2019 Revision 1105 Application for Debt Education Course Provider

Application for Debt Education Course Provider

Revision 2019 1105-0085

Application for Debt Education Course Provider

OMB: 1105-0085

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OMB No. 1105-0085

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Appendix A: Acknowledgments, Agreements, and Declarations
in Support of Application for Approval as a Provider
of a Personal Financial Management Instructional Course
(Application for Approval as a Provider of a Personal Financial Management Instructional Course)

Name of Provider:
The Provider hereby assures and certifies compliance with all applicable federal statutes,
regulations, policies, guidelines, and requirements including, but not limited to, 11 U.S.C. §§ 109(h) and
111. The Provider also specifically assures, certifies, and agrees that:
1.

It is in compliance with all applicable laws and regulations of the United States and each state,
commonwealth, district, or territory of the United States in which the Provider seeks approval
from the United States Trustee.

2.

It will comply with the policies and directives of the United States Trustee and the Executive
Office for United States Trustees, as may be issued from time to time.

3.

It will make all records relating to the Provider’s compliance with 11 U.S.C. § 111 available to
the United States Trustee upon request and cooperate with the United States Trustee for any
scheduled or unscheduled on-site visits and customer service audits, notwithstanding the
existence of any contrary privacy policy or agreement.

4.

It will cooperate with the United States Trustee and the Executive Office for United States
Trustees and timely respond to any questions or inquiries concerning the Provider’s operations
and services.

5.

It shall immediately notify the United States Trustee, in writing, of any material changes,
including changes in the Provider’s name, structure, principal contact, management, instructors,
physical location, instructional course, fee policy, language services, or method of delivery.

6.

It shall immediately notify the United States Trustee, in writing, of any changes that render
inapplicable, inaccurate, incomplete, or misleading any statement it previously made in its
application or related materials, as well as any statement to the United States Trustee.

7.

It will seek permission from the United States Trustee by submitting an amended application
before: engaging an independent contractor to provide an instructional course; making or
implementing any increase or decrease in fees, contributions or payments received from debtors
for an instructional course; making or implementing any change in its fee policy; any expansion
into additional federal judicial districts; or making or implementing any material change in an
instructional course or any change to its methods of delivery.

8.

No member of the board of directors or trustees, officer, or supervisor is a relative of an employee
of the United States Trustee; a panel trustee in any federal judicial district where the Provider is
providing or is applying to provide an instructional course; or a federal judge or federal court
employee in any federal judicial district where the Provider is providing or is applying to provide
an instructional course.

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9.

Any fee, contribution, or payment received for an instructional course will be reasonable in
amount, and it will provide the instructional course without regard to a debtor’s ability to pay.

10.

It will not disclose or provide to a credit reporting agency information concerning whether an
individual has received or sought instruction concerning personal financial management from the
Provider; nor sell information about the debtor to any third party without the debtor’s prior
written permission; nor expose the debtor to commercial advertising as part of the instructional
course; nor market or sell financial products or services during the instructional course (though it
may generally discuss all available financial products and services).

11.

Any forms, agreements, contracts or other materials provided to a debtor will not limit the
debtor’s right to seek damages against the Provider, as set forth in 11 U.S.C. § 111(g)(2).

12.

It will refer debtors for an instructional course only to Providers that are approved by the United
States Trustee.

13.

It will not enter into any referral agreements or receive any financial benefit that involves the
Provider paying to or receiving from any entity or person referral fees or compensation for the
referral of debtors to or by the Provider.

14.

Any advertisement that refers to the United States Trustee’s approval for the Provider to provide
an instructional course in compliance with the Bankruptcy Code shall only be phrased in the
following manner: “Approved to issue certificates in compliance with the Bankruptcy Code.
Approval does not endorse or assure the quality of a Provider’s services.”

15.

It will not use the United States Department of Justice’s seal, the United States Trustee’s seal, the
Bankruptcy Court’s seal, or any seal of the United States or a likeness thereof.

16.

It will send a certificate to the debtor, upon completion of an instructional course, no later than
three business days after completion of the instructional course, and shall issue certificates only in
the form approved by the United States Trustee and only from the Certificate Generating System
maintained by the United States Trustee.

17.

It consents to the release and disclosure of the Provider’s name on the approved list and the
publication of the Provider’s contact information.

I HEREBY DECLARE under penalty of perjury that the foregoing representations are true and correct to
the best of my knowledge, information, and belief.
______________________________________

Signature of President, Chairman, Trustee, or Other
Authorized Official

______________________________________
Type or Print Title of Signer (if applicable)

_______________________________________

Type or Print Name of Signer

_______________________________________

Date

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Appendix B: Judicial Districts

OMB No. 1105-0085

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(Application for Approval as a Provider of a Personal Financial Management Instructional Course)

Name of Provider: ______________________________________________________________
Check each federal judicial district for which the Provider requests approval:
Alaska

Louisiana, Eastern

Pennsylvania, Eastern

Arizona

Louisiana, Middle

Pennsylvania, Middle

Arkansas, Eastern

Louisiana, Western

Pennsylvania, Western

Arkansas, Western

Maine

Rhode Island

California, Central

Maryland

South Carolina

California, Eastern

Massachusetts

South Dakota

California, Northern

Michigan, Eastern

Tennessee, Eastern

California, Southern

Michigan, Western

Tennessee, Middle

Colorado

Minnesota

Tennessee, Western

Connecticut

Mississippi, Northern

Texas, Eastern

Delaware

Mississippi, Southern

Texas, Northern

District of Columbia

Missouri, Eastern

Texas, Southern

Florida, Middle

Missouri, Western

Texas, Western

Florida, Northern

Montana

Utah

Florida, Southern

Nebraska

Vermont

Georgia, Middle

Nevada

Virginia, Eastern

Georgia, Northern

New Hampshire

Virginia, Western

Georgia, Southern

New Jersey

Washington, Eastern

Hawaii

New Mexico

Washington, Western

Idaho

New York, Eastern

West Virginia, Northern

Illinois, Central

New York, Northern

West Virginia, Southern

Illinois, Northern

New York, Southern

Wisconsin, Eastern

Illinois, Southern

New York, Western

Wisconsin, Western

Indiana, Northern

North Dakota

Wyoming

Indiana, Southern

Ohio, Northern

Guam

Iowa, Northern

Ohio, Southern

Northern Mariana Islands

Iowa, Southern

Oklahoma, Eastern

Puerto Rico

Kansas

Oklahoma, Northern

Virgin Islands

Kentucky, Eastern

Oklahoma, Western

Kentucky, Western

Oregon

The federal judicial districts in Alabama and North Carolina are not covered by the United States Trustee
Program.

Appendix C: Business Locations

OMB No. 1105-0085

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(Application for Approval as a Provider of a Personal Financial Management Instructional Course)

Name of Provider:_________________________________________________________________
Contact Information: (To be posted on the United States Trustee approved list)
Address:

Telephone number:

Web address:

Business Locations:
List all business locations and include telephone number and business hours. In the last
column, check the box if In-Person instruction is available at the location.
ADDRESS
(include street, city, county and state)

TELEPHONE
NUMBER

BUSINESS
HOURS

IN PERSON
CLASS
AVAILABLE

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Appendix D: Matrix of Current Instructors

(Application for Approval as a Provider of a Personal Financial Management Instructional Course)

Name of Provider:
Other business names used at this location, if any:
Street address:

Supervisor (check)
EDUCATION - Highest Degree Received (check one)
High School
A.D.
B.A./B.S.
Graduate (M.S., J.D., Ph.D.)
Other (specify)*
INSTRUCTOR CERTIFICATION (check all that apply)
Certified as a Credit or
Financial Counselor*
Course of Study*
CFP
RFC
CPA
EXPERIENCE (state years of experience)
Credit Counseling
Financial Management Financial Planning
Consumer Credit Education
Consumer Economics
Other (specify)*
ANNUAL CONTINUING EDUCATION
State year of most recent
completion of continuing
education course.
* Disclose on separate page. See Section 7, Appendix D, of Instructions for additional detail.

10.

9.

8.

7.

6.

5.

4.

3.

2.

1.

__________

(Copy this page for
additional employees)

Instructor Names

Total number of
personnel at this
location:

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Appendix E: Activity Report for Approved Providers

(Application for Approval as a Provider of a Personal Financial M anagement Instructional Course)

Questions? Contact Executive Office for United States Trustees at (202) 514-4100, or [email protected].

