THDA Foreclosure Intervention Initiative Client Data Reporting Back End Debt-to-Income RatioRoundDoes the client have a second loan?Is loan: First or Second LoanIs loan: Option ARMIs loan: HybridCounseling Outcome Date, Format is MM/DD/YYYYIs loan: Privately Held LoanIs loan: FHA or VA Insured LoanIs loan: Interest Only LoanFDIC/NCULA or Mortgage Company Name(if available)Referral SourceIf Servicer is NOT Listed, please email to have it added.Branch or Sub-granteeZipStateCountyCityStreet NameStreet NumberCounseling OutcomeLoan Status at First ContactPrimary reason for defaultIf type of loan at intake is an ARM -has the interest rate already reset?Type of first Loan Product at IntakeTotal Monthly Payment (PITI) at intakeSource of Credit ScoreCredit Score at IntakeLoan number assigned by Current ServicerName of Current ServicerOriginal Loan Number(if available)Current Servicer FDIC(if available)Name of Originating LenderTotal group foreclosure education hours takenTotal individual foreclosure counseling hours receivedAddress of Property - Do Not use PO BoxHousehold Income LevelAnnual Household Family IncomeHousehold TypeClients GenderClients Ethnicity (Hispanic Y/N)Clients RaceClients AgeClients Last NameClients First NameMode of CounselingCounseling Intake Date, Format is MM/DD/YYYYCounseling Level  Please make sure all information is correct before clicking the Submit Information Button.

Social Security Number ex. 111-11-1111