Truth in Lending (TILA); Regulation Z

Bur. of Consumer Financial Protection

Pt. 1026, App. H

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APPENDIX H TO PART 1026—CLOSED-END
MODEL FORMS AND CLAUSES
H–1 Credit Sale Model Form (§ 1026.18)
H–2 Loan Model Form (§ 1026.18)
H–3 Amount Financed Itemization Model
Form (§ 1026.18(c))
H–4(A) Variable-Rate
Model
Clauses
(§ 1026.18(f)(1))
H–4(B) Variable-Rate
Model
Clauses
(§ 1026.18(f)(2))
H–4(C) Variable-Rate
Model
Clauses
(§ 1026.19(b))
H–4(D)(1) Adjustable-Rate Mortgage Model
Form (§ 1026.20(c))
H–4(D)(2) Adjustable-Rate Mortgage Sample
Form (§ 1026.20(c))
H–4(D)(3) Adjustable-Rate Mortgage Model
Form (§ 1026.20(d))
H–4(D)(4) Adjustable-Rate Mortgage Sample
Form (§ 1026.20(d))
H–4(E) Fixed-Rate Mortgage Interest Rate
and Payment Summary Model Clause
(§ 1026.18(s))
H–4(F) Adjustable-Rate Mortgage or StepRate Mortgage Interest Rate and Payment
Summary Model Clause (§ 1026.18(s))
H–4(G) Mortgage with Negative Amortization Interest Rate and Payment Summary
Model Clause (§ 1026.18(s))
H–4(H) Fixed-Rate Mortgage with InterestOnly Interest Rate and Payment Summary
Model Clause (§ 1026.18(s))
H–4(I) Adjustable-Rate Mortgage Introductory
Rate
Disclosure
Model
Clause
(§ 1026.18(s)(2)(iii))
H–4(J) Balloon Payment Disclosure Model
Clause (§ 1026.18(s)(5))
H–4(K) No Guarantee to Refinance Statement Model Clause (§ 1026.18(t))
H–5 Demand
Feature
Model
Clauses
(§ 1026.18(i))
H–6 Assumption
Policy
Model
Clause
(§ 1026.18(q))
H–7 Required
Deposit
Model
Clause
(§ 1026.18(r))
H–8 Rescission
Model
Form
(General)
(§ 1026.23)
H–9 Rescission Model Form (Refinancing
(with Original Creditor)) (§ 1026.23)
H–10 Credit Sale Sample

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Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

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H–11 Installment Loan Sample
H–12 Refinancing Sample
H–13 Closed-End Transaction With Demand
Feature Sample
H–14 Variable-Rate
Mortgage
Sample
(§ 1026.19(b))
H–15 Closed-End
Graduated-Payment
Transaction Sample
H–16 Mortgage Sample
H–17(A) Debt Suspension Model Clause
H–17(B) Debt Suspension Sample
H–18 Private Education Loan Application
and Solicitation Model Form
H–19 Private Education Loan Approval
Model Form
H–20 Private Education Loan Final Model
Form
H–21 Private Education Loan Application
and Solicitation Sample
H–22 Private Education Loan Approval
Sample
H–23 Private Education Loan Final Sample
H–24(A) Mortgage Loan Transaction Loan
Estimate—Model Form
H–24(B) Mortgage Loan Transaction Loan
Estimate—Fixed Rate Loan Sample
H–24(C) Mortgage Loan Transaction Loan
Estimate—Interest Only Adjustable Rate
Loan Sample
H–24(D) Mortgage Loan Transaction Loan
Estimate—Refinance Sample
H–24(E) Mortgage Loan Transaction Loan
Estimate—Balloon Payment Sample
H–24(F) Mortgage Loan Transaction Loan
Estimate—Negative Amortization Sample
H–24(G) Mortgage Loan Transaction Loan
Estimate—Modification to Loan Estimate
for Transaction Not Involving Seller—
Model Form
H–25(A) Mortgage Loan Transaction Closing
Disclosure—Model Form
H–25(B) Mortgage Loan Transaction Closing
Disclosure—Fixed Rate Loan Sample
H–25(C) Mortgage Loan Transaction Closing
Disclosure—Borrower Funds From SecondLien Loan in Summaries of Transactions
Sample
H–25(D) Mortgage Loan Transaction Closing
Disclosure—Borrower Satisfaction of Seller’s Second-Lien Loan Outside of Closing
in Summaries of Transactions Sample
H–25(E) Mortgage Loan Transaction Closing
Disclosure—Refinance Transaction Sample
H–25(F) Mortgage Loan Transaction Closing
Disclosure—Refinance Transaction Sample
(amount in excess of § 1026.19(e)(3))
H–25(G) Mortgage Loan Transaction Closing
Disclosure—Refinance Transaction With
Cash From Consumer at Consummation
Sample

