CSA San Diego County Counseling Intake

Part I: HOMEOWNER/CLIENT INFORMATION

Part II: Demographics

Part III: Client (Borrower) Income

Part IV: Household Assets

VI: A. Subject Property

B. Other Real Estate Owned

Part VII: MORTGAGE INFORMATION (if applicable)

Part VIII: HOME OWNERSHIP/MORTGAGE ISSUES

Part IX: REASONS FOR HOUSING ISSUES

Dear Client:

Upon completion of your counseling session with your counselor, you are given an Action Plan to aid you in the expectations from CSA Sam Diego.

Please understand that there is a high volume of clients who are in similar situations and we are trying our best to meet their needs as our capacity will allow.

I Understand That:

1.CSA SAN DIEGO COUNTY's workshop provides counseling advice through its counselors, educators, and its Partners/Supporters. It is your sole responsibility to seek any future services that may be needed. This file and supporting documents will be retained by CSA SAN DIEGO COUNTY and information provided might be shared with CSA SAN DIEGO COUNTY, partners, supporters or 3rd parties to provide service to you.

2. CSA SAN DIEGO COUNTY may receive funding from the US Dept. of HUD and/or HUD Intermediaries and as such, is required to: a) share some of my personal information with HUD program administrators or their agents; b) to open my file to be reviewed for purposes of program monitoring, compliance; c) to conduct follow up with me related to program evaluation.

3.CSA SAN DIEGO COUNTY and its nonprofit partners provide housing counseling after which I will receive a written action plan consisting of recommendation for handling my finances, credit, and possibly including referrals to housing agencies as appropriate.

4. A counselor may answer and provide information, but not give legal advice. If I want legal advice, I will be referred for appropriate assistance.

5.CSA SAN DIEGO COUNTY and its nonprofit partners provide information and education on numerous loan products and housing programs and I further understand that the housing counseling I receive from CSA SAN DIEGO COUNTY in no way obligates me to choose any of these particular products or housing programs.

6. I may be referred to other housing services of the organization, another agency or agencies as appropriate that may be able to assist with my particular concerns that have been identified. I also understand that I am not obligated to use any of the services offered to me.

7.CSA SAN DIEGO COUNTY hosts Workshops to help me/participating individuals ("Participants") among other services distinguish legal problems from non-legal problems, and to refer them to service providers, agencies, organizations, or other lawyer sources to provide them with any necessary substantive legal advice or representation. I further understand that by signing and dating this form, CSA SAN DIEGO COUNTY and its counselors do not and cannot provide legal advice or guidance in the course of the meetings with Participants, and do not establish or create any type of attorney-client relationships with Participants. I also understand that after consultation with counselor, Participants are urged to promptly consult with the service providers, agencies, organizations, or other lawyer referral sources to which the Participants have been referred for follow up on their potential legal issues.

I affix my signature below in agreement of what is stated in this Counseling Agreement.

CSA is a non-profit organization dedicated to eradicating fair housing discrimination by enforcing the Affirmatively Furthering Fair Housing regulation. CSA's mission is to promote positive attitudes and action that ensure respect, acceptance, and equal opportunity for all people. We realize that the concerns you bring to us are highly personal in nature and we are committed to the responsible management, use and protection of personal information. We assure you that all information shared both orally and in writing will be managed within legal and ethical considerations. You "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 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 Gathered

We collect personal information to support our housing counseling program and to aid your housing needs counseling. We collect personal information about you and we may disclose the following kinds of personal information about you:

1. Information we receive from you orally, on applications or forms, such as name, address, social security number, employer, occupation, assts, debts and income;

2. Information about your transactions with us, our affiliates, your creditors. Or others, such as your account balance, payment history, parties to transactions and credit usage; and

3. Information we receive from a consumer credit reporting agency, such as your credit bureau reports, your credit history and your credit worthiness. You May Opt-Out of Certain Disclosures

You May Opt-Out of Certain Disclosures

1. You have the opportunity to "opt-out", we will not be able to answer questions from your creditors. If at any time, you wish to change your decision and "opt-out", you may call us at (800) 954-0441.

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 3rd parties where we have determined that it would be helpful to you, would aid us in counseling you, or is a requirement of grants 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) Confidentiality and Security

Confidentiality and Security

We restrict access to personal and information about you to those of our employees, volunteers and affiliated organizations 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. Our safeguards strive to comply with federal regulations to guard your personal information.

 

Conflict of Interests Policy

No CSA San Diego employee, volunteer, contractor or agent will partake in any action that may result in or appear to gain personal or private gain through counseling operations. No CSA San Diego staff will have preferential treatment towards any person or organization or engage in any actions that may compromise our agency's compliance with federal regulations and our commitment to serving in the best interests of

Directing Us Not To Make Disclosures to Third Parties

If you prefer that we not disclose personal information about you to unaffiliated third parties, you may opt out of those disclosures, that is, you may direct us not to make those disclosures(other than disclosures permitted by law).

1. If you wish to opt out of disclosures to unaffiliated third parties other than nonprofit organizations involved in community development, you may check the box of the Privacy Choice Form below.