Northern Arizona Council of Governments

Transcription

1 Northern Arizona Council of Governments 119 EAST ASPEN AVENUE FLAGSTAFF, ARIZONA (928) FAX (928) KENNETH J. SWEET EXECUTIVE DIRECTOR Dear Homeowner, Thank you for contacting us for assistance with your mortgage issues. To assist us in providing you with the most effective and efficient service, please complete, sign and return the following forms: Client Authorization and Release Third Party Agreement and Release Client Counselor Agreement Privacy Notice Client Information form. In addition to the attached documents, provide the following information, either via fax at or by mail to: NACOG Housing Counseling, 119 E Aspen Avenue, Flagstaff, AZ Hardship Letter Copy of your current credit report (it may be obtained free of charge at Most recent pay stubs for all employment and/or benefits award letters Last two months of all bank statements Last year s tax return Any correspondence from the mortgage company or its attorney, even if it s unopened Any documentation from the courts or the sheriff regarding a foreclosure All of the above information is needed to help you resolve the problems you are having with your mortgage. If there are questions or information you don t understand, feel free to contact this office at (928) or khaislet@nacog.org. Sincerely, Housing Counselor FOR TTY ACCESS, CALL THE ARIZONA RELAY SERVICE AT AND ASK FOR NACOG AT

2 FORECLOSURE MITIGATION COUNSELING PROGRAM CLIENT AUTHORIZATION AND RELEASE 1. I understand that Northern Arizona Council of Governments (NACOG) 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 NACOG 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 NACOG, NFMC program administrators and/or their agents to pull my credit report up to two additional times between now and December 31, 2012 and to give authorization for NACOG and NFMC program administrators and/or their agents to follow-up with me between now and December 31, 2012 for the purposes of program evaluation. 4. I give permission for NACOG to release or otherwise disclose any information I give to NACOG, and any credit information obtained by NACOG on my behalf to the Arizona Department of Housing (ADOH) or its agents for the purposes complying with the requirements of the NFMC program. I understand that NACOG, ADOH, or ADOH s agents may disclose any information obtained about me during the counseling program to the Neighborhood Reinvestment Corporation, a nonprofit corporation chartered by the Congress of the United States, or its affiliates and agents, as necessary to comply with the requirements of the NFMC program. 5. I acknowledge that I have received a copy of NACOG s Privacy Policy. 6. I may be referred to other housing services of the organization or another agency or agencies as appropriate that may be able to assist with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me. 7. A counselor may answer questions and provide information; however the counselor is not authorized to provide legal advice. If I want legal advice, I then must seek the advice of independent legal counsel. 8. I understand that NACOG provides information and education on numerous loan products and housing programs and I further understand that the housing counseling I receive from NACOG in no way obligates me to choose any of these particular loan products or housing programs. Client s signature: Date: Client s Name (print): Client s signature: Date: Client s Name (print): FOR TTY ACCESS, CALL THE ARIZONA RELAY SERVICE AT AND ASK FOR NACOG AT

3 Signature çsign Third-Party Authorization Form personal information and the terms of any agreements under the Making Home Affordable or Hardest Hit Fund Programs by Servicer or State HFA to the U.S. Department of the Treasury or their agents in connection with their [State HFA Entity] [State HFA Contact Name and Phone Numberj COUNSELOR above Servicer and the following third parties Mortgage LenderlServicer Name ( Servicer ) [Account][Loan] Number [Other Third Party] [Third Party Contact Name and Phone Number] The undersigned Borrower and Co-Borrower (if any) (individually and collectively, Borrower or I ), authorize the other public and non-public personal information contained in or related to the mortgage loan of the Borrower. This [Relationship of Other Third Party to Borrower and Co-Borrower] [Counseling Agency] [Agency Contact Name and Phone Number] Northern Arizona Council of Governments Kim Haislet (928) information may include (but is not limited to) the name, address, telephone number, social security number, credit (individually and collectively, Third Party ) to obtain, share, release, discuss, and otherwise provide to and with each The Servicer will take reasonable steps to verify the identity of a Third Party, but has no responsibility or liability to score, credit report, income, government monitoring information, loss mitigation application status, account balances, program eligibility, and payment activity of the Borrower. I also understand and consent to the disclosure of my verify the identity of such Third Party. The Servicer also has no responsibility or liability for what a Third Party does with such information. responsibilities under the Emergency Economic Stabilization Act. This Third-Party Authorization is valid when signed by all borrowers and co-borrowers named on the mortgage and I UNDERSTAND AND AGREE WITH THE TERMS OF THIS THIRD-PARTY AUTHORIZATION: until the Servicer receives a written revocation signed by any borrower or co-borrower. Borrower Co-Borrower Before signing this Third-Party Authorization, beware of foreclosure rescue scams! Please visit to verify you are working with a It is expected that a HUD-approved housing counselor, HFA representative or other Beware of anyone who asks you to pay a fee in exchange for a counseling service or Date Date Printed Name Printed Name authorized third party will work directly with your lender/mortgage servicer. modification of a delinquent loan. HUD-approved housing counseling agency.