H–25(H) Mortgage Loan Transaction Closing
Disclosure—Modification to Closing Cost
Details—Model Form
H–25(I) Mortgage Loan Transaction Closing
Disclosure—Modification to Closing Disclosure for Disclosure Provided to Seller—
Model Form
H–25(J) Mortgage Loan Transaction Closing
Disclosure—Modification to Closing Disclosure for Transaction Not Involving Seller—Model Form
H–26 Mortgage
Loan
Transaction—PreLoan Estimate Statement—Model Form
H–27(A) Mortgage
Loan
Transaction
—Written List of Providers—Model Form
H–27(B) Mortgage Loan Transaction—Sample of Written List of Providers
H–27(C) Mortgage Loan Transaction—Sample of Written List of Providers with Services You Cannot Shop For
H–28(A) Mortgage Loan Transaction Loan
Estimate—Spanish Language Model Form
H–28(B) Mortgage Loan Transaction Loan
Estimate—Spanish Language Purchase
Sample
H–28(C) Mortgage Loan Transaction Loan
Estimate—Spanish Language Refinance
Sample
H–28(D) Mortgage Loan Transaction Loan
Estimate—Spanish Language Balloon Payment Sample
H–28(E) Mortgage Loan Transaction Loan
Estimate—Spanish
Language
Negative
Amortization Sample
H–28(F) Mortgage Loan Transaction Closing
Disclosure—Spanish Language Model Form
H–28(G) Mortgage Loan Transaction Closing
Disclosure—Spanish Language Purchase
Sample
H–28(H) Mortgage Loan Transaction Closing
Disclosure—Spanish Language Refinance
Sample
H–28(I) Mortgage Loan Transaction Loan
Estimate—Modification to Loan Estimate
for Transaction Not Involving Seller—
Spanish Language Model Form
H–28(J) Mortgage Loan Transaction Closing
Disclosure—Modification to Closing Disclosure for Transaction Not Involving Seller—Spanish Language Model Form
H–29 Escrow Cancellation Notice Model
Form (§ 1026.20(e))
H–30(A) Sample Form of Periodic Statement
(§ 1026.41)
H–30(B) Sample Form of Periodic Statement
with Delinquency Box (§ 1026.41)
H–30(C) Sample Form of Periodic Statement
for a Payment-Option Loan
H–30(D) Sample Clause for Homeownership
Counselor Contact Information (§ 1026.41)

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Pt. 1026, App. H

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12 CFR Ch. X (1–1–16 Edition)

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Pt. 1026, App. H

Pt. 1026, App. H

H–4(C)—VARIABLE-RATE MODEL CLAUSES
This disclosure describes the features of
the adjustable-rate mortgage (ARM) program you are considering. Information on

other ARM programs is available upon request.
How Your Interest Rate and Payment Are
Determined

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Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

• Your interest rate will be based on [an
index plus a margin] [a formula].
• Your payment will be based on the interest rate, loan balance, and loan term.
—[The interest rate will be based on (identification of index) plus our margin. Ask for
our current interest rate and margin.]
—[The interest rate will be based on (identification of formula). Ask us for our current
interest rate.]
—Information about the index [formula for
rate adjustments] is published [can be found]
llllll.
—[The initial interest rate is not based on
the (index) (formula) used to make later
adjustments. Ask us for the amount of current interest rate discounts.]
How Your Interest Rate Can Change
• Your interest rate can change (frequency).
• [Your interest rate cannot increase or decrease more than ll percentage points at
each adjustment.]
• Your interest rate cannot increase [or decrease] more than ll percentage points
over the term of the loan.
How Your Payment Can Change

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• Your payment can change (frequency)
based on changes in the interest rate.
• [Your payment cannot increase more
than (amount or percentage) at each adjustment.]

• You will be notified in writing llll
days before the due date of a payment at a
new level. This notice will contain information about your interest rates, payment
amount, and loan balance.
• [You will be notified once each year during which interest rate adjustments, but no
payment adjustments, have been made to
your loan. This notice will contain information about your interest rates, payment
amount, and loan balance.]
• [For example, on a $10,000 [term] loan
with an initial interest rate of llll [(the
rate shown in the interest rate column below
for the year 19 llll)] [(in effect (month)
(year)], the maximum amount that the interest rate can rise under this program is
llll percentage points, to llll%, and
the monthly payment can rise from a firstyear payment of $llll to a maximum of
$llll in the lllll year. To see what
your payments would be, divide your mortgage amount by $10,000; then multiply the
monthly payment by that amount. (For example, the monthly payment for a mortgage
amount of $60,000 would be: $60,000 ÷ $10,000 =
6; 6 × llll = $llll per month.)]
[Example
The example below shows how your payments would have changed under this ARM
program based on actual changes in the
index from 1982 to 1996. This does not necessarily indicate how your index will change
in the future.
The example is based on the following assumptions:

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Pt. 1026, App. H

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12 CFR Ch. X (1–1–16 Edition)

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Pt. 1026, App. H

ER14FE13.003

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12 CFR Ch. X (1–1–16 Edition)

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Pt. 1026, App. H

Pt. 1026, App. H

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Pt. 1026, App. H

Pt. 1026, App. H

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Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–4(J)—BALLOON PAYMENT MODEL CLAUSE

H–4(I)—INTRODUCTORY RATE MODEL CLAUSE

[Final Balloon
$llllll]

Payment

due

(date):

H–4(K)—‘‘NO-GUARANTEE-TO-REFINANCE’’
STATEMENT MODEL CLAUSE
There is no guarantee that you will be able
to refinance to lower your rate and payments.

