A non profit community service agency helping people with finances
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Disclosure Form for Pre-Filing Bankruptcy Clients
We understand that you are contacting us because you are experiencing financial problems, and you may be considering filing for bankruptcy. Before filing for bankruptcy, you are now required to receive credit counseling. We are here to help you fulfill that requirement. Our agency, Credit Counseling of Arkansas ( CCOA for short) has over ten years of experience helping people with financial problems. Our role is not to judge you, but rather to provide information and assistance. Specifically, we will work with you to create a budget analysis that will examine your financial situation. We will discuss the factors that may be the cause of the financial problems, help you explore your options, and work with you to create a plan for dealing with your financial concerns. We will provide you with some information about bankruptcy, including the bankruptcy process, and some of the possible consequences of bankruptcy. We will also review some of the alternatives to bankruptcy. We believe the purpose of this session is to provide you with information so that YOU may chose the option that you think is best. At the conclusion of the session, we will provide you with a certificate that you will need if you decide to file for bankruptcy. The certificate is valid for 180 days from the date of the counseling session.
Our agency is a member of the National Foundation for Credit Counseling (NFCC). The NFCC has high standards for quality credit counseling and financial education. Our agency complies with those standards. In addition, our agency is accredited by the Council on Accreditation, an independent, third-party organization that reviews and monitors organizations working in the social service field. We are a not-for-profit agency, organized to operate as a provider of educational services in accordance with Section 501(c)(3) of the IRS code. The consumer credit counselor conducting or supervising your session has been trained and certified according to NFCC standards. While the counselor has been trained to help those with financial problems, s/he is not a lawyer, and cannot provide you with legal advice. In fact, this session is designed to provide you with information and alternatives; it is not intended to take the place of a consultation with an attorney to explore your legal rights and options.
In order to assist you, it is important that you provide us with information that is as accurate and complete as possible. You can be assured that the financial information you provide during the session is strictly confidential. Such information would include, but not be limited to, your income, debts, credit accounts, earnings, assets, and employment. We will not disclose any such information that you provide verbally or in writing to anyone, except as authorized by you in writing, or as required by law, such as in response to a subpoena. We may compile and group data that you give us, but this information will not be disclosed in any manner that would personally identify you. CCOA will not disclose or provide any information about this session to a credit reporting agency. One option we may discuss with you is the use of a Debt Management Plan (DMP). If you decide to make use of a DMP, you will be provided with separate agreement and disclosure forms. You should be aware that bankruptcy could have a severe impact on your credit standing. A DMP can also affect credit, either favorably or unfavorably, according to your creditors’ policies regarding the DMP, and your payment history prior to and during the DMP.
There is a fee of $50 per session for this service. We can take payment in cash (exact change appreciated), cashier’s check/money order, personal check, or online payment. Under limited circumstances, you may be eligible to have this fee waived. CCOA will provide services without regard to a client’s ability to pay
(fee waiver policy)
. In addition to the client fees, CCOA also receives funding in the form of grants from HUD and certain financial institutions. A significant portion of our agency funding comes from creditors who participate in DMPs and provide us with voluntary contributions. Since creditors have a financial interest in having debts repaid, many are willing to make a contribution to help the overall services of this agency. These contributions are usually calculated as a percentage of payments that are made through a DMP. Should you decide to utilize a DMP, you will receive specific information on how the plan works, and how the agency is funded.
We are required to verify that the person counseled is the person in whose name the certificate is issued. In other words, no “stand-ins” for counseling sessions. For this reason, you will be asked to provide some form of photo identification at an in-person counseling session. If your session is conducted by phone, you will be asked when you schedule the appointment to provide some form of unique personal information, such as mother’s maiden name, favorite color, or last four digits of your social security number. Your counselor will verify that information at the time of the counseling session.
By submitting this data sheet, you are acknowledging that you have read and understood the disclosures made above. Submitting this form also serves as an affidavit, certifying that the information you provide is accurate, complete, and made in good faith. Your submission of this form will also certify that the person(s) participating in the counseling session is the person whose name will appear on the certificate to be issued.