Homeowner Assistance Form Page 3
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5Income/expenses for household
Important note: All income must be documented.
Include combined income and expenses from the borrower and co-borrower (if any). If you will be including income and expenses from a
household member who is not a borrower, please specify on the back of this form. Also, include the non-borrower(s) start date(s) for
employment information. You are not required to disclose child support, alimony or separation maintenance income unless you choose to have
it considered by your servicer.
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Monthly household income
Monthly household expenses/debt
Household assets
Monthly gross wages
$
First mortgage payment
$
Checking account(s)
$
Second mortgage payment/
Overtime
$
$
$
other liens
Borrower start date of
Savings/ money market
$
Homeowners insurance
1
$
$
employment (MMDDYYYY)
account(s)
Co-borrower start of
$
Property taxes
2
$
$
employment (MMDDYYYY)
Borrower other employment
Credit cards/ installment
Certificate(s) of deposit
state date (MMDDYYYY) (If
$
loan(s) (total minimum
$
$
(CDs)
borrower has a second job)
payment per month)
Alimony/ separation
Co-borrower other employment
$
maintenance/ child support
$
$
start date (MMDDYYYY)
payments
Child
Net rental expenses/
support/alimony/separation
$
property maintenance
$
$
maintenance
expenses
Non-taxable Social
Homeowners association/
Security/Social Security
$
$
Stocks/bond(s)
$
condominium fees
Disability Insurance
Taxable Social Security benefits $
Child care expenses
$
$
Other monthly income from
Car payments, including car
pensions, annuities or
$
Other cash on hand
$
lease payments
retirement plans
Tips, commissions and bonus
Car insurance/ gas/
Other real estate (estimated
$
$
$
income
maintenance
value)
Health insurance/ medical
Self-employment income
$
$
Other
$
expenses
Life insurance premiums
Unemployment income
$
$
$
(not withheld from pay)
Start date of unemployment
$
Groceries
$
$
(MMDDYYYY)
Rent received
$
Water/sewer/utilities
$
$
Internet/ cable/ satellite/ cell
Boarder income
$
$
phone/ home phone
Do not include retirement plans when
Food stamps/Welfare
$
Personal loans/tuition
$
calculating assets (401k, pension funds,
Other (investment income,
$
Tithes/religious
$
annuities, IRAs, Keogh plans, etc.)
royalties, interest, dividends,
contributions
etc.)
Other
Total (gross income)
$
Total debts/expenses
$
Total assets
$
1. Only include your homeowners insurance payment if you pay this amount yourself.
2. Only include your property tax payments if you pay them yourself.
Homeowner Assistance Form (HAMP)
RFDocType 50431
Page 3 of 5
29290MU 11/11
BARCODE
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