Form xxx Appendix E: Activity Report for Approved Agencies (old f

Appendix E: Activity Report for Approved Agencies

(Application for Approval as a Nonprofit Budget and Credit Counseling Agency)

Name of Agency:__________________________________________________________________

Circle - Estimated or Actual

Total number of clients counseled during probationary or annual approval period.

Certificates Issued and Fees/Contributions Collected:

Number Of Certificates Issued During Probationary or Annual Approval Period
Counseling Methods*
In-Person	Telephone	Internet		Total Fee/Contribution
			Certificates issued at no cost	$ 0.00
			Certificates issued at reduced cost	$
			Certificates issued at regular cost	$
			Total	$

Debt Management Plans (DMP’s):

Number of Debt Management Plans Administered During Probationary or Annual Approval Period
DMPs active, start of reporting period
New DMPs during reporting period (+)
DMPs closed on completion of the plan during reporting period (-)
DMPs closed prior to completion of the plan during reporting period (-)
DMPs active, end of reporting period
Percentage of credit counseling clients enrolled in DMPs

*Combine Telephone and Telephone/Internet counseling methods and report under Telephone.