Reporting Period: (Check one)

□July-December

□January-June

Year: ____________

Provider No:
Name of Provider:
Contact Person:

E-Mail:
Someone who could answer USTP questions

Instructions: Please provide actual (not estimated) data for all debtors instructed by the Provider this reporting period.
No cell should be left blank. If none, enter “0” in the cell.
Debtors Receiving Instruction this Reporting Period
Q1

Number of debtors receiving instruction this reporting period

Q2

Number of debtors requesting instruction in language other than English*

Q3

Number of debtors provided instruction in language other than English*

Q4

Number of hearing-impaired debtors requesting instruction

Q5

Number of hearing-impaired debtors provided instruction

* Specify

languages on next page

Instructions: Please provide actual (not estimated) data for all fees and bankruptcy certificates issued by the Provider
this reporting period. No cell should be left blank. If none, please enter "0" in the cell.
Debtor Education Certificates Issued this Reporting Period
a

Q6 Certificates issued at no cost

Instructional Method

In-Person

b

Telephone

Q9

c

Total Fees or
Contributions

Internet

Q7 Certificates issued at reduced cost

►a

Q8 Certificates issued at regular cost

►b

Total

(Q6a+Q7a+Q8a)

(Q6b+Q7b+Q8b)

(Q6c+Q7c+Q8c)

(Q9a+Q9b)

Course Evaluation Summary:
For courses conducted during
Probationary or Annual Period

In-Person
%Yes

%No

COURSE
Goals were explained clearly.
Course topics were relevant to my life.
Learning materials were helpful.
Course content was easy to understand.
INSTRUCTOR
Instructor was well prepared.
Instructor was helpful.
COURSE ENVIRONMENT
Training facility was comfortable.
Facility location was convenient.
COURSE RESULTS
I learned something I can use.
I will use a budget at home.
Languages Requested other than English*
1.

6.

2.

7.

3.

8.

4.

9.

5.

10.

* If more than ten, please attach a list of additional languages requested.

Languages Provided other than English*
1.

6.

2.

7.

3.

8.

4.

9.

5.

10.

* If more than ten, please attach a list of additional languages provided.

Telephone
%Yes

%No

Internet
%Yes

%No

OMB No. 1105-0085

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U.S. Department of Justice
Executive Office for United States Trustees

INSTRUCTIONS FOR APPLICATION FOR APPROVAL AS A PROVIDER OF A
PERSONAL FINANCIAL MANAGEMENT INSTRUCTIONAL COURSE
Introduction. In accordance with 11 U.S.C. § 111, as implemented by Application Procedures
and Criteria for Approval of Providers of a Personal Financial Management Instructional
Course by United States Trustees, 28 C.F.R. §§ 58.25 - 58.36 (the “Rule”), a provider of a
personal financial management instructional course (a “Provider”) seeking approval by the United
States Trustee1 shall submit an application to the Executive Office for United States Trustees
(“EOUST”) in the form described below. The Provider shall provide all information and
documents required by the EOUST or United States Trustee responsible for each judicial district
in which the Provider seeks approval. Unless otherwise stated, the application and appendices
shall be typewritten2 using the space provided on the form, as well as attachments if necessary.
The application has been revised to reflect changes to the process under the Rule. All
Providers should review the Rule thoroughly before completing an application.
Application Form and Instructions. The application form and Instructions comprise the
following sections:

1

Section 1.

General Information Concerning the Provider

Section 2.

Provider Names and Personnel

Section 3.

Quality, Experience, and Background in Providing Personal Financial
Management Instructional Courses

Section 4.

Learning Materials and Methodologies (Course Curriculum)

Section 5.

Fees and Fee Waivers

Section 6.

Disclosures

As defined in 28. C.F.R. § 58.25(b)(30), the term “United States Trustee” means, alternatively:
(i) The Executive Office for United States Trustees
(ii) A United States Trustee appointed under 28 U.S.C. 581;
(iii) A person acting as a United States Trustee;
(iv) An employee of a United States Trustee; or
(v) Any other entity authorized by the Attorney General to act on behalf of the United States under this part.

“Typewritten” includes completion of the online fillable PDF form, or completion of the form using a word
processing application or a typewriter.
2

Section 7.

Appendices
Appendix A. Acknowledgments, Agreements, and Declarations in
Support of Application for Approval as a Provider of a
Personal Financial Management Instructional Course
Appendix B. Judicial Districts
Appendix C. Business Locations
Appendix D. Matrix of Current Instructors
Appendix E. Activity Report for Approved Providers

Section 8.

Certification and Signature

Except where a “No Change” (“NC”) box appears, complete all items in the application, even if
the requested information has not changed since the most recent application. Do not leave any
items blank. If the Provider has no information to provide, state “N/A” with respect to the
relevant item.
New Applicants. Check the box marked “New Applicant” in item 1.1. Complete every item in
the application and submit completed Appendices A through E. Do not check any of the “NC”
boxes. Where an item provides alternatives for new applicants and returning applicants, respond
as directed for new applicants only.
Returning Applicants. Check the box marked “Returning Applicant” in item1.1. Where an item
provides alternatives for new applicants and returning applicants, respond as directed for
returning applicants only.
Statement of No Change for Returning Applicants. Where a “NC” box appears beside an
item, if the Provider’s response to that item is identical to its response in the most recent
application, the Provider may check the “NC” box indicating no changes have occurred and
continue to the next item. If an item does not offer the option of checking a “NC” box, then the
Provider must complete the item even if its response has not changed since the previous
application.
Mailing Instructions, Information Requests, and Notifications. The application should be
completed in its entirety, which includes all supplemental documents and information that are
requested, before submission to the United States Trustee. An incomplete application may result
in delay or denial of the application. Once completed, the application should be sent by one of
two permissible delivery methods:
(1)

By electronic mail to the following address:
[email protected]

The application may be submitted in one or more e-mail transmissions to accommodate file size
limitations. The maximum size of any e-mail is 10MB. Please include the Provider’s name (and
Provider number, if previously assigned), in the subject line of all e-mail transmissions. Retain
the original application for your records.
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(2)

By overnight mail to the following address:
Executive Office for United States Trustees
Debtor Education Application Processing
441 G Street, N.W.
Suite 6150
Washington, D.C. 20530
(202) 514-4100

