Uniform Assistance Form PDF Details

The Uniform Borrower Assistance Form 110D is a crucial document designed for homeowners facing either temporary or long-term financial hardships, guiding them through the process of applying for mortgage relief solutions. This comprehensive form requires individuals to detail their current financial situation, their intentions regarding their property—whether they plan to keep or sell it—and provide specific information about their hardship. It consists of several sections, each requesting different sets of information and documentation. Initially, applicants must disclose personal details, property status, real estate taxes, insurance premiums, bankruptcy status, credit counseling involvement, and any other liens. The form progresses to require a thorough breakdown of income, expenses, and assets, accompanied by stipulated income documentation for substantiation. The critical component of the form is the Hardship Affidavit, where the borrower outlines the nature of their hardship and submits required supporting documentation. Additionally, the form includes a section for important certifications and agreements, underscoring the accuracy of provided information and the implications of submitting false information. This form not only serves as a structured pathway for requesting assistance but also as a legal document binding the borrower to truthfulness, with the reminder to include all necessary documentation before submission, reinforcing its importance in the mortgage relief process.

Form NameUniform Assistance Form
Form Length4 pages
Fillable fields0
Avg. time to fill out1 min
Other names2013, uniform borrower form, uniform borrower assistance form 2018, 710UBAF

Form Preview Example

Uniform Borrower Assistance Form


If you are experiencing a temporary or long-term hardship and need help, you must complete and submit this form along with other required documentation to be considered for available solutions. On this page, you must disclose information about (1) you and your intentions to either keep or transition out of your home; (2) information on the property’s status;(3) real estate taxes; (4) home owner’s insurance premiums;(5) bankruptcy;

(6) your credit counseling agency, and (7) information concerning other liens, if any, on your property.

On Page 2 you must disclose information about all of your income, expenses and assets. Page 2 also lists the required income documentation that you must submit in support of your request for assistance. Then on Page 3, you must complete the Hardship Affidavit in which you disclose the nature of your hardship. The Hardship Affidavit informs you of the required documentation that you must submit in support of your hardship claim. You will also be required to write a hardship letter explaining the details of the situation.

NOTICE: In addition when you sign and date this form, you will make important certifications, representations and agreements, including certifying that all of the information in this Borrower Assistance Form is accurate and truthful and any identified hardship has contributed to your submission of this request for mortgage relief.

REMINDER: The Borrower Response Package you need to return consists of: (1) this completed, signed and dated Borrower Assistance Form;

(2) completed and signed IRS Form 4506-T; (3) required income documentation, and (4) required hardship documentation.


Loan I.D. Number

(usually found on your monthly mortgage statement)








I want to:


□ Keep the Property

□ Sell the Property






The property is currently:

□ My Primary Residence

□ A Second Home

□ An Investment Property





The property is currently:

□ An Investment Property

□ Renter Occupied

□ Vacant





















Borrower’ s Name



Co-Borrower’s Name







Social Security #


Date of Birth

Social Security #

Date of Birth






Home Phone



Home Phone







Cell Phone



Cell Phone







Mailing Address








Property Address (If same as mailing address, just write “same”)


Email Address




Is the property listed for sale? □ Yes

□ No

Have you contacted a credit-counseling agency for help? □ Yes □ No

(if yes, provide a copy of the current listing agreement)

If yes, please complete the counselor contact information below:




If yes, what was the listing date? _____________________

Counselor’s Name: ________________________________________________

If property has been listed for sale, have you received an offer on the



property? □ Yes

□ No


Agency’s Name:___________________________________________________




Date of offer: ________________ Amount of Offer: $ __________________



Agent’s Name: ___________________________________________________

Counselor’s Phone Number:_________________________________________



Agent’s Phone Number: ______________ For Sale By Owner? □ Yes □ No

Counselor’s Email:_________________________________________________





Do you have condominium or homeowner association (HOA) fees? □ Yes □ No

Total monthly amount: $_________________________________

Name and address that fees are paid to:_________________________________________________________________________________________________

Are the fees paid and current ? □ Yes

□ No

If no, please list the total delinquent amount: $______________

Legal proceedings started? □ Yes □ No






Have you filed for bankruptcy?

