Hmda Data Collection Form PDF Details

As a homebuyer, you may be required to complete a Hmda Data Collection Form. This is a form used by the government to collect data about race, ethnicity, and neighborhood demographics. Completing this form is important because it helps the government track trends and ensure equal access to housing. If you're unsure about how to complete the form or have any questions, consult with your real estate agent or lender. They will be able to help guide you through the process.

This knowledge can help you comprehend better the details of the hmda data collection form before you start filling it out.

Form NameHmda Data Collection Form
Form Length3 pages
Fillable fields58
Avg. time to fill out12 min 21 sec
Other nameshmda collection form, hmda data collection form, hmda data reported on what document, hmda data form sample

Form Preview Example


LO: Loan/Borrower Name: ________________________________________________________________

LO: Property Address: ____________________________________________________________________

LO: Loan Number: __________________________ Loan Officer: ________________________________


LO: 1. Is this a Home/Dwelling Purchase, Non-HELOC Home/Dwelling Improvement, or Home/Dwelling Refinance Loan?

____YES ____NO

If the answer is YES, this form must be fully completed by the loan officer and retained in the loan file. Incomplete forms will be returned to the loan officer, with the loan file, for completion. Please note that a commercial loan could be a HMDA reportable loan, and if so, this form must also be completed by the loan officer. For HMDA purposes, a dwelling is a residential structure, including a single family residence, condo, manufactured home, or apartment building. If your answer to question #1 is NO, and the loan is not for a Home Purchase, Non-HELOC Home Improvement, or Home Refinance, you may stop now.

LO: 2. Did this loan start as a request for Prequalification? ____YES _____NO

*If the answer is YES, is there a letter in the file indicating that the prequalification request was approved or denied? ____YES ____NO

Date of letter: _____________________

There must be a letter in the file for this loan to be considered a prequalification.

If the loan request is for a property with a specific address, this is a preapproval and not a prequalification.

If this is a true prequalification, and not a preapproval, STOP completing this form, provided there is a prequalification letter in the file. If this is a prequalification that turned into an actual loan request, continue filling out the form.


OP: 3. Enter the following information:

Date credit was pulled on applicant: _______________________

Date written on the original 1003/application form by the Loan Officer, or date commercial App was made via other means:


Date 1003/application form was received at the Bank, if via mail or internet: ________________________

If this is a prequalification request that turned into an actual loan request, enter the date that a property address was identified for this loan:

_________________________________ . What document in the file is used to verify receipt of an address and switch to a loan request:


For RE Mortgage Loans: Date of Good Faith Estimate: ______________________________

Date of Early TILA Disclosure: _____________________________

For COMMERCIAL Loans: Does the Loan File include a conversation or other log/evidence documenting when and how the application occurred? If NO, explain why not.

________YES _________NO

LO: 4. Type of Loan (circle one):

Code 1—Conventional (any loan other than FHA, VA, FSA, or RHS loans)

Code 2—FHA-insured (Federal Housing Administration)

Code 3—VA-guaranteed (Veterans Administration)

Code 4—FSA/RHS-guaranteed (Farm Service Agency or Rural Housing Service)

LO: 5. Property Type (circle one):

Code 1—One-to-four family dwelling (other than manufactured housing)

Code 2—Manufactured housing

Code 3—Multi-family dwelling (housing five or more families)

LO: 6. Purpose of Loan (circle one):

Code 1—Home purchase (also use if home purchase and home improvement; or purchase and refinance; or purchase, improvement, and refinance) Code 2—Home improvement (also use if home improvement and refinance)

Code 3—Refinancing (means existing dwelling-secured loan is being paid off by new dwelling-secured loan).

LO: 7. Occupancy of property (circle one):

Code 1—Owner-occupied as principal dwelling;

Code 2—Not owner-occupied as principal dwelling (use for investment property, rental properties; second homes; vacation homes) Code 3—Not Applicable (if you use this code, use Property Type Code 3, in question #6, for Multifamily dwelling)


LO: 8. Enter dollar amount of the loan (to be rounded up or down to the nearest thousand on the LAR): __________________________

LO: 9. Was this a request for a preapproval for a home purchase (circle one):

Code 1—Preapproval requested

Code 2—Preapproval not requested

Code 3—Not Applicable--Use this Code if the Purpose of the Loan is a Refinance or Home Improvement.

If Code 1, indicate date of preapproval letter in file, denying or approving preapproval request: _____________________________

CL: 10. Action taken (circle one):

Code 1—Loan originated [loan originated/funded, including preapprovals] Code 2—Application approved but not accepted [do not use for preapproval] Code 3—Application denied [do not use for preapproval]*

Code 4—Application withdrawn [do not use if preapproval withdrawn; only if application withdrawn before credit decision made. Withdrawn preapprovals are not reported under HMDA]

Code 5—File closed for incompleteness [do not use if preapproval file closed for incompleteness; these are not reported under HMDA.. You must have sent written notice of incompleteness]

Code 6—Loan purchased by your institution Code 7—Preapproval request denied*

Code 8—Preapproval request approved but not accepted (optional reporting)

**Note the difference between codes 3 and 7—application denied and preapproval denied; and codes 2 and 8—application approved but not accepted and preapproval approved but not accepted. Codes 2 and 3 should NOT be used for preapprovals; Codes 7 and 8 should NOT be used for actual applications.

