Foreclosure Prevention Intake Form

Transcription

1 Community Homeownership Center, Inc 1284 W. 20 th Street Jacksonville, FL Tel (904) Fax (904) Dear Homeowner, We are glad you took the first step and contacted CHC about your mortgage. We understand how hard that was to do and promise to work with you to help find a resolution to your situation. To assist us in providing you with the most effective and efficient service, please complete the attached intake form as thoroughly as possible, and provide PHOTOCOPIES of all required documents - please do not bring originals. This information is the key element to resolving your financial situation, and the lender will not review our request for assistance without a complete financial package. If there are questions or information you don t understand, that s okay, do your best and we will go through the rest of it together during your scheduled appointment; or you may call us at We look forward to helping you! Sincerely, CHC Staff 1

2 Client Name Date In order to complete your application for assistance, we need the following items as checked below: Proof of Income Two (2) MONTHS CURRENT pay stubs, SSI determination letter, Unemployment Benefits Statement, Statement from Employer, etc. Copy of CURRENT documents received from Mortgage Company or statement showing amount due. Hardship letter outlining the reason for delinquency (example of hardship letter attached) If a bankruptcy has been filed, a copy of your discharge letter (we cannot proceed without the letter) Documentation of ownership (Probate or Estate transfer) if there has been a death of the original homeowner. TWO (2) months of CURRENT bank statements (All pages) Completed financial worksheet Completed Application and included documents Photo I.D. from applicant and co-applicant ONE(1) MONTH (most current) utility bill (All pages) LAST TWO (2) YEARS Taxes with all of the schedules included W2 s, LAST TWO (2) YEARS Other : Summons of complaint from court and attorney letters Copies of HUD-1 settlement form Copies of note, mortgage and any riders Due to the fact that many families are in the same position as you, and the high demand for our services we ask that you notify us at least 6 hours prior to your appointment if you are unable to attend. If you are unable to bring ALL the necessary photocopied documents to your appointment, your counseling session may be delayed. 2

3 APPOINTMENT CHECKLIST Forms Checklist: Please complete and Bring to Appointment Complete the enclosed intake form Complete the Borrower Financial Information form Read and sign the Authorization to Release Information Read and sign the Borrower Signature Authorization Form Credit Reports and Verifications Read and sign Hold Harmless Agreement Read, complete and sign the Personal Information Release form Read and sign the Counselor Homeowner Agreement Read and sign the List of services If you have a question about the intake form or releases please complete as much as possible and we will finish them during the appointment. Document Checklist: Please bring to Appointment Current loan documents (documents signed at the loan closing) One (1) month s most recent pay stubs for each job, for each occupant and any other income documentation. Two (2) Years Most recent tax returns with all attachments for each occupant Most recent utility bill (All pages) Two(2) Months most recent bank statements for all accounts (All pages) Most recent mortgage statement(s) or last mortgage statement(s) received Most recent property tax and property insurance statement (if you pay the taxes and insurance on your own) and homeowner s association information (if applicable) Most recent installment loan statements including: auto loans, credit cards, personal loans, and home equity lines of credit Information on any other monthly expense, debt, or liability Once you have completed the enclosed application and it has been received in our office, the counselor will review your application, and contact you if more information is required. Your counselor will then begin working on your case. Please note that if you do not qualify for services through our program, we will notify you as soon as possible. We will be contacting your servicer via phone/fax to determine your options. This can be a time consuming process. It may take from 30 days to 6 months before a resolution is complete. If you have not made payments, it s quite possible that collections activity will continue. Don t panic. We will continue to work with your servicer to determine what options are available. If you are served with foreclosure documents, you must seek the assistance of an attorney. 3

4 BORROWER INFORMATION Borrower First Name: MI: Last Name: Cellular Phone: Home Phone: Work Phone: Fax #: Best Time to Call: Social Security: Date of Birth: Co Borrower First Name: MI: Last Name: Cellular Phone: Home Phone: Work Phone: Fax #: Best Time to Call: Social Security: Date of Birth: Property Information Street Address: City: State: Zip: County: How long have you been at this address? Is this an investment property? Housing Type: Single Family Home Duplex/Tri plex/four plex Townhouse/Condo Mobile Home Employment & Income Information Employer: Monthly Income: $ Address: Phone # Position: Start Date: End Date: Other Income: Amount: $ Co Borrower Employer: Monthly Income: $ Address: Phone # Position: Start Date: End Date: 4