4 Fax: Phone: Client Counselor Agreement Flagstaff, AZ Counselor Date Homeowner Date Homeowner Date sever its service assistance to me/us. I/we understand that breaking this agreement may cause the counseling organization to I /we will contact the counselor about any change in our situation immediately appointment will still end at the scheduled time. I/we will be on time for appointments and understand that if we are late for an tirneframe requested. 1/we will provide all necessary documentation and follow-up information within the verbally or in writing. I/we will always provide honest and complete information to my/our counselor whether I agree to the following terms of service. Development of a spending plan Analysis of the mortgage default, including the amount and cause of default Assistance communicating with the mortgage servicer and other creditors Timely completion of promised action Confidentiality, honesty, respect and professionalism in all services Presentation and explanation of reasonable options available to the homeowner Explanation of collection and foreclosure process Referrals to needed resources Northern Arizona Council of Governments and its counselors agree to provide the following services. 119 E Aspen Avenue NACOG

5 Northern Arizona Council of Governments (NACOG) Privacy Policy Northern Arizona Council of Governments (NACOG) is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all information shared both verbally 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 Foreclosure Mitigation Counseling Agreement. 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 verbally, 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 1. You have the opportunity to opt-out of disclosures of your nonpublic personal information to third parties (such as your creditors), that is. direct us not to make those disclosures. 2. If you choose to 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 notify us in writing. Release of your information to third parties 1. 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 you, or is a requirement of grant awards which make our services possible. 2. We may also disclose any nonpublic personal information about you or former customers to anyone as permitted by law (e.g., if we are compelled by legal process). 3. Within the organization, we restrict access to nonpublic 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 nonpublic personal information. Signature Date FOR TTY ACCESS, CALL THE ARIZONA RELAY SERVICE AT 1-8OO AND ASK FOR NACOG AT

6 Please fill out completely. Leave shaded boxes blank. CLIENT INFORMATION FORM Fax: Phone: Flagstaff, AZ of6 Has your ARM Reset? Privately Held? VA or FHA Insured? Option ARM? Hybrid ARM? Interest Only? ARM (Adjustable Rate Mortgage) Current Rate: Fixed Interest Rate: Loan Product Type Loan Status Monthly Mortgage Amount: Current Servicer s Loan Number: Current Servicer s FDIC Number: Current Loan Servicer Original Loan Number Original Lender s FDIC Number Name of Originating Lender Mortgage/Loan Information: What condition is the property in? What moderate or major repairs are needed? Home: Cell: Other: Phone Numbers and best times to reach you: House Number Street Name City State Zip How Many Children in the Household? Household Type Spouse s First Name Spouse s Last Name Age Race Ethnicity (Hipanic: Yes or No) Gender (male or female) First Name Client ID 119 E Aspen Avenue NACOG

7 Child Support Received Monthly Annual Spouse s Employment Hourly Hrs/wk Annual 2 of 6 Notes/Anticipated Changes: Other: Pension or Retirement Funds Assets Which Can Be Sold Anticipated Tax Refunds Court Cases Pending Against Others Savings Assets and Other Resources Amount Income Categoiy Total Household Income Monthly Annual Other: Food Stamps, Cash Assistance Monthly Annual SSI, Disability, Vet Benefits Monthly Annual Client Employment Hourly Hrs/wk Annual Household Income Sources:

8 FICA Income_Tax_Withheld Social_Security Payroll Deductions 3 of 6 Other Internet Cable TV Cell Land_Line Telephone: Water/Sewer Oil Electric Home Maintenance! Upkeep Gas Utilities Mobile_Home_Lot_Rent Insurance Real_Estate_Taxes Third_Mortgage Second_Mortgage Mortgage_or_Rent Home Related Expenses Other Credit Union Wage_Garnishments Type Of Expense Budget Actual or Expected Crisis Budget Household Expenses:

9 Clothing (Iroceri es Eating_Out Food 4 of 6 Pet Expenses Charity/Church Newspapers/Magazines Entertainment Student Loan Payments School Expenses Alimony or Support Paid Life Insurance Public_Transportation Gas and Maintenance Car Insurance Auto Payments Transportation Other Insurance Co-Payments or Premiums Dental Prescriptions Current Needs Medical Laundry and Cleaning ;:pe 0/Expense, Continued: Budget Actual or Expected Crisis Budget

10 Debts Credit Card Credit Card Credit Card Medical Bill Medical Bill Monthly Payment Balance Other Back Bills: (List) Co-sicined Debts Business Debts Other Month lv ExDenses TOTAL Other Important Debt Issues: Monthly Amount Balance Wage Garnishments Pending Court Cases Pending Utility Shut-offs Car Loan Defaults, Repossessions, or Tax Debts Student Loan Debts Other: Other: Notes/Anticipated Changes: 5 of 6

11 6 of 6 Printed Name Printed Name 5i nature Date has been withheld. We understand the necessity for accurate and complete information and we will All of the information that I/We have provided in this worksheet is correct and factual. No information Signature Date inaccurate information or an unwillingness to timely provide the counselor with the necessary provide any needed information to complete this worksheet. We understand that deliberately providing counselor will be provided. information or documents to assist us will result in a closing of our file and no further assistance from the