OMB Control No. 2900-0249
Respondent Burden: 25 minutes
Expiration Date: 11/30/2019
OFF. JURIS.
OFF. ORIG.
TYPE
LOAN NUMBER
NAME CODE
LOAN SERVICE REPORT
2. DATE OF INTERVIEW
1. INTERVIEW CONDUCTED
3. TELEPHONE NUMBER
B. BUSINESS
A. HOME
EMAIL
IN OFFICE
IN FIELD
BY PHONE
4. EMAIL ADDRESS
5. NAME(S) OF PERSON(S) INTERVIEWED
SECTION I - FINANCIAL INFORMATION
6. PLEASE CHECK THE APPROPRIATE BOX(ES). IF ONE OR MORE ARE CHECKED, THIS REPORT MUST INCLUDE INFORMATION CONCERNING THE BORROWER'S
SPOUSE (OR FORMER SPOUSE IF BOX "D" IS CHECKED). IF NO BOXES ARE CHECKED, NO INFORMATION CONCERNING THE SPOUSE NEED BE FURNISHED.
A. THE SPOUSE IS OR WILL BE
B. THE BORROWER IS MARRIED AND
C. THE BORROWER IS
D. THE BORROWER IS RELYING ON ALIMONY,
RELYING ON THE SPOUSE'S
CHILD SUPPORT, OR SEPARATE
JOINTLY OBLIGATED WITH
THE PROPERTY SECURING THE
INCOME AS A BASIS FOR
MAINTENANCE PAYMENTS FROM A SPOUSE
THE BORROWER ON THE
LOAN IS LOCATED IN A COMMUNITY
REPAYMENT OF THE LOAN
OR FORMER SPOUSE AS A BASIS FOR
LOAN
PROPERTY STATE
REPAYMENT OF THE LOAN
7. NAME AND ADDRESS OF EMPLOYER
8. LENGTH OF
9. TYPE OF WORK
10. MONTHLY EXPENSES
EMPLOYMENT
A. MORTGAGE PAYMENT
$
B. FOOD
11. NAME AND ADDRESS OF SPOUSE'S EMPLOYER
12. LENGTH OF
13. TYPE OF WORK
C. HEATING OIL
EMPLOYMENT
D. GAS
E. ELECTRIC
14A. NAME AND ADDRESS OF NEXT OF KIN
14B. TELEPHONE NO. OF NEXT OF KIN
F. TELEPHONE
HOME
BUSINESS
G. TRANSPORTATION
H. GASOLINE
15. AGE(S) OF OTHER DEPENDENT(S)
I. AUTO INSURANCE
J. LIFE INSURANCE
16. AVERAGE MONTHLY INCOME FROM ALL SOURCES
K. MEDICAL
(Take-home
A. SALARIES
B. COMP. OR
C. RENTAL OR OTHER
D. TOTAL
L. CLOTHING
pay)
PENSION
(Specify lender)
M. LOAN
$
$
$
$
(Specify lender)
N. LOAN
17. DISCRETIONARY INCOME
(Item 16D)
A. TOTAL MONTHLY INCOME
$
(Co. name)
O. CREDIT CARD
B. MINUS TOTAL MONTHLY EXPENSES
-
$
(Co. name)
(Item 9R)
P. CREDIT CARD
C. TOTAL MONTHLY DISCRETIONARY INCOME
$
AVAILABLE TO REPAY THE DELINQUENCY
Q. MISC.-PERSONAL
(Date)
17D. REG. INSTALLMENT 17E. TOTAL DELINQUENCY 17F. TOTAL DELINQUENCY AS OF
R. TOTAL MONTHLY EXPENSES
$
$
$
18. ASSETS
(Checking and savings accounts, building and loan accounts,
A.CASH AVAILABLE
$
(Current value)
E. SAVINGS BONDS
on-hand, etc.)