As soon after receipt as practicable, the United States Trustee will send the Provider an
acknowledgment letter confirming receipt. The principal contact identified in the application
shall receive all notices and requests for information. Correspondence with the United States
Trustee should be submitted to the address set forth above, unless otherwise instructed.
Duty to notify the United States Trustee. The Provider has a continuing duty to promptly
notify the United States Trustee of any circumstances that would materially alter or change a
response to any section of the application regardless of whether they occur while an application to
become an approved Provider is pending before the United States Trustee or after the Provider
has been approved. Notification to the United States Trustee must be in writing, signed by an
authorized official, and include all pages of the application and/or appendices that are affected by
the change. Notification shall be transmitted in the same manner as the application.
The Provider shall immediately notify the United States Trustee in writing of any failure by the
Provider to comply with any statutory or regulatory standard or requirement specified in 11
U.S.C. §§ 109 or 111, the Rule, or the terms under which the United States Trustee approved the
Provider to act as an approved Provider. Specifically, the Provider shall immediately notify the
United States Trustee, in writing, of any of the following events:
(1) Cessation of business by the approved Provider or by any office of the Provider, or
withdrawal from any federal judicial district(s) where the approved Provider is approved;
(2) Any investigation of, or any administrative or judicial action brought against, the
approved Provider by any governmental unit;
(3) Any action by a governmental unit or a court to suspend or revoke the approved
Provider’s articles of incorporation, or any license held by the approved Provider, or any
authorization necessary to engage in business; or
(4) A suspension, or action to suspend, any accreditation held by the approved Provider, or
any withdrawal by the approved Provider of any application for accreditation, or any denial
of any application of the approved Provider for accreditation.
Approval Period and Deadline for Submission of Application for Renewal. Unless
terminated earlier, the Provider approved to provide a personal financial management
instructional course for the first time shall be approved for a six-month probationary period.
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Except as provided below, each approval period after the probationary period shall be for one
year. The Provider shall apply no later than 45 days before the expiration of its existing approval
period to be considered for renewal. The Provider is responsible for monitoring the expiration
date of the current approval period as well as the application deadline, and for timely submitting
an application. The United States Trustee will not send application deadline reminders to the
Provider.
So long as the Provider has submitted a complete and timely application for renewal, it may
continue to provide an instructional course while its application for renewal is under review by
the United States Trustee. If the renewal application is approved for an additional one-year
period, that renewal period will begin on a) the date after its current approval period expires, or b)
the date the United States Trustee approves the application, whichever is later.
If the Provider does not submit an application for renewal before the expiration of its current
approval period, the approval will automatically expire, the Provider no longer will be authorized
to act as an approved Provider, and the Provider must apply for a new six-month probationary
period before providing an instructional course to debtors pursuant to 11 U.S.C. § 111.
Amendments. After approval, the Provider must obtain the United States Trustee’s approval
before making any of the following changes:
(1) The engagement of an independent contractor to provide an instructional course;
(2) Any increase in the fees received from debtors for an instructional course or a change
in the Provider’s fee policy;
(3) Expansion into additional federal judicial districts;
(4) Any changes to the method of delivery the approved Provider employs to provide an
instructional course; or
(5) Any changes in the approved Provider’s instructional course.
The Provider shall submit an amended application, reflecting all material changes that will occur
due to the changes, and include a newly executed Section 8, “Certification and Signature.” The
amended application need only include the items affected by the changes.
Limitations on Advertising. Approved Providers may not contact any debtor utilizing the
United States Postal Service or other mail carrier, or electronic mail for the purpose of soliciting
debtors to utilize the Provider’s instructional course, unless:
(1) any such solicitations include the phrase “This is an advertisement for services” or
“This is a solicitation;”
(2) prominently displayed at the beginning of each page of the solicitation;
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(3) in a font size larger than or equal to the largest font size otherwise used in the
solicitation; and
(4) any such solicitations include only logos, seals, or similar marks that are substantially
dissimilar to the logo, seal, or similar mark of any Provider or court of the United States
government, including but not limited to the United States Trustee Program.
Burden Statement. Respondents are not required to complete this form unless it contains a valid
OMB number. The public reporting burden for this application is estimated to average ten hours
for an initial application and four hours for a re-application, including time for reviewing
instructions, gathering information, and completing the application. Comments regarding this
burden estimate or any other aspect of this application, including suggestions for reducing the
burden, should be directed to the Executive Office for United States Trustees, Debtor Education
Application Processing, 441 G Street, N.W., Suite 6150, Washington, D.C., 20530.
Privacy Act Statement. Section 111 of title 11, United States Code, authorizes the collection of
this information. The primary use of this information is by the United States Trustee to approve
Providers of personal financial management instructional courses. Disclosure of this information
may be to an appropriate federal, state, local, regulatory, tribal, or foreign law enforcement
agency when the information indicates a violation or potential violation of law, or to a
complainant or victim when such information is necessary to provide an explanation concerning
the results of an investigation of which they complained or were a victim. Other disclosures may
be made pursuant to the routine uses enunciated in the United States Trustee Program’s system of
records notice, UST-005, “Credit Counseling and Debtor Education Files and Associated
Records.” See 71 Fed. Reg. 59,818, 59,727-59,830 (Oct. 11, 2006). Additional disclosure of the
information may be to district and regional offices of each United States Trustee. The
information will not be shared with any other agencies unless allowed by law.
Any person doing business with the federal government must furnish a taxpayer identifying
number. 31 U.S.C. § 7701. Furnishing the taxpayer identifying number, as well as other data, is
voluntary, but failure to do so may delay or prevent action on the application.
APPLICATION AND INSTRUCTIONS
Section 1. General Information Concerning the Provider
Item 1.1: United States Trustee assigned Provider number. New applicants: Enter “N/A” for this
item. Returning applicants: Provide the four or five digit number the United States Trustee
assigned when the Provider first applied for approval as a provider of a personal financial
management instructional course.
Item 1.2: Name of Provider. Provide the Provider’s legal name as designated by the state of
incorporation or organization.
Item 1.4: Additional names. List all aliases, d/b/a, or fictitious names the Provider currently uses
(the Provider should list former names in item 2.1).
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Section 2. Provider Names and Personnel
Guidelines.

Ethical standards. The Provider may not enter into any referral agreements or
receive any financial benefit that involves the Provider paying to or receiving from
any entity or person referral fees for the referral of debtors to or by the Provider.
The Provider may not enter into agreements involving an instructional course that
creates a conflict of interest.
No member of the board of directors or trustees, officer or supervisor of an
approved Provider may be a relative of an employee of the United States Trustee,
a trustee appointed under 11 U.S.C. § 586(a)(1) for any federal judicial district
where the Provider is providing or is applying to provide an instructional course, a
federal judge in any federal judicial district where the Provider is providing or is
applying to provide an instructional course, or a federal court employee in any
federal judicial district where the Provider is providing or is applying to provide
an instructional course.

Specific Instructions.
Items 2.2 and 2.3: Current officers, directors, and trustees. Provide information about individuals
currently serving as officers, directors, and trustees. “Compensation” includes both direct
compensation, such as wages and salaries, and indirect compensation, such as bonuses, deferred
compensation, and noncash compensation.
Item 2.4: Material management changes. New applicants: State whether the Provider’s officers
or the members of its board of directors/trustees have changed in the last three years. If so,
complete items 2.5 and/or 2.6. If not, continue to item 2.7. Returning applicants: State whether
the Provider’s officers or the members of its board of directors/trustees have changed since the
most recent application as approved. If so, complete items 2.5 and/or 2.6. If not, continue to item
2.7.
Item 2.5 and 2.6: Former officers, directors, and trustees. New applicants: Provide information
about individuals who are not currently on the board, but have served as officers, directors, or
trustees within the last three years. Returning applicants: Provide information about individuals
who are not currently on the board, but have served as officers, directors, or trustees within the
last year.
When supplying address information, provide the individual’s current employer or residential
address, and not the Provider’s business address. “Compensation” includes both direct

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compensation, such as wages and salaries, and indirect compensation, such as bonuses, deferred
compensation, and noncash compensation.
Item 2.7(a) and (b): Referrals. Provide information about individuals or entities who provide
referrals to the Provider or receive referrals from the Provider. Disclose oral referral agreements
and arrangements as well as written agreements.
Item 2.7(c): Contracts. Disclose all contracts with related individuals or entities, whether or not
they pertain to an instructional course. For purposes of this item, a “related entity” includes a
business in which an officer, director or employee of the Provider, or relative of an officer, director
or employee of the Provider, owns, manages, controls or holds, directly or indirectly, a 20
percent ownership or financial interest in the business.
Item 2.8: Independent contractors. The term “independent contractor” means a person or entity
who provides any goods or services to the Provider other than as an employee and as to whom the
Provider does not:
(1) direct or control the means or methods of delivery of the goods or services being
provided;
(2) make financial decisions concerning the business aspects of the goods or services
being provided; or
(3) have any common employees.
“Independent contractors” do not include instructors employed by the Provider. Do not list the
Provider’s own instructors. List those on Appendix D.
Section 3. Quality, Experience, and Background in Providing Personal Financial
Management Instructional Courses
Guidelines.

Business experience. The Provider must have adequate experience and
background in providing an instructional course. To meet this requirement, the
Provider must have experience providing an instructional course for the last two
years. If the Provider has not provided an instructional course for the last two
years, then it must employ in each office location that provides an instructional
course at least one supervisor with experience and background in providing an
instructional course for no less than two of the last five years.
Compliance with laws and regulations. The Provider must be in compliance with
all applicable laws and regulations of the United States and each state,
commonwealth, district, or territory of the United States in which the Provider
conducts an instructional course, including all laws governing licensing and
registration.

