HMDA Data Collection Worksheet

Demographic Addendum:

NA for loans in the name of a business

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

Demographic Addendum Upload:

Maximum file size: 3MB

PDF file preferred. Less than 3MB file size please.

Prepared By:

Email Address:

Borrower Name:

Loan Number:

Application Date:

Loan Type:

Loan Amount:

Loan Officer

Loan Purpose:

Select One

Occupancy:

Principal Residence

Second Residence

Investment Property

Construction Method:

Site-built

Manufactured Home

Select One

Action Taken Date:

Date of the NOTE or Denial

Action Taken:

Loan Originated

Application Approved but Not Accepted

Application Denied

Application Withdrawn by Applicant

File Closed for Incompleteness

Subject Property Address:

City

State/Province

Zip/Postal

Country

Lien Status:

Secured by a First Lien

Secured by a Subordinate Lien

Qualifying Income:

Annual income used in qualifying. Enter "NA" for business application.

Total Number of Units:

Applicant Credit Score:

Enter "NA" for business application.

Applicant’s Date of Birth:

Enter "NA" for business application.

Co-Applicant Credit Score:

Enter "NA" for business application.

Co-Applicant's Date of Birth:

Enter "NA" for business application.

Applicant Credit Scoring Model:

Co-Applicant Credit Scoring Model:

Interest Rate:

%

Prepayment Penalty Term:

Enter 0 for none available.

Combined LTV:

%

Loan Term:

Introductory Rate Period:

Enter 0 for none available.

Balloon Payment:

Yes

No

Interest-only Payments:

Interest-only Payments

No Interest-only Payments

Property Value:

Multifamily Affordable Units:

Enter 0 for none available.

Open-end Line of Credit:

Open-end Line of Credit

Not an Open-end Line of Credit

Line of Credit Purpose:

Primarily for business/commercial purpose

Not primarily for business/commercial purpose

Debt to Income Calculation:

Not calculated

NA for Business

%%

Enter only if used in qualifying

For Cash-Out Loans:

Paying Off Lien

Purpose of FundsPurpose of Funds

Reason for Denial

For reportable loans, complete the following HMDA data:

Thank You!

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