Available from

CL: 11. Date of Action Taken: __________________________________________

What document in the file is used to verify the Action Taken date?_____________________________________________

PR: 12. Property Location (Circle appropriate County and fill in Census Tract Number):





42020= San Luis Obispo County

079=San Luis Obispo County

42060= Santa Barbara County

083=Santa Barbara County

41500= Monterey County

053=Monterey County

12540=Kern County

029=Kern County

Other= _______________

111=Ventura County



Other: ______________________



Other= _______________

Census Tract Number: ________________

If the property location data is not pulled automatically by software, is there an FFIEC geocode [or Flood Certification] printout/verification in the file?


________ NO If NO, one should be printed out and included in the file.


LO: 13. For RE Mortgage Loans, is the Government Monitoring Information (GMI)—Race, Ethnicity, Sex—completed on the initial 1003 form, including

how the application was received?

______YES ____NO








The GMI in the initial and final 1003s must be identical.








Does the GMI in the initial and final 1003s match? _________ YES ________ NO







If NO, the loan officer must make appropriate notations to ensure that the GMI matches.







If the loan officer marked GMI information based on visual observation, is that notation included on the 1003, along with the date the visual


observation was made?________ YES

__________ NO







For Commercial Loans, was a separate Monitoring Information Form completed? _______ YES _______ NO












Ethnicity – 1= Hispanic or Latino




















2 = Not Hispanic or Latino








3 = Information not provided











4 = N/A











5 = No Co-applicant










Race – 1

= American Indian or Alaska Native









2 = Asian










3= African American


Sex – 1 = Male







4 = Native Hawaiian or Pacific Islander

2 = Female








= White


3 = Information Not Provided







= Information not Provided


4 = N/A








= N/A


5 = No Co-applicant







= No Co-applicant










LO: 14. Income of Applicant—for a one to four family dwelling, enter the annual income of the applicant (to be rounded up or down to the nearest

thousand on the LAR). If the applicant is not a natural person (i.e., loan to a business entity), or for a multifamily dwelling, enter N/A:_________________

CL: 15. Type of purchaser (circle one):

Code 0—Loan was not originated or was not sold in calendar year covered by register. Use if applications were denied, withdrawn, or approved but not accepted, or if file was closed for incompleteness.

Code 1—Fannie Mae Code 2—Ginnie Mae Code 3—Freddie Mac Code 4—Farmer Mac

Code 5—Private securitization

Code 6—Commercial bank, savings bank, or savings association

Code 7—Life insurance company, credit union, mortgage bank, or finance company Code 8—Affiliate institution

Code 9—Other type of purchaser. Specify purchaser: _____________________________________________

PR: 16. Lender should indicate the following data regarding the loan, as documented in the file:

Rate Lock Date: ________________

Term: ___________________

Final APR: ___________________

If loan did not originate, circle N/A here: N/A

CL: 17. Rate Spread:

Using the rate lock date, term, and final APR set forth above, obtain the rate spread through the website’s rate spread calculator. Indicate Rate Spread from website, or N/A if applicable: _________________________

LO: 18: Lien Status (circle one)—also, for loans that do not originate, circle the code that would have been appropriate:

Code 1—Secured by first lien

Code 2—Secured by subordinate lien

Code 3—Not secured by lien

Code 4—Not applicable (purchased loan)







(Including verification of loan officer’s reported data)







After verification of Loan Officer Data, information should be input into the HMDA LAR, and this form should be retained in the Loan File for future compliance oversight reviews and FDIC examination and external audit purposes.

Available from

How to Edit Hmda Data Collection Form Online for Free

We were creating the PDF editor with the idea of making it as effortless to work with as it can be. That's the reason the process of filling in the online hmda form make will undoubtedly be effortless as you go through the next actions:

Step 1: The initial step would be to hit the orange "Get Form Now" button.

Step 2: You can now modify your online hmda form make. You should use our multifunctional toolbar to include, remove, and modify the text of the document.

It is essential to provide the next information to be able to complete the file:

portion of fields in hmda collection form sample

Fill out the Date, credit, was, pulled, on, applicant Date, of, Early, TILA, Disclosure LO, Type, of, Loan, circle, one YES, and LO, Property, Type, circle, one areas with any information that may be asked by the program.

hmda collection form sample Datecreditwaspulledonapplicant, DateofEarlyTILADisclosure, LOTypeofLoancircleone, YES, and LOPropertyTypecircleone fields to fill

In the CL, Action, taken, circle, one box, point out the crucial information.

Completing hmda collection form sample part 3

Identify the rights and obligations of the parties inside the field MS, AMD County, California, Other State, Census, Tract, Number and YES, NO

hmda collection form sample MSAMD, County, CaliforniaOther, State, CensusTractNumber, and YESNO fields to complete

Finish the file by taking a look at the next areas: Ethnicity, Information, Not, Provided No, Co, applicant Sex, Male Applicant, Applicant, Applicant, Applicant, Applicant, Applicant, Race, and Sex.

Filling in hmda collection form sample step 5

Step 3: Press the Done button to save your document. Then it is obtainable for upload to your electronic device.

Step 4: Generate duplicates of the template. This may save you from forthcoming challenges. We cannot check or display your details, as a consequence you can be confident it's going to be safe.

Watch Hmda Data Collection Form Video Instruction

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .