"Debt Collection Agency - Licensing & Renewal Supplement" - New York City

Debt Collection Agency - Licensing & Renewal Supplement is a legal document that was released by the New York City Department of Consumer Affairs - a government authority operating within New York City.

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  • Released on November 5, 2018;
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Download "Debt Collection Agency - Licensing & Renewal Supplement" - New York City

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DCA LICENSING CENTER
42 Broadway, Lobby
New York, NY 10004
Renewal Unit Telephone: (212) 487-4060
nyc.gov/dca
DEBT COLLECTION AGENCY – LICENSING & RENEWAL SUPPLEMENT
Instructions: You must provide current information for your business as requested in the boxes below and affirm that
your responses are true. For the purposes of this form, the terms “you” and “your” refer to the business entity applying for
a license or renewal.
Applicant / Licensee Information:
(A) Legal Name of Business:
(B) DCA License Number:
(The Legal Name that you provide must be exactly as filed with the County Clerk or New York State
(Fill in if you are renewing; leave blank if this is a new
Secretary of State)
license application.)
(C) Business Premises Address:
(Building Number, Street Name, Unit, e.g., Floor, Suite)
City:
State/Province:
ZIP Code:
Country:
(D) Telephone Number:
(E) Fax Number:
(F) Email:
(G) Website:
For the purposes of the questions below, the term “debt” is defined to have the meaning set forth in Section 20-489(d) of
the New York City Administrative Code. (“The term ‘debt’ means any obligation or alleged obligation of a consumer to pay
money arising out of a transaction in which the money, property, insurance, or services which are the subject of the
transaction are primarily for personal, family, or household purposes, whether or not such obligation has been reduced to
judgment, or any obligation or alleged obligation arising out of a judgment or valid agreement for the payment of child
support.”)
 YES
 NO
1. (a) Does your business contact NYC
consumers directly to collect debt, including by
(Contacts consumers directly
(Does not contact
mail or telephone?
to collect debt.)
consumers directly to collect
debt.)
(b) If YES, what is the total number of NYC
consumers contacted by your business in 2017
2017 ________________
2018_________________
and 2018?
 YES
 NO
2. (a) Does your business contact consumers in a
language other than English to collect debts?
(Contacts consumers in a
(Does not contact
language other than English.)
consumers in a language
other than English.)
(b) If YES, which languages?
a. Spanish
e. Korean
b. Arabic
f. Russian
c. Chinese
g. Other ____________
d. Haitian Creole
(c) If YES, which services do you provide
a. Collection letters
c. General translation
consumers in languages other than English?
services
b. Multilingual customer
representatives
Updated 11-05-2018
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Debt Collection Agency Licensing & Renewal Supplement
DCA LICENSING CENTER
42 Broadway, Lobby
New York, NY 10004
Renewal Unit Telephone: (212) 487-4060
nyc.gov/dca
DEBT COLLECTION AGENCY – LICENSING & RENEWAL SUPPLEMENT
Instructions: You must provide current information for your business as requested in the boxes below and affirm that
your responses are true. For the purposes of this form, the terms “you” and “your” refer to the business entity applying for
a license or renewal.
Applicant / Licensee Information:
(A) Legal Name of Business:
(B) DCA License Number:
(The Legal Name that you provide must be exactly as filed with the County Clerk or New York State
(Fill in if you are renewing; leave blank if this is a new
Secretary of State)
license application.)
(C) Business Premises Address:
(Building Number, Street Name, Unit, e.g., Floor, Suite)
City:
State/Province:
ZIP Code:
Country:
(D) Telephone Number:
(E) Fax Number:
(F) Email:
(G) Website:
For the purposes of the questions below, the term “debt” is defined to have the meaning set forth in Section 20-489(d) of
the New York City Administrative Code. (“The term ‘debt’ means any obligation or alleged obligation of a consumer to pay
money arising out of a transaction in which the money, property, insurance, or services which are the subject of the
transaction are primarily for personal, family, or household purposes, whether or not such obligation has been reduced to
judgment, or any obligation or alleged obligation arising out of a judgment or valid agreement for the payment of child
support.”)
 YES
 NO
1. (a) Does your business contact NYC
consumers directly to collect debt, including by
(Contacts consumers directly
(Does not contact
mail or telephone?
to collect debt.)
consumers directly to collect
debt.)
(b) If YES, what is the total number of NYC
consumers contacted by your business in 2017
2017 ________________
2018_________________
and 2018?
 YES
 NO
2. (a) Does your business contact consumers in a
language other than English to collect debts?
(Contacts consumers in a
(Does not contact
language other than English.)
consumers in a language
other than English.)
(b) If YES, which languages?
a. Spanish
e. Korean
b. Arabic
f. Russian
c. Chinese
g. Other ____________
d. Haitian Creole
(c) If YES, which services do you provide
