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Acknowledgement and Agreement, Including the Dodd-Frank Certification

As part of your loan modification application, you’ll need to certify that you haven’t been convicted of various crimes in the past 10 years by signing the first page of this form (Acknowledgment and Agreement). We’ll let you know if you need to also complete the second page. Consult your home preservation specialist for the correct form to use.

The form on this page is to be used by Federal Housing Administration (FHA) or United States Department of Agriculture (USDA) loan customers.

Avoid delays in processing your application

For all documents:

  • Make sure the copies you send are legible.
  • Do not include documents that have been altered with correction fluid or by other means.
  • Submit the entire requested document and include all pages (even blank ones).