5 Other Income: Amount: $ OTHER COUNSELING ORGANIZATIONS Are you working with any other foreclosure or credit counseling organization? Yes No If yes, what s the name of the organization? COMMITMENT Wants to stay in home: Yes No Previous delinquencies: Yes No Talked to Mortgage Company: Yes No If yes, what was discussed? Other steps taken to resolve the situation: Amount available to put towards mortgage: $ 5

6 1 ST Mortgage Company LOAN INFORMATION Are you behind on your mortgage payments? Yes No How behind are you? 30 days 60 days 90 days 120 days In Foreclosure Mortgage Company: Loan Number: Monthly Payment: Delinquency: # of Months Amount Behind: $ Homeowners Association Fees: $ Homeowners Insurance: $ Purchase Date: Amount Financed: Balance Due: Loan Type: FHA VA Conventional Other What is the type of loan? Fixed ARM What is the interest rate? Term of mortgage: 10 years 15 years 20 years 30 years Are Taxes and Insurance included in your mortgage payment? Yes No If NO are your taxes current? Yes No If NO is your insurance current? Yes No Has the reason for delinquency been resolved? Yes No Have you refinanced the loan? Yes No How many times? Date(s): If the loan is an ARM, has the rate reset as of yet? Yes No How many times: When? 2 ND Mortgage Company Are you behind on your mortgage payments? Yes No How behind are you? 30 days 60 days 90 days 120 days In Foreclosure Mortgage Company: Loan Number: Monthly Payment: Delinquency: # of Months Amount: $ Loan Type: FHA VA Conventional Other What is the type of loan? Fixed ARM What is the interest rate? Term of mortgage: 10 years 15 years 20 years 30 years Purchase Date: Amount Purchase Date: Amount Financed: Balance Due: Has the reason for delinquency been resolved? Yes No 6

7 DEMOGRAPHIC INFORMATION HOUSEHOLD INFORMATION REFFERAL SOURCE Number of people living in household Agency / Organization Number of people on title Mailer / Flyer / Brochure Gender Male Female Lender / Mortgage company Household gross annual income $ Media CITIZENSHIP Friend / Relative Non-resident Alien Internet Permanent Resident Alien Realtor US Citizen ETHNICITY COUNTRY OF ORIGIN Hispanic Non-Hispanic United States American Indian / Alaska Native Asian CHECK ALL THAT APPLY Black or African-American Female Head of Household Native Hawaiian or Other Pacific Single Head of Household Islander White US Veteran Undisclosed First Time Homebuyer PREFFERED LANGUAGE Owned Home in Last 3 Years English CLIENT TYPE Homeless ARE YOU DISABLED? Yes No Homeowner(Mortgage paid-off HIGHEST EDUCATION COMPLETED Mortgagor No High school Diploma Potential Buyer High school Diploma Potential Renter GED Diploma Vocational Certificate Associates Degree Bachelors Degree Masters Degree Doctoral Degree 7

8 Monthly Expense Fixed Expenses Mortgage or Rent Housing Current Budget Adjusted Difference Condo/HOA Fee Heating (gas or oil) Electricity Telephones (land lines and cell phones) Transportation Gas Car Payment Public Transportation or Taxi Parking and Tolls Insurance Health (medical and dental, if not payroll-deducted) Life Disability Child Care Child Care or Babysitters Child Support or Alimony Fixed Expenses Subtotal: Periodic Fixed Expenses (Divide annual payment by 12) Housing Homeowners Insurance (if not included in mortgage) Water or Sewage Trash Service Transportation Car Insurance Car Inspection Car Repairs and Maintenance License Plates and Registration Fees 8

