"Debt Collection Agency - New & Renewal License Application Supplement" - New York City

Debt Collection Agency - New & Renewal License Application 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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DEPARTMENT OF CONSUMER
NYC SMALL BUSINESS
AFFAIRS (DCA) LICENSING CENTER
SUPPORT CENTER
42 Broadway, Lobby
90-27 Sutphin Blvd, 4th Floor
New York, NY 10004
Jamaica, NY 11435
By Appointment Only Hours:
By Appointment Only Hours:
Monday, Wednesday: 8 a.m. – 4 p.m.
Tuesday, Thursday: 8 a.m. – 4 p.m.
Last appointment: 3:30 p.m.
Last appointment: 3:30 p.m.
2021 Debt Collection Agency – New & Renewal License Application Supplement
Instructions: You must complete this form by providing current information for your business and affirm that your
responses are true and complete. 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
(Fill in if you are renewing; leave blank
Clerk or New York State Secretary of State.)
if this is a new 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.”)
1. What is the total number of
NYC consumer accounts on which
2019 ________________
2020 _________________
you collected or attempted to collect
a debt in 2019 and 2020?
 YES
 NO
2. Does your business contact
NYC consumers directly to collect
(Contacts consumers
(Does not contact
debt, including by mail or telephone?
directly to collect debt.)
consumers directly to
collect debt.)
 YES
 NO
3. (a) Does your business collect debts in a
language other than English?
(Contacts consumers in a
(Does not contact
language other than
consumers in a language
English.)
other than English.)
(b) If YES, which languages?
a. Spanish
e. Korean
b. Arabic
f. Russian
c. Chinese
g. Other
d. Haitian Creole
_________________
Updated 11/13/2020
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2021 Debt Collection Agency New & Renewal License Application Supplement
DEPARTMENT OF CONSUMER
NYC SMALL BUSINESS
AFFAIRS (DCA) LICENSING CENTER
SUPPORT CENTER
42 Broadway, Lobby
90-27 Sutphin Blvd, 4th Floor
New York, NY 10004
Jamaica, NY 11435
By Appointment Only Hours:
By Appointment Only Hours:
Monday, Wednesday: 8 a.m. – 4 p.m.
Tuesday, Thursday: 8 a.m. – 4 p.m.
Last appointment: 3:30 p.m.
Last appointment: 3:30 p.m.
2021 Debt Collection Agency – New & Renewal License Application Supplement
Instructions: You must complete this form by providing current information for your business and affirm that your
responses are true and complete. 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
(Fill in if you are renewing; leave blank
Clerk or New York State Secretary of State.)
if this is a new 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.”)
1. What is the total number of
NYC consumer accounts on which
2019 ________________
2020 _________________
you collected or attempted to collect
a debt in 2019 and 2020?
 YES
 NO
2. Does your business contact
NYC consumers directly to collect
(Contacts consumers
(Does not contact
debt, including by mail or telephone?
directly to collect debt.)
consumers directly to
collect debt.)
 YES
 NO
3. (a) Does your business collect debts in a
language other than English?
(Contacts consumers in a
(Does not contact
language other than
consumers in a language
English.)
other than English.)
(b) If YES, which languages?
a. Spanish
e. Korean
b. Arabic
f. Russian
c. Chinese
g. Other
d. Haitian Creole
_________________
Updated 11/13/2020
Page 1 of 5
2021 Debt Collection Agency New & Renewal License Application Supplement
(c) If YES, what services do you provide
a. Collection letters
c. General translation
consumers in a language other than
services
English?
b. Multilingual
d. Other (Explain.)
customer service
_________________
representatives
_________________
If you check b., what
_________________
is the total number
_________________
of employees
_________________
assigned to collect
_________________
debt in a language
other than English:
2019 _________
2020 _________
(d) If YES, what is the total number of
NYC consumer accounts on which you
2019 ________________
2020 _________________
attempted to collect a debt in a language
other than English?
 YES
 NO
4. Does your business purchase
delinquent debt?
(Purchases delinquent
(Does not purchase
debt.)
delinquent debt.)
 YES
 NO
5. (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
Supervising Attorney’s Information:
State of 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,
Number of
limited to the total number of attorneys
Attorneys on Staff:
who are currently licensed to practice law
in the State of New York.
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2021 Debt Collection Agency New & Renewal License Application Supplement
6. Check all the type(s) of business activities that you engage in:
a. First party collections
k. Third party collections
b. Debt buyer
l.
Account / billing services
c. Furnish consumer information
m. Child support collections
to credit bureaus
d. Bad check recovery
n. Student loan debt servicing
e. Consumer credit card
o. Student loan debt collections
collections
f.
Government / Municipal
p. Initiating consumer collection
collections
lawsuits
g. Medical debt collections
q. Enforcing consumer credit
If you check g., what
judgments
percentage of NYC consumer
accounts pertain to medical
debt? ___________
h. Payday loan collections
r. Mortgage financing
i.
Automobile debt collections
s. Telecom / Utilities collections
j.
Collect on time-barred debt
t.
Furniture and appliances
financing collections
7. Within the last two years, has your business been subject to:
1) an adverse finding or decision in private litigation (other than on procedural matters) related to your
debt collection practices; or
2) an adverse finding or a settlement agreement related to your debt collection practices (other than
operating without a license) by any regulatory agency, including but not limited to, the Federal Trade
Commission (FTC), Consumer Financial Protection Bureau (CFPB), State Attorneys General, or a
licensing or consumer affairs agency in any jurisdiction.
 YES
 NO
If YES, you must provide copies of all adverse findings in private litigation and all adverse
findings, consent orders, or settlements with any government or regulatory body in 2019 and
2020. Your application will be denied if you fail to submit actual copies of the requested
documents with this application.
 YES
 NO
8. (a) Does your business record telephone
conversations with consumers?
 YES
 NO
(b) If YES, does your business maintain
the recordings?
If YES, what percentage
of recordings does your
business maintain?
_________________
____
 YES
 NO
9. Does your business or any third party on
your behalf charge fees to consumers for
processing payments?
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2021 Debt Collection Agency New & Renewal License Application Supplement
10. Does your business maintain written protocols, policies, or guidelines addressing the following activities:
(Check all that apply.)
a. Handling consumer debt
e. Providing services to
disputes
consumers in a language
other than English
b. Confirming the validity of
f.
Entering into debt payment
debts before collection
schedules and settlement
agreements
c. Providing consumers
g. Maintaining debt collection
written verification of debts
records
d. Collecting time-barred
h. Responding to consumer
debts
complaints (including those
submitted to DCA)
11. 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 Number:
(G) Email:
(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.
Page 4 of 5
2021 Debt Collection Agency New & Renewal License Application Supplement
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 name in the signature field.
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2021 Debt Collection Agency New & Renewal License Application Supplement
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