Disclosure Form for Pre-Filing Bankruptcy Clients

Welcome! We understand that you are here because you are experiencing financial problems, and that you may be considering filing for bankruptcy and are required to receive "counseling" before you may file.

This agency has over 20 years of experience of helping people with financial problems. Our role is not to be judgmental, but to provide assistance. Specifically, we will do a budget analysis that will examine your financial situation, discuss the factors that may be the cause of your problems, and explore your options for developing a reasonable plan for dealing with them. We will provide you with information about bankruptcy, including its process and possible consequences. We will also consider alternatives to bankruptcy to resolve your problems. It is our view that the purpose of this online course is to provide you with information so that YOU may choose the option that you think is best. At the conclusion of this course, you will be provided with a certificate that you will need should you decide to file for bankruptcy, within 1 business day. The certificate is valid for 180 days after the date on which counseling is completed.

This agency is a member of the National Foundation for Credit Counseling ("NFCC") The NFCC has high standards for quality credit counseling and financial education, and this agency complies with those standards. In addition, this agency is accredited by the Council on Accreditation ("COA"), an independent third-party organization that reviews and monitors entities that provide social services. We are a non-profit agency. We are organized and operate in accordance with Section 501(c)(3) of the Internal Revenue Code.

The consumer credit counselor conducting or supervising this online course has been trained and certified in accordance with the NFCC standards, and while he/she has expertise in helping those with financial problems, he/she cannot provide you with legal advice. In fact, this course is designed to provide you with information and alternatives; it is not intended to take the place of a consultation with an attorney to explore your legal rights and options.

In order to assist you, it is essential that you provide us with information that is as accurate and complete as possible. Rest assured that the information concerning your financial condition and status that you provide during this course is strictly confidential. Such information would include, but is not limited to, income, debts, credit accounts, earnings, assets, and employment data. We will not disclose any such information that you provide orally or in writing to anyone, except as authorized by you in writing or as required by law, such as in response to a subpoena. We may compile data and aggregate information that you give us, but this information will not be disclosed in any manner that would personally identify you. This agency will not disclose or provide any information about this course to a credit reporting agency. Since this agency does not report any information to a credit reporting agency, there is no impact [of counseling] on credit reports.

To help cover the cost of providing this course to you, this agency charges a fee of $40 for single filer and $60 for a married couple filing jointly. Payments are accepted in the form of online payment via our website. Online clients who wish to pay by mailing a money order or cashier's check to us in advance should contact us for instructions at 1-800-255-2227 or www.cccs@fsainc.org. In limited circumstances, you may be eligible to have this fee waived.

This agency also receives funding in the form of grants from state and federal governmental units, and creditors. A significant portion of funding for this agency comes from voluntary contributions from creditors who participate in DMPs. Since creditors have a financial interest in having debts repaid, most are willing to make a contribution to help fund the overall services of this agency. These contributions are usually calculated as a percentage of payments that are made through a DMP.