9 Monthly Expense Periodic Fixed Expenses Subtotal: Current Budget Adjusted Difference Flexible Expenses Groceries Food School Lunches Work-Related (lunches and snacks) Lawn Care Housing Furnishings Home Maintenance and Cleaning Supplies Medical Doctor Dentist Prescriptions Savings Emergency Fund Down Payment Fund Clothing Clothing Laundry and Dry Cleaning Education Tuition Books, Papers and Supplies Newspapers and Magazines Lessons (sports, dance, music) Donations Religious or Charity Other (if not payroll deducted): Gifts Birthdays 9

10 Monthly Expense Major Holidays Current Budget Adjusted Difference Personal Barber or Beauty Shop Toiletries Children s Allowances Tobacco Products Beer, Wine, Liquor Entertainment Movies, Sporting Events, Concerts, Theater, Etc. Video Rentals Internet Service Cable/Satellite TV Restaurants and Take-Out Meals Gambling or Lottery Tickets Fitness or Social Clubs Vacations/Trips Hobbies or Crafts Miscellaneous Checking Account, Money Order Fees, Etc. Pet Care or Supplies Postage Pictures and Photo Processing Mad Money Debts Student Loan Credit Card (monthly minimum*) Credit Card (monthly minimum*) Credit Card (monthly minimum*) Medical Bills Personal Loan 10

11 Indebtedness Subtotal: Total Monthly Expenses (fixed + periodic fixed + flexible + indebtedness) Income Total Monthly Net Income Additional Savings Amount Left Over for Savings (total monthly net income total monthly expenses) HOUSEHOLD INCOME Other income Amount per month Social Security / SSI / SSDI $ Child or Spousal Support $ Unemployment Compensation $ Workers Disability Compensation $ Veterans Benefits $ Monies from Rental Properties $ Children s Wages $ Food Stamps $ Other $ 11

12 HOUSEHOLD ASSETS DESCRIPTION VALUE/AMOUNT AMOUNT OWED IF ANY Automobile #1 Automobile #2 Automobile #3 Cash on hand over $100 Checking account Savings account Boat / wet bikes Money market funds Computers RV / recreational homes IRA / Keogh accounts Motorcycles/ snowmobiles Stocks/bonds CDs annuities, etc. Farm equipment Other property Trailers Other Anticipated tax refunds TOTAL IN ASSETS $ Please read carefully: As head of household I declare that members of my household have no ownership, in full or part, of any assets other than those identified above; the value of which have been disclosed. Please sign below: Signature Date Signature Date 12

13 SAMPLE HARDSHIP LETTER Dear Homeowner, This document has been designed to assist you with completing a hardship letter to your lender. Please keep in mind that the review process can take more than 30 days. In the interim period, the collection process is moving forward. This means you may be served with foreclosure papers. It is recommended that you save the money you normally use to pay your mortgage. Keep adding to the money and DO NOT spend on other debt. You will need this money as a down payment if you are approved for workout plan. You will only need a one page letter to explain your hardship addressed to your Lender. The letter should include all of the information requested below: Your name Your property address along with your mailing address if different. Name of lender and department. Your loan number Your phone number and best time to reach you. Describe your hardship: For example: I lost my job with ABC Manufactures in July, 2008 and have been unemployed until August, I am currently working for a new company and will be receiving my first check September, Describe the financial steps you have taken during this time: For example: My wife continued to work for ABC Inc. and was able to obtain a part-time job with DEF Inc. in July, I worked odd jobs when available and borrowed money from my grandmother to get by. Describe your current goal: For example: I was able to afford the home when we first purchased it, but since the payment increased due to my adjustable rate mortgage we have not been able to keep up. Our goal is to keep the home and we would like any assistance available. Describe the contribution amount you have for the lender: For example: I am 4 months behind and do not have the full amount owed, however I have saved $2000 towards a contribution payment. I am hoping that my $2000 will be acceptable for a down payment on a workout plan. Please make sure you sign and print your name on the hardship letter. Please contact your Housing Counselor at (904) if you need additional help. 13

