Dear Homeowner, Thank you for requesting assistance for

Dear Homeowner,

Thank you for requesting assistance for foreclosure prevention by RIHousing.

To complete your request, you must first fill out our Financial Information Package and send us the

required documents which are needed to process your request for assistance. Please use the

required documents checklist attached. Please do not send original documents. You can send the

completed application and required documents packet to us by facsimile, mail, or e-mail.

You may also simply drop them off at our office:

RIHousing HelpCenter

44 Washington Street

Providence, RI 02903

Fax: 401-450-1373

Please return your financial information packet as soon as possible, as this is a time-sensitive

process.

Once we have received your application packet, you will be assigned to a HUD Counselor. The HUD

Counselor will follow up with you to review your options and/or discuss additional information that

may be needed.

If you have any questions or need any assistance with the application, please contact us at:

(401) 457-1130.

TTY: (401) 450-1394.

Thank you for reaching out to the RIHousing HelpCenter.

Sincerely,

RIHousing HelpCenter

NOTE: If you have an impairment, disability, language barrier, or otherwise require an alternative means of

completing this form or accessing information about our housing counseling program, please inform our

housing counselor program staff so alternative accommodations may be arranged.

REQUIRED DOCUMENTS CHECKLIST

Please DO NOT Send Originals

Single-sided Copies Please

1. Most recent pay stubs – 30 consecutive days of pay stubs for all borrowers/ contributors (person

other than mortgage holder). Contributors must send signed and dated contribution amount letter.

2. Proof of all other sources of income for borrowers/contributors (SSI, SSDI, child support, rental

income etc.) Most recent benefit award letter for all SSI, SSDI, TDI and/or Unemployment income

being received. If receiving Government Assistance (ex. SNAP), please include the Quarterly Benefit

Statement. Rental income leases.

3. Two years of recent Federal Tax Returns – signed tax returns for the last two years (personal and

business) with all schedules and W-2’s. If no tax returns, then a letter, signed and dates, explaining

why no taxes were filed.

4. Two months of recent bank statements from all saving & checking accounts, allpages, front and

back, for the last two months (personal and business). Transaction history is not acceptable.

5. Self-employed borrowers must provide most recent quarterly or year-to-date Profit & Loss

Statement. Statement must be signed and dated.

6. Most recent utility bill – at least one gas, electric, or cable bill.

7. Most recent mortgage statement with loan number and lender/servicer contact information.

8. Delinquency letters/notices – mediation, conciliation, tax sale, or foreclosure notices, if applicable.

9. Property tax bill – only if current mortgage payment does not include an escrow payment.

10. Homeowners Insurance Policy – declaration page(s). Only if current mortgage payment does not

include and escrow payment.

11. Bankruptcy discharge notice, if applicable.

12. Court Orders – Final Divorce Decree, Alimony, and Child support payments, if applicable

13. Homeowners Association Fee Statement, if applicable.

14. HUD Approved Counseling Program Authorization, Disclosure, Housing Stability Counseling

Program Authorization, Dodd Frank, Homeowner/Counselor Agreement, and Consent to the Use

of Tax Return Information Forms – signed and dated by all borrowers (pgs. 7-13).

15. Hardship Letter – signed and dated by all borrowers (pg. 6).

16. Copy of Drivers License or State ID

Borrower Information

Financial Information

Number of people in household.

Name

Relationship to Applicant

Age

Page 1/13

BORROWER CO-BORROWER

Borrower’s Name

Co-Borrower’s Name

Social Security Number

Date of Birth (month/day/year)

Social Security Number

Date of Birth (month/day/year)

Primary Phone Number With Area Code

Secondary Phone Number

Email Address

Mailing Address

Present Address (If Same As Mailing Address, Write Same)

Married Unmarried (includes single, divorced, widowed) Separated Married Unmarried (includes single, divorced, widowed) Separated

Yrs School Yrs School

Military Status: N/A Active Veteran

Are you a US Citizen? Yes No Are you a US Citizen? Yes No

Are you a Permanent Resident Alien? Yes No Are you a Permanent Resident Alien? Yes No

