HECM Pre-Appointment Packet

HECM Pre-Appointment Packet

Please read the disclosure in it's entirety.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Marital Status
If married, spouse must be counseled
Applicant Race
Applicant Ethnicity
Applicant Gender
Applicant Primary Language Spoken
Spouse's Name (If applicable)

First NameLast Name
Please list anyone listed on the deed of the property
Property Type:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you interested in a HECM for purchase?
Counselor Access Code
If you have the Counselor Access Code, please enter it here
Addendum to List of HECM Counselors

(Pursuant to California Civil Code § 1923.2(k))
You have been provided a list of not fewer than ten housing counseling agencies approved by
the United States Department of Housing and Urban Development to engage in reverse
mortgage counseling, and you acknowledge that:

(1) A lender may not accept a final and complete application for a reverse mortgage from you or
assess any fees upon you without first receiving certification that you have received counseling
from an approved counseling agency.

(2) Reverse mortgage counseling is to be conducted in person, unless you elect to receive the counseling in another manner.
Phone CallIn-PersonOther
HECM Pricing Disclosure

Please read the disclosure in it's entirety.
Our Home Equity Conversion Mortgage (HECM), or Reverse Mortgage, counseling services are provided for a fee of $110, payable upon submission of the intake form.

DISCLAIMER: Please be advised that the certificate we issue is ONLY valid for FHA-backed HECMs, NOT private or Jumbo reverse mortgages.

If there is a durable Power of Attorney involved, please email it to us prior to the appointment to avoid any delays.
Applicant Name*

First NameLast Name
Applicant Signature*

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Date Signed*

MonthDayYear
Date
Housing Counseling Disclosure

Please read the disclosure in it's entirety.
Services Offered:
NeighborWorks® HomeOwnership Center Sacramento Region offers the following HUD one-on-one counseling and group education services: Pre-Purchase Counseling, Foreclosure Prevention Counseling, Home Equity Conversion Mortgage Counseling, Rental Counseling, Non-Delinquent Post-Purchase Counseling, Preparing for HomeOwnership Workshops, and Financial Capability Classes. See the first Addendum, “HomeOwnership Center Services,” for a full description of our services.

Privacy Statement:
NeighborWorks® HomeOwnership Center Sacramento Region values your privacy. When you use our service, we collect personal information in order to provide the services you requested and to support our housing counseling program. We collect the following information: information we receive from your application and other forms, information about your transactions with us, our affiliates, or others, and information we receive from a consumer reporting agency. Our agency takes precautions to keep your information confidential and secure per HUD requirements. NeighborWorks® HomeOwnership Center Sacramento Region may not use or disclose the information provided by you without written consent except under the following circumstances: as necessary to provide the services you request, as required by law or in response to a subpoena or search warrant, or to outside auditors such as HUD or NeighborWorks® America who have agreed to keep the information confidential.

Relationships with Industry Partners:
NeighborWorks® HomeOwnership Center has financial relationships with several partners in the industries of lending, real estate, insurance, and other related fields. See the Addendum “Financial Partnerships” for a list of partnering organizations.

No Client Obligation:
There is no obligation to receive, purchase, or use any product or service offered by this agency or any services of its industry partners or another party in exchange for your receiving HUD housing counseling and/or education services.

Alternatives:
As a condition of our services and in compliance with HUD’s Housing Counseling Program requirements, we may provide information on alternative services, programs, and products available to you.
Acknowledgments
Please initial that you have read and understand the following acknowledgments:

1. I understand that NeighborWorks Sacramento provides housing counseling. A written action plan will be provided consisting of recommendations for handling my situation, possibly including referrals to other housing agencies as appropriate.

2. I understand that NeighborWorks Sacramento receives Congressional funds for housing counseling. As such, it is required to submit client-level information through the online reporting system with program administrators or their agents for program monitoring, compliance, and evaluation.

3. I may be referred to other housing services or agencies as appropriate to able to assist with concerns that have been identified. I understand that I am not obligated to use any of the services offered to me.
Third-Party Release of Information

1. NeighborWorks Sacramento may disclose some or all of the information that we collect, as described above, to creditors, where we have determined that it would be helpful to you, would aid us in counseling you, or is a requirement for grant awards.

2. We may also disclose any nonpublic personal information about you as permitted by law (e.g., if we are compelled by legal process).

3. 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.

I acknowledge the above and have received a copy of NeighborWorks Sacramento’s privacy policy.
Applicant Printed Name*

First NameLast Name
Applicant Signature*

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Date Signed*

MonthDayYear
Date

Additional Disclosures and Disclaimers

The following document are for your reference only. No signatures or submissions are required.
Please review this file before your appointment and have any questions ready for your counselor. You will receive a copy of this document once you submit your form.
My Products*
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HECM Counseling Fee
$110.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

HECM Pre-Appointment Packet

Addendum to List of HECM Counselors

HECM Pricing Disclosure

Housing Counseling Disclosure

Additional Disclosures and Disclaimers