Foreclosure Prevention Intake Form - Home Ownership Center of Greater Cincinnati

HOC FORECLOSURE PREVENTION INTAKE

Client’s Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone

Email *

How did you hear about HOC? (select all that apply)

Co-Homebuyer Information

Co-Client’s Name

First

Last

Is the Co-Client’s address different then the homebuyer's?

Yes
No

Co-Client’s Address (if different then homebuyer)

Address Line 1

Address Line 2

City

State

Zip Code

Co-Client’s Phone

Co-Client’s Email

The following information is requested by the federal government in order to monitor compliance with federal statutes that prohibit discrimination in housing. You are not required to furnish this information but are encouraged to do so. The law provides that a lender/servicer or counseling agency may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, the lender/servicer or counseling agency is required to note the information on the basis of visual observation or surname if you have made this request for a loan or counseling assistance in person. If you do not wish to furnish the information, please check the box below

Client’s Race and ethnic information

Yes I will furnish this information
No I will not furnish this information

Client’s Ethnicity

Hispanic or Latino
Not Hispanic or Latino

Is Client’s Foreign Born

Yes
No

Client’s Race

Client’s Sex

Female
Male

Is the Client’s Disabled

Yes
No

Is the Client’s a Veteran

Yes
No

Client’s Date of Birth

Co-Client’s Race and ethnic information

Yes I will furnish this information
No I will not furnish this information

Co-Client’s Ethnicity

Hispanic or Latino
Not Hispanic or Latino

Is Co-Client Foreign Born

Yes
No

Co-Client’s Race

Co-Client’s Sex

Female
Male

Is the Co-Client Disabled

Yes
No

Is the Co-Client’s a Veteran

Yes
No

Co-Client Date of Birth

Homebuyer Education

Please select highest level of education

Co-Homebuyer Education

Please select highest level of education of the co-client

Total Household Size

Dependent's (First Name and Age of each)

Are there non-dependents who will be living in the home?

Yes
No

Non-dependents relationship

Marital Status

Single
Married
Divorced
Separated

Household Type

Widowed
Male headed single parent
Female headed single parent
Two or more unrelated adults

Additional Household Type

Homebuyer Employment Information

Client’s Primary Employer

Client’s Position/Title

Client’s Date Hired

Client’s Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Client’s Employer Phone

Full Time
Part Time

Client’s Gross Monthly Income

How is the Client Paid?

weekly
monthly
every two weeks
twice a month

Co-Homebuyer Employment Information

Co-Client’s Primary Employer

Co-Client’s Position/Title

Co-Client’s Date Hired

Co-Client’s Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Co-Client’s Employer Phone

Is the Co-Client

Full Time
Part Time

Co-Client’s Gross Monthly Income

How is the Co-Client Paid?

weekly
monthly
every two weeks
twice a month

Other Income Sources

Child Support

Yes
No

Client Child Support Monthly Amount

Co- Client Child Support Monthly Amount

Social Security

Yes
No

Client Social Security Monthly Amount

Co-Client Social Security Monthly Amount

Retirement Income

Yes
No

Client Retirement Income Monthly Amount

Co-Client Retirement Income Monthly Amount

Self-Employment

Yes
No

Client Self-Employment Monthly Amount

Co-Client Self-Employment Monthly Amount

Disability

Yes
No

Client Disability Monthly Amount

Co-Client Disability Monthly Amount

Alimony

Yes
No

Client Alimony Monthly Amount

Co-Client Alimony Monthly Amount

Other Income

Yes
No

Client Other Monthly Amount

Co-Client Other Monthly Amount

All entries should reflect annual amounts. For example, if your present salary is $2,000 per month, line 1 would be $24,000 ($2,000 x 12). Documents must include the most recent 30 days income. 1. W2 wage jobs paystubs showing employer name, address and phone, employee name, year-to-date gross earnings, gross hourly or salary payment rate for the pay period; and number of hours worked in the pay period. Plus, fees, tips and bonuses, and other compensation for personal services. 2. Business, self-employment and gig economy jobs require most recent quarterly profit and loss statement, all pages of statements for all bank accounts (business and personal) for the same three-month period, and most recent tax return with all schedules. 3. Interest, royalty, and dividend income require most recent tax return with all schedules. Or if one has a 6-month average checking balance of $6,000 in an interest-bearing account using the current Passbook Rate of .02, the income generated from the checking account would be $120 or ($6,000x.02 = $120). 4. Retirement, insurance, Social Security income should include the full amount of periodic payments received from Social Security, annuities, insurance policies, retirement funds, pensions, or death benefits, and other types of periodic receipts. 5. Unemployment, disability, worker's compensation, and severance pay should include payments in lieu of earnings, such as unemployment and disability compensation, workers comp and severance pay. 6.Welfare Assistance, government cash assistance and housing subsidies require most recent award letter or payment statement. 7. Alimony, Child Support, & Gift Income require most recent award letter, divorce decree, court document or payment statement. 8. Armed Forces Income require most recent award letter or payment statement. You must provide supporting documentation for each entry on the income worksheet that applies to your household. Failure to supply adequate documentation will result in the return of your application.

MORTGAGE LOAN INFORMATION

Is the mortgage on your principal or primary residence?

Yes
No

Is the address of the house the same as the one listed above?

Yes
No

What is the address of the house

Are you currently under a forbearance agreement with your lender?

Yes
No

Is there a second mortgage on this property?

Yes
No

Do you own any other real estate, rental houses, etc.?

Yes
No

Name of Lender or Servicer

Phone Number

Loan Number

Who pays the property taxes?

I do
Servicer does

Is there a monthly condo or homeowners fee?

Yes
No

Monthly condo or homeowners fee amount

Are fees paid current?

Yes
No

Who pays the homeowners insurance policy for your property?

Yes
No

Is the policy current?

Yes
No

Annual homeowner’s insurance

If there are additional liens/mortgages or judgments on this property, please name the person(s) or company and give the following information. (Use additional paper if necessary.)

Lien holder name/servicer

Phone number

Loan Number

Balance

MOST RECENT STATUS OF MORTGAGE

I have a forbearance agreement and I am concerned about the money I owe.

Yes
No

I have received a foreclosure notice from the court.

Yes
No

I have received a notice about a Sheriff’s sale.

Yes
No

Date of sale?

Foreclosure Prevention Counseling

HOC FORECLOSURE PREVENTION INTAKE

Co-Homebuyer Information

Homebuyer Education

Co-Homebuyer Education

Homebuyer Employment Information

Co-Homebuyer Employment Information

Other Income Sources

MORTGAGE LOAN INFORMATION

MOST RECENT STATUS OF MORTGAGE

HOME BUYER EDUCATION CLASS

FORECLOSURE PREVENTION

FINANCIAL COUNSELING

HOME PURCHASE COUNSELING

RENTAL RELIEF COUNSELING

2820 Vernon Place
Cincinnati, OH 45219

Quick Links

Foreclosure Prevention Counseling

HOC FORECLOSURE PREVENTION INTAKE

Co-Homebuyer Information

Homebuyer Education

Co-Homebuyer Education

Homebuyer Employment Information

Co-Homebuyer Employment Information

Other Income Sources

MORTGAGE LOAN INFORMATION

MOST RECENT STATUS OF MORTGAGE

HOME BUYER EDUCATION CLASS

FORECLOSURE PREVENTION

FINANCIAL COUNSELING

HOME PURCHASE COUNSELING

RENTAL RELIEF COUNSELING

2820 Vernon PlaceCincinnati, OH 45219

Quick Links

2820 Vernon Place
Cincinnati, OH 45219