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[Introductory Rate Notice
You have a discounted introductory rate of
llll % that ends after (period).
In the (period in sequence), even if market
rates do not change, this rate will increase
to ll %.]

Pt. 1026, App. H

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12 CFR Ch. X (1–1–16 Edition)

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–9—RESCISSION MODEL FORM (REFINANCING
WITH ORIGINAL CREDITOR)

If we do not take possession of the money
within 20 calendar days of your offer, you
may keep it without further obligation.

NOTICE OF RIGHT TO CANCEL

How To Cancel

Your Right To Cancel

lpowell on DSK54DXVN1OFR with $$_JOB

You are entering into a new transaction to
increase the amount of credit previously provided to you. Your home is the security for
this new transaction. You have a legal right
under Federal law to cancel this new transaction, without cost, within three business
days from whichever of the following events
occurs last:
(1) the date of this new transaction, which
is llllll; or
(2) the date you received your new Truth in
Lending disclosures; or
(3) the date you received this notice of
your right to cancel.
If you cancel this new transaction, it will
not affect any amount that you presently
owe. Your home is the security for that
amount. Within 20 calendar days after we receive your notice of cancellation of this new
transaction, we must take the steps necessary to reflect the fact that your home
does not secure the increase of credit. We
must also return any money you have given
to us or anyone else in connection with this
new transaction.
You may keep any money we have given
you in this new transaction until we have
done the things mentioned above, but you
must then offer to return the money at the
address below.

If you decide to cancel this new transaction, you may do so by notifying us in
writing, at lllllllllllllllllllllll
(Creditor’s name and business address).
You may use any written statement that is
signed and dated by you and states your intention to cancel, or you may use this notice
by dating and signing below. Keep one copy
of this notice because it contains important
information about your rights.
If you cancel by mail or telegram, you
must send the notice no later than midnight
of lllllllllllllllllllllll
(Date) llllllllllllllllllll
(or midnight of the third business day following the latest of the three events listed
above).
If you send or deliver your written notice
to cancel some other way, it must be delivered to the above address no later than that
time.
I WISH TO CANCEL
Consumer’s Signature llllllllllll
Date lllllllllllllllllllll

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12 CFR Ch. X (1–1–16 Edition)

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Pt. 1026, App. H

Pt. 1026, App. H

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12 CFR Ch. X (1–1–16 Edition)

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–13—CLOSED-END TRANSACTION WITH DEMAND FEATURE SAMPLE

H–14—VARIABLE-RATE MORTGAGE SAMPLE
This disclosure describes the features of
the adjustable-rate mortgage (ARM) program you are considering. Information on
other ARM programs is available upon request.

How Your Monthly Payment Can Change

How Your Interest Rate and Payment Are
Determined
• Your interest rate will be based on an
index rate plus a margin.
• Your payment will be based on the interest rate, loan balance, and loan term.
—The interest rate will be based on the
weekly average yield on United States
Treasury securities adjusted to a constant
maturity of 1 year (your index), plus our
margin. Ask us for our current interest
rate and margin.
—Information about the index rate is published weekly in the Wall Street Journal.
• Your interest rate will equal the index
rate plus our margin unless your interest
rate ‘‘caps’’ limit the amount of change in
the interest rate.
How Your Interest Rate Can Change
• Your interest rate can change yearly.

• Your monthly payment can increase or
decrease substantially based on annual
changes in the interest rate.
• [For example, on a $10,000, 30-year loan
with an initial interest rate of 12.41 percent
in effect in July 1996, the maximum amount
that the interest rate can rise under this program is 5 percentage points, to 17.41 percent,
and the monthly payment can rise from a
first-year payment of $106.03 to a maximum
of $145.34 in the fourth year. To see what
your payment is, divide your mortgage
amount by $10,000; then multiply the monthly payment by that amount. (For example,
the monthly payment for a mortgage
amount of $60,000 would be: $60,000 ÷ $10,000 =
6; 6 × 106.03 = $636.18 per month.)
• You will be notified in writing 25 days before the annual payment adjustment may be
made. This notice will contain information

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• Your interest rate cannot increase or decrease more than 2 percentage points per
year.
• Your interest rate cannot increase or decrease more than 5 percentage points over
the term of the loan.

