Emergency Homeownership Loan Program

4. Were you at least 90 days late on your mortgage as of June 1, 2011?

❏ Yes

❏ No

5. Have you received written notification from your 1st mortgage lender or servicer stating that you are at
least 60 days late on your mortgage and at risk of foreclosure (this is often referred to as a “breach letter”)?
❏ Yes ❏ No
6. Did you usually pay your mortgage(s) in full and on time before you became unemployed or
underemployed? ❏ Yes
❏ No
7. Are you and ALL of the persons named on your 1st mortgage and promissory note one of the following –
US Citizen, US non-citizen national, or qualified alien (see required documentation attached):
❏ Yes ❏ No
8. Do you occupy the home as your principal residence?

❏ Yes

❏ No

9. Please indicate if you are delinquent on any of the following federal debt payments (check all that apply):
❏ Student Loans ❏ Taxes ❏ Other ❏ I am not delinquent on any federal debt payments
10. Besides your 1st mortgage, are there any other open liens secured against the mortgaged property at
this time?
❏ Yes ❏ No ❏ Don’t Know
If yes, check and indicate, in the space provided, how many of each type:
❏ Additional Mortgage: _____
❏ Tax: _____

❏ Home Equity Line of Credit (HELOC): _____

❏ Other: _____

11. Are you currently in bankruptcy?

❏ Yes

12. Do you live in a flood zone? ❏ Yes

❏ No

❏ No

If yes, do you have flood insurance? ❏ Yes

❏ Unsure
❏ No

13. Is your home scheduled for foreclosure sale? ❏ Yes

❏ Unsure
❏ No

If yes, what is the date for the scheduled sale? (mm/dd/yyyy) _____/_____/__________

Worksheet must be submitted by July 22, 2011.

www.FindEHLP.org

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Checklist
Documents for All Applicants
The following checklist provides the documentation you will need if you are selected from the lottery to
complete an EHLP application.*
❏❏ Written notification from your most recent employer indicating termination, a change in employment
status from full-time to part-time, or a reduction in income;
Note that if you were self-employed or your most recent employer is no longer in business, you must
complete an affidavit form in lieu of providing the written notification described above (the counseling
agency will provide an affidavit form); and
❏❏ Most recent/current residential utility bill; and
❏❏ Most recent/current mortgage statement(s); and
❏❏ Copy of current flood insurance policy demonstrating the coverage, as applicable; and
❏❏ Letter from your mortgage lender or servicer stating the you are delinquent on your 1st mortgage and at
risk of foreclosure (often referred to as a “breach” or “acceleration” letter); and
❏❏ 2009 and 2010 Tax Returns (IRS 1040, 1040A, or 1040EZ Tax Return(s), without schedules) for all persons
named on your first mortgage loan documents; and
❏❏ A signed IRS 4506-T for all persons named on your first mortgage loan documents; and
❏❏ Documentation of current income for all persons named on your first mortgage loan documents,
which must include:
❍❍ Pay Stubs capturing the most recent month or four weeks (if any);
❍❍ Unemployment check stubs for the most recent month or four weeks (if any);
❍❍ Disability/SSI check stubs for the most recent month or four weeks (if any);
❍❍ Pension check stubs for the most recent month or four weeks (if any);
❍❍ TANF check stubs for the most recent month or four weeks (if any).
❏❏ Citizenship documentation for all persons named on your first mortgage loan documents:

For United States citizens and United States non-citizen nationals can include:
❍❍ A birth certificate; or
❍❍ United States passport; or
❍❍ See guidance at www.FindEHLP.org/citizenship

For “qualified aliens” can include:
❍❍ See guidance at www.FindEHLP.org/citizenship

*If you are selected to submit a full application, all persons named on your first mortgage loan documents must provide the
documentation and sign certifications as part of the application process.

www.FindEHLP.org

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