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Specific Instructions.
Item 3.2: Time in business. State the length of time the Provider has offered an instructional
course. A Provider with fewer than two years of experience immediately preceding the
application date shall complete item 3.3. All other Providers may continue to item 3.4.
Item 3.5: Revocation of accreditation or certification. If the Provider’s accreditation was revoked,
suspended, or lapsed at any time during the last five years, state the date(s) of revocation,
suspension or lapse, and provide a detailed explanation of the circumstances that led to the
Provider’s accreditation being revoked, suspended, or lapsed. If any instructor’s certification was
revoked, suspended, or lapsed at any time during the last five years, identify the instructor, identify
the relevant date(s) and provide a detailed explanation of the circumstances.
Item 3.7: Financial statements. Provide audited financial statements if they exist. To the extent
the Provider has not obtained audited financial statements, the Provider may substitute unaudited
financial statements. If the Provider has not commenced operations as of the application date, it
may provide pro forma financial statements in lieu of audited or unaudited financial statements.
Item 3.8: Litigation. List all legal actions, proceedings, investigations, arbitrations, mediations,
and potential bond or other claims, whether pending or adjudicated, in which the Provider, any
affiliate listed in the response to item 2.7(c), or any officer, director, trustee, employee, or agent of
the Provider is a party, and the outcomes of any such actions.
Item 3.9: Regulatory oversight and investigations. Disclose audits, investigations, and
enforcement actions by state and local tax, oversight, and regulatory agencies. Routine audits
performed on an annual or other periodic basis need not be disclosed, except to the extent
they form the basis of an enforcement action.
Item 3.10: Continuing obligation to update. Disclose to the United States Trustee any new actions
of the type described in items 3.5, 3.8, and 3.9 that commence during the application review
period.
Section 4. Learning Materials and Methodologies (Course Curriculum)
Guidelines.

Adequate personal financial management instruction. A personal financial
management instructional course shall include the following substantive
instruction:
(1) Budget development, which consists of the following:
(A) setting short-term and long-term financial goals, as well as developing
skills to assist in achieving these goals;
(B) calculating gross monthly income and net monthly income; and
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(C) identifying and classifying monthly expenses as fixed, variable, or
periodic;
(2) Money management, which consists of the following:
(A) keeping adequate financial records;
(B) developing decision-making skills required to distinguish between
wants and needs, and to comparison shop for goods and services;
(C) maintaining appropriate levels of insurance coverage, taking into
account the types and costs of insurance; and
(D) saving for emergencies, for periodic payments, and for financial goals;
(3) Wise use of credit, which consists of the following:
(A) identifying the types, sources, and costs of credit and loans;
(B) identifying debt warning signs;
(C) discussing appropriate use of credit and alternatives to credit use; and
(D) checking a credit rating;
(4) Consumer information, which consists of the following:
(A) identifying public and non-profit resources for consumer assistance;
and
(B) identifying applicable consumer protection laws and regulations, such
as those governing correction of a credit record and protection against
consumer fraud; and
(5) Coping with unexpected financial crisis, which consists of the following:
(A) identifying alternatives to additional borrowing in times of
unanticipated events; and
(B) seeking advice from public and private service agencies for assistance.
Providers of telephone services or internet services. In addition to meeting all
other requirements, the Provider that provides telephone services or internet
services must demonstrate sufficient experience and proficiency in designing and
providing services by these methods of delivery, including proficiency in
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employing verification procedures to ensure the person receiving the instructional
course is the debtor and to determine whether the debtor has completely received
the instructional course. Determining whether the debtor has completely received
the instructional course means ensuring that the debtor is the same person who
both commences and completes the instructional course, and that the debtor
completed the instructional course in its entirety. Identity verification requires the
Provider to:
(1) obtain one or more unique personal identifiers from the debtor and assign an
individual access code, user ID, or password at the time of enrollment; and
(2) require the debtor to provide the appropriate access code, user ID, or password,
and also one or more of the unique personal identifiers during the course of
delivery of the instructional course.
The Provider shall furnish toll-free telephone numbers for both hearing and
hearing-impaired debtors whenever telephone communication is required. The
Provider shall provide telephone amplification, sign language services, or other
communication methods for hearing-impaired debtors.
Course duration. The Provider shall ensure the instructional course contains
sufficient learning materials and teaching methodologies so that the debtor
receives a minimum of two hours of instruction, regardless of the method of
delivery of the course.
Language services. The Provider shall inform debtors with limited English
proficiency of the languages it offers.
Prohibition against legal advice. The Provider shall refrain from giving legal
advice to debtors.
Certificates of instruction. The Provider agrees to issue certificates of instruction
in accordance with the directives established by the United States Trustee. For
reference, please consult 28 C.F.R. § 58.35. Note that an approved Provider shall
not withhold the issuance of a certificate because of a debtor’s failure to submit an
evaluation form, though the Provider should make reasonable effort to ensure that
debtors complete and submit course evaluation forms. The approved Provider
also shall not withhold issuance of a certificate because of the debtor’s failure
to obtain a passing grade on a quiz, examination, or test.
Specific Instructions.
Check the box for each method of delivery for which the Provider seeks approval, and describe
any languages, other than English, in which the Provider offers instruction.

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Item 4.1: Other instructional or counseling services. List the other types of services the Provider
offers, whether or not related to an instructional course, such as housing counseling or mortgage
counseling.
Item 4.4: Language referrals. List the number of referrals of debtors the Provider provided to
other approved Providers for an instructional course based on limited English proficiency, and
identify the languages, other than English, requested by such debtors.
Items 4.5 - 4.7: Instructional course process. The Provider that seeks approval to provide more
than one delivery method shall provide a complete response for each delivery method. As to each
element below, provide examples of instruction or identity verification forms (whether used by
the debtor, the instructor, or both), written instructional materials, procedures, manuals, scripts,
outlines, and/or guidelines, where applicable. If the listed materials are available on the internet
(whether or not accessible to the debtor), provide the URL for the website and, if necessary,
instructions for accessing such materials, such as a username and a password. If the listed
materials are available only on the Provider’s intranet, provide printed screens of all such resource
materials. The Provider shall not unilaterally change its curriculum without prior United
States Trustee approval.
Item 4.5: In-person instruction. Describe the instructional course process, beginning with the
process of providing information to or obtaining information from a debtor, and ending with
certificate issuance:
(a)

Describe the process of obtaining debtor information and providing mandatory
disclosures. If any portion of the information-gathering takes place by telephone
or internet, describe that portion in detail and provide the telephone number a
debtor calls or the URL for the website where the debtor provides or obtains the
information. Provide copies of any and all agreements and consents the Provider
requires debtors to sign in connection with the instructional course. If the
agreement or consent takes an electronic form, provide the URL for the website
where the debtor accesses the form;

(b)

Describe the substance of the instructional course, including a description of the
five criteria listed under the Section 4 Guidelines, beginning on page 8, entitled
“adequate personal financial management instruction;”

(c)

The Provider shall limit class size to ensure an effective presentation of the
instructional course materials. Describe the Provider’s policies concerning class
size;

(d)

The Provider shall ensure that an instructor is present to instruct and interact with
debtors. Describe the Provider’s procedures for ensuring that an instructor is
present to instruct and interact with debtors; and

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(e)

Describe the certificate issuance process, including the timing of certificate
issuance and the Provider’s policies concerning which personnel may issue
certificates.

Item 4.6: Telephone instruction. Describe the instructional course process, beginning with the
process of providing information to or obtaining information from a debtor, and ending with
certificate issuance:
(a)

Describe the process of obtaining debtor information and providing mandatory
disclosures. If any portion of the information-gathering takes place by telephone
or internet, describe that portion in detail and provide the telephone number a
debtor calls or the URL for the website where the debtor provides or obtains the
information. Provide copies of any and all agreements and consents the Provider
requires debtors to sign in connection with the instructional course. If the
agreement or consent takes an electronic form, provide the URL for the website
where the debtor accesses the form;

(b)

Describe the substance of the instructional course, including a description of the
five criteria listed under the Section 4 Guidelines, beginning on page 8, entitled
“adequate personal financial management instruction;”

(c)

Describe the Provider’s experience and proficiency in providing instructional
courses over the telephone;

(d)

Describe the Provider’s debtor identity verification processes, including the
method by which the Provider confirms the identity of the debtor before receiving
the instructional course by telephone by:
(1) obtaining one or more unique personal identifiers from the debtor and
assigning an individual access code, user ID, or password at the time of
enrollment; and
(2) requiring the debtor to provide the appropriate access code, user ID, or
password, and also one or more of the unique personal identifiers during
the course of delivery of the instructional course;

(e)

The Provider shall ensure that an instructor is telephonically present to instruct and
interact with debtors. Describe the Provider’s procedures for ensuring that an
instructor is telephonically present to instruct and interact with debtors;

(f)

The Provider shall provide learning materials to debtors before the instructional
course begins. Describe the Provider’s procedures for providing learning materials
to debtors before the instructional course;

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(g)

The Provider shall incorporate tests into the curriculum that support the learning
materials, ensure completion of the course, and measure comprehension. Describe
the Provider’s procedures for incorporating such tests into the curriculum;

(h)

The Provider shall ensure tests are reviewed prior to the completion of the
instructional course. Describe the Provider’s procedures for ensuring such review
of tests occurs prior to the completion of the instructional course. Note that the
approved Provider shall not withhold issuance of a certificate because of the
debtor’s failure to obtain a passing grade on a quiz, examination, or test;

(i)

The Provider shall ensure direct oral communication from an instructor by
telephone or in person with all debtors who fail to complete the test in a
satisfactory manner or who receive less than a 70 percent score. Describe the
Provider’s procedures for ensuring such direct oral communication from an
instructor;

(j)

Describe the criteria the Provider employs to measure the time spent by the debtor
to complete the instructional course;

(k)

Provide a complete response to items 4.6(d) - (j) as to spouses receiving joint
instruction; and

(l)

Describe the certificate issuance process, including the timing of certificate
issuance, the method of delivery to the debtor, and the Provider’s policies
concerning which personnel may issue certificates.

Item 4.7: Internet instruction. Describe the instructional course process, beginning with the
process of providing information to or obtaining information from a debtor, and ending with
certificate issuance:
(a)

Describe the process of obtaining debtor information and providing mandatory
disclosures. If any portion of the information-gathering takes place by telephone
or internet, describe that portion in detail and provide the telephone number a
debtor calls or the URL for the website where the debtor provides or obtains the
information. Provide copies of any and all agreements and consents the Provider
requires debtors to sign in connection with the instructional course. If the
agreement or consent takes an electronic form, provide the URL for the website
where the debtor accesses the form;

(b)

Describe the substance of the instructional course, including a description of the
five criteria listed under the Section 4 Guidelines, beginning on page 8, entitled
“adequate personal financial management instruction;”

(c)

Describe the Provider’s experience and proficiency in providing instructional
courses by internet;
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(d)

Describe the Provider’s debtor identity verification processes, including the
method by which the Provider confirms the identity of the debtor before receiving
the instructional course by internet by:
(1) obtaining one or more unique personal identifiers from the debtor and
assigning an individual access code, user ID, or password at the time of
enrollment; and
(2) requiring the debtor to provide the appropriate access code, user ID, or
password, and also one or more of the unique personal identifiers during
the course of delivery of the instructional course;

(e)

The Provider shall incorporate tests into the curriculum that support the learning
materials, ensure completion of the course, and measure comprehension. Describe
the Provider’s procedures for incorporating such tests into the curriculum;

(f)

The Provider shall ensure tests are reviewed prior to the completion of the
instructional course. Describe the Provider’s procedures for ensuring such review
of tests occurs prior to the completion of the instructional course. Note that the
approved Provider shall not withhold issuance of a certificate because of the
debtor’s failure to obtain a passing grade on a quiz, examination, or test;

(g)

The Provider shall ensure direct communication from an instructor by electronic
mail, live chat, or telephone with all debtors who fail to complete the test in a
satisfactory manner or who receive less than a 70 percent score. Describe the
Provider’s procedures for ensuring such direct communication from an instructor;

(h)

Describe the criteria the Provider employs to measure the time spent by the debtor
to complete the instructional course;

(i)

The Provider shall respond to a debtor’s questions or comments within one
business day. Describe the Provider’s procedures for responding to a debtor’s
questions or comments within one business day;

(j)

Provide a complete response to items 4.7(d) - (i) as to spouses receiving joint
instruction; and

(k)

Describe the certificate issuance process, including the timing of certificate
issuance, the method of delivery to the debtor, and the Provider’s policies
concerning which personnel may issue certificates.

Section 5. Fees and Fee Waivers.
Guidelines.

Fees. The Provider shall charge reasonable fees for, or relating to, an instructional
course. A fee of less than or equal to $50 is presumed reasonable; fees in excess of
$50 are presumed not reasonable and require prior approval of the United States
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Trustee. The Provider may exceed the presumptively reasonable fee after
receiving approval from the United States Trustee, by demonstrating, at a
minimum, that its costs for delivering the instructional course justify the requested
fee. The Provider bears the burden of establishing that its proposed fee is
reasonable.
Fee waivers. The Provider must provide services without regard to a debtor’s
ability to pay the fee. A debtor is presumptively entitled to a fee waiver if the
debtor’s current household income is less than 150 percent of the poverty guidelines
updated periodically in the Federal Register by the U.S. Department of Health and
Human Services under the authority of 42 U.S.C. § 9902(2), as adjusted from time
to time, for a household or family of the size involved in the fee determination.
The Provider may rebut the presumption, and charge a reduced fee, if it determines,
based on income information the debtor submits in connection with the
instructional course, that the debtor is able to pay the fee in a reduced amount.
Specific Instructions.
Item 5.1: Fees.
(a)

Types of fees. Disclose all fees charged for the instructional course, including
additional fees for certificate issuance. If the Provider charges different fees based
on delivery method (e.g., in-person, telephone, and internet instruction), disclose
the different fees and specify the applicable delivery method.

(b)

Fee reductions and special rates. Do not include reductions based on inability to
pay in your response to this item. Disclose such fee waivers and fee reductions in
the response to item 5.2(a). If the Provider charges a reduced or discounted rate
for spouses who take the course together, disclose the joint rate as well as the
individual rate. If the Provider charges reduced rates based on criteria other than
ability to pay, such as reduced rates to debtors of certain attorneys or law firms, or
debtors obtained through referrals, state the reduced rate and specify the basis for
the reduction and the identity of the individual or entity serving as the basis for
reduction. If the reduction is pursuant to oral or written agreement, or is in
consideration of a referral agreement or arrangement, disclose such agreements or
arrangements in response to item 2.7. The Provider shall not unilaterally
decrease its fee without prior United States Trustee approval.

(c)

Fee communication to debtors; disclosures. State whether the disclosures are
communicated to debtors orally, by recording, in writing, or electronically (for
example, via the internet or e-mail). Specify the timing of disclosures to debtors.
Provide the URL for electronic disclosures. Include copies of all written and/or
electronic disclosures in response to section 6; do not include copies of the
disclosures here.

(d)

Fees exceeding $50 per debtor. If the Provider has been approved to charge a fee
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over $50 per debtor in connection with a prior application, the Provider need not
provide a fee justification in connection with this application unless the Provider
seeks a further increase in any of its fees. If the Provider seeks an increase over
$50 per debtor for the first time, or seeks to increase an existing fee in excess of
$50 per debtor, the Provider shall provide appropriate documentation
demonstrating that its costs for providing the instruction exceed the proposed fee.
The Provider shall not unilaterally increase its fee without prior United
States Trustee approval.
Item 5.2: Fee waiver and fee reduction.
(a)

Fee waiver policies. Fully describe any and all fee waiver and fee reduction
policies based on the debtor’s ability to pay, including those policies at the
discretion of the Provider or instructor, such as the debtor’s net worth, dependence
on government assistance, or receipt of pro bono legal services in connection with
a bankruptcy case.

(b)

Fee waiver disclosure. State whether the fee waiver disclosures are communicated
to debtors orally, by recording, in writing, or electronically (for example, via the
internet or e-mail). Specify the timing of disclosures to debtors. Provide the URL
for electronic disclosures. Include copies of all written and/or electronic
disclosures in response to section 6; do not include copies of the disclosures here.

Section 6.

Disclosures

Guidelines.

