CHN Housing Partners Homeownership Preservation Application

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Thank you for contacting CHN Housing Partners for assistance with your mortgage and/or property taxes. We are here to help! 

CHN Housing Partners has provided housing counseling and mortgage assistance to homeowners of Cuyahoga County for over 15 years.

How does it work? 

STEP 1: Complete the application
Once an application is submitted and has been deemed complete, someone from CHN will contact you to schedule a virtual appointment. (Please see page 7 of this application for a complete list of documentation.)

STEP 2: Meet with a HUD-Certified Housing Counselor
During this appointment, you will have the opportunity to discuss mortgage and/or property tax options with a housing counselor, review your credit report, and put together a financial plan. Housing counseling services are available for all residents of Cuyahoga County, regardless of income or location. 

Some applicants may be eligible for financial assistance. All available financial assistance programs are grants (the funds do not need to be paid back) and the funds will be sent directly to the mortgage servicer or Property Tax Assessor. Some programs may require that applicants meet income and hardship eligibility requirements. 

Online Application Guidelines
To apply for programs with CHN Housing Partners, you must complete an application with us along with providing documents to verify the information submitted. We have split this into the following sections:

1. Application information: Your contact and demographic information
2. Household members: Other members of your household and their demographic information
3. Income sources: All sources of income and public benefits for all household members over 18
4. Assets: All liquid assets for all household members over 18
5. Housing & utility details: Details about your mortgage and utilities for program-specific purposes and to help us assess what program(s) you may need
6. Document upload: We will request scanned copies, legible photos or screenshots of documents as verification for your eligibility for programs. 

You may encounter a slow system or downtime due to a high volume of traffic on the site. Please use the "Save my progress and resume later" feature located at the top of the form OFTEN to avoid losing any information. (This form is powered by FormAssembly.)


Fair Housing Act (42 USC 3600, et seq.)
If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about our services, please talk to us about arranging alternative accommodations. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws, including the federal Fair Housing Act (42 USC 3600, et seq.)

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Applicant and Co-Applicant Details

In this section, please enter your most up to date contact information and demographic information.

CHN Housing Partners (CHN) is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all personal information shared verbally and/or in writing will be managed within ethical and legal consideration. Additionally, we want you to understand how we use the personal information we collect. Please carefully review this notice as it describes our policy regarding the collection and disclosure of your nonpublic, personal information.
 
CHN's Housing Counseling Disclosure and Privacy Policy

The Applicant (and Co-Applicant, if applicable) should be an adult member of your household who will be able to represent, provide information for, and make decisions on behalf of your household. 

Please prepare for upload: Photo Identification and Social Security Cards for each Applicant and Co-Applicant.
Applicant Information


















Enter date in MM/DD/YYYY format









Co-Applicant Information











Enter date in MM/DD/YYYY format








WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.

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Household Members

Please enter additional members who reside in your household (i.e. children, dependents, other family members, etc.). Use the "Add Additional Household Member" link to add as many as you need.

You do not need to re-enter Applicant or Co-applicant (if applicable) information here.


Please prepare for upload: For each household member, be prepared to provide verification that they are your dependents - such as Social Security Cards and Birth certificates

Household Member


Enter date in MM/DD/YYYY format










WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.

Page 4


Current Income Sources and Public Benefits


Please enter all sources of Income and Public Benefits that the household is CURRENTLY receiving, for all household members over the age of 18. 


Use the "Add Additional Income Source" link to add as many as you need


Current Annual Income is the estimated income for the current year including any wages,

benefits, alimony, child support and other forms of financial income or support.


Income includes: Full-time employment, part-time employment, self-employment, spousal support, child support, investment income, Social security, SSI, SSDI, income from assets, pension/annuity, unemployment, adoption subsidy, short term disability, long term disability, veteran's benefits, zero income, family contribution, other

Public benefits include: Food stamps, WIC, ADC, OWF/TANF, rental subsidy, utility allowance, other public benefit

Please prepare for upload: Verification of income for the past 60 days - pay stubs, employment letters, award letters, etc. 


Current Income or Public Benefit Source

Enter the Household Member who this income belongs to


Provide the Job Title for Employment types, if applicable
Please take the total income you received in the last 30 days and multiply by 12 to determine your annual income:

Please estimate to the best of your ability. Our staff will review your documents and provide a full eligibility determination.
Monthly Expenses
Please input the monthly amounts in each of these categories. 












Monthly Expenses
Please input the monthly amounts in each of these categories. 












WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.

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Assets Declaration
Please enter all liquid Assets you have control over for all household members over the age of 18. Liquid assets are cash on hand or assets in any other form that can be converted to cash within 20 days (SSA.gov). Please include all bank accounts; if the account balance is $0, enter $0 as the value.

Asset types include: Bank Accounts - Savings and/or Checking, Investment Accounts, Retirement, Certificates of Deposit, Cash on Hand, Pre-paid Debit Cards, Health Savings Accounts, Life Insurance Cash Value

Asset


Please estimate to the best of your ability - enter 0 if unsure
WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.

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Household and Utility details

We will be asking more specific questions about your Housing Details here, including your living situation, mortgage payment amount, and utility details. This information will allow for us to screen eligibility for the wide range of programs we offer. You will be under no obligation to participate in programs we recommend.

Please prepared for upload: Mortgage statement, copies of utility bills for all utilities and additional verification as requested in each section that follows
Housing






Mortgage Servicer Information

By providing your mortgage servicer's information, you authorize us to contact them to discuss your housing situation. Your will review a third-party letter of authorization with your housing counselor during your appointment and this form will be sent to your mortgage company. 














We encourage you to check your property tax bill using this link: myplace.cuyahogacounty.us
If you occupy this home as your primary residence, you are eligible for a 2.5% credit on your bill. If you occupy this home as your primary residence and are permanently disabled and/or are 65 or older, you may be eligible for the Homestead exemption. Applications for both can be obtained on the website linked above. 
Hardship Statement
We require a statement of Hardship that helps explain why you need assistance. Please select the category that represents the primary hardship reason and any additional detail in the Hardship Statement. 


Please briefly explain your hardship here:

up to 255 characters

WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.

Page 7


Upload Documents

Please use this page to upload documents that support your application. You can attach electronically downloaded documents, use a scanner, or take pictures or screenshots of your documents with your phone.

You can upload multiple files per section by using the "Add another ..." link. There is a limitation of 20 files per form. If you have more than 20 files to upload, please email them to info@neorenthelp.org.

Gather the required documents:
1. Photo identification for all household members 18 years or older
2. Verification of household members (Social Security card preferred, or birth certificate) for all household members
3. Mortgage Statement
4. Income documentation for the most recent 60 days
5. Bank Statements for the most recent 60 days. Include statements for all active accounts, including all pages (even if blank). 
6. Federal Income Tax Returns for the past two years. Include your entire Form 1040 and any applicable schedules (e.g. Schedule C for self-employment income). Sign and date page 2 of your Form 1040. (Do not include the City and State.)

*Note: These are the only documents required for your initial eligibility screening. Additional documentation may be required depending on the resolution type. Your housing counselor will advise of additional required information.  


Complete applications with all required supporting documents will be processed faster - please upload as much as you are able to and ensure you have documents for each section!  


If taking photos with your phone/camera, you can line up your IDs and Social Security cards within one image, instead of one at a time
ID
Mortgage Statement

Upload a copy of your most recent mortgage statement. The mortgage statement should include: the account number, payment amount, delinquent balance. 





Utility Bills
Upload Utility Bills in each section listed here based on programs you are requesting assistance for. Please upload the actual bill, showing usage, even if the bill is not in your name.






WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.

Page 8

Housing Counseling Disclosure

About Us and Program Purpose: The mission of CHN Housing Partners (CHN) is to build strong families and vibrant neighborhoods through quality affordable housing and strengthened financial stability. CHN is a nonprofit, HUD-approved housing counseling agency. We provide free housing counseling and education services, including Mortgage Delinquency & Default Resolution, Reverse Mortgage, Pre-purchase, Financial, Budgeting, & Credit Repair, and Rental Housing Counseling services, as well as Financial, Budgeting, & Credit Repair and Pre-purchase Homebuyer Education Workshops. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws, including the federal Fair Housing Act (42 USC 3600, et seq.). As a housing counseling program participant, please affirm your roles and responsibilities along with the following disclosures and initial, sign, and date this form below.

Client and Counselor Roles and Responsibilities

Termination of Services: Failure to work cooperatively with your housing counselor and/or CHN will result in the discontinuation of counseling services. This includes, but is not limited to, missing three consecutive appointments. By signing below, you are acknowledging that you have read and understood this. 

Agency Conduct: No CHN employee, volunteer, or agent shall undertake any action that might result in, or create the appearance of, administering counseling operations for personal or private gain, provide preferential treatment for any person or organization, or engage in conduct that will compromise our agency’s compliance with federal regulations and our commitment to serving the best interests of our clients.

Agency Relationship: CHN has financial affiliation with HUD, United Way of Greater Cleveland, the State of Ohio, Cuyahoga County, the City of Cleveland, and banks including Third Federal, KeyBank, and JP Morgan Chase. As a housing counseling program participant, you are not obligated to use the products and services of CHN or our industry partners.  

Alternative Services, Programs, and Products & Client Freedom of Choice: In the interest of full disclosure, CHN also provides utility services with partnerships through: Dominion East Ohio, Illuminating Company, Cleveland Public Power, Division of Water, NEO Regional Sewer District, and U.S. Department of Energy, Health, and Human Services. CHN also provides tax preparation through a partnership with Enterprise Community Partners and the IRS VITA program. As a housing counseling client, you are not obligated to participate in any of these services. You are entitled to choose whatever services and/or products best meet your needs. 

Fees: CHN currently charges a fee of $125 for Reverse Mortgage Counseling, paid to CHN upon service. All other direct services are free of charge. Service cannot be denied due to an inability to pay and cannot impose a financial hardship. CHN also offers two online homebuyer education platforms, Framework and eHome America, which cost $75 and $99, respectively, and are paid directly to the vendor. If applicable, I/we acknowledge that you received a copy of CHN’s Fee Structure at the time Reverse Mortgage Services were provided. 

Referrals and Community Resources: CHN provides a community resource list which outlines regional services available to meet a variety of needs, including utility assistance, food banks, and legal aid assistance, among others. This list also identifies alternative agencies that provide services, programs, or products identical to those offered by CHN. 

Privacy Policy: I/we acknowledge that you received a copy of CHN’s Privacy Policy.

Home Inspection: If applicable, I/we acknowledge that you received a copy of ‘For Your Protection: Get a Home Inspection’ and ’10 Important Questions to Ask Your Home Inspector’.

Errors and Omissions and Disclaimer of Liability: I/we agree that CHN, its employees, agents, and directors are not liable for any claims and causes of actions arising from errors or omissions by such parties, or related to my participation in CHN counseling; and I hereby release and waive all claims of action against CHN and its affiliates. I have read this document, understand that I have given up substantial rights by signing it, and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law. If any provision of this document is unenforceable, it shall be modified to the extent necessary to make the provision valid and binding, and the remainder of this document shall remain enforceable to the full extent allowed by law. Please note that representatives of CHN do not provide tax or legal advice and that you should consult your tax advisor or attorney for such guidance.

Quality Assurance: In order to assess client satisfaction and in compliance with grant funding requirements, CHN, or one of its partners, may contact you during or after the completion of your housing counseling service. You may be requested to complete a survey asking you to evaluate your client experience. Your survey data may be confidentially shared with CHN grantors such as HUD.

Sharing of Information: By signing this Disclosure Statement I give CHN authorization to share my information with HUD and other third parties, as applicable.

Clients of Neighborhood Housing Services of Greater Cleveland, Inc.: In July of 2019, NHS of Greater Cleveland, Inc. became an affiliate of CHN and all housing counseling activities of both agencies are now administered and managed by CHN. If you were an active client of NHS of Greater Cleveland, Inc. before July 2019 we require your agreement to allow CHN employees to access your information across our integrated platform in the ways and for the purposes outlined above. You may receive this request from us even if you have a current authorization form on file with NHS of Greater Cleveland, Inc. 

HSCP: CHN receives funding through the Housing Stability Counseling Program (HSCP). I understand that HSCP may review my file for monitoring and compliance purposes. HSCP may conduct follow-up with as it relates to program evaluation.

Privacy Policy:

CHN Housing Partners CHN) is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all personal information shared orally and/or in writing will be managed within ethical and legal consideration. Additionally, we want you to understand how we use the personal information we collect. Please carefully review this notice as it describes our policy regarding the collection and disclosure of your nonpublic, personal information.

 What is nonpublic, personal information?
  • Information that identifies an individual personally and is not otherwise publicly available information, such as your Social Security Number or demographic data such as your race and ethnicity
  • Includes personal financial information such as credit history, income, employment history, financial assets, bank account information and financial debts
What personal information does CHN collect about you and from what sources? 
  • Information that you provide on applications, forms, emails, or verbally 
  • Information about your transactions with us, our affiliates, or others 
  • Information we receive from your creditors or employment references
  • Credit report
What categories of information do we disclose and to whom? 
We may disclose the following personal information to financial service providers (such as companies providing home mortgages) Federal, State, and nonprofit partners for program review, monitoring auditing, research, and/or oversight purposes, and/or any other preauthorized individual and/or organization. The types of information we disclose are as follows: 
  • Information you provide on applications/forms or other forms of communication. This information may include your name, address, Social Security Number, employer, occupation, account numbers, assets, expenses, and income. 
  • Information about your transactions with us, our affiliates, or others; such as your account balance, monthly payment, payment history, and method of payment. 
  • Information we receive from a consumer credit reporting agency, such as bureau reports, your credit and payment history, your credit scores, and/or your creditworthiness. 
  • We do not sell or rent your personal information to any outside entity. 
  • We may share anonymous, aggregated case file information; but this information may not be disclosed in a manner that may personally identify you in any way. This is done in order to evaluate our program, gather valuable research information, and/or design future programs. 
  • We may also disclose personal information about you to third parties as permitted by law or when required by a governmental authority
How is your personal information secured? We restrict access to your nonpublic personal information to CHN employees who need to know that information in order to perform their housing counseling duties. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information; and we train our staff to safeguard client information and prevent unauthorized access, disclosure, or use.

Opting out of certain disclosures: You may direct CHN to not disclose your nonpublic, personal information to third partners (other than disclosures made to project partners, those permitted by law or required by governmental authorities). However, if you choose to opt out, we will not be able to answer any questions from your creditors, which may limit CHN’s ability to provide services such as foreclosure prevention counseling. If you choose to opt out, please call 216.881.8443 and advise that you wish to opt out of certain disclosures. 


Acknowledgement & Submit

I/we certify that all provided information is correct to the best of my knowledge and have read and agree with the Housing Counseling Disclosure and Privacy Policy forms. I/we authorize CHN Housing Partners to verify all information contained on this online form and to pull my credit report. I/we understand that I may be assisted by federal funds which carry severe penalties, including incarceration.

By typing my full name below, I hereby authorize CHN to release nonpublic personal information it obtains about me to any third parties necessary to provide me with the services I requested. I give CHN permission to pull my credit report. I acknowledge that I have read and understand the above privacy practices. I understand I will receive a copy of all information submitted at the email address I provided on Page 2, "Applicant E-mail Address".




WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.
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