Employment Information

BORROWER CO-BORROWER

Employed Unemployed Self-employed Employed Unemployed Self-employed

Employer

Work Phone Number With Area Code

# Of Years at Current or Most Recent Job # Of Years at Current or Most Recent Job

Position/Title

Property Information

Page 2/13

Single Family Multi-family (1-4 Units) Condo Property Purchase Date

Property Condition: Excellent Good Fair Poor Estimated Property Value

I want to: Keep the Property Sell the Property This property is my: Primary Residence Second Home Investment

Is the property listed for sale? Yes No

For Sale by Owner? Yes

Agent’s Name:

Agent’s Phone Number:

Have you received an offer on the property? Yes No

Date of Offer Amount of Offer $

Have you contacted a credit-counseling agency for help? Yes No

If yes, please complete counselor contact information below.

Counselor’s Name:

Counselor’s Phone Number:

Counselor’s Email:

Have you received a foreclosure sale date?

Yes Foreclosure Date

Have you received a notice of Mediation or Conciliation? Yes No

Have you filed for bankruptcy? Yes No If yes: Chapter 7 Chapter 13 Filing Date:

Has your bankruptcy been discharged?

Yes

No Bankruptcy Case Number: Attorney:

Mortgage Information

First Mortgage Lender/Servicer Name

First Mortgage Loan Number

Balance

Interest Rate

Monthly Payment Amount (Principal, Interest, Taxes, and Insurance)

Monthly Mortgage Insurance Payment (If Applicable)

Are you current on your First Mortgage? Yes No

If yes, are you in danger of falling delinquent? Yes No

Has your mortgage ever been modified or have you entered into aforbearance plan? Yes

Have you received Hardest Hit Funds in the past: Yes No

Who pays the real estate tax bill on your property?

Who pays hazard insurance policy for your property?

Are the taxes current? Yes No

Is the policy current? Yes No

Condominium or HOA Fee: Yes $ No

Paid to:

Do you have a second mortgage/ Home Equity Loan? Yes No If yes, provide detail below.

Second Mortgage Lender/Servicer Name

Second Mortgage Loan Number

Balance

Interest Rate

Monthly Payment Amount (Principal, Interest, Taxes, and Insurance)

Monthly Mortgage Insurance Payment (If Applicable)

List other Liens/Mortgages or Judgments on this property, please name the person(s), company or firm and their telephone numbers.

Lien Holder’s Name/Servicer Balance

Contact Number Loan Number

Page 3/13

Information for Government Monitoring Purposes

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 or servicer 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 or servicer is required to note the information on the basis of visual observation or surname if you have made

this request for a loan or grant in person.

If you do not wish to furnish the information, please check the box below.

BORROWER

I do not wish to furnish this information

CO-BORROWER

I do not wish to furnish this information

Ethnicity:

Hispanic or Latino Not Hispanic or Latino

Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

Race:

American Indian or Alaska Native

Asian Black or African American

Native Hawaiian or Other Pacific Islander

White

Race:

American Indian or Alaska Native

Asian Black or African American

Native Hawaiian or Other Pacific Islander

White

Sex:

Female Male

Sex:

Female Male

Page 4/13

Monthly Income/Expenses For Household

Page 5/13

0.00

Hardship Affidavit

Explanation (Required):

If additional space is needed for Explanation, please include an additional page.

Page 6/13

HUD-Approved Counseling Agency

Authorization

Note: if you have an impairment, disability, language barrier, or otherwise require an alternative means of

reviewing and completing this Authorization, please talk to us about arranging alternative accommodations.

Rhode Island Housing and Mortgage Finance Corporation’s (“RIHousing”) HelpCenter is a HUD-approved

counseling agency that provides foreclosure prevention counseling services (the “Counseling Services”) to

homeowners in the State of Rhode Island. As a participant in our counseling program, please read this

Authorization and indicate your understanding and consent by signing below.