□ Yes

□ No



If yes:

□ Chapter 7

□ Chapter 13

Filing Date: _____________


Has your bankruptcy been discharged?

□ Yes

□ No

Bankruptcy case number: _____________


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Uniform Borrower Assistance Form





(associated with the property and/ or borrower(s)











Monthly Gross Wages


First Mortgage Payment


Checking Account(s)










Second Mortgage Payment


Checking Account(s)








Child Support / Alimony*


Homeowner’s Insurance


Savings/Money Market








Non-taxable social security/SSI


Property Taxes


401k/ lRA/403B/Keogh/


ESPO Accounts












Taxable SS benefits or other


Credit Cards/Installment





Loan(s)(total minimum




monthly income from annu-






ities or retirement plans






per month)















Tips, commissions, bonus and


Alimony, child support


Other Cash on Hand


self-employed income






Rents Received


Car lease Payments


Other Real Estate


(estimated value)












Unemployment Income


HOA/Condo Fees/Property
















Food Stamps/Welfare


Mortgage Payments on


Life Insurance


other properties (PITI)

(Whole Life not Term)























Total (Gross Income)


Total Debt / Expenses


Total Assets














Lien Holder’s Name


Balance/Interest Rate


Loan Number























Do you earn a wage?

For each borrower who is a salaried employee, include the most recent pay stubs that reflects at least 30 days of year-to-date earnings for each borrower for all positions (include any part-time positions held) AND most recent bank statements (all pages).

Are you self-employed?

For each borrower who receives self-employed income, include a complete, signed individual federal income tax return and, as applicable, the business tax return; AND either the most recent signed and dated quarterly OR year -to-date profit/loss statement that reflects activity for the most recent three months; AND copies of bank statements for the business account for the last two months evidencing continuation of business activity.

Do you have any additional sources of income? Provide for each borrower as applicable as well as 1 full month of bank statements:

“Other Earned Income” such as bonuses, commissions, housing allowance, tips, or overtime:

□ Reliable third -party documentation describing the nature of the income (e.g., employment contract or printouts documenting tip income).

Social Security, disability or death benefits, pension, public assistance, or adoption assistance:

Documentation showing the amount and frequency of the benefits, such as letters, exhibits, disability policy or benefits statements from the provider, and

Documentation showing the receipt of payment, such as copies of the two most recent bank statements showing deposit amounts.

Rental Income:

Copy of the most recent filed federal tax return with all schedules,including Schedule E-Supplement Income and Loss. Rental income for qualifying purposes will be 75% of the gross rent reduced by the monthly debt service on the property, if applicable; OR

If rental income is not reported on Schedule E- Supplement Income and Loss, provide a copy of the current lease/rental agreement with either bank statements or canceled rent checks demonstrating receipt of rent.

Investment Income:

□ Copies of the two most recent investment statements or bank statements supporting receipt of this income.

Alimony, child support, or separation maintenance payments as qualifying income:*

Copy of divorce decree, separation agreement, or other written legal agreement filed with a court, or court decree that states the amount of the alimony, child support, or separation maintenance payments and the period of time over which the payments will be received, and

Copies of your two most recent bank statements or other third-party documents showing receipt of payment.

*Notice: Alimony, child support or separate maintenance income need not be revealed if you do not choose to have it considered for repaying this loan.

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(provide a written explanation with this request describing the specific nature of your hardship)

I am requesting review of my current financial situation to determine whether I qualify for temporary or long-term mortgage relief options.

