Disclosure Form for Pre-Filing Bankruptcy Clients
We understand that you are contacting us because you are experiencing financial problems, and you are considering filing for bankruptcy. Before filing for bankruptcy, you are required to receive credit counseling.
Our agency, Credit Counseling of Arkansas (CCOA), has extensive experience helping people with financial problems. Our role is not to judge you, but to provide information and assistance. We will help you create a budget analysis to 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. The purpose of this session is to provide you with information so that YOU may choose 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. CCOA is also accredited by the Council on Accreditation, an independent, third-party organization that reviews and monitors social service organizations. We are a not-for-profit agency, operating as a provider of educational services in accordance with Section 501(c)(3) of the IRS code. We are approved by the Executive Office of U.S. Trustee (EOUST) to provide pre-filing bankruptcy counseling and education. EOUST approval is not an endorsement of overall agency services.
The consumer credit counselor conducting or supervising your session has been trained and certified according to NFCC standards. CCOA has English and Spanish speaking counselors available to conduct your session. Though trained to help you assess financial problems, your counselor is not a lawyer, and cannot provide you with legal advice. 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. 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 or as required in an EOUST quality review. We may be required to disclose debtor information to EOUST in connection with their oversight of our company's services, during an investigation of any inquiries, during on-site visits, and during quality of service reviews. 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 the bankruptcy pre-filing counseling. We can take payment in cash, cashier's check/money order, personal check, or debit card. CCOA will provide services without regard to a client's ability to pay. If your household gross income is less than 150% of the poverty guidelines provided by the U.S. Department of Health and Human Services, you may be eligible for a full or partial fee waiver. You will need to complete a Fee Waiver form and provide documentation of household income.
We prohibit payment or receipt of referral fees. CCOA receives funding from client fees and grants, as well as funding from some 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.