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
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.
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.
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, all pages, 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. Help Center Authorization & Dodd Frank Forms signed and dated by all borrowers (pgs. 7 & 9)
15. Hardship Letter signed and dated by all borrowers (pg. 6).
Page 1/9
Borrower Information
Number of people in household.
Financial Information
Relationship to Applicant
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
Yrs School
Military Status: N/A Active Veteran
Are you a US Citizen? Yes No
Are you a Permanent Resident Alien? Yes No
Page 2/9
Employment Information
Employed Unemployed Self-employed
Employed Unemployed Self-employed
Work Phone Number With Area Code
( ) -
Work Phone Number With Area Code
( ) -
# Of Years at Current or Most Recent Job
# Of Years at Current or Most Recent Job
Property Information
Single Family
Multi-family (1-4 Units)
Property Purchase Date
Property Condition:
Excellent Good
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 No
Have you contacted a credit-counseling agency for help? Yes No
If yes, please complete counselor contact information below.
Agent’s Name:
Counselor’s Name:
Agent’s Phone Number:
Have you received an offer on the property? Yes No
Counselor’s Phone Number:
Date of Offer Amount of Offer $
Counselor’s Email:
Have you received a foreclosure sale date? Yes
Foreclosure Date No
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:
Page 3/9
Mortgage Information
First Mortgage Lender/Servicer Name
First Mortgage Loan Number
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 a forbearance 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
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 4/9
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.
I do not wish to furnish this information
I do not wish to furnish this information
Hispanic or Latino Not Hispanic or Latino
Hispanic or Latino Not Hispanic or Latino
American Indian or Alaska Native
Asian Black or African American
Native Hawaiian or Other Pacific Islander White
American Indian or Alaska Native
Asian Black or African American
Native Hawaiian or Other Pacific Islander White
Female Male
Female Male
Page 5/9
Monthly Income/Expenses For Household
Page 6/9
Hardship Affidavit
Explanation (Required):
If additional space is needed for Explanation, please include an additional page.
Page 7/9
HelpCenter Authorization / Disclosure
I understand that RIHousing provides foreclosure prevention counseling (“Counseling”) and I request that RIHousing provide me
such assistance. An overview of the range of Counseling services that I am entitled to receive is set forth on Attachment A. I
understand that I have a choice with respect to HUD-approved counseling agencies, and I am not required to use RIHousing to
provide counseling.
I authorize RIHousing to contact my mortgage lender or servicer (collectively,
the “Mortgagee”) on my behalf regarding any loan secured by my property located at
the “Loan”) and to obtain from such Mortgagee any information regarding my Loan that RIHousing deems necessary to provide
the Counseling.
I have provided RIHousing information regarding my personal finances and authorize RIHousing to obtain a credit report on me
in order to provide the Counseling (this information, along with the information obtained from the Mortgagee, the “Financial
I understand and agree that RIHousing will use the Financial Information to evaluate my options regarding the Loan and to develop an
action plan consisting of recommendations for handling of the Loan and my finances, which will be presented to me.
I understand that the Loan and the Financial Information will be discussed with the Mortgagee and that I may or may not be
present during the discussion.
I may be referred to other housing services of RIHousing or another agency or agencies as appropriate that may be able to assist with
particular issues that have been identified. I understand that I am not obligated to use any of the services offered to me. I understand
that RIHousing provides a variety of lending and mortgage products, including: mortgage loans to low- and moderate-income
homebuyers and homeowners; home repair loans; home equity loans; septic system replacement loans; sewer tie- in loans; lead
abatement loans; loans for home weatherization; loans under the federal Hardest Hit Fund program to prevent avoidable foreclosures;
and loans for home modification to assist disabled residents. The loans described above 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 or its participating lenders or brokers.
RIHousing offers a variety of mortgage-related services, including first-time homebuyer training and landlord training. I
understand that I am not obligated to use or receive any of these other services from RIHousing. If I already receive mortgage-
related services from RIHousing, I understand that I am not obligated to use RIHousing for Counseling services and may choose
from among HUD-approved housing counseling agencies.
I understand that a counselor may answer questions and provide information, but not provide legal advice. Counseling is not a
substitute for legal advice. If I want legal advice, I will be referred for appropriate assistance.
I acknowledge that I have received a copy of RIHousing’s Privacy Policy.
Loan Number
Name (printed) Signature Date
Name (printed) Signature Date
click to sign
click to edit
click to sign
click to edit
Page 8/9
Attachment A
Outline of Counseling Services
The following is an outline of the Counseling Services which are provided as part of this program.
1. The Intake Counselor reviews the homeowner’s financial situation. In order to complete this review, the counselor obtains a credit
report and collects income and expense documentation. This allows the Counselor to analyze the homeowner’s financial capacity
and determine if there is a hardship.
2. If, based upon this intake and initial file, mortgage fraud is suspected, we may refer the case to the Consumer Protection Division
of the Rhode Island Attorney General and the Rhode Island Department of Business Regulation.
3. Based on the review of the information developed through the intake, and any supplemental information submitted, we will work
with you to develop an action plan to seek relief, including steps you may need to take to control household expenses, and any
additional documents you must submit.
4. We will review your situation to determine potential eligibility for loss mitigation options including the Making Home Affordable
programs and lender’s proprietary programs.
5. If appropriate, we will inform you of other local programs and resources that may be available to assist you. Examples of the
these services and programs include Food Stamps, Heating Assistance programs, Community Action Program agencies,
alternative housing options, financial management assistance (through Money Management International), legal assistance
(through Rhode Island Legal Services or the Rhode Island Bar Association), and the like.
6. If appropriate, we will assist you in preparing a hardship letter for submission to your lender/servicer to support your request for a
work out option. We will maintain communication with you and your lender/servicer to monitor the status of your loan workout
request and to ensure that all necessary documentation is submitted on time.
7. We will review and evaluate any written work out proposal you receive from your lender/servicer to help you determine whether
to accept the proposal.
8. We will ask you whether you have been offered questionable mortgage foreclosure prevention assistance, including proposals
that guarantee a successful outcome; require payment in advance of the provision of assistance; require that you stop making
mortgage payment or require redirection of your mortgage payments to someone other than your lender/servicer; involve signing
over title to your home to a third-party. If we suspect that improper practices are present we will report the practices to the
Consumer Division of the Rhode Island Attorney General and the Loan Modification Scam alert website.
Page 9/9
Rev. Jan-19
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.
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
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
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
Reasons we can share your personal information
Does RIHousing share?
Can you limit this
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
For our marketing purposes to offer our products and
services to you
For joint marketing with other financial companies
For our affiliates’ everyday business purposes information
about your transactions and experiences
For our affiliates’ everyday business purposes information
about your creditworthiness
For nonaffiliates to market to you
*If N/A, RIHousing does not share your personal information so your ability to limit is not applicable.
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
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
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
Federal law gives you the right to limit only:
Sharing for affiliates’ everyday business purposes information about your
Affiliates from using your information to market to you
Sharing for nonaffiliates to market to you
Companies related by common ownership and control. They can be financial and nonfinancial
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.
Companies not related by common ownership or control. They can be financial or nonfinancial
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.
Other important information
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.
Provisions pertaining to protected medical 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.
To: HelpCenter
Fax: 401-450-1373
Re: HelpCenter Financial Information Package