatures of all parties and any required witness or notary details

What sections are optional to include in a Collection Authorisation Form?

1. Recurring Payment Authorization: Additional authorization for recurring automatic payments, used when setting up payment plans

2. Multiple Debt Schedule: Section for listing multiple debts under the same authorization, used when collecting various debts from the same debtor

3. Third-Party Authorization: Authorization for communication with specified third parties about the debt, used when involving authorized representatives

4. Electronic Communication Consent: Specific consent for electronic communications and documents, used when planning to communicate electronically

5. Special Payment Arrangements: Details of any special payment arrangements or settlements, used when non-standard payment terms are agreed

6. Medical Information Release: Special authorization for handling medical information, used when collecting medical debts

What schedules should be included in a Collection Authorisation Form?

1. Schedule A - Debt Details: Detailed breakdown of the debt(s) including principal, interest, fees, and payment history

2. Schedule B - Payment Plan: Details of agreed payment plan including amounts, dates, and payment methods

3. Appendix 1 - Required State Disclosures: State-specific disclosures and notices required by applicable state laws

4. Appendix 2 - Consumer Rights Summary: Detailed summary of consumer rights under FDCPA and state laws

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Financial Services

Healthcare

Insurance

Retail

Utilities

Telecommunications

Education

Professional Services

Real Estate

Consumer Services

Relevant Teams

Collections

Accounts Receivable

Legal

Compliance

Finance

Credit Control

Revenue Cycle

Risk Management

Customer Service

Operations

Relevant Roles

Collections Manager

Accounts Receivable Manager

Credit Controller

Financial Services Manager

Compliance Officer

Legal Counsel

Revenue Cycle Manager

Collections Specialist

Billing Coordinator

Risk Manager

Account Manager

Credit Analyst

Patient Financial Services Manager

Treasury Manager

Debt Recovery Specialist

Find the exact document you need

Vital Records Authorisation Form

A U.S. legal form authorizing the release of vital records while ensuring compliance with federal and state privacy regulations.

��������Ƶ

How ��������Ƶ reduced drafting time by 75% for a legal firm

Let's create your Collection Authorisation Form

Generate a Bespoke Document

What is a Collection Authorisation Form?

What sections should be included in a Collection Authorisation Form?

What sections are optional to include in a Collection Authorisation Form?

What schedules should be included in a Collection Authorisation Form?

Authors

Alex Denne

Find the exact document you need

Vital Records Authorisation Form

Tenant Authorisation Form

Parental Authorisation Form

Overtime Authorisation Form

Return Merchandise Authorisation Form

Non Borrower Credit Authorisation Form

Manufacturer Authorisation Form

Disbursement Authorisation Form

Appointment Of Authorised Representative Form

Pet Care Emergency Authorisation Form

Vendor Direct Deposit Authorisation Form

Deposit Authorisation Form

Medical Authorisation Form For Adults

Authorisation Of Release Of Unemployment Records Form

Electronic Funds Transfer Authorisation Form

Return Authorisation Form

Payroll Authorisation Form

Check Authorisation Form

Authorisation For Release Of Records

Medical Records Release Authorisation Form

Owner Authorisation Form

Payoff Authorisation Form

Agent Authorisation Form

Pre Employment Background Check Authorisation Form

Pre Authorised Debit Form

Payroll Deduction Authorisation Form

Third Party Authorisation Form

Authorised Representative Form

Background Check Authorisation Form

Direct Deposit Authorisation Form

Direct Deposit Enrolment Form

Authorization To Release A Medical Certificate

Voided Check Form

Time Off Request Form

Ach Form

Credit Reference Request Form

Overtime Form

Representative Form Ircc

Direct Debit Authorisation Form

Eft Authorization Form

Client Authorisation Form

Collection Authorisation Form

Direct Credit Authorisation Form

Written Authorization Form

Workers Compensation Authorization Form

Workers Comp Authorization Form

Work Authorization Letter

Vendor Ach Form

Vendor Ach Authorization Form

Travel Consent Form For Minor With Notary

Third Party Release Form

Third Party Credit Card Authorization Form Hotel

Third Party Credit Card Authorization Form

Third Party Authorization Form

Tenant Release And Consent Form

Tenant Authorization Letter

Tenant Authorization Form

Temporary Medical Consent Form For Minor

Student Authorization To Hold Excess Funds

Standard Release Of Information Form

Special Power Of Attorney For Authorized Representative

Special Power Of Attorney Authorization Letter

Social Media Consent Form For Patients

Simple Release Of Information Form

Simple Authorization Letter

Signature Authorization Form

Return Merchandise Authorization Form

Return Authorization Form

Resolution Letter To Sign On Behalf Of Company

��Ƶ

How ��Ƶ reduced drafting time by 75% for a legal firm

�ұ�Ծ��’s Security Promise