Bankruptcy Counseling - Course 1 - Disclosure

Statement of Bankruptcy Counseling Services
Please read the following statements carefully so that you will understand the procedures for this session. Please sign your name at the bottom of this form after you have read this information.

Consumer Credit Counseling has over 40 years of experience helping people struggling with financial issues. Our role is not to be judgmental, but to help you see options that best fit your situation. We will provide you with very basic bankruptcy information. If you are seeking detailed information about bankruptcy you will want to visit with an attorney that practices bankruptcy law. 

Since you are taking this program online, the program will ask questions about your budget, assets, creditors and factors that led you to consider bankruptcy. There is a requirement by law that you must have interaction with your counselor in the counseling process. Your counselor will contact by phone or email to ask questions about the information you provided. Your counselor will discuss the factors/reasons leading you to why you are considering bankruptcy, and review your budget, creditors and assets. Your counselor will conduct an analysis of your financial situation, explore your options with you and develop an individualized action plan for dealing with your situation. Once this is complete you will be notified by email to log back into the program where you can print copies of all this information. 

At the conclusion of the counseling, you will be provided with a certificate that you will need, should you decide to file for bankruptcy. We have an obligation to provide a certificate of counseling completion in a prompt manner. You will only receive the certificate if you complete the entire session. This certificate is valid for 180 days after the date and time the counseling is completed. 

A certified consumer credit counselor will be conducting this session. While he/she has expertise in helping those with financial problems, he/she cannot provide you with legal advice. In fact, this session is designed to provide you with information and alternatives; it is not intended to take the place of a consultation with an attorney to explore your legal rights and options. 

To help cover the cost of providing this session to you, this agency charges a fee. The cost is $50 for each person payable in by debit/credit card. You may be eligible for a waiver of this fee based on your lack of ability to pay. A waived fee is based on 150% of poverty guidelines, with proof of income, updated periodically by the US Department of Health and Human Services. As you proceed you will be asked a question about hour household size and income. The online program will notify you if you may be eligible for a waiver. If so, you will be provided instructions on how to forward your proof of income to us. If you choose not to provide proof of your income, you can proceed and will be charged $50 per person. If you are not eligible for a fee waiver, you will proceed to the payment page where the fee is $50 per person. 

In order to assist you, it is essential that you provide us with information that is as accurate and complete as possible. For that reason, we may ask you to authorize us to access your credit history. Your credit report is not impacted by obtaining counseling through our agency and our agency will not disclose or provide any information about this counseling session to a credit reporting agency. Rest assured that the information concerning your financial condition and status that you provide during this session is strictly confidential. Such information would include, but is not limited to, income, debts, credit accounts, earnings, assets, and employment data. We will not disclose any such information that you provide orally or in writing to anyone, except as authorized by you in writing or as required by law, such as in response to a subpoena or to the United States Trustee in their oversight of this agency or during the investigation of complaints, during on-site visits or during quality service reviews. We may compile data and aggregate information that you give us, but this information will not be disclosed in any manner that would personally identify you. If your financial situation allows for the opportunity to negotiate alternative payment plans, those options will be discussed with you. If you should decide to enter into a Debt Management Plan (“DMP”), as offered by our agency, (which will be explained in the course of this session) you will be provided with separate agreement and disclosure forms. If you choose to use a DMP you may incur additional fees which would be explained to you should you be interested in this program. 

If you choose to file for bankruptcy, you should know that your bankruptcy will affect your credit report. A bankruptcy does not delete accurate information off of your credit report regarding your past delinquencies. A bankruptcy is a matter of public record and will be reported in the public section of your credit report. A bankruptcy will have a negative effect on your credit report and credit score. A potential creditor, landlord, or employer in the future may view this negatively. Depending on the type of bankruptcy you file, a bankruptcy may remain on your credit report for 7 to 10 years. 

If, after your session, you choose to enroll in a Debt Management program, participation in a debt management program may change information which is already on your credit report. If your credit report shows that you have paid your accounts as agreed in the past, a Debt Management Program could have a negative impact on a creditworthiness decision by a potential creditor, landlord, or employer in the future. 

This agency also receives funding in the form of grants from state and government agencies as well as support from the United Way. A portion of funding for this agency comes from voluntary contributions from creditors who participate in DMPs. Since creditors have a financial interest in having debts repaid, some are willing to make a contribution to help fund the overall services of this agency. These contributions are usually calculated as a percentage of payments that are made through a DMP. Again, should you decide to enter into a DMP, you will receive specific information on how the plan works and how the agency is funded. 

Our agency has a policy of prohibiting it from paying or receiving referral fees for the referral of clients, except under a fair share agreement. No fees are either paid or received by our agency for the referral of a client to a bankruptcy attorney or any bankruptcy alternative agency. 

We do not provide bilingual counseling services or professional interpreter assistance to any limited English proficient clients. To find an organization that provides these services please go to the US Trustee site at: If you are dissatisfied with the service provided by our agency you can utilize the Complaint Resolution Process. 

The United State Trustee has reviewed only our credit counseling and personal financial management instructional course pursuant to 11 U.S.C 111(d) and the US Trustees has neither reviewed or approved any other services we provide to clients. This agency is a member of the National Foundation for Credit Counseling (“NFCC”) The NFCC has high standards for quality credit counseling and financial education, and this agency complies with those standards. In addition, this agency is accredited by the Council on Accreditation (“COA”), an independent third-party organization that reviews and monitors entities that provide social services. We are a non-profit agency. We are organized and operate in accordance with Section 501(c)(3) of the Internal Revenue Code. 


 I agree and would like to continue.

I waive my right to a fee waiver and would like to continue.

I disagree and would like to return to the home page.