1. I have provided RIHousing information regarding my personal finances (the “Financial Information”). I

understand that RIHousing will use the Financial Information to provide me with the Counseling Services,

evaluate any options that may be available to me regarding my mortgage loan (the “Loan”), and develop

an action plan consisting of recommendations for managing my finances. An overview of my counselor’s

and my roles and responsibilities is set forth at Attachment A.

I authorize RIHousing to obtain a consumer credit report on me and to use the report to provide me with the

Counseling Services. I understand that credit inquiries have the ability to impact my credit score.

3. I give RIHousing permission to contact my mortgage lender/servicer, ,

(the "Mortgagee") and to obtain from the Mortgagee any information regarding the Loan that RIHousing

deems necessary in order to provide the Counseling Services.

4. I authorize RIHousing to share the Financial Information with the Mortgagee and to discuss the Loan

and the Financial Information with the Mortgagee. I understand that I may or may not be present during

these discussions.

5. RIHousing’s HelpCenter is a HUD-approved counseling agency and may receive funding from the

United States Department of Housing and Urban Development (“HUD”). Due to the nature of these

relationships, RIHousing may be required to share information about me with HUD for program

monitoring, compliance, and evaluation purposes. I authorize RIHousing to make information relating to

the Loan, the Financial Information, and other information in my counseling file (including, but not limited

to, my social security number, date of birth, account numbers, and income information) available to HUD

and/or HUD’s agents and/or representatives for program monitoring and compliance purposes. Further, I

authorize RIHousing, HUD, and HUD’s agents and/or representatives to contact me for program evaluation

purposes.

Name (printed)

Signature Date _

Name (printed)

Signature Date _

Property Address:

Page 7/13

Attachment A

Client Roles and Responsibilities

Counselor Roles and Responsibilities

• Providing RIHousing with accurate and

complete information regarding your income,

assets, debts, and credit history in the

Financial Package.

• Compiling all documents listed on the

“Required Document” checklist.

• Completing the steps assigned to you in your

Action Plan.

• Attending meetings, returning telephone

calls, and providing paperwork and

information in a timely manner.

• Notifying RIHousing or your counselor in the

event that you change your housing goals.

• As and where appropriate, seeking the

advice of an attorney, accountant, or financial

advisor.

• Reviewing your Financial Package and your

credit report and analyzing your financial

capacity. If mortgage fraud is suspected, we

may notify the appropriate authorities.

• Developing an Action Plan to assist you in

achieving your housing goals. Your counselor

is not responsible for achieving your housing

goal, but will only provide support and

guidance.

• Determining your potential eligibility for loss

mitigation options.

• If appropriate, assisting you in preparing a

hardship letter for submission to the

Mortgagee.

• Maintaining communication with you and/or,

as necessary, the Mortgagee.

• Reviewing any loss mitigation proposals you

receive from the Mortgagee.

• Assisting you in preparing a household

budget to help you manage your debt,

expenses, and savings.

• As appropriate, providing you with

recommendations and referrals to housing,

financial, utility, or legal aid services.

Page 8/13

Disclosure

Note: if you have an impairment, disability, language barrier, or otherwise require an alternative means of

reviewing and completing this Disclosure, please talk to us about arranging alternative accommodations.

Rhode Island Housing and Mortgage Finance Corporation’s (“RIHousing”) HelpCenter is a HUD-approved

counseling agency that provides foreclosure prevention counseling services (the “Counseling Services”) to

homeowners in the State of Rhode Island. We serve all clients regardless of income, race, color,

religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We

administer our programs in conformance with local, state, and federal anti-discrimination laws. As a

participant in our counseling program, please read this Disclosure and indicate your understanding

and consent by signing and dating.

Referrals. In the course of providing me with Counseling Services my counselor may recommend or refer to

me other housing, financial, utility, or legal services. These services may be provided by RIHousing or other

organizations. I understand that I am not obligated to use any of the services that are referred or

recommended to me. I understand that RIHousing offers a variety of lending and mortgage products and loans,

and that some of these loans may also be originated by participating lenders or third-party brokers who are

compensated by RIHousing for their origination services. I further understand that I am not obligated to use or

receive any other products or services from RIHousing, its participating lenders and brokers, or any other

organization and that information on alternative services, programs, and products will be provided to me.

Legal/Financial Disclaimer. I understand that the recommendations and information that will be provided to

me as part of the Counseling Services are for educational and informational purposes only and are not a

substitute for legal or financial advice that can be provided by my own attorney, accountant, and/or financial

advisor. I understand that my counselor may answer questions and provide information, but not provide legal

advice. I acknowledge that RIHousing recommends that I consult with my tax consultant, accountant, financial

advisor, or lawyer for any and all questions and concerns that I have, may have, or hereafter have regarding

my income and taxes and specific financial and/or legal situation.

Disclaimer of Liability. I, with the intention of binding my heirs, executors, and administrators (collectively,

the “Releasing Parties”) agree that RIHousing, its employees, directors, officers, commissioners, agents,

successors, and assigns (collectively, the “Released Parties”) are not liable for any claims or causes of action

arising from errors or omissions in connection with the Counseling Services and hereby release, waive,

discharge, and covenant not to sue the Released Parties for any and all claims or liabilities relating in any way

to the Counseling Services. I understand and agree that the purpose and intent of this disclaimer of liability is

to release and fully and forever extinguish each and every claim, demand, and cause of action that the

Releasing Parties may have against Released Parties with respect to the Counseling Services.

Capacity and Duress. I acknowledge that I have read this Disclosure and represent that I have the legal

capacity to understand it and to be fully bound thereby. I further acknowledge that I am executing this

Disclosure by my own free will and not under duress. My decision to receive the Counseling Services and

execute this Disclosure is a fully formed decision and I am aware of all legal and other ramifications of such

decision. If any provision of this Disclosure is held to be unenforceable or invalid under any applicable law or

by any court or competent governmental authority having jurisdiction thereover, I agree that the remaining

provisions of this Disclosure shall continue in full force and effect without being impaired or invalidated in any

way.

Name (printed)

Signature Date _

Name (printed)

Signature Date _ Page 9/13

Housing Stability Counseling Program

Authorization

Note: if you have an impairment, disability, language barrier, or otherwise require an alternative means of

reviewing and completing this Authorization, please talk to us about arranging alternative accommodations.

Rhode Island Housing and Mortgage Finance Corporation’s (“RIHousing”) HelpCenter is a HUD-approved

counseling agency that provides foreclosure prevention and housing stability counseling services to

homeowners in the State of Rhode Island. RIHousing’s HelpCenter is also a subgrantee and participant in the

Housing Stability Counseling Program (“HSCP”), a federally funded program established by the American

Rescue Plan Act of 2021 and administered by NeighborWorks America. As a participant in the HSCP,

please read this Authorization and indicate your understanding and consent by signing below.

1. Through the HSCP, RIHousing will provide me with housing stability counseling and a written action

plan consisting of recommendations for handling my situation. This action plan may include referrals for

other housing services, as appropriate. These services may be provided by RIHousing or other agencies.

I understand that I am not obligated to use any of the services that may be referred to me.

2. I authorize RIHousing to pull my credit report.

I Choose to Opt Out.*

*I understand and agree that if I opt out I must provide RIHousing with a copy of my

credit report, and that this credit report must be dated within thirty (30) days of the HSCP

intake date.

3. I understand that RIHousing receives federal funding through the HSCP and, as such, is required to

submit information about me to the HSCP online reporting system and share information about me with

HSCP administrators or their agents for purposes of HSCP monitoring, compliance, and evaluation. The

information about me that will be submitted and shared may include, but may not be limited to, my social

security number, date of birth, and any information contained in the documents that I provide to

RIHousing regarding my personal finances and my mortgage loan(s).

I Choose to Opt Out

4. I give permission for HSCP administrators and/or their agents to contact me between now and June

30, 2026, for the purposes of HSCP evaluation.

