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Uniform Borrower Assistance Form Template

Streamline your mortgage assistance with this user-friendly form

If you're struggling to keep up with mortgage payments, finding the right assistance can feel overwhelming. This Uniform Borrower Assistance Form Template is designed to help homeowners like you clearly communicate your needs and secure financial support. With easy-to-follow questions, the template simplifies the application process, ensures you gather all necessary information, promotes faster responses from lenders, and can be easily customized to fit your situation. Start using the template today for a smoother path to assistance.

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Borrower full name
Email address
Phone number
Mailing address
Is there a co-borrower on this loan?
Yes
No
Co-borrower full name
Co-borrower email address
Co-borrower phone number
Mortgage servicer name
Loan number (if known)
Property address
Is this property your primary residence?
Yes
No
Property occupancy
Owner-occupied
Second home
Investment property
Vacant
Prefer not to say
Property type
Single-family
Condominium
Townhome
Multi-unit (2-4)
Manufactured/mobile
Other/Not sure
If delinquent, how many payments behind are you?
Current total monthly mortgage payment (include taxes, insurance, HOA if applicable)
Next payment due date
Are you currently delinquent on your mortgage?
Yes
No
Type of hardship (select all that apply)
Please Specify:
Briefly describe your hardship
Hardship start date
Is the hardship expected to be temporary or permanent?
Temporary
Permanent
Not sure
Have you previously received mortgage assistance on this loan?
Yes
No
Total monthly gross household income (before taxes)
Other income details (if applicable)
Total monthly housing payment you can afford at this time
Total monthly non-housing debt payments (e.g., credit cards, auto, student loans)
Primary source of income
Please Specify:
Total available cash and bank balances
Estimated current value of the property
Estimated total mortgage balance owed
Are there any additional mortgages or liens on the property?
Yes
No
Which assistance options are you open to? (select all that apply)
Forbearance
Repayment plan
Loan modification
Partial claim or payment deferral
Short sale
Deed in lieu of foreclosure
Payment reduction review
Unsure-please advise
What is your preference regarding the property?
I want to keep the property
I am considering leaving or selling the property
Not sure
I consent to be contacted by phone, email, and text about assistance on this loan.
Yes
No
I authorize the servicer to obtain, use, and share my information with the mortgage investor/insurer to evaluate assistance options.
Yes
No
Type your full legal name as your signature
Signature date
I certify that the information provided in this form is true and correct to the best of my knowledge.
Yes
No
Preferred contact method
Phone call
Text message
Email
Any of the above
Best time to contact you
Morning
Afternoon
Evening
Anytime
Preferred language
English
Spanish
Other
Please Specify:
Do you need an interpreter?
Yes
No
{"name":"Borrower full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Borrower full name, Email address, Phone number","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration depicting the Uniform Borrower Assistance Form Template for FormCreatorAI article.

When to use this form

Use this template when you service mortgages or consumer loans and need to evaluate a hardship assistance request. It helps you collect the hardship reason, income, expenses, and property details so you can decide on forbearance, a repayment plan, or a modification. It is ideal for homeowners who missed payments after a job loss or disaster, self-employed borrowers with a revenue dip, or small landlords facing vacancies. For business borrowers, pair it with the Small business loan intake form to capture current operations. If you approve new terms, document them with the Promissory note form. To record fee waivers or interest credits tied to a resolution, route a Credit note request form.

Must Ask Uniform Borrower Assistance Questions

  1. What hardship caused you to fall behind, and when did it begin?

    Cause and start date show eligibility and how long the issue may last. Clear timing helps you choose between short-term forbearance and a longer-term modification.

  2. What is your current gross monthly income, by source, and how stable is it?

    Income level and stability determine a payment you can sustain. If you own a business, align figures with your recent Business financing request form to speed review.

  3. What are your monthly housing costs and other debt payments, including past-due amounts?

    Total obligations reveal capacity for a trial plan and risk of redefault. Precise numbers reduce back-and-forth and shorten underwriting.

  4. Is the property your primary residence, and do you receive any rental income from it?

    Occupancy and rental income affect program eligibility and net affordability. This also informs outreach and any inspection or documentation needs.

  5. Which assistance are you requesting, and what is the maximum monthly amount you can pay for the next three months?

    Stating the option and an affordable amount lets you model scenarios quickly and set a trial plan. If the numbers work, you can move straight to the offer and disclosures.

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