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SubscribeH4H Workout Package Form
Here is the new H4H Workout Package Form. Print and Fill out and then when you have 2 hours to do the workout give us a call - to link you in and oversee the call.
Hope 4 Homeowners: Workout Plan Form
| Date of Summary: | ||
| Referral Received Date: | ||
| Priority Type: | ||
| 1st Mortgage/Servicer: | ||
| 1st Mortgage Type (current rate): | ||
| Has interest reset on ARM loan?: | ||
| 1st Mortgage loan #: | ||
| 1st Mortgage monthly payment (PITI): | ||
| 1st Mortgage Loan Status: | ||
| 2nd Mortgage/Servicer: | ||
| 2nd Mortgage type: | ||
| 2nd Mortgage loan #: | ||
| 2nd Mortgage monthly payment: | ||
| 2nd Mortgage loan status: | ||
| Property for sale?: | ||
| List Price of Home: | ||
| Realty Company Name: | ||
| Has notice of Foreclosure sale been received?: | ||
| Borrower Name: | ||
| Address: | ||
| City/State/Zip: | ||
| Phone: | ||
| Secondary Contact Number: | ||
| Email Address: | ||
| Primary Default Reason Type: | ||
| Secondary Default Reason Type: | ||
| Monthly Net Income: | ||
| Household Income: | ||
| Income Category Type: | ||
| Number of adults contributing to household income: | ||
| Owner Occupied: Y | ||
| # of People in House: | ||
| Household Type: | ||
| Bankruptcy?: | ||
| bankruptcy Attorney: | ||
| Credit Score: | ||
| Intake Score Type: | ||
|
Result Type |
||
| HUD Outcome: | ||
| HUD Termination Reason: | ||
| HUD Termination date: | ||
| Have you worked with your mortgage company to develop a solution: | ||
| Have you worked with another counseling agency for help with your mortgage?: | ||
| Presenting issues/Main reason(s) for default: | ||
| Recommended action items: | ||
| Follow up notes after initial counseling: | ||
| Agency: | ||
| Agency Tracking Id: | ||
| Privacy consent agree to?: | ||
| Summary report sent by alternate method: | ||
| Summary report sent by alternate method date: | ||
| Budget | ||
| Income | Primary Income | |
| Secondary Income | ||
| Pension Income | ||
| Alimony/Child Support Income | ||
| Social Security Benefits | ||
| Other Benefits (food stamps, welfare, etc.) | ||
| Other Income | ||
| Subtotal: | ||
| Dependants | Child Care/Babysitter | |
| Child Support Payments | ||
| Other | ||
| Subtotal: | ||
| Housing | Mortgage | |
| 2nd Mortgage/HELOC | ||
| Property Taxes/Homeowner’s Insurance | ||
| Rent | ||
| Association Fees | ||
| Other | ||
| Subtotal: | ||
| Utilities | Electric | |
| Water | ||
| Gas/Oil | ||
| Telephone | ||
| Cable | ||
| Internet | ||
| Cell Phone | ||
| Other | ||
| Subtotal: | ||
| Transportation | Car Payment (loan/lease) | |
| Car Maintenance | ||
| Gasoline | ||
| Car Insurance | ||
| Public Transportation/Tolls | ||
| Other | ||
| Subtotal: | ||
| Necessities | Groceries | |
| Medical/Life Insurance | ||
| Household Supplies | ||
| Laundry/Dry Cleaning | ||
| Health/Hair/Personal Care | ||
| Other | ||
| Subtotal: | ||
| Education | Tuition | |
| School Lunches | ||
| Other | ||
| Subtotal: | ||
| Medical | Medical/Dental Bills | |
| Prescriptions/Co-Payments | ||
| Other | ||
| Subtotal: | ||
| Misc/Entertainment | Eating Out | |
| Contributions/Church/Charities | ||
| Crafts/Sports/Hobbies | ||
| Holidays/Birthdays/Weddings | ||
| Memberships/Subscriptions | ||
| Pet/Veterinary | ||
| Other | ||
| Subtotal: | ||
| Monthly Debt Payments | Credit Card Payments | |
| Student Loans | ||
| Secured Debt | ||
| Other | ||
| Income Total: | ||
| Expense Total: | ||
| Total Surplus or Deficit: |
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