HMDA Data Collection Worksheet

Applications that meet the following criteria should be reported (must meet ALL of the following):

  • Complete application (defined as: prop address, loan amount, value, income, borrower SS#)
  • Applications for purchase, home improvement or refinancing
  • Applications for loans secured by a Residential Structures
  • Applications for loans NOT for primarily agricultural proposes
  • Applications for “permanent” financing (the borrower does not intend to replace the loan)

For reportable loans, please complete the following.

HMDA Data Collection Worksheet
Demographic Addendum:
If the loan is in the name of an individual, please attach a completed Demographic Addendum for each borrower.

Maximum file size: 3MB

PDF file preferred. Less than 3MB file size please.
Loan Purpose:
Select One
Occupancy:
Construction Method:
Select One
Date of the NOTE or Denial
Action Taken:
Subject Property Address:
Subject Property Address:
City
State/Province
Zip/Postal
Country
Lien Status:
Annual income used in qualifying. Enter "NA" for business application.
Enter "NA" for business application.
Age at Application Date. Enter "NA" for business application.
Enter "NA" for business application.
Enter "NA" for business application.
Applicant Credit Scoring Model:
Co-Applicant Credit Scoring Model:
%
Enter 0 for none available.
%
Enter 0 for none available.
Balloon Payment:
Interest-only Payments:
Enter 0 for none available.
Open-end Line of Credit:
Line of Credit Purpose:
Debt to Income Calculation:
Enter only if used in qualifying
For Cash-Out Loans:
Reason for Denial

Thank You!

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