Question	Answer
Form Name	Request Mortgage Assistance Form
Form Length	5 pages
Fillable?	Yes
Fillable fields	204
Avg. time to fill out	21 min 3 sec
Other names	sps rma form, rma pdf, rma mortgage assistance, rma assistance form

Completing this form will help us understand your current situation.
We’ll work with you to find a solution as quickly as possible.			Loan Number: _____________________________
Step 1: Tell us about you		For the purposes of this form, a Customer is someone who is obligated on the Note for the loan or
		interested in assuming responsibility for the Note. If another person not on the Note has community
		property or similar rights per applicable state law, please provide their name: ______________________________
CUSTOMER			ADDITIONAL CUSTOMER
Customer’s			Customer’s
name			name
Last four digits of Social	Date		Last four digits of Social	Date
Security number	of birth		Security number	of birth
Mobile or daytime number with area	Preferred contact method		Mobile or daytime number with area	Preferred contact method
code1		Text	code1	Text
		Voice		Voice
		Email		Email

Email address			Email address

	DESCRIBE YOUR HARDSHIP: _____________________________________________________________________	Date situation began:
	_______________________________________________________________________________________________	_______/_______/_______
	_______________________________________________________________________________________________	I believe my situation is:
	If your mortgage loan is insured or guaranteed by the Federal Housing Administration (FHA) or the Rural Housing	Temporary
	Service (RHS), you are considered to be facing imminent default if your loan is up to date or less than 30 days past	Temporary
		Long term
	due and you have a hardship that will keep you from making your next mortgage loan payment in the month it’s due.	Long term

Check all boxes that explain your situation:	Please send us the documents that apply:
Unemployment	A copy of your benefits statement or letter detailing the amount, frequency and duration
Unemployment	of your unemployment benefits.
	of your unemployment benefits.
*For FHA ONLY: Unemployed customer not currently	Are you seeking new employment?	Yes	No
receiving benefits	Are you available for employment?	Yes	No
Unemployment start date:_______________________	Are you available for employment?	Yes	No
Unemployment start date:_______________________

	For FHA, we need:
Excessive obligations	• An explanation of why the obligations are excessive, and
Excessive obligations	• Documents that support excessive obligation - including but not

	limited to monthly billing statements and home repair invoices
Income reduction/underemployment	No hardship documentation is required as long as you have submitted documents that
Payment increase	show your income. If you have an FHA loan, you may need to send more documents.
Divorce or legal separation; separation of customers	• Divorce decree or separation agreement signed by the court; or
unrelated by marriage, civil union or similar domestic	• Current credit report showing divorce, separation or different address of
partnership under applicable law	non-occupying customer; or

Death of a customer, or death of either the primary or	• Death certificate; or
additional wage earner in the household or a dependent family member	• Obituary or newspaper article reporting the death
Long-term or permanent disability; serious illness of a	Do not send medical records or any details of your illness or disability. Instead,
Long-term or permanent disability; serious illness of a	please send:
customer, additional customer or a dependent family	• Written statement from you or other documentation verifying disability or illness; or
member	• Proof of monthly insurance benefits or government assistance (with expiration date, if
	applicable)
Disaster (natural or man-made) adversely affecting	• Insurance claim; or
the property or customer's place of employment	• Proof of a FEMA grant or Small Business Administration loan; or
	• Evidence that customer or employer property is in a federally-declared disaster area
	• For active duty Servicemembers: Permanent Change of Station (PCS) orders or
	letter showing transfer
Distant employment transfer	• For employment transfers/new employment:
	• Copy of your signed offer letter, notice from your employer showing transfer to a
	new location (if applicable), or written explanation from your employer; and
	• Documentation that reflects the amount of any relocation assistance provided
	• Tax return from the previous year (including all schedules), and
	• Proof of business failure supported by one of the following:
	• Bankruptcy filing for the business; or
Business failure	• Two months of recent bank statements for the business account
	showing that business activity has stopped; or
	• Most recent signed and dated quarterly or year-to-date profit and
	loss statement

I'm interested in:	All assistance options
	Only options that involve moving out of the property

	ADDITIONAL CONTRIBUTOR INFORMATION (Optional)
Does anyone not listed on the loan live in and contribute financially to the household?			Yes	No
Monthly amount they contribute to the household (including amount contributed to the mortgage): $ ___________________________
First and Last Name(s): ____________________________________		Please indicate any living expenses for this person(s) in
Last four digits of SSN: ____________________________________		the Contributor column of the Monthly Living Expenses
		section of this form (see next page).

WAGE:
Employer 1 name: __________________________________ Start date: _____/_____/_____
If you work seasonally or in the education field, how many months per year are you		$	$	$
paid:________		$	$	$
paid:________

WAGE:
Employer 2 name: __________________________________ Start date: _____/_____/_____
If you work seasonally or in the education field, how many months per year are you		$	$	$
paid:________

Self-employment income:
(Includes 1099 income)		$	$	$
Percentage of business ownership: _______%

Benefits Income:
Social Security benefits, investments, pensions or other retirement benefits		$	$	$
Please specify: ________________________________________		$	$	$
Please specify: ________________________________________

Voluntary Income:
Child support/alimony/separation maintenance		$	$	$
You aren’t required to disclose child support, alimony or separation maintenance income		$	$	$

unless you want us to consider it as qualifying income.

Gross rents/boarder rents received (Primary recipient)		$	$	$

Unemployment Income	Start Date _______ End Date_________	$	$	$

Food stamps/welfare (Primary recipient)		$	$	$

Tips, commissions, bonuses		$	$	$

Other (please specify)____________________________________		$	$	$

Expense	Customer(s)			Contributor(s)

Food (required field)	$		$

Utilities (required field)	$		$

Automobile (required field)	$		$
(insurance, maintenance, gas)	$		$
No automobile

Life insurance premium	$		$

Clothing	$		$

Cable, internet, phone	$		$

Medical	$		$

Tuition/school	$		$

Child care (daycare, babysitting)	$		$

Child support/alimony	$		$

Total monthly living expenses	$	0.00	$	0.00

Do you have any existing asset accounts as listed below?	Yes If Yes, please complete this
	Yes If Yes, please complete this
	No		section excluding Retirement
			section excluding Retirement
			Funds.

Checking account #1		$
Bank name: ________________________________________________________		$


Checking account #2
Checking account #2		$
Bank name: ________________________________________________________		$


Savings/money market #1		$
Bank name: ________________________________________________________		$

Number of people in household: ________________			Number of vehicles: _______________
The property is my:	Primary Residence	Second Home	Investment
The property is:	Owner Occupied	Renter Occupied	Vacant


Servicer: ______________________________________________________________			Account #: _____________________________________
Servicer: ______________________________________________________________			Account #: _____________________________________
Servicer: ______________________________________________________________			Account #: _____________________________________

Condominium or HOA fees? Yes	No	If yes, how much each month? $___________ Are payments up to date?		Yes	No

Loan #: __________________________________________________________		Monthly principal and interest payment: $__________________
Escrow payment (taxes, insurance, PMI): $___________ Property is:	Vacant	Second/seasonal home	Owner-occupied	Rented

Loan #: __________________________________________________________		Monthly principal and interest payment: $__________________
Escrow payment (taxes, insurance, PMI): $___________ Property is:	Vacant	Second/seasonal home	Owner-occupied	Rented

Overnight Mail:	Regular Mail:	Fax:
Chase	Chase	1-866-282-5682
720 S. Colorado Blvd., STE 210	PO Box 469030	Online: chase.com
Glendale, CO 80246-1904	Glendale, CO 80246-9030	Online: chase.com

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