Date Hardship Began is: _____________________

I believe that my situation is: □ Short term (under 6 months) □ Medium term (6-12 months) □ Long-term or Permanent Hardship (greater than 12 months)

I am having difficulty making my monthly payment because of reason set forth below: (Please check all that apply and submit required documentation demonstrating your hardship)





□ Unemployment

□ Unemployment filing/unemployment benefit information showing file


date and duration of benefits


□ Bank statements (1 month) showing deposits showing weekly payment amount


□ Termination letter (if applicable)



□ Underemployment

□ Pay stubs (1 mo) from previous position complete with year to date information


□ Pay stubs (1 mo) from current position complete with year


to date information


□ Federal Tax Returns from previous year complete with all schedules


W-2 Statements from last year AND W-2 from previous position



□ Income reduction (e.g., elimination of overtime, reduction in regular

□ Pay stubs from previous position, Federal Income Tax returns from last

working hours, or a reduction in base pay)

year, W-2 from last year, 1 month bank statements AND 30 days pay stubs


and/or offer letter demonstrating the new pay rate



□ Divorce or legal separation; Separation of Borrowers unrelated by marriage,

□ Divorce decree or separation agreement signed by the court AND

civil union or similar domestic partnership under applicable law

□ Current credit report evidencing divorce, separation, or


non-occupying borrower has a different address OR


□ Recorded quitclaim deed evidencing that the non-occupying


Borrower or co-Borrower has relinquished all rights to the property



□ Death of a borrower or death of either the primary or secondary wage

□ Death certificate OR

earner in the household

□ Obituary or newspaper article reporting the death



Long-term or permanent disability; Serious illness of a borrower/

□ Doctor’s certificate of illnessor disability OR

co-borrower or dependent family member

□ Medical bills OR


□ Proof of monthly insurance benefits or government assistance


(if applicable)



□ Disaster (natural or man-made) adversely impacting the property or

□ Insurance claim OR

Borrower ‘s place of employment

□ Federal Emergency Management Agency grant or Small Business


Administration loan OR


□ Borrower or Employer property located in a federally declared disaster area



□ Distant employment transfer

□ Letter from employer stating date of transfer


□ Documentation supporting any changes to income as a result of transfer


(e.g. letter from employer, pay stubs, etc)



□ Business failure

□ Tax return from the previous year (including all schedules) AND


□ Proof of business failure supported by one of the following:


• Bankruptcy filling for the business; or


• Two months recent bank statements for the business account evidencing


cessation of business activity; OR


• Most recent signed and dated quarterly or year-t o-date profit and loss





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1.I certify that all of the information in this Borrower Assistance Form is truthful and the hardship(s) identified above has contributed to submission of this request for mortgage relief.

2.I understand and acknowledge that the Servicer, owner or guarantor of my mortgage, or their agent(s) may investigate the accuracy of my statements, may require me to provide additional supporting documentation, and that knowingly submitting false information may violate Federal and other applicable law.

3.I understand the Servicer will obtain a current credit report on all borrowers obligated on the Note.

4.I understand that if I have intentionally defaulted on my existing mortgage, engaged in fraud or misrepresented any fact(s) in connection with this request for mortgage relief or if I do not provide all required documentation, the Servicer may cancel any mortgage relief granted and may pursue foreclosure on my home and/or pursue any available legal remedies.

5.I certify that my property has not received a condemnation notice.

6.I certify that I am willing to provide all requested documents and to respond to all Servicer communications in a timely manner.

I understand that time is of the essence.

7.I understand that the Servicer will use this information to evaluate my eligibility for available relief options and foreclosure alternatives, but the Servicer is not obligated to offer me assistance based solely on the representations in this document or other documentation submitted in connection with my request.

8.If I am eligible for a repayment plan, forbearance plan, workout option and/or modification and I accept and agree to all terms of such plan, I also agree that the terms of this Acknowledgment and Agreement are incorporated into such plan by reference as if set forth in such plan in full. My first timely payment following my Servicer’s determination and notification of my eligibility or prequalification for a modification, repayment plan or forbearance plan (when applicable) or other workout option will serve as acceptance of the terms set forth in the notice sent to me that sets forth the terms and conditions of the workout option, modification repayment plan or forbearance plan.