I Choose to Opt Out

Name (printed) Name (printed)

Signature Signature

Date Date

Page 10/13

Page 11/13

Homeowner/Counselor Agreement

The RIHo

using Help Center and its counselors agree to provide the following services:

•

Development of a financial budget to determine homeowner’s income, expenses and affordability

•

Analysis of the mortgage default, including the amount and cause of default

•

Presentation and explanation of reasonable options available to the homeowner

•

Submit homeowner’s file to the lender for review for all retention and/or liquidation options available, based on

the homeowner’s eligibility and needs

•

Communicate with the mortgage servicer and/or investor and provide the homeowner with requests for any

additional/updated information as needed

•

Timely completion of action plan

•

Explanation of collection and foreclosure process

•

Identify and provide homeowner with information on additional resources that may be available

•

Confidentiality, honesty, respect and professionalism in all services

•

The HelpCenter cannot control the lender’s processing time or decision

•

The HelpCenter cannot and does not provide legal advice or representation. The informational services provided

by the HelpCenter are not a substitute for legal advice. The HelpCenter encourages homeowners to contact an

attorney if they feel they need legal advice or services

I/We agree to the following terms of service:

I/We will always provide honest and complete information to my/our counselor, whether verbally or in writing.

I/We will be on time for appointments and understand that if I/we are late for an appointment, the appointment may have

to be rescheduled

I/We will call within 24 hours of any future scheduled appointment(s) if I/we will be unable to attend an appointment.

I/We will follow up with our mortgage servicer and/or investor, on a bi-weekly basis, and provide the counselor with any

updates as well as provide the counselor with any correspondence or requests for any additional documentation.

I/We will provide all necessary documentation and follow-up information within 72 hours from the time requested.

I/We will contact the counselor about any changes in my/our situation immediately.

I/We will make an appointment with my/our counselor should any follow up face to face meeting be needed.

I/We understand that RIHousing will provide one counseling session per calendar year.

I/We understand that breaking this agreement may cause the HelpCenter to terminate its service assistance to me/us.

I/We understand that the HelpCenter is not providing legal advice or representation, and that the informational services

provided by the HelpCenter are not a substitute for legal advice. I/We understand that I/we should contact an attorney if

we wish to receive legal advice or services.

Homeowner Date

Counselor Date

RIHousing Help Center | 44 Washington Street Providence, RI 02903 | 401 457-1130

Page 12/13

Consent to the Use of Tax Return Information

I understand, acknowledge, and agree that Rhode Island Housing and Mortgage Finance Corporation and its

affiliates, agents, service providers, successors and assigns (collectively, “RIHousing”) can obtain, use, and share my

tax return information with the Loan Participants for the purpose of providing me with foreclosure prevention

counseling or as otherwise permitted by applicable law, including state and federal privacy and data security laws.

The Loan Participants include any actual or potential owners of my loan, or acquirers of any beneficial or other

interest in my loan, any mortgage insurer, guarantor, any servicers or service providers for these parties and any of

the aforementioned parties’ successors and assigns.

I understand that RIHousing’s HelpCenter is a housing counseling agency that is approved by the United States

Department of Housing and Urban Development (“HUD”). I acknowledge and agree that RIHousing can share

my tax return information with HUD for its program monitoring and compliance purposes.

Acknowledgment: By signing below I hereby acknowledge and agree that I have read and understood the

information that is set forth above.

Borrower Signature Date

Co-Borrower Signature Date

Page 13/13

WHAT DOES RIHOUSING DO WITH YOUR

PERSONAL INFORMATION?

Rev. Jan-19

Why?

Financial companies choose how they share your personal information. Federal law gives

customers the right to limit some but not all sharing. Federal law also gives customers the right to

view personal records, and to correct a record that is inaccurate or incomplete. Federal law

requires us to tell you how we collect, share, and protect your personal information.