14 COUNSELOR AND HOMEOWNER AGREEMENT CHC and its counselors agree to provide professional foreclosure counseling services to. The undersigned client(s) understand that our counselors are not attorney s and do not provide legal advice or assistance. The counselor will help you understand: The foreclosure process so that you know what to expect and when; Explore options available to you for preventing foreclosure. The amount and cause of the mortgage default; Your income and expenses by developing a spending plan; Solutions to the cause of default and adjustments to your spending plan, as needed; Your mortgage product and communicate with your mortgage company; Available options for preventing foreclosure including the pros and cons of each. Counselors are not able to prevent foreclosure in every situation but are committed to working with you so you can make the best decisions possible. Counselor Commitment The counselor agrees to: Provide you with factual information; Develop an action plan and assist you with completing action plan steps in a timely manner; Make referrals to needed resources; Provide services confidentially, honestly and respectfully; Not provide you with any form of legal advice or assistance. Homeowner Commitment You understand that in order for the counselor to provide you with the best service possible, you agree to: Provide honest and complete information. Provide all necessary documentation a complete action plan steps within the timeframe requested. Notify the counselor immediately, preferably 6 hours before a scheduled appointment, if you will be unable to attend an appointment. Arrive on time for appointments. You understand that if you are late for an appointment, the appointment will still end at the scheduled time and the counselor may need to reschedule. Contact the counselor about any changes in your situation immediately. Homeowner Date Homeowner Date 14

15 Personal Information Release CHC is a non-profit 501c-3 Florida Corporation that facilitates educational programs and provides counseling services to help individuals achieve and maintain homeownership. The Organization receives funding for these programs from a variety of organizations and foundations. In turn, the Organization provides periodic reports to its benefactors on program effectiveness. I/We hereby authorize and direct CHC to disclose any and all information obtained in conjunction with my/our participation in the Foreclosure Counseling Program to their benefactors for the purposes of: 1. Monitoring the performance and effectiveness of CHC and the counseling and education program. 2. Providing reports about the program to the Organization s benefactors; 3. Conducting follow up surveys to get feedback on the program and determine the effectiveness of the program. A photocopy of this form will also serve as evidence of my/our authorization to share information with the Organization. I/We may revoke this authorization by giving written notice. If I/We revoke this authorization, The Organization will not be authorized to obtain any additional information about me/us, but may, consistent with this authorization, maintain and use information already obtained. All information collected will be treated with confidentiality. Authorization Printed Name: Social Security: Signature: Date: Printed Name: Social Security: Signature: Date: 15

16 Hold Harmless Agreement The undersigned parties (borrowers) agree to seek independent Counsel pertaining to the sale of their home, land, real property in matter of state and federal taxes and legal implications. The undersigned borrower(s) shall contact an attorney to obtain qualified counsel relating to the implications of foreclosure. Property Address: City: State: Zip: The undersigned agree that there have been no guarantees or promises of foreclosure avoidance or approval of any loss mitigation option made to them by the counselor or CHC It has been explained to them, and they agree to as much below, that a counselor can make no warranties implied or otherwise as to the servicer/investor approval of a modification, sale, forbearance, deed in lieu, repayment plan, refinance, or any other loss mitigation alternative. Any information that the counselor has presented to the client is to assist the client in making an informed decision in the loss mitigation process but in no way should preclude the client from seeking professional legal as well as tax advice, it is expressly suggested that the client do both. IN SIGNING THIS RELEASE, I/We ACKNOWLEGE AND REPRESENT THAT I/WE have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign if voluntarily as my/our own free act and deed; no oral representations, statements or inducement, apart from the foregoing written agreement, have been made; I/We am at least eighteen (18) years of age, and fully competent; and I/We execute the Release for full, adequate and complete consideration fully intending to be bound by the same. Borrower Printed Name: Social Security: Signature: Date: Co Borrower Printed Name: Social Security: Signature: Date 16