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

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about your interest rates, payment amount
and loan balance.]
Example
The example below shows how your payments would have changed under this ARM

program based on actual changes in the
index from 1982 to 1996. This does not necessarily indicate how your index will change
in the future. The example is based on the
following assumptions:

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Pt. 1026, App. H

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Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

would be: $60,000 ÷ $10,000 = 6; 6 × $106.73 =
$640.38.)
• You will be notified in writing 25 days before the annual payment adjustment may be
made. This notice will contain information
about your interest rates, payment amount
and loan balance.]

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NOTE: To see what your payments would
have been during that period, divide your
mortgage amount by $10,000; then multiply
the monthly payment by that amount. (For
example, in 1996 the monthly payment for a
mortgage amount of $60,000 taken out in 1982

Bur. of Consumer Financial Protection

CLOSED-END GRADUATED PAYMENT TRANSACTION SAMPLE

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H–15

Pt. 1026, App. H

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–17(A) DEBT SUSPENSION MODEL CLAUSE

X

llllllllllllllllllllll
H–17(B) DEBT SUSPENSION SAMPLE

Please enroll me in the optional [name of
program], and bill my account the fee of
$200.00. I understand that enrollment is not
required to obtain credit. I also understand
that depending on the event, the protection
may only temporarily suspend my duty to
make minimum payments, not reduce the
balance I owe. I understand that my balance
will actually grow during the suspension period as interest continues to accumulate.
To Enroll, Initial Here.
X
llllllllllllllllllllll

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Please enroll me in the optional [insert
name of program], and bill my account the
fee of [insert charge for the initial term of
coverage]. I understand that enrollment is
not required to obtain credit. I also understand that depending on the event, the protection may only temporarily suspend my
duty to make minimum payments, not reduce the balance I owe. I understand that my
balance will actually grow during the suspension period as interest continues to accumulate.
[To Enroll, Sign Here]/[To Enroll, Initial
Here].

Pt. 1026, App. H

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Pt. 1026, App. H

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

258

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Pt. 1026, App. H

Pt. 1026, App. H

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

260

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Pt. 1026, App. H

Pt. 1026, App. H

261

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ER22DE11.060

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–24(A) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—MODEL FORM

262

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ER22DE11.061

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Description: This is a blank model Loan Estimate that illustrates the application of the

content requirements in § 1026.37. This form
provides two variations of page one, four
variations of page two, and four variations of
page three, reflecting the variable content
requirements in § 1026.37.

Pt. 1026, App. H

263

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

264

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ER31DE13.007

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Pt. 1026, App. H

Pt. 1026, App. H

265

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

266

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Pt. 1026, App. H

Pt. 1026, App. H

267

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

268

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Pt. 1026, App. H

Pt. 1026, App. H

269

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

270

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ER31DE13.013

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Pt. 1026, App. H

Pt. 1026, App. H

271

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ER31DE13.014

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

Description: This is a sample of a completed
Loan Estimate for a fixed rate loan. This
loan is for the purchase of property at a sale
price of $180,000 and has a loan amount of
$162,000, a 30-year loan term, a fixed interest

rate of 3.875 percent, and a prepayment penalty equal to 2.00 percent of the outstanding
principal balance of the loan for the first two
years after consummation of the transaction. The consumer has elected to lock the
interest rate. The creditor requires an escrow account and that the consumer pay for
private mortgage insurance.

272

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31

ER31DE13.015

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H–24(B) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—FIXED RATE LOAN SAMPLE

Pt. 1026, App. H

273

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

274

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ER31DE13.017

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

Description: This is a sample of a completed
Loan Estimate for an adjustable rate loan
with interest only payments. This loan is for
the purchase of property at a sale price of
$240,000 and has a loan amount of $211,000 and
a 30-year loan term. For the first five years

of the loan term, the scheduled payments
cover only interest and the loan has an introductory interest rate that is fixed at 4.00
percent. After five years, the payments include principal and the interest rate adjusts
every three years based on the value of the
Monthly Treasury Average index plus a margin of 4.00 percent. The consumer has elected
to lock the interest rate. The creditor does
not require an escrow account with the loan.

275

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31

ER31DE13.018

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H–24(C) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—INTEREST ONLY ADJUSTABLE
RATE LOAN SAMPLE

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

276

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ER31DE13.019

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The creditor requires that the consumer pay
for private mortgage insurance.

Pt. 1026, App. H

277

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ER31DE13.020

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

Description: This is a sample of a completed
Loan Estimate for a transaction that is for a
refinance of an existing mortgage loan that
secures the property, for which the consumer
is estimated to receive funds from the trans-

action. The estimated property value is
$180,000, the loan amount is $150,000, the estimated outstanding balance of the existing
mortgage loan is $120,000, and the interest
rate is 4.25 percent. The consumer has elected to lock the interest rate. The creditor requires an escrow account and that the consumer pay for private mortgage insurance.

