NHS of the Fox Valley One American Way Elgin, IL 60120

(847) 695-0399 ● (847) 695-0711 ● foxvalleyinfo@nhschicago.org

Revised: 08/18/2016

Foreclosure Prevention Process How to OBTAIN a one-to-one consultation with a HUD-certified counselor please follow these simple steps:

Read the Foreclosure Prevention Package carefully, complete all applicable forms and sign/date where indicated. It is critical that you provide the required documents listed on the checklist.

Gather COPIES of all the documents for all borrowers involved with the loan.

PLEASE NOTE ORIGINAL DOCUMENTS WILL NOT BE ACCEPTED

AND COPIES WILL NOT BE MADE.

How to SUBMIT the completed Foreclosure Prevention Package and all supporting documents either by email or in person:

1. By email: send email to foxvalleyinfo@nhschicago.org with the attached documents in PDF format only.

2. In person: To allow ample time to review and advise of any missing

documentation it is essential to call our offices at 847-695-0399 x4600 during our normal business hours of Monday-Friday from 9 a.m. to 5 p.m. before arriving.

NHS FORECLOSURE INTERVENTION INTAKE FORM Return Via: Fax 773-329-4076 │Email homeownership@nhschicago.org

2016

Neighborhood Housing Services of Chicago │ Intake Department │ 1279 N Milwaukee Ave, Chicago, IL 60622 │ 773 -329-4111

The information on this form along with other required documentation will be used to advise you on available foreclosure prev ention options to either keep or transition out of your property. Please complete this form in its entirety as missing information may cause a delay in processing.

SELECT PREFERRED NHS OFFICE FOR CONSULATION

☐ Central/Wicker Park 1279 N. Milwaukee, 4th Floor, Chicago, IL 60622

☐ West Humboldt 3601 W Chicago Ave. Chicago, IL 60651

☐ North Lawndale

906 S. Homan Ave. Chicago, IL 60624

☐ Auburn Gresham 449 W 79th St. Chicago, IL 60620

☐ Chicago Lawn 2609 W 63

rd St. Chicago, IL 60629

☐ Roseland 11001 S. Michigan Ave. Chicago, IL 60628

☐ South Suburbs 1920 W 174

th St. East Hazel Crest, IL 60429

☐ Fox Valley One American Way, Elgin IL 60120

BORROWER INFORMATION

Date: Referral Source:

Name: Gender: ☐ Male ☐Female

Date of Birth: SSN (Last 4): Military Status:☐ Veteran ☐ Active ☐ N/A

Phone: Phone: Email:

Race: ☐ White ☐ Black/African American ☐ Asian ☐ Pacific Islander ☐ Other Ethnicity: ☐ Hispanic ☐Non-Hispanic

Preferred Language: Disabled: ☐ Yes ☐ No

Number of People in Household: No. of Dependents:

Household Type: ☐ Single Adult ☐Married w/ Children ☐Married w/o Children ☐ Female-Headed Single Parent

☐ Male-Headed Single Parent ☐ Two or More Unrelated Adults ☐ Other

Highest Education: ☐ Junior High ☐ High-School ☐ Junior College ☐ University ☐ Grad School

CO-BORROWER

Name: Gender: ☐ Male ☐Female

Date of birth: SSN (Last 4): Military Status:☐ Veteran ☐ Active ☐ N/A

Phone: Phone: Email:

Race: ☐ White ☐ Black/African American ☐ Asian ☐ Pacific Islander ☐ Other Ethnicity: ☐ Hispanic ☐Non-Hispanic

Preferred Language: Disabled: ☐ Yes ☐ No

Highest Education: ☐ Junior High ☐ High-School ☐ Junior College ☐ University ☐ Grad School

PROPERTY INFORMATION

Property Address:

City: State: Zip:

Primary Residence: ☐ Yes ☐ No Vacant or Condemned: ☐ Yes ☐ No Current Property Value:

Property Type: ☐ Single Family ☐ Condo ☐ Multi-Family 4 units or less ☐ Multi Family 5+ units

Previously Received a Modification: ☐ Yes ☐ No Previous HAMP Modification: ☐ Yes ☐ No

Months Delinquent: Received Foreclosure Notice: ☐ Yes ☐ No

Foreclosure Sale Scheduled: ☐ Yes ☐ No Sale Date:

Reason for Delinquency:

☐ High Debt Obligations ☐ Medical Issues ☐ Inability to Sell Property ☐ Business Failure ☐ Marital Difficulties

☐ Death of Homeowner/Family Member ☐ Loss of Income ☐ Increase in Loan Payment ☐ Loss of Income

Recent Bankruptcy: ☐ Yes ☐ No Bankruptcy Type: Discharge/Dismiss Date:

In a court Foreclosure Mediation Program: ☐ Yes ☐ No Title/Probate Issues: ☐ Yes ☐ No

Owner of Additional Properties: ☐ Yes ☐ No Quantity of Additional Properties:

NHS FORECLOSURE INTERVENTION INTAKE FORM Return Via: Fax 773-329-4076 │Email homeownership@nhschicago.org

2016

Neighborhood Housing Services of Chicago │ Intake Department │ 1279 N Milwaukee Ave, Chicago, IL 60622 │ 773 -329-4111

FIRST MORTGAGE

Lender/Servicer Name:

Loan No.: Mortgage Balance:

Loan Origination Date: Original Loan Amount:

Home Purchase Date: If Taxes and Insurance Escrowed, Amt. per Month:

If Not Escrowed, Property Tax Amt. per Year: If Not Escrowed, Property Insurance Amt. per Year:

Loan Type: ☐ Conventional ☐ FHA ☐VA Insurance Company:

Interest Rate: Interest Only Loan: ☐ Yes ☐ No

Fixed or ARM: ARM Adjusted: ☐ Yes ☐ No

SECOND MORTGAGE

Lender/Servicer Name: Loan No.:

Mortgage Balance: HELOC (Home Equity):

Interest Rate: Fixed or ARM:

MONTHLY GROSS INCOME

Borrower Employer Name: Co-Borrower Employer Name:

Salary/Wages: Salary/Wages:

Social Security Income: Social Security Income:

Retirement/Pension: Retirement/Pension:

Other: Other:

MONTHLY EXPENSES (DO NOT INCLUDE INFORAMTION ON RENTAL PROPERTIES)

First Mortgage Payment: Grocery:

Second Mortgage Payment: Phone/Cable/Internet:

Child Support/Alimony: Electricity:

Bankruptcy: Gas:

Condo/HOA: Transportation:

CREDIT CARDS AND LOANS (CAR, STUDENT, PAYDAY)

Lender Name Account Type Balance Monthly payment

LIQUID ASSETS (CHECKING ACCOUNT, SAVINGS ACCOUNT)

Description Value

ADDITIONAL INFORMATION: FOR STAFF USE

Fannie Mae or Freddie Mac Owned Loan: ☐ Fannie Mae ☐ Freddie Mac ☐ Neither

Notes:

Returned signed forms to: NHS of Chicago, Attn. Intake ● 1279 N Milwaukee Ave ● Chicago, IL 60622 Revised 09/13

Foreclosure Mitigation Counseling Agreement and Authorization

I, ______________________________________, hereby authorize Neighborhood Housing Services of Chicago, Inc. (NHS) to collect information regarding my financial history, credit score, demographics and any other information or data the NHS determines necessary to assist me with my delinquent mortgage. Additionally, I acknowledge and agree to the following statements related to the counseling services provided by NHS:

1. I understand that NHS 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. A counselor may answer questions and provide information, but not give legal advice. If I want legal

advice, I will be referred for appropriate assistance.

3. I may be referred to other housing services offered by NHS 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.

4. I understand that NHS provides information and education on numerous loan products and housing programs, and I further understand that the housing counseling I receive from NHS in no way obligates me to choose any of these particular loan products or housing programs.

5. I understand that NHS receives Congressional and other funds through the National Foreclosure Mitigation Counseling (NFMC) program, HUD, the City of Chicago, NeighborWorks America and other governmental agencies and, as such, is required to share some of my personal information with NFMC, NeighborWorks America, the City of Chicago, HUD, other governmental agencies, and their program administrators or their agents for purposes of program monitoring, compliance and evaluation, and I hereby give NHS my permission to share this information with said organizations, administrators and agents.

6. I give permission for NFMC program administrators and/or their agents to follow-up with me for the

purposes of program evaluation.

7. I acknowledge that I have received a copy of the NHS Privacy Policy. 8. I understand that NHS does not guarantee that services provided by NHS will (a) keep my home out of

foreclosure, (b) secure from my lender/loan servicer an affordable/sustainable payment plan or work-out agreement or (c) enable me to obtain financing to either redeem my home from foreclosure or reinstate my delinquent loan.

9. I understand that by signing this agreement I will hold harmless NHS and its staff for the options NHS might offer, the advice that may be given, or for the outcome of the foreclosure mitigation counseling services provided by NHS.

Client’s signature________________________________ Date______________________

Client’s signature_________________________________ Date______________________

Revised 07/15

Privacy Policy

Neighborhood Housing Services of Chicago, Inc. (NHS) 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 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 Foreclosure Mitigation Counseling Agreement and Authorization. We also may use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs. We reserve the right to maintain your personal information that you have submitted either by email, fax, United States Postal Service or otherwise for at least five years. Participants in the Illinois Hardest Hit Fund Program will receive this Privacy Policy notification every year during this time frame and it will be included in your file. 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 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 call us at (773) 329-4111 and do so. 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 you, 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 are compelled by legal process).

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. Agency Relationships NHS has financial affiliation with HUD, NeighborWorks America, the State of Illinois, the City of Chicago, Illinois Housing Development Authority, Chicago Housing Authority, Freddie Mac, Fannie Mae, State Farm, the Housing Partnership Network, philanthropic foundations and financial institutions.

NHS of the Fox Valley One American Way Elgin, IL 60120

(847) 695-0399 ● (847) 695-0711 ● foxvalleyinfo@nhschicago.org

Revised: 07/11/2016 Page 1 of 1

Foreclosure Prevention Checklist Required Documentation

NHS is a HUD-certified non-profit counseling agency that is able to help homeowners struggling

to make their mortgage payments. There are many options available to prevent foreclosure and

we are here to help guide you through the application process.

To receive a one-to-one consultation gather copies of the following documents listed below for ALL

borrower(s) on the loan.

Required Documents Explanation NHS STAFF ONLY (Documents submitted)

Paycheck

Stubs/Profit and Loss/SSI; etc.

Proof of 30 most current days; last quarter

for profit and loss and most recent award letter if SSI is received

Yes/No

Mortgage Statements Most recently issued within 30 days and for

all mortgages on this property

Yes/No

Bank Statements 2 most recent consecutive months, all pages

even blank pages. For all savings/ checking accounts

Yes/No

Federal Tax Returns,

W2s and/or 1099s

Submit 2 recent years of your US Federal

Income Tax Returns, and W2, including all schedules

* Sign and date page 1 or 2 of the Form

1040 Do not include the State Tax Return

Yes/No

Hardship Letter Clarify the hardship, date of hardship,

and if the hardship has been resolved

Must be signed and dated by all

borrowers

Be concise and clear, can be

handwritten or typed

Yes/No