Generally. The Provider shall make mandatory disclosures prior to providing any
information to or obtaining any information from a debtor, and prior to providing
the instructional course. The Provider may use more than one form to
communicate the required disclosures, including intake sheets, debtor agreements,
welcome letters or similar documents, but one form is preferable. The written
form and the electronic form, if any, must be consistent.
Mandatory disclosures. The list of mandatory disclosures includes:
(1) The Provider’s fee policy, including any fees associated with generation of the
certificate;
(2) The Provider’s policies enabling debtors to obtain an instructional course for
free or at reduced rates based upon the debtor’s lack of ability to pay. To the
extent an approved Provider publishes information concerning its fees on the
internet, such fee information must include the Provider’s policies enabling debtors
to obtain an instructional course for free or at reduced rates based upon the
debtor’s lack of ability to pay;
(3) The Provider’s policy to provide free bilingual instruction or professional
interpreter assistance to any limited English proficient debtor;
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(4) The instructors’ qualifications;
(5) The Provider’s policy prohibiting it from paying or receiving referral fees for
the referral of debtors;
(6) The Provider’s obligation to provide a certificate to the debtor promptly upon
the completion of an instructional course;
(7) The fact that the Provider might disclose debtor information to the United
States Trustee in connection with the United States Trustee’s oversight of the
Provider, or during the investigation of complaints, during on-site visits, or during
quality of service reviews;
(8) The fact that the United States Trustee has reviewed only the Provider’s
instructional course (and, if applicable, its services as a credit counseling agency
pursuant to 11 U.S.C. § 111(c)), and the fact that the United States Trustee has
neither reviewed nor approved any other services the Provider provides to debtors;
and
(9) The fact that a debtor will only receive a certificate if the debtor completes an
instructional course.
Specific instructions.
Provide copies of any and all disclosures the Provider supplies debtors in connection with the
instructional course. If the Provider also provides an electronic disclosure, provide the URL for
the webpages evidencing those disclosures. Ensure that the Provider’s responses to items 4.5(a),
4.6(a), and 4.7(a) describe the timing of the disclosures to the debtor.
Section 7. Appendices
New applicants: Complete Appendices A, B, C, and D. Do not complete Appendix E.
Returning applicants: Complete Appendices A, B, C, D, and E.
Appendix A: Acknowledgments, Agreements, and Declarations in Support of
Application for Approval as a Provider of a Personal Financial Management Instructional Course.
By executing and submitting the Application for Approval as a Provider of a Personal Financial
Management Instructional Course, the Provider acknowledges and agrees to comply with the
prohibitions, limitations, and obligations set forth in Appendix A, Acknowledgments,
Agreements, and Declarations in Support of Application for Approval as a Provider of a Personal
Financial Management Instructional Course.

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Appendix B: Judicial Districts.
Check the box for each judicial district in which the Provider seeks approval. The Provider is
responsible for ensuring that it complies with all applicable laws and regulations of the United
States and each state, district, commonwealth, or territory of the United States in which it seeks
approval from the United States Trustee.
After approval, the Provider must submit an amended application to add judicial districts. A
Provider that withdraws from any judicial district where it is approved must immediately notify
the United States Trustee in writing.
Appendix C: Business Locations.
List the Provider’s business locations and specify whether in-person services are available at each
listed location.
Appendix D: Matrix of Current Instructors.
The Provider shall use only instructors who possess adequate experience providing an
instructional course, which means that each instructor either:
(a) holds one of the certifications listed below and who has complied with all continuing
education requirements necessary to maintain that certification:
(1) certified as a Certified Financial Planner;
(2) certified as a credit counselor by an accrediting organization;
(3) registered as a Registered Financial Consultant; or
(4) certified as a Certified Public Accountant; or
(b) has successfully completed a course of study or worked a minimum of six months in a
related area such as personal finance, budgeting, or credit or debt management. A course
of study must include training in personal finance, budgeting, or credit or debt
management. An instructor shall also receive annual continuing education in the areas of
personal finance, budgeting, or credit or debt management. The United States Trustee
Program does not endorse any specific course or certification program.
Complete the requested information regarding the basis for certification and experience for each
instructor. For each instructor who is certified by an independent organization, attach a statement
to Appendix D setting forth the organization’s name, contact information, and the criteria for
obtaining the certification. Instructors must satisfy an annual continuing education requirement.
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Appendix E: Activity Report for Approved Providers.
Appendix E applies only to Providers who have previously been approved by the United States
Trustee and are seeking re-approval. If the Provider has not yet been approved by the United
States Trustee as an approved Provider, do not submit Appendix E with the application.
The relevant time periods for Appendix E are January 1-June 30 and July 1-December 31 of each
year. After a Provider has been approved, it must submit a completed Appendix E by January 31
and July 31 of every year. Attach Appendix E for the most recent six-month period when
submitting an application.
Q7: Certificates issued at reduced cost. Include data only for fee reductions based on
ability to pay. Do not include reductions based on criteria independent of ability to pay,
such as arrangements with attorneys, referrals, or joint debtor discounts.
Section 8. Certification and Signature
The Provider has a continuing duty to promptly notify the United States Trustee of any
circumstances that would materially alter or change a response to any section of the application,
during the application process or otherwise. Notification must be in writing, include all pages of
the application and/or appendices that are affected by the change and a newly executed
“certification and signature.”
By signing the application, the Provider’s president, chairman, trustee, or other authorized
representative declares that he or she is authorized to complete the application on behalf of the
Provider; that he or she has read and knows the contents of the application and all enclosures and
attachments submitted; and that he or she affirms, under penalty of perjury, that all of the
representations and statements contained therein are true and correct to the best of that
individual’s knowledge, information, and belief.

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OMB No. 1105-0085

Approval Expires

U.S. Department of Justice
Executive Office for United States Trustees
APPLICATION FOR APPROVAL AS A PROVIDER OF A PERSONAL FINANCIAL
MANAGEMENT INSTRUCTIONAL COURSE
Introduction. In accordance with 11 U.S.C. § 111, as implemented by Application Procedures and
Criteria for Approval of Providers of a Personal Financial Management Instructional Course by United
States Trustees, 28 C.F.R. §§ 58.25 - 58.36 (the “Rule”), a provider of a personal financial management
instructional course (a “Provider”) seeking approval by the United States Trustee shall submit an
application to the Executive Office for United States Trustees (“EOUST”) in the form described below and
in the accompanying Instructions. The Provider shall provide all information and documents required by
the EOUST or the United States Trustee responsible for each judicial district in which the Provider seeks
approval. Unless otherwise stated, the application and appendices shall be typewritten1 using the space
provided on the form, as well as attachments if necessary.
An application is complete when all sections of the application have been addressed and copies of the
documents requested in the application are attached. Failure to file a complete application may result in
processing delay or denial of the application. If additional space is required to complete a response, attach
a separate page with the name of the Provider, the federal tax identification number, if applicable, and the
item number indicated on the top, right-side of the page.
Except where a “No Change” (“NC”) box appears, complete all items in the application, even if the
requested information has not changed since the most recent application. Do not leave any items blank.
If the Provider has no information to provide, state “N/A” with respect to the relevant item. Please see the
accompanying Instructions for detailed guidance on completing each item.
New Applicants. Check the box marked “New Applicant” in item 1.1. Complete every item in the
application. Do not check any of the “NC” boxes. Where an item provides alternatives for new applicants
and returning applicants, respond as directed for new applicants only.
Returning Applicants. Check the box marked “Returning Applicant” in item 1.1. Where an item
provides alternatives for new applicants and returning applicants, respond as directed for returning
applicants only.
Statement of No Change for Returning Applicants. Where a “NC” box appears beside an item, if the
Provider’s response to that item is identical to its response in the most recent application, the Provider may
check the “NC” box indicating no changes have occurred and continue to the next item. If an item does
not offer the option of checking a “NC” box, then the Provider must complete the item even if its response
has not changed since the previous application.
Burden Statement. Respondents are not required to complete this form unless it contains a valid OMB
number. The public reporting burden for this application is estimated to average ten hours for an initial
application and four hours for a re-application, including time for reviewing instructions, gathering
information, and completing the application. Comments regarding this burden estimate or any or other
aspect of this application, including suggestions for reducing the burden, should be directed to the
“Typewritten” includes completion of the online fillable PDF form, or completion of the form using a word
processing application or a typewriter.
1

- 1 -

Executive Office for United States Trustees, Debtor Education Application Processing, 441 G Street,
NW, Suite 6150, Washington, DC 20530.
Section 1. General Information Concerning the Provider
1.1

Check only one box.
New Applicant.
Returning Applicant. Check here and provide the United States Trustee assigned Provider
number:

1.2

Name of Provider:

1.3

Federal Tax Identification Number of Provider, if applicable:

1.4

Additional names currently being used, including any d/b/a:

1.5

Primary business address:
Street address:

1.6

Mailing address: (if different)

Telephone No.:

Fax No.:

Website(s):
1.7

Principal contact for the Provider:
Name:

Title:

Email address:
If different from primary business address:
Fax No.:

Telephone No.:
Mailing address:

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1.8

Provider is:

1.9

State of organization:

Corporation
Partnership
Limited Liability Corp.

Institute of Higher Education
Limited Liability Partnership
Other:
Date of organization:

Section 2. Provider Names and Personnel
NC
2.1
List all former names, f/k/a, and mailing addresses used by the Provider other than
those listed on items 1.2 and 1.4.
New Applicants: Supply the requested information for the most recent three years.
Returning Applicants: Supply the requested information for the most recent year.

NC

2.2

Identify the current officers and provide his or her: 1) title; 2) principal occupation;
3) employer name; and 4) amount of direct or indirect compensation (including deferred
compensation and other financial benefits). Attach a resume for each officer who has
served less than one year.

NC

2.3

Identify the current directors and trustees and provide his or her: 1) title; 2) principal
occupation; 3) employer name; and 4) amount of direct or indirect compensation
(including deferred compensation and other financial benefits). Attach a resume for
each director or trustee who has served less than one year.

2.4

Material management changes.
New Applicants: Have any of the officers, directors, or trustees of the Provider changed
in the last three years?

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Returning Applicants: Have any of the officers, directors, or trustees of
the Provider changed since the last application?
Yes. Complete items 2.5 and/or 2.6.
No. Continue to item 2.7.
2.5

Identify individuals who previously served as officers, but are no longer officers, and
provide his or her 1) title, 2) term(s) in office, and 3) the reason why he or she is no
longer an officer. State the amount of direct and indirect compensation (including
deferred compensation and other financial benefits) for each individual.
New Applicants: Supply the requested information for the most recent three years.
Returning Applicants: Supply the requested information for the most recent year.

2.6

Identify individuals who previously served as directors or trustees, but are no longer
directors or trustees, and provide his or her 1) title, 2) term(s) in office, and 3) the reason
why he or she is no longer a director or trustee. State the amount of direct and indirect
compensation (including deferred compensation and other financial benefits) for each
individual.
New Applicants: Supply the requested information for the most recent three years.
Returning Applicants: Supply the requested information for the most recent year.

NC

2.7

Contracts and Referrals.
(a) Referrals to the Provider. Identify each individual or entity that regularly refers
debtors to the Provider, and provide the following: 1) the individual or entity’s mailing
address, telephone number, e-mail address, and web address; 2) whether referred debtors
receive a discount from the Provider’s ordinary instructional course fee; and 3) copies of
any written contracts or agreements. This includes all oral and written agreements with
attorneys who refer clients to the Provider.
New Applicants: Supply the requested information for the most recent two years.
Returning Applicants: Supply the requested information for the most recent year.

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(b) Referrals by the Provider. Identify each individual or entity to whom the
Provider regularly refers or has referred debtors, and provide the following: 1) the
individual or entity’s mailing address, telephone number, e-mail address, and web
address; 2) whether referred debtors receive a discount from the Provider’s ordinary
instructional course fee; and 3) copies of any written contracts or agreements.
New Applicants: Supply the requested information for the most recent two years.
Returning Applicants: Supply the requested information for the most recent year.

(c) Contracts. To the extent the Provider has engaged in transactions with its officers,
directors, shareholders, affiliates, subsidiaries, or related individuals or entities, identify
the individual or entity and provide the following: 1) the individual or entity’s mailing
address, telephone number, e-mail address, and web address; and 2) copies of any written
contracts or agreements.
New Applicants: Supply the requested information for the most recent two years.
Returning Applicants: Supply the requested information for the most recent year.

NC

2.8

Independent Contractors. Identify each independent contractor that performs
instructional course services or other services on behalf of the Provider, and provide the
following: 1) the contractor’s mailing address, telephone number, e-mail address, and
web address and 2) copies of any written contracts or agreements.

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Section 3. Quality, Experience, and Background in Providing Personal Financial Management
Instructional Courses
3.1

How long has the Provider been in business?

3.2

How long has the Provider provided personal financial management instructional courses?
Years

3.3

Years

Months

Months

If the response to item 3.2 is less than 2 years, complete this item. Otherwise, check the
“N/A” box and continue to item 3.4.
N/A
For each location that serves debtors, does the Provider employ at least one office
supervisor with experience and background in providing financial management
instructional courses for no fewer than two of the last five years?
Yes.
No.
Attach the following to the application:
(a)

Identify the individual who will serve as the supervisor for each office offering
instructional courses and attach a resume describing that individual’s experience
and educational background.

Names:
Documents are attached.
NC

3.4

List the Provider’s accreditations by accrediting organizations. Do not list instructor
certifications here. List those on Appendix D.

NC

3.5

If the Provider’s accreditation was revoked, suspended, or lapsed at any time during the
last five years, state the dates and circumstances. If any instructor’s certification was
revoked, suspended, or lapsed at any time during the last five years, identify the
instructor and state the dates and circumstances.
New Applicants: Supply the requested information for the most recent five years.
Returning Applicants: Supply the requested information for the most recent year.

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NC

3.6

List each state in which the Provider is licensed or certified to conduct financial
education services. For each state identified, also identify the state regulatory body
that issued the license or certificate and the license or certificate number, if any.

3.7

Attach the most recent year-end financial statements prepared in accordance with
generally accepted accounting principles. If no audited financial statements were
prepared, provide unaudited financial statements.
Documents are attached.

NC

3.8

List all legal actions, proceedings, investigations, arbitrations, mediations, and potential
bond or other claims, whether pending or adjudicated, in which the Provider, any
affiliate listed in the response to item 2.7(c), or any officer, director, trustee, employee,
or agent of the Provider is a party, and the outcomes of any such actions.
New Applicants: Supply the requested information for the most recent three years.
Returning Applicants: Supply the requested information for the most recent year.

NC

3.9

List all audits, disciplinary or enforcement actions by any applicable tax, oversight,
licensing, registration, or certification body against the Provider, any affiliate listed in the
response to item 2.7(c), or any officer, director, trustee, employee, or agent of the
Provider, and the outcomes of any such actions.
New Applicants: Supply the requested information for the most recent three years.
Returning Applicants: Supply the requested information for the most recent year.

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3.10

Continuing obligation to update. If any action described in items 3.5, 3.8 or 3.9 occurs
while the application is pending, or the status of any existing action described in items
3.5, 3.8 or 3.9 changes while the application is pending, the Provider must promptly
notify the United States Trustees at the address identified in the Instructions.
I certify that I will notify the United States Trustee under the circumstances
described above.

Section 4. Learning Materials and Methodologies (Course Curriculum)
Teaching Methods:
In-Person:
Yes

Telephone:
No

Languages Offered:

Internet:
No

Yes
Languages Offered:

Yes
Languages Offered:

NC

4.1

List all other instructional courses or services that the Provider provides.

NC

4.2

Describe the Provider’s continuing education policy for instructors.

NC

4.3

State the average duration of an instructional course in hours and minutes.

Classroom:
NC

4.4

Telephone:

No

Internet:

List the number of referrals of debtors for an instructional course based on limited
English proficiency, and identify the languages, other than English, requested by such
debtors.
New Applicants: Supply the requested information for the most recent two years.
Returning Applicants: Supply the requested information for the most recent year.

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Sections 4.5 - 4.7: Instructional Methods and Procedures.
Please see the Instructions before completing this section for required information and guidelines.
New Applicants: Complete each applicable item. Supply responses on a separate
attachment. A Provider that seeks approval to provide more than one delivery method
shall provide a complete response for each delivery method.
Returning Applicants: If the Provider has made no changes to its instructional methods
or procedures since the previous application as approved, check “NC” where applicable
and proceed to item 4.8. The Provider shall not unilaterally change its curriculum
without prior United States Trustee approval.
NC

NC

4.5

4.6

In-person instruction. Describe the instructional course process, beginning with the
process of providing information to or obtaining information from a debtor, and ending
with certificate issuance. Include the following elements:
(a)

The process of obtaining debtor information and providing mandatory disclosures;

(b)

The substance of the instructional course;

(c)

The Provider’s policies concerning class size;

(d)

The Provider’s procedures for ensuring that an instructor is present to instruct and
interact with debtors; and

(e)

The certificate issuance process, including the timing of certificate issuance and
the Provider’s policies concerning which personnel may issue certificates.