278

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31

ER31DE13.021

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H–24(D) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—REFINANCE SAMPLE

Pt. 1026, App. H

279

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ER31DE13.022

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

280

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ER31DE13.023

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–24(E) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—BALLOON PAYMENT SAMPLE

a transaction with a loan term of seven
years that includes a final balloon payment.

281

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31

ER31DE13.024

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Description: This is a sample of the information required by § 1026.37(a) through (c) for

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–24(F) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—NEGATIVE AMORTIZATION SAMPLE

282

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ER31DE13.025

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Description: This is a sample of the information required by § 1026.37(a) and (b) for a
transaction with negative amortization.

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–24(G) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—MODIFICATION TO LOAN ESTIMATE FOR TRANSACTION NOT INVOLVING
SELLER—MODEL FORM

283

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31

ER31DE13.026

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Description: This is a blank model Loan Estimate that illustrates the application of the

content requirements in § 1026.37, with the
optional alternative tables permitted by
§ 1026.37(d)(2) and (h)(2) for transactions without a seller. This form provides one variation
of page one, four variations of page two, and
four variations of page three, reflecting the
variable content requirements in § 1026.37.

12 CFR Ch. X (1–1–16 Edition)

284

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Pt. 1026, App. H

Pt. 1026, App. H

285

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ER31DE13.028

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

286

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Pt. 1026, App. H

Pt. 1026, App. H

287

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

288

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Pt. 1026, App. H

Pt. 1026, App. H

289

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

290

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ER31DE13.033

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Pt. 1026, App. H

Pt. 1026, App. H

291

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ER31DE13.034

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Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–25(A) MORTGAGE LOAN TRANSACTION
CLOSING DISCLOSURE—MODEL FORM

292

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ER31DE13.035

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a blank model Closing
Disclosure that illustrates the content requirements in § 1026.38. This form provides

three variations of page one, one page two,
one page three, four variations of page four,
and four variations of page five, reflecting
the variable content requirements in
§ 1026.38. This form does not reflect modifications permitted under § 1026.38(t).

Pt. 1026, App. H

293

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

294

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Pt. 1026, App. H

Pt. 1026, App. H

295

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ER31DE13.038

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

296

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Pt. 1026, App. H

Pt. 1026, App. H

297

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

298

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Pt. 1026, App. H

Pt. 1026, App. H

299

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

300

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Pt. 1026, App. H

Pt. 1026, App. H

301

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ER31DE13.045

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

302

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Pt. 1026, App. H

Pt. 1026, App. H

303

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ER31DE13.047

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

304

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ER31DE13.048

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–25(B) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—FIXED RATE LOAN SAMPLE

305

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ER31DE13.049

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Description: This is a sample of a completed
Closing Disclosure for the fixed rate loan illustrated by form H–24(B). The purpose,

product, sale price, loan amount, loan term,
and interest rate have not changed from the
estimates provided on the Loan Estimate.
The creditor requires an escrow account and
that the consumer pay for private mortgage
insurance for the transaction.

12 CFR Ch. X (1–1–16 Edition)

306

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Pt. 1026, App. H

Pt. 1026, App. H

307

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ER31DE13.051

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

308

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ER31DE13.052

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Pt. 1026, App. H

Pt. 1026, App. H

309

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ER31DE13.053

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–25(C) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—BORROWER FUNDS FROM
SECOND-LIEN LOAN IN SUMMARIES OF
TRANSACTIONS SAMPLE

310

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31

ER31DE13.054

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a sample of the information required on the Closing Disclosure by

§ 1026.38(j) for disclosure of consumer funds
from a simultaneous second-lien credit
transaction not otherwise disclosed pursuant
to § 1026.38(j)(2)(iii) or (iv) that is used to finance part of the purchase price of the property subject to the transaction.

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–25(D) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—BORROWER SATISFACTION
OF SELLER’S SECOND-LIEN LOAN OUTSIDE OF
CLOSING IN SUMMARIES OF TRANSACTIONS
SAMPLE

§ 1026.38(j) and (k) for the satisfaction of a
junior-lien transaction by the consumer,
which was not paid from closing funds.

311

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31

ER31DE13.055

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Description: This is a sample of the information required on the Closing Disclosure by

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–25(E) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—REFINANCE TRANSACTION
SAMPLE

312

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ER31DE13.056

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Description: This is a sample of a completed
Closing Disclosure for the refinance transaction illustrated by form H–24(D). The purpose, loan amount, loan term, and interest

rate have not changed from the estimates
provided on the Loan Estimate. The outstanding balance of the existing mortgage
loan securing the property was less than estimated on the Loan Estimate. The creditor
requires an escrow account and that the consumer pay for private mortgage insurance
for the transaction.