We provide this notice to customers at the time of application for RIHousing programs, products,

or services, and annually thereafter. From time to time, we may revise this notice to reflect

changes in the law or changes in our policies. Please read this notice carefully to understand what

we do.

What?

The types of personal information we collect and share depend on the product or service you have

with us. This information can include:



Social Security Number



Income



Account balance



Payment history



Credit history



Credit score



Date of birth



Medical information and blood lead level test results (for lead hazard reduction programs)

When you are no longer our customer, we continue to share your information as described in this

notice.

How?

All financial companies need to share customers’ personal information to run their everyday

business. In the section below, we list the reasons financial companies can share their customers’

personal information; the reason RIHousing chooses to share; and whether you can limit this

sharing.

Reasons we can share your personal information

Does RIHousing share?

Can you limit this

sharing?*

For our everyday business purposes – such as to process

your transactions, maintain your account(s), respond to court

orders and legal investigations, or report to credit bureaus

Yes No

For our marketing purposes – to offer our products and

services to you

Yes No

For joint marketing with other financial companies

No N/A

For our affiliates’ everyday business purposes – information

about your transactions and experiences

No N/A

For our affiliates’ everyday business purposes – information

about your creditworthiness

No N/A

For nonaffiliates to market to you

No N/A

*If N/A, RIHousing does not share your personal information so your ability to limit is not applicable.

FACTS

Questions?

Call (800) 854-1180 or (401) 457-1180

Who we are

Who is providing

this notice?

Rhode Island Housing and Mortgage Finance Corporation (“RIHousing”)

What we do

How does

RIHousing protect

my personal

information?

To protect your personal information from unauthorized access and use, we use security measures

that comply with federal and state law and regulation. These measures include computer

safeguards and secured files and buildings.

How does

RIHousing collect

my personal

information?

We collect your personal information, for example, when you:



Apply for financing



Give us your contact information



Give us your employment history



Give us your income information



Show us your driver’s license

We also collect your personal information from government agencies, public sources, and others,

such as credit bureaus, affiliates, or other companies.

Why can’t I limit all

sharing?

Federal law gives you the right to limit only:



Sharing for affiliates’ everyday business purposes – information about your

creditworthiness



Affiliates from using your information to market to you



Sharing for nonaffiliates to market to you

Definitions

Affiliates

Companies related by common ownership and control. They can be financial and nonfinancial

companies.



Our affiliates include Rhode Island Housing Development Corporation, Rhode Island Housing

Equity Corporation, Rhode Island Housing Equity Pool, L.P., and Rhode Island Housing Equity

Pool-I, L.P.

Nonaffiliates

Companies not related by common ownership or control. They can be financial or nonfinancial

companies.



RIHousing does not share your personal information with nonaffiliates so they can

market to you.

Joint marketing

A formal agreement between nonaffiliated financial companies that together market financial

products or services to you.



RIHousing does not jointly market.

Service providers with whom we share information for everyday business purposes may include coupon or statement

printers, billing services, payment processing companies, mail, print, and telephone service companies, insurers, property

inspection firms, government agencies, attorneys, laboratories, community action programs, auditors, quality control

vendors, consultants, or other service providers.

Other important information

In the context of carrying out certain residential lead hazard reduction programs, RIHousing may receive certain medical

information. A customer’s rights with respect to protected medical information include (a) the right to request

restrictions on certain uses and disclosures, subject to denial by RIHousing; (b) the right to receive confidential

communications of the information; (c) the right to inspect and copy the information; (d) the right to amend the

information; (e) the right to receive an accounting of disclosures of the information; and (f) the right to obtain a paper

copy of this notice upon request. A customer may complain to RIHousing if they believe their privacy rights have been

violated by writing a letter addressed to RIHousing, 44 Washington Street, Providence, RI 02903,

ATTN: Lead Program. A customer will not be retaliated against for filing a complaint.

Provisions pertaining to protected medical information

Fax

To: HelpCenter

Fax: 401-450-1373

From:

Pages:

Date:

Re: HelpCenter Financial Information Package

Comments: