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Prepare for housing counseling

Full-service preparation adds the questions housing counselors commonly ask. You choose what to answer. HomeBase prepares your facts; your counselor handles their own intake, permissions and counseling records.

These answers are separate from your mortgage application. They do not authorize anyone to contact your mortgage company, request a credit report or share your information.

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Every question is optional. Enter another person’s information only with their permission. Blank means unanswered; zero means an amount you entered. Demographic questions include an option to decline. Share only what your chosen agency needs. Do not enter Social Security numbers in these answers.

Contact

Name

Date of birth

Telephone number

Work phone

Mailing street address

City

State

ZIP code

County

Length of occupancy

Preferred contact method

Safe contact instructions / reasonable accommodation needed

Household

Preferred language

Highest education level attained

How did you hear about us?

Race

Ethnicity

Rural area status

Limited English proficiency status

Legal marital status

Gender

Household type

Total household size (including applicant)

Number of dependents

Number of minors in household

Do you have a disability?

Do you have a disabled dependent?

Are you a veteran?

Are you active military?

Are you foreign born?

Do you or your household receive a Housing Choice Voucher?

Have you owned a residence before?

Are you a first-generation homebuyer?

Are you a farm worker?

Are you a colonias resident?

Have you experienced housing discrimination?

Citizenship / permanent resident status (only if your chosen agency asks)

Counseling needs

How may we help?

Housing arrangement

What is your goal for the house?

Other HUD assistance received (program or none)

Credit score, source and date (if known; no credit report request)

Reason credit score is unavailable (if known)

Predatory lending or loan scam concern

Previous counseling: agency and dates (if any)

Job duration

Total household debt (if known)

Is a member of the household 62 years old or over?

Finances

Household monthly income (before taxes, all household members)

Household annual income (before taxes, all household members)

Income period covered / current versus historical

Income level as a percentage of Area Median Income (if known)

Sources of income and gross monthly amounts, by person

Debts: creditor, balance and monthly payment (by person)

Assets: checking, savings, cash, CDs, securities, retirement and other liquid funds (by person)

Bankruptcy: chapter, filing date, case number, discharge date, mortgage included

Previous foreclosure date (if applicable)

Income by source after taxes (monthly, if known)

Withholding (monthly)

Monthly savings deposits

Employment

Current employer

Title

Hire date

Employer phone

Employer address

Hours per week

Pay rate

Pay frequency

Other employer

Other job title

Other job hire date

Other employer phone

Other employer address

Other job hours per week

Other job pay rate

Other job pay frequency

Home and mortgage

Property type / number of units

Estimated property value

Other properties: address, use, value, loan balance, monthly payment and rent

First mortgage: servicer, loan type, fixed/ARM, term, origination date, HELOC, balance, payment, rate, last payment, amount due

Second mortgage: servicer, type, term, origination date, HELOC, balance, payment, rate, last payment, amount due

Taxes and insurance: escrow included, separate amounts, paid current

Sale listing, agent, offer and closing date

Prior forbearance, deferral or modification (program and dates)

Hardship reason, start date and current status

How many days are you past due?

Loan purpose, originating lender, original amount, first reset date, reset interval, periodic cap, lifetime cap, balloon amount/date, prepayment amount and years in effect

Forced place insurance?

Mortgage company contact person, phone and fax (as shown on your records)

When did the mortgage company last accept a payment? How much was the payment?

Previous defaults?

Has the homeowner talked to the servicer?

Is your name on the mortgage?

Relation to the applicant

Monthly spending

Rent

Mortgage payment

Water / sewer / garbage

Electric

Heat / gas

Phone / cell phone

Internet

Cable / TV subscriptions

Vehicle payments

Auto insurance

Gasoline

Vehicle maintenance

Health insurance

Medical debt payment

Doctor visits

Prescriptions / medications

Groceries

Dining out

Clothing

Toiletries

Laundry / dry cleaning

Barber / beauty / personal care

Gym / health club

Child care

Child support payments

Tuition / school

Credit card payments

Student loan payments

Personal loan payments

Music subscriptions

Other insurance

Donations

Other expenses

Property tax

Homeowners insurance

Mortgage insurance

HOA / condo fees

Second mortgage payment

Credit collections

Payday loan

Public transportation

Savings / emergency fund

Gifts

Pet expenses

Retirement account deposits

College fund deposits

Investment account deposits

Other savings / investments

Other housing expense

Other transportation expense

Other personal expense

Other entertainment expense

Other child expenses

Second client: Contact

Second client — Name

Second client — Date of birth

Second client — Telephone number

Second client — Work phone

Second client — Email

Second client — Mailing street address

Second client — City

Second client — State

Second client — ZIP code

Second client — County

Second client — Length of occupancy

Second client: Household

Second client — Preferred language

Second client — Highest education level attained

Second client — Race

Second client — Ethnicity

Second client — Legal marital status

Second client — Gender

Second client — Do you have a disability?

Second client — Are you a veteran?

Second client — Are you active military?

Second client — Are you foreign born?

Second client — Citizenship / permanent resident status (only if your chosen agency asks)

Second client: Employment

Second client — Current employer

Second client — Title

Second client — Hire date

Second client — Employer phone

Second client — Employer address

Second client — Hours per week

Second client — Pay rate

Second client — Pay frequency

Second client — Other employer

Second client — Other job title

Second client — Other job hire date

Second client — Other employer phone

Second client — Other employer address

Second client — Other job hours per week

Second client — Other job pay rate

Second client — Other job pay frequency

Second client: Finances

Second client — Sources of income and gross monthly amounts, by person

Second client — Debts: creditor, balance and monthly payment (by person)

Second client — Assets: checking, savings, cash, CDs, securities, retirement and other liquid funds (by person)

Second client — Bankruptcy: chapter, filing date, case number, discharge date, mortgage included

Second client — Previous foreclosure date (if applicable)

Second client — Income by source after taxes (monthly, if known)

Second client: Home and mortgage

Second client — Is your name on the mortgage?

Second client — Relation to the applicant

Saving clears these answers from the page. They are saved securely to your account, with no browser storage copy. Open the intake again when you want to review it.

Prepared from public agency forms and HUD reporting documents checked October 9, 2026. Your agency may have different or newer questions. This is a preparation draft, not an agency intake submission.

Prepare for housing counseling

Social Security number — optional