Telephone instruction. Describe the instructional course process, beginning with the
process of providing information to or obtaining information from a debtor, and ending
with certificate issuance. Include the following elements:
(a)

The process of obtaining debtor information and providing mandatory disclosures;

(b)

The substance of the instructional course;

(c)

The Provider’s experience and proficiency in providing an instructional course
over the telephone;

(d)

The Provider’s debtor identity verification processes;

(e)

The Provider’s procedures for ensuring that an instructor is telephonically present
to instruct and interact with debtors;

(f)

The Provider’s procedures for providing learning materials to debtors before the
telephone instructional course session;

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NC

4.7

(g)

The Provider’s procedures for incorporating tests into the curriculum that support
the learning materials, ensure completion of the course, and measure
comprehension;

(h)

The Provider’s procedures for ensuring review of tests prior to the completion of
the instructional course;

(i)

The Provider’s procedures for ensuring direct oral communication from an
instructor by telephone or in person with all debtors who fail to complete the test
in a satisfactory manner or who receive less than a 70% score;

(j)

The criteria the Provider employs to measure the time spent by the debtor to
complete the instructional course;

(k)

A complete response to items 4.6(d) - (j) as to spouses receiving joint instruction;
and

(l)

The certificate issuance process, including the timing of certificate issuance and
the Provider’s policies concerning which personnel may issue certificates.

Internet instruction. Describe the instructional course process, beginning with the
process of providing information to or obtaining information from a debtor, and ending
with certificate issuance. Include the following elements:
(a)

The process of obtaining debtor information and providing mandatory disclosures;

(b)

The substance of the instructional course;

(c)

The Provider’s experience and proficiency in providing instructional courses over
the internet;

(d)

The Provider’s debtor identity verification processes;

(e)

The Provider’s procedures for incorporating tests into the curriculum that support
the learning materials, ensure completion of the course, and measure
comprehension;

(f)

The Provider’s procedures for ensuring review of tests prior to the completion of
the instructional course;

(g)

The Provider’s procedures for ensuring direct communication from an instructor
by electronic mail, live chat, or telephone with all debtors who fail to complete the
test in a satisfactory manner or who receive less than a 70% score;

(h)

The criteria the Provider employs to measure the time spent by the debtor to
complete the instructional course;

(i)

The Provider’s procedures for responding to a debtor’s questions or comments
within one business day;

(j)

A complete response to items 4.7(d)-(i) as to spouses receiving joint instruction;
and

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(k)

The certificate issuance process, including the timing of certificate issuance and
the Provider’s policies concerning which personnel may issue certificates.

NC

4.8

Describe the Provider’s procedures concerning completion and submission of course
evaluation forms by debtors. Attach a copy of the proposed evaluation form. Note that
certificate issuance may not be withheld based on a debtor’s failure to submit a course
evaluation form or failure to obtain a passing grade on a quiz, examination, or test.

NC

4.9

Attach copies of written standards, manuals, procedures, or guidelines, if any, the
Provider supplies to its instructors relating to the matters set forth in items 4.5 through
4.7.

Section 5.
5.1

Fees and Fee Waivers.
Fees
(a) List all fees and contributions paid by the debtor in connection with the instructional
course.

(b) List any reduced rates and the reason for such reduction, including discounts or
special rates for debtors referred by any attorney or law firm, or special rates for
spouses who take the course together, based on criteria other than ability to pay. The
Provider shall not unilaterally decrease its fee without prior notice to the United
States Trustee.

(c) List all attorneys or law firms from whom the Provider directly or indirectly
accepts, or to whom the Provider provides reduced rates or discounts (including
coupons) in connection with financial education services.

(d) Describe how the Provider discloses to debtors its fees, and reduced rates or
discounts identified in (a), (b), and (c) and describe the timing of disclosures.

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(e) If the Provider seeks fees in excess of $50 per debtor, describe the basis for the fee
increase and provide a cost-based justification. Please see the Instructions. The
Provider shall not unilaterally increase its fee without prior United States Trustee
approval.

5.2

Fee waivers.
(a) Describe any and all fee waiver and fee reduction policies based on the
debtor’s ability to pay.

(b) Describe how the Provider discloses to the debtor its fee waiver or fee reduction
policies based on the debtor’s ability to pay, and describe the timing of disclosures.

Section 6. Disclosures
Attach copies of all disclosure form(s) that will be provided to debtors. Please see the
Instructions for a complete list of mandatory disclosures.
Disclosure documents are attached.
Section 7. Appendices (to be completed and attached to the application)
New Applicants: Complete Appendices A, B, C, and D. Do not complete Appendix E.
Returning Applicants: Complete Appendices A, B, C, D, and E.
7.1

Appendix A: Acknowledgments, Agreements, and Declarations in Support of
Application for Approval as a Provider of a Personal Financial Management
Instructional Course.

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7.2

Appendix B: Judicial Districts.

7.3

Appendix C: Business Locations.

7.4

Appendix D: Matrix of Current Instructors. For each location listed on Appendix C
that will be staffed by instructors providing instructional courses to debtors, enter the
instructor’s name in the employee box and complete the information as instructed.

7.5

Appendix E: Activity Report for Approved Personal Financial Management Instructional
Course Providers. If the Provider has never been approved to provide an instructional
course, do not complete Appendix E.
Documents are attached.

Section 8. Certification and Signature
I declare under penalty of perjury that I am authorized to complete this application on behalf of
the above named organization; I have examined the contents of the application, enclosures, and other
accompanying documents; the application does not falsify, conceal, cover up by any trick, scheme or
device a material fact; the application does not make any materially false, fictitious or fraudulent
statement or representation; the documents provided with this application are authentic, complete, and
accurate and do not make any materially false, fictitious or fraudulent statement or representation; and all
representations are true and correct to the best of my knowledge, information, and belief.

Signature of President, Chairman, Trustee, or Other
Authorized Representative

Type or Print Name of Signer

Type or Print Title of Signer

Date

- 13 -

OMB No. 1105-0085 Approval Expires ________

U.S. Department of Justice
Executive Office for United States Trustees

SUPPLEMENTAL
INSTRUCTIONS FOR APPLICATION FOR APPROVAL AS A PROVIDER
OF A PERSONAL FINANCIAL MANAGEMENT INSTRUCTIONAL COURSE
FOR ACCREDITED UNIVERSITIES AND COMMUNITY COLLEGES
Introduction. The United States Trustee Program has determined that accredited universities
and community colleges are eligible to apply to become providers of personal financial
management instructional courses using a streamlined version of the Application for Approval as
a Provider of a Personal Financial Management Instructional Course (the “Application”).
Instructions. Accredited universities and community colleges should obtain a copy of the:
(1) Application; and (2) Instructions from the United States Trustee’s website located at
www.usdoj.gov/ust.
New Applicants. Check the box marked “New Applicant” in item 1.1. Complete every item in
the application. Do not check any of the “NC” (No Change) boxes. Where an item provides
alternatives for new applicants and returning applicants, respond as directed for new applicants
only.
Returning Applicants. Check the box marked “Returning Applicant” in item 1.1. Where an
item provides alternatives for new applicants and returning applicants, respond as directed for
returning applicants only.
Statement of No Change for Returning Applicants. Where a “NC” box appears beside an
item, if the Provider’s response to that item is identical to its response in the most recent
application, the Provider may check the “NC” box indicating no changes have occurred and
continue to the next item. If an item does not offer the option of checking a “NC” box, then the
Provider must complete the item even if its response has not changed since the previous
application.
Notwithstanding the directions contained in the Instructions, accredited universities and
community colleges must complete only the following portions of the Application:
Section 1. General Information Concerning the Provider
Complete all of section 1.
Section 4. Learning Materials and Methodologies (Course Curriculum)
Complete “Teaching Methods” and Sections: 4.2 - 4.9.

Section 5. Fees and Fee Waivers
Complete all of section 5.
Section 6. Disclosures
Complete all of section 6.
Section 7. Appendices.
Complete all of section 7.
Section 8. Certification and Signature
Execute Application as set forth in section 8.
Completed applications should be submitted to the Executive Office for U.S. Trustees in
accordance with the Instructions for the Application. For questions regarding submission of an
application pursuant to these Supplemental Instructions, please call (202) 514-4100.

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File Typeapplication/pdf
AuthorUnited States Department of Justice
File Modified2019-10-16
File Created2019-10-16

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