a. Collection letters
c. General translation
consumers in languages other than English?
services
b. Multilingual customer
representatives
Updated 11-05-2018
Page 1 of 3
Debt Collection Agency Licensing & Renewal Supplement
 YES
 NO
3. Does your business purchase delinquent
debt?
(Purchases delinquent debt.)
(Does not purchase
delinquent debt.)
 YES
 NO
4. (a) Is your business a law firm?
(Business is a law firm.)
(Business is not a law firm.)
 YES
 NO
(b) Does your business collect debt in the
capacity of an attorney-at-law or law firm on
behalf of and in the name of a client or clients
solely through activities that may only be
performed by a licensed attorney?
 YES
 NO
(c) Does your business operate under the
supervision of at least one attorney who is
currently licensed to practice law in the State of
Supervising Attorney’s Information:
New York?
First Name:
If the answer is YES, provide the name of the
New York State-licensed attorney who
Last Name:
supervises debt collection activities and the
size of the Supervising Attorney’s staff, limited
Number of Attorneys
to the total number of attorneys who are
on Staff:
currently licensed to practice law in the State of
New York.
5. Check the type(s) of business activities that you engage in (check all that apply):
a. First party collections
k. Third party collections
b. Debt buyer
l. Account / billing services
c. Initiating collection lawsuits
m. Child support collections
d. Bad check recovery
n. Student loan debt servicing
e. Consumer credit collections
o. Student loan debt collections
f. Government / Municipal collections
p. Litigating collection lawsuits
g. Medical debt collections
q. Enforcing consumer credit judgments
h. Payday loan collections
r. Mortgage servicing
i. Debt / Credit counseling
s. Telecom / Utilities collections
j. Debt settlement
t. Credit repair
6. Have you been subject to an adverse finding or settlement for debt collection practices by any regulatory agency,
including but not limited to the Federal Trade Commission (FTC), Consumer Financial Protection Bureau (CFPB),
State Attorneys General in any jurisdiction, within the last two years?
 YES
 NO
If YES, provide copies of all findings, consent orders, or settlements with any government or regulatory body in 2017
and 2018.
Page 2 of 3
Debt Collection Agency Licensing & Renewal Supplement
7. Provide the following information about the person who completed this form:
Person completing this form:
(A) Name:
(B) Title:
(C) Company:
(D) Address:
(E) Telephone number:
(F) Fax:
(G) Email address:
(H) Relationship to applicant / license holder:
 I am a designated representative of the license holder.
 I am an owner, partner, or corporate officer of the license holder.
Affirmation:
I am authorized to complete and submit this application (the "Application"). I have reviewed the entire Application.
To the best of my knowledge, this Application is true, correct, and complete.
If any of the information in this Application changes, the applicant must inform the Department of Consumer Affairs of
those changes. I also understand that the applicant must comply with all relevant laws and rules relating to the license
which I am renewing.
I understand that the submission of this Application does not mean that my license has been renewed and that any
operation of my business after the expiration of my current license and before the issuance of a new license may
subject me to penalties. This affirmation shall be deemed executed in the City and State of New York and shall be
governed by and construed in accordance with the laws of the State of New York (notwithstanding New York choice of
law or conflict of law principles) and the laws of the United States.
PENALTY FOR FALSE STATEMENTS:
It is against the law to make a statement in this Application that you know is false. If you make a statement that you
know is false, you may be punished.
Under Sections 210.45 and 175.30 of the New York Penal Law, you may be:
fined up to $1000 and / or
sent to jail for up to one year
Under Section 175.35 of the New York Penal Law, you may be punished if you:
make a statement that you know is false and / or
make the statement because you intend to mislead the Department of Consumer Affairs
Under Section 175.35 of the New York Penal Law, you may be:
fined up to $5000 or
fined an amount that is twice the amount of money you received by making the false statement and / or
sent to jail for up to 4 years
The Department of Consumer Affairs may also punish you for making a false statement on this Application. These
punishments may include:
fines or penalties of up to $500 for each false statement
permanent loss (revocation) of your license
By signing below, I affirm that the statements above are true and correct.
___________________________________________________
___________________________________________________
Applicant’s Signature*
Applicant’s Position/Title (if any)
___________________________________________________
___________________________________________________
Print Full Name
Date
*If you submit this form as an electronically filled-in PDF, the applicant may type his or her name in the signature field.
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Debt Collection Agency Licensing & Renewal Supplement
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