17 Privacy Policy CHC is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that concerns you bring to us are highly personal in nature. We assure you that all information shared both orally and in writing will be managed within legal and ethical considerations. Your nonpublic personal information, such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to creditors, program monitors, and others only with your authorization and signature on the Authorization to Release Information. We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs. Types of information that we gather about you Information we receive from you orally, on applications or other forms, such as your name, address, social security number, assets, and income; Information about your transactions with us, your creditors, or others, such as your account balance, payment history, parties to transactions and credit card usage; and Information we receive from a credit reporting agency, such as your credit history. You may opt out of certain disclosures You have the opportunity to opt out of disclosures of your non public personal information to third parties (such as your creditors), that is, direct us not to make those disclosures. If you choose to opt opt out, we will not be able to answer questions from your creditors. If at any time, you wish to change your decision with regard to your opt out, you may call us at or notify us in writing at 1284 W. 20 TH St. Jacksonville, FL Release of your information to third Parties So long as you have not opted out, we may disclose some or all of the information that we collect, as described above, to your creditors or third parties where we have determined that it would be helpful to you, would aid us in counseling your, or is a requirement of grant awards which make our services possible. We may also disclose any nonpublic personal information about you or former customers to anyone as permitted by law (e.g., if we were compelled by legal process). Within the organization, we restrict access to no public personal information about you to those employees who need to know that information to provide services to you. We maintain physical, electronic and procedural safeguards that comply with federal regulations to guard your non public personal information. 17

18 THIRD PARTY AUTHORIZATION FORM 1. I understand that CHC provides foreclosure mitigation counseling after which I will receive a written action plan consisting of recommendations for handling my finances, possibly including referrals to other housing agencies as appropriate. 2. I understand that CHC receives Congressional funds through the National Foreclosure Mitigation Counseling (NFMC) program and, as such, is required to share some of my personal information with NFMC program administrators or their agents for purposes of program monitoring, compliance and evaluation. 3. I give permission for NFMC program administrators and/or their agents to follow-up with me between now and June 30, 2011 for the purposes of program evaluation. 4. I acknowledge that I have received a copy of the CHC s Privacy Policy. Client s signature Date Co-Applicant s signature Date 18

19 List of Services CHC Inc. is a non-profit counseling and educational services provider. We offer an array of services to meet the needs of our clients and the community at large. Below is a listing of our services. Budget & Credit Counseling Debt Counseling & Management Financial Fitness Education Foreclosure Intervention Counseling Homebuyer Education Homeowner Education Individual counseling sessions in which you work with a counselor to review your complete financial situation including income, expenses, credit, and debt. Your counselor will help you identify troubled areas and develop an action plan to overcome those barriers. Individual counseling sessions in which you work with a counselor to review your overall debt load and debt-to-income ratio. Your counselor will make recommendations to help you reduce high debt amounts in the most efficient and cost effective way possible. Debt management plans are available to those who qualify. In this five week workshop series you will learn to change the way you manage your money. We will cover topics such as how to budget, avoiding the credit trap, managing bank accounts, developing a savings plan, and most importantly achieving your financial goal. Individual counseling sessions in which you will be provided with the information and assistance you need to avoid foreclosure. Your counselor will help you to understand the cause of your delinquency and provide assistance in overcoming immediate financial issues. You will also explore various loss prevention options to get and keep your loan current. In this eight hour workshop you will learn about the home buying process while getting advice and encouraging support from certified trainers, industry professionals, and fellow classmates. We will cover topics such as managing your money, understanding credit, obtaining a loan, shopping for a home, and protecting your investment. Certificates will be issued upon course completion. This eight hour workshop will prepare you for the new challenges brought about by buying a new home. We will cover topics such as the benefits of home ownership, money management, home maintenance and improvement, and community. Involvement. Important Disclosure Participation in any of our service offerings does not obligate you to receive any other services from us or from any of our partnering organizations. This list has been included with this document for your reference. Client Signature Date Co-Client Signature Date Counselor Signature Date 19

20 HOMEOWNER ACTION PLAN IS THE DEFAULT CURABLE? Yes No Options available to home owner Priority by home owner Yes No Home owner action steps Action Date / / Enroll in financial fitness workshop / / When should these steps be taken? What alternatives have been discussed? 20

21 What results are anticipated? When are results anticipated? Does the client understand and agree with the steps to be taken? Yes No 3 rd party authorization signed? Yes No Date of next review: / / Client Signature(s) Date Counselor Signature Date 21