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Consumer Intake

Section A: Basic Information

Please provide the following basic information, which will be used to perform a conflicts check. If we are unable to assist you based on this information, we will not review and will delete from our systems the information in the following sections. * indicates a required field.
WhiteBlackHisp./LatinoAsianPacific Island.Native Amer.Biracial/MultiracialPrefer Not to AnswerOther
FemaleMaleGender NonconformingPrefer Not to AnswerOther:
By applying for legal assistance online you are agreeing to be contacted by all methods. If you prefer not to be contacted by these methods please call the intake line at 202-628-1161 option 2.

Section B: Household Income

Legal Aid generally serves individuals whose household income is at or below 200% of the Federal Poverty Guidelines. For some types of cases, we may serve individuals whose household income is between 200% and 300% of the Federal Poverty Guidelines. Please provide the following basic information about your household income so that we can determine whether you are eligible for our services. If we are unable to assist you for any reason, this information in this section will be deleted from our system.
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency

Section C: Information about Your Legal Matter

Please provide the additional information below describing your legal matter. If we are unable to provide you with legal representation on this matter for any reason, the information in this section will be deleted from our system. Type of consumer matter: Debt CollectionForeclosureOther
DEBT COLLECTION/OTHER 1. What company or who says that you owe them money?  Please include the name of any debt collection agency. 2. Did you receive any letters or notices about this debt? YesNo
Please upload, email to onlineintake@legalaiddc.org, or fax to 202.727.2132 (Attn: Online intake).
3. Do you have any court papers related to this problem? YesNo
Please upload, email to onlineintake@legalaiddc.org, or fax to 202.727.2132 (Attn: Online intake) .

a. How did you receive these papers?

4. Have you had any contact with the company suing you or their attorney? YesNo

a. What was said? b. Did you agree to a payment plan or discuss payment arrangements?

Debt 5. Do you recognize the account related to this debt? YesNo 6. Are there any co-applicants or authorized users on this account? YesNo 7. Do you agree with the amount they say you owe? YesNo
Please explain why you think the amount may be wrong.
8. When did you last make any payments or use the account? 9. What caused you to fall behind on payments? Detailed income and financial information 1. What is your gross income? Please note amount and frequency. 2. What is your net income? Please note amount and frequency. 3. What is the source of your income? Ex: employment, Social Security, benefits (Food Stamps, etc.) 4. Do you have any bank accounts? YesNo
Are any joint accounts? YesNo
5. Do you own a car, a home, or other major asset? YesNo

What assets do you own? Are these assets currently mortgaged or financed, or have they been paid off?

6. Can you afford to make payments toward this debt? YesNo 7. Are you currently suffering a hardship based on your financial or other circumstances? Please explain. Ex: unemployed/underemployed, receive public benefits, live in public housing, medical conditions, supporting large family, disability, etc. Is there anything else we should know about your case?
FORECLOSURE Home 1. Have you been sued for foreclosure? YesNo

a. If yes, What is your court case number? b. If no, Have you received any notices on D.C. Government letterhead? YesNo

If yes, please upload, email to onlineintake@legalaiddc.org, or fax to 202.727.2132 (Attn: Online intake) .

2. What is the address of the home that is in danger of foreclosure? 3. Do you live in the home facing foreclosure? YesNo 4. Who else lives there? Please enter names and DOBs, if known, of anyone else living there, including tenants. This information is required for conflict check purposes. 5. Who owns the home (i.e. who is on the deed)? 6. Is your home part of a condominium or homeowners’ association? YesNo
What is your current monthly condo or HOA fee? Are you behind on your condo or HOA fees? YesNo
7. Do you own any other properties? YesNo   Mortgage 1. Who is your mortgage company? 2. Please provide basic information about the loan at issue:

a. Who is the borrower on the loan? b. Is your loan an FHA loan? YesNoNot sure c. What is your current mortgage payment? Even if you are not currently making payments, please provide an estimate of what your payment was before you stopped making payments.

Please upload a recent monthly statement, email to onlineintake@legalaiddc.org, or fax to 202.727.2132 (Attn: Online intake) .

d. When was the last time you made a payment on the mortgage? Please provide an estimate if you are not sure. e. What caused you to fall behind on the payments? f. Have you ever applied for a loan modification? YesNo

    

- When? -What was the result of your application? ApprovedDenied

What reason did the mortgage company give for the denial?

3. Do you have any other mortgages or lines of credit on the property? YesNo Detailed income information 1. What is your gross income? Please note amount and frequency. 2. What is your net income? Please note amount and frequency. 3. What is the source of your income? Ex: employment, Social Security, benefits (Food Stamps, etc.), rental payments, etc. 4. Please list the income of each person in the household, including gross/net/source. 5. Are you able to document all of the income in the household (through paystubs, benefits letters, tax returns, etc.)? YesNo 6. Is any income expected to change?  YesNo
Please explain:
    Goals Do you want to keep the home, sell it (is the property already listed?), or do something else with it?