9.I agree that when the Servicer accepts and posts a payment during the term of any repayment plan, modification,forbearance plan or other workout option, it will be without prejudice to, and will not be deemed a waiver of, the acceleration of my loan or foreclosure action and related activities and shall not constitute a cure of my default under my loan unless such payments are sufficient to completely cure my entire default under my loan.

10.I agree that any prior waiver as to my payment of escrow items to Servicer in connection with my loan has been revoked.

11.If I qualify for and enter into a repayment plan, forbearance plan, modification and/or other workout option I agree to the establishment of an escrow account and the payment of escrow items if an escrow account never existed on my loan.

12.I understand that Servicer will collect and record personal information that I submit in this Borrower Response Package and during the evaluation process, including, but not limited to, my name, address, telephone number, social security number, credit score, income, payment history, and information about my account balances and activity. I understand and consent to the Servicer’s disclosure of my personal information and the terms of any relief or foreclosure alternative that I receive to any investor, insurer, guarantor, or servicer that owns, insures, guarantees, or services my first lien or subordinate lien (if applicable) mortgage loan(s) or to any HUD certified housing counselor.

13.I consent to being contacted concerning this request for mortgage assistance at any cellular or mobile telephone number I have provided to the Lender. This can include text messages and telephone calls to my cellular or mobile telephone

Name (print)






Name (print)



*Before mailing, make sure you have signed and dated the form and attached copies of the appropriate documentation*

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Step 1: Select the orange button "Get Form Here" on the web page.

Step 2: You can now alter your 2013. Our multifunctional toolbar permits you to insert, delete, transform, and highlight content or perhaps carry out several other commands.

The next parts are within the PDF form you'll be creating.

part 1 to writing evidencing

You have to complete the Agents Name, Agents Phone Number For Sale By, Counselors Email, Do you have condominium or, Name and address that fees are, Are the fees paid and current, Have you filed for bankruptcy, Yes No, If yes, Chapter, Chapter Filing Date, Has your bankruptcy been, Rev, and Detroit Avenue Lakewood OH area with the expected data.

Finishing evidencing stage 2

Write down any details you need inside the space MONTHLY HOUSEHOLD INCOME, MONTHLY HOUSEHOLD EXPENSESDEBT, HOUSEHOLD ASSETS associated with, Monthly Gross Wages, Overtime, Child Support Alimony, Nontaxable social securitySSI, Taxable SS benefits or other, Tips commissions bonus and, Rents Received, Unemployment Income, Food StampsWelfare, Other, Total Gross Income, and First Mortgage Payment.

Filling out evidencing step 3

You will need to define the rights and responsibilities of each party in field Do you earn a wage For each, REQUIRED INCOME DOCUMENTATION, Are you selfemployed For each, Do you have any additional, Other Earned Income such as, Social Security disability or, Documentation showing the receipt, Rental Income Copy of the most, purposes will be of the gross, If rental income is not reported, statements or canceled rent checks, Investment Income Copies of the, Alimony child support or, child support or separation, and Copies of your two most recent.

Finishing evidencing part 4

Terminate by reading the next areas and filling them in correspondingly: HARDSHIP AFFIDAVIT provide a, I am requesting review of my, Date Hardship Began is, I believe that my situation is, I am having difficulty making my, Unemployment, Unemployment filingunemployment, IF YOUR HARDSHIP IS, THEN THE REQUIRED HARDSHIP, Underemployment, date and duration of benefits, Bank statements month showing, Pay stubs mo from previous, to date information, and Federal Tax Returns from previous.

step 5 to entering details in evidencing

Step 3: Select the "Done" button. So now, you can transfer the PDF file - upload it to your device or send it by using electronic mail.

Step 4: In order to avoid potential forthcoming difficulties, it is important to get at least a couple of duplicates of each separate file.

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