Pt. 1026, App. H

313

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31

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

314

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Pt. 1026, App. H

Pt. 1026, App. H

315

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

316

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31

ER31DE13.060

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–25(F) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—REFINANCE TRANSACTION
(AMOUNT
IN
EXCESS
OF
SAMPLE
§ 1026.19(E)(3))

317

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31

ER31DE13.061

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Description: This is a sample of the completed disclosures required by § 1026.38(e) and

(h) for a completed Closing Disclosure for
the refinance transaction illustrated by form
H–24(D). The Closing Costs have increased in
excess of the good faith requirements of
§ 1026.19(e)(3) by $200, for which the creditor
has provided a refund under § 1026.19(f)(2)(v).

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–25(G) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—REFINANCE TRANSACTION
WITH CASH FROM CONSUMER AT CONSUMMATION

action in which the consumer must pay additional funds to satisfy the existing mortgage
loan securing the property and other existing debt to consummate the transaction.

318

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31

ER31DE13.062

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Description: This is a sample of a completed
Closing Disclosure for a refinance trans-

Pt. 1026, App. H

319

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ER31DE13.063

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

320

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ER31DE13.064

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Pt. 1026, App. H

Pt. 1026, App. H

321

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

322

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31

ER31DE13.066

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–25(H) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—MODIFICATION TO CLOSING
COST DETAILS—MODEL FORM

323

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31

ER31DE13.067

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Description: This is a blank model form of
the modification to Closing Cost Details permitted by § 1026.38(t)(5)(iv)(B).

12 CFR Ch. X (1–1–16 Edition)

324

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31

ER31DE13.068

lpowell on DSK54DXVN1OFR with $$_JOB

Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

Description: This is a blank model form of
the
modification
permitted
by
§ 1026.38(t)(5)(vi).

325

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31

ER31DE13.069

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H–25(I) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—MODIFICATION TO CLOSING
DISCLOSURE FOR DISCLOSURE PROVIDED TO
SELLER—MODEL FORM

12 CFR Ch. X (1–1–16 Edition)

326

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31

ER31DE13.070

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–25(J) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—MODIFICATION TO CLOSING
DISCLOSURE FOR TRANSACTION NOT INVOLVING SELLER—MODEL FORM

permitted by § 1026.38(d)(2), (e), and (t)(5)(vii)
for transactions without a seller.

327

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31

ER31DE13.071

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Description: This is a blank model form of
the alternative disclosures and modifications

12 CFR Ch. X (1–1–16 Edition)

328

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31

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Pt. 1026, App. H

Pt. 1026, App. H

329

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31

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

330

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31

ER31DE13.074

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Pt. 1026, App. H

Pt. 1026, App. H

331

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31

ER31DE13.075

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

332

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31

ER31DE13.076

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Pt. 1026, App. H

Pt. 1026, App. H

333

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31

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

334

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31

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Pt. 1026, App. H

Pt. 1026, App. H

335

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31

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

336

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31

ER31DE13.080

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Pt. 1026, App. H

Pt. 1026, App. H

337

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31

ER31DE13.081

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

338

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31

ER31DE13.082

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–26 MORTGAGE LOAN TRANSACTION—PRELOAN ESTIMATE STATEMENT—MODEL FORM

339

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31

ER31DE13.083

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a model of the statement required by § 1026.19(e)(2)(ii) to be stat-

ed at the top of the front of the first page of
a written estimate of terms or costs specific
to a consumer that is provided to a consumer
before the consumer receives the disclosures
required under § 1026.19(e)(1)(i).

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–27(A) MORTGAGE LOAN TRANSACTION—
WRITTEN LIST OF PROVIDERS—MODEL FORM

340

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31

ER31DE13.084

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a blank model form for
the written list of settlement service pro-

viders required by § 1026.19(e)(1)(vi) and the
statement required by § 1026.19(e)(1)(vi)(C)
that the consumer may select a settlement
service provider that is not on the list.

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–27(B) MORTGAGE LOAN TRANSACTION—
SAMPLE OF WRITTEN LIST OF PROVIDERS

sample Loan Estimate illustrated by form H–
24(B).

341

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31

ER31DE13.085

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a sample of the Written
List of Providers for the transaction in the

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–27(C) MORTGAGE LOAN TRANSACTION—SAMPLE OF WRITTEN LIST OF PROVIDERS WITH
SERVICES YOU CANNOT SHOP FOR

providers selected by the creditor for the
charges disclosed pursuant to § 1026.37(f)(2).

342

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31

ER31DE13.086

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a sample of the Written
List of Providers with information about the

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–28(A) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—SPANISH LANGUAGE MODEL FORM

translated into the Spanish language as permitted by § 1026.37(o)(5)(ii). This form provides two variations of page one, four variations of page two, and four variations of
page three, reflecting the variable content
requirements in § 1026.37.

343

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31

ER31DE13.087

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a blank model Loan Estimate that illustrates the application of the
content requirements in § 1026.37, and is

12 CFR Ch. X (1–1–16 Edition)

344

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31

ER31DE13.088

lpowell on DSK54DXVN1OFR with $$_JOB

Pt. 1026, App. H

Pt. 1026, App. H

345

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31

ER31DE13.089

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

346

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31

ER31DE13.090

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Pt. 1026, App. H

Pt. 1026, App. H

347

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31

ER31DE13.091

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

348

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31

ER31DE13.092

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Pt. 1026, App. H

Pt. 1026, App. H

349

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31

ER31DE13.093

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

350

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31

ER31DE13.094

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Pt. 1026, App. H

Pt. 1026, App. H

351

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31

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

352

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31

ER31DE13.096

lpowell on DSK54DXVN1OFR with $$_JOB

Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–28(B) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—SPANISH LANGUAGE PURCHASE
SAMPLE

Year Interest Only, 5/3 Adjustable Rate loan,
translated into the Spanish language as permitted by § 1026.37(o)(5)(ii).

353

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31

ER31DE13.097

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a sample of the Loan
Estimate illustrated by form H–24(C) for a 5

12 CFR Ch. X (1–1–16 Edition)

354

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31

ER31DE13.098

lpowell on DSK54DXVN1OFR with $$_JOB

Pt. 1026, App. H

Pt. 1026, App. H

355

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31

ER31DE13.099

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–28(C) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—SPANISH LANGUAGE REFINANCE
SAMPLE

356

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31

ER31DE13.100

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a sample of the Loan
Estimate illustrated by form H–24(D) for a

refinance transaction in which the consumer
is estimated to receive funds from the transaction, translated into the Spanish language
as permitted by § 1026.37(o)(5)(ii).

Pt. 1026, App. H

357

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ER31DE13.101

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

358

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31

ER31DE13.102

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–28(D) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—SPANISH LANGUAGE BALLOON
PAYMENT SAMPLE

359

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31

ER31DE13.103

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a sample of the information required by § 1026.37(a) through (c) for

a transaction with a loan term of seven
years that includes a final balloon payment
illustrated by form H–24(E), translated into
the Spanish language as permitted by
§ 1026.37(o)(5)(ii).

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–28(E) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—SPANISH LANGUAGE NEGATIVE
AMORTIZATION SAMPLE

360

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31

ER31DE13.104

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a sample of the information required by § 1026.37(a) and (b) for a

transaction with negative amortization illustrated by form H–24(F), translated into
the Spanish language as permitted by
§ 1026.37(o)(5)(ii).

Bur. of Consumer Financial Protection

Pt. 1026, App. H

H–28(F) MORTGAGE LOAN TRANSACTION CLOSING
DISCLOSURE—SPANISH
LANGUAGE
MODEL FORM

361

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31

ER31DE13.105

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a blank model Closing
Disclosure that illustrates the content requirements in § 1026.38, and is translated into
the Spanish language as permitted by

§ 1026.38(t)(5)(viii). This form provides three
variations of page one, one page two, one
page three, four variations of page four, four
variations of page five, and two variations of
page six reflecting the variable content requirements in § 1026.38. This form does not
reflect any other modifications permitted
under § 1026.38(t).

12 CFR Ch. X (1–1–16 Edition)

362

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31

ER31DE13.106

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Pt. 1026, App. H

Pt. 1026, App. H

363

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

364

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31

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Pt. 1026, App. H

Pt. 1026, App. H

365

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

366

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31

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Pt. 1026, App. H

Pt. 1026, App. H

367

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

368

VerDate Sep<11>2014

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ER31DE13.112

lpowell on DSK54DXVN1OFR with $$_JOB

Pt. 1026, App. H

Pt. 1026, App. H

369

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ER31DE13.113

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

370

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ER31DE13.114

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Pt. 1026, App. H

Pt. 1026, App. H

371

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ER31DE13.115

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

372

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ER31DE13.116

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Pt. 1026, App. H

Pt. 1026, App. H

373

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ER31DE13.117

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

374

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ER31DE13.118

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Pt. 1026, App. H

Pt. 1026, App. H

375

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ER31DE13.119

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–28(G) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—SPANISH LANGUAGE PURCHASE SAMPLE

lated into the Spanish language as permitted
by § 1026.38(t)(5)(viii).

376

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ER31DE13.120

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a sample of the Closing
Disclosure illustrated by form H–25(B) trans-

Pt. 1026, App. H

377

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ER31DE13.121

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

378

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ER31DE13.122

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Pt. 1026, App. H

Pt. 1026, App. H

379

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ER31DE13.123

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

380

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ER31DE13.124

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Pt. 1026, App. H

Pt. 1026, App. H

381

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ER31DE13.125

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–28(H) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—SPANISH LANGUAGE REFINANCE SAMPLE

lated into the Spanish language as permitted
by § 1026.38(t)(5)(viii).

382

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ER31DE13.126

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Description: This is a sample of the Closing
Disclosure illustrated by form H–25(E) trans-

Pt. 1026, App. H

383

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ER31DE13.127

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

384

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Pt. 1026, App. H

Pt. 1026, App. H

385

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ER31DE13.129

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

386

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ER31DE13.130

lpowell on DSK54DXVN1OFR with $$_JOB

Pt. 1026, App. H

Pt. 1026, App. H

387

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ER31DE13.131

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

Pt. 1026, App. H

12 CFR Ch. X (1–1–16 Edition)

H–28(I) MORTGAGE LOAN TRANSACTION LOAN
ESTIMATE—MODIFICATION TO LOAN ESTIMATE FOR TRANSACTION NOT INVOLVING
SELLER—SPANISH LANGUAGE MODEL FORM

388

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ER31DE13.132

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Description: This is a blank model Loan Estimate that illustrates form H–24(G), with

the optional alternative disclosures permitted by § 1026.37(d)(2) and (h)(2) for transactions without a seller, translated into the
Spanish
language
as
permitted
by
§ 1026.37(o)(5)(ii).

Pt. 1026, App. H

389

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

390

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ER31DE13.134

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Pt. 1026, App. H

Pt. 1026, App. H

391

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ER31DE13.135

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

392

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ER31DE13.136

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Pt. 1026, App. H

Pt. 1026, App. H

393

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

394

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ER31DE13.138

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Pt. 1026, App. H

Pt. 1026, App. H

395

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ER31DE13.139

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

396

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ER31DE13.140

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Pt. 1026, App. H

Bur. of Consumer Financial Protection

Pt. 1026, App. H

with the alternative disclosures under
§ 1026.38(d)(2), (e), and (t)(5)(vii) for transactions without a seller, translated into the
Spanish
language
as
permitted
by
§ 1026.38(t)(5)(viii).

Description: This is a blank model Closing
Disclosure that illustrates form H–25(J),

397

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ER31DE13.141

lpowell on DSK54DXVN1OFR with $$_JOB

H–28(J) MORTGAGE LOAN TRANSACTION CLOSING DISCLOSURE—MODIFICATION TO CLOSING
DISCLOSURE FOR TRANSACTION NOT INVOLVING SELLER—SPANISH LANGUAGE MODEL
FORM

12 CFR Ch. X (1–1–16 Edition)

398

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ER31DE13.142

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Pt. 1026, App. H

Pt. 1026, App. H

399

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ER31DE13.143

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

400

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Pt. 1026, App. H

Pt. 1026, App. H

401

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

402

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Pt. 1026, App. H

Pt. 1026, App. H

403

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ER31DE13.147

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

404

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ER31DE13.148

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Pt. 1026, App. H

Pt. 1026, App. H

405

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ER31DE13.149

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

406

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Pt. 1026, App. H

Pt. 1026, App. H

407

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ER31DE13.151

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

408

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ER31DE13.152

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Pt. 1026, App. H

Pt. 1026, App. H

409

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ER31DE13.153

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Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

410

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ER31DE13.154

lpowell on DSK54DXVN1OFR with $$_JOB

Pt. 1026, App. H

Bur. of Consumer Financial Protection

H–29

Pt. 1026, App. H

ESCROW CANCELLATION NOTICE MODEL
FORM (§ 1026.20(E))

411

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ER31DE13.155

lpowell on DSK54DXVN1OFR with $$_JOB

Description: This is a blank model form of
the disclosures required by § 1026.20(e).

12 CFR Ch. X (1–1–16 Edition)

412

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ER31DE13.156

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Pt. 1026, App. H

Pt. 1026, App. H

413

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ER14FE13.008

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

12 CFR Ch. X (1–1–16 Edition)

414

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ER14FE13.009

lpowell on DSK54DXVN1OFR with $$_JOB

Pt. 1026, App. H

Pt. 1026, App. H

H–30(D) Sample Clause for Homeownership
Counselor Contact Information

Housing Counselor Information: If you would
like counseling or assistance, you can contact the following:

415

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ER14FE13.010

lpowell on DSK54DXVN1OFR with $$_JOB

Bur. of Consumer Financial Protection

Pt. 1026, App. J

12 CFR Ch. X (1–1–16 Edition)

• U.S. Department of Housing and Urban
Development (HUD): For a list of homeownership counselors or counseling organizations in your area, go to http://www.hud.gov/
offices/hsg/sfh/hcc/hcs.cfm or call 800–569–4287.

lpowell on DSK54DXVN1OFR with $$_JOB

[76 FR 79772, Dec. 22, 2011, as amended at 78
FR 11008, Feb. 14, 2013; 78 FR 80130, Dec. 31,
2013; 80 FR 8776, Feb. 19, 2015]

416

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