$
(Current value)
F. STOCKS AND OTHER BONDS
(Resale value)
B. FURNITURE AND HOUSEHOLD GOODS
(Resale value)
G. REAL ESTATE OWNED
(Resale value)
(Itemize)
H. OTHER ASSETS
C. AUTOMOBILES
MAKE
YEAR
MODEL
(Resale value)
D. TRAILERS, BOATS, CAMPERS
$
I. TOTAL ASSETS
19. BORROWER'S EXPLANATION OF DELINQUENCY
SECTION II - CERTIFICATIONS (See Privacy Act Information)
I (WE) AFFIRM that the information contained herein is true, correct, and complete to the best of my (our) knowledge and belief.
21B. DATE
Sign in ink
20A. SIGNATURE OF BORROWER/APPLICANT
20B. DATE
21A. SIGNATURE OF SPOUSE (
)
Sign in ink
(
)
PENALTY - The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of a statement or evidence of a material fact,
knowing it to be false.
Page 1
VA FORM
SUPERSEDES VA FORM 26-6808, MAR 2014,
26-6808
NOV 2016
WHICH WILL NOT BE USED.
OMB Control No. 2900-0249
Respondent Burden: 25 minutes
Expiration Date: 11/30/2019
OFF. JURIS.
OFF. ORIG.
TYPE
LOAN NUMBER
NAME CODE
LOAN SERVICE REPORT
2. DATE OF INTERVIEW
1. INTERVIEW CONDUCTED
3. TELEPHONE NUMBER
B. BUSINESS
A. HOME
EMAIL
IN OFFICE
IN FIELD
BY PHONE
4. EMAIL ADDRESS
5. NAME(S) OF PERSON(S) INTERVIEWED
SECTION I - FINANCIAL INFORMATION
6. PLEASE CHECK THE APPROPRIATE BOX(ES). IF ONE OR MORE ARE CHECKED, THIS REPORT MUST INCLUDE INFORMATION CONCERNING THE BORROWER'S
SPOUSE (OR FORMER SPOUSE IF BOX "D" IS CHECKED). IF NO BOXES ARE CHECKED, NO INFORMATION CONCERNING THE SPOUSE NEED BE FURNISHED.
A. THE SPOUSE IS OR WILL BE
B. THE BORROWER IS MARRIED AND
C. THE BORROWER IS
D. THE BORROWER IS RELYING ON ALIMONY,
RELYING ON THE SPOUSE'S
CHILD SUPPORT, OR SEPARATE
JOINTLY OBLIGATED WITH
THE PROPERTY SECURING THE
INCOME AS A BASIS FOR
MAINTENANCE PAYMENTS FROM A SPOUSE
THE BORROWER ON THE
LOAN IS LOCATED IN A COMMUNITY
REPAYMENT OF THE LOAN
OR FORMER SPOUSE AS A BASIS FOR
LOAN
PROPERTY STATE
REPAYMENT OF THE LOAN
7. NAME AND ADDRESS OF EMPLOYER
8. LENGTH OF
9. TYPE OF WORK
10. MONTHLY EXPENSES
EMPLOYMENT
A. MORTGAGE PAYMENT
$
B. FOOD
11. NAME AND ADDRESS OF SPOUSE'S EMPLOYER
12. LENGTH OF
13. TYPE OF WORK
C. HEATING OIL
EMPLOYMENT
D. GAS
E. ELECTRIC
14A. NAME AND ADDRESS OF NEXT OF KIN
14B. TELEPHONE NO. OF NEXT OF KIN
F. TELEPHONE
HOME
BUSINESS
G. TRANSPORTATION
H. GASOLINE
15. AGE(S) OF OTHER DEPENDENT(S)
I. AUTO INSURANCE
J. LIFE INSURANCE
16. AVERAGE MONTHLY INCOME FROM ALL SOURCES
K. MEDICAL
(Take-home
A. SALARIES
B. COMP. OR
C. RENTAL OR OTHER
D. TOTAL
L. CLOTHING
pay)
PENSION
(Specify lender)
M. LOAN
$
$
$
$
(Specify lender)
N. LOAN
17. DISCRETIONARY INCOME
(Item 16D)
A. TOTAL MONTHLY INCOME
$
(Co. name)
O. CREDIT CARD
B. MINUS TOTAL MONTHLY EXPENSES
-
$
(Co. name)
(Item 9R)
P. CREDIT CARD
C. TOTAL MONTHLY DISCRETIONARY INCOME
$
AVAILABLE TO REPAY THE DELINQUENCY
Q. MISC.-PERSONAL
(Date)
17D. REG. INSTALLMENT 17E. TOTAL DELINQUENCY 17F. TOTAL DELINQUENCY AS OF
R. TOTAL MONTHLY EXPENSES
$
$
$
18. ASSETS
(Checking and savings accounts, building and loan accounts,
A.CASH AVAILABLE
$
(Current value)
E. SAVINGS BONDS
on-hand, etc.)
$
(Current value)
F. STOCKS AND OTHER BONDS
(Resale value)
B. FURNITURE AND HOUSEHOLD GOODS
(Resale value)
G. REAL ESTATE OWNED
(Resale value)
(Itemize)
H. OTHER ASSETS
C. AUTOMOBILES
MAKE
YEAR
MODEL
(Resale value)
D. TRAILERS, BOATS, CAMPERS
$
I. TOTAL ASSETS
19. BORROWER'S EXPLANATION OF DELINQUENCY
SECTION II - CERTIFICATIONS (See Privacy Act Information)
I (WE) AFFIRM that the information contained herein is true, correct, and complete to the best of my (our) knowledge and belief.
21B. DATE
Sign in ink
20A. SIGNATURE OF BORROWER/APPLICANT
20B. DATE
21A. SIGNATURE OF SPOUSE (
)
Sign in ink
(
)
PENALTY - The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of a statement or evidence of a material fact,
knowing it to be false.
Page 1
VA FORM
SUPERSEDES VA FORM 26-6808, MAR 2014,
26-6808
NOV 2016
WHICH WILL NOT BE USED.
SECTION III - PROPERTY INFORMATION
22. PROPERTY ADDRESS
(If different from Item 22)
23. NO. OF LIVING UNITS
24. MAILING ADDRESS
25. GENERAL CONDITION OF PROPERTY
(Check appropriate box)
26A. PROPERTY IS
26B. NAME OF TENANT
26C. AMOUNT OF RENT
26D. RENT PAID TO
(Complete
OWNER
VACANT
RENTED
OCCUPIED
Items 26B, C, and D)
27A. MAJOR REPAIRS REQUIRED
27B. ESTIMATED COST
29. DELINQUENCY REGARDED AS
28. YOUR OPINION AS TO CAUSE OF DELINQUENCY
30. DOMESTIC SITUATION
PERMANENT
TEMPORARY
(Should be realistic and within borrower's ability to repay)
31. PROPOSED REPAYMENT SCHEDULE
32. RECOMMENDATIONS
(Explain - Use Item 33, Remarks, if necessary)
FORBEARANCE
OTHER
33. REMARKS
Sign in ink
35. DATE SIGNED
34. SIGNATURE OF REPRESENTATIVE (
)
PRIVACY ACT NOTICE - VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974
or Title 38, Code of Federal Regulations 1.576 for routine uses (e.g., to a member of Congress inquiring on behalf of a veteran) as identified in the VA system of
records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee
Loan Applicant Records - VA, and published in the Federal Register. Your obligation to respond is voluntary, but without this information VA may be unable to
provide financial counseling or assistance in dealing with your mortgage loan holder.
RESPONDENT BURDEN: We need this information to provide financial counseling under Title 38 USC 3732(a)(4). We estimate that you will need an average of 25
minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control
number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the
OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions
about this form.
Page 2
VA FORM 26-6808, NOV 2016