Forms

  • Upper Arkansas Area Council of Governments
    Chaffee - Custer - Fremont - Lake Counties

Home Repair Application

UAACOG’s Home Repair Program provides affordable loans to low-income homeowners in Chaffee, Custer, Fremont, Lake, Park and Teller Counties. The loans repair owner-occupied homes — leaking roofs, electrical and heating systems, plumbing and septic, sagging floors, crumbling foundations, fire mitigation, accessibility and other safety concerns — and can also pay for energy efficiency upgrades. UAACOG partners with the Colorado Division of Housing to provide this assistance.

Our goal is to make this process as friendly and easy as possible, so please do not worry about filling everything in perfectly. Several staff members are available to help you with any application, loan or construction question, and anything you leave out can be sorted out at your intake appointment.

This program is designed to help homeowners who own and occupy their home, meet income guidelines, need home repairs and/or have overcrowding issues, or would like to improve their home’s energy efficiency.

Your Social Security numbers and bank account numbers are encrypted and are never sent by email. They are stored securely and can only be read by authorized UAACOG housing staff signed in to our staff portal.

Please do not attach or email documents containing this information. Supporting documents are collected at your intake appointment.

Pull your own credit reports before your appointment. This prevents us from adding an inquiry to your credit report. You can obtain a free credit report by calling 1-877-322-8228 or by visiting annualcreditreport.com. By law you are entitled to one free credit file disclosure every 12 months from each of the three nationwide credit reporting companies – Equifax, Experian and TransUnion. Your credit report will not include your credit score, so please also pull your current scores (Credit Karma, or your credit card company may offer a free score). You should be able to obtain 3 credit reports and 3 credit scores.

After you submit this application, contact loan officer Jackie Wolf at 719-275-8350 to schedule an intake appointment. Please bring the following to that appointment:

  1. Employment information for all adults in the household – the most recent two months’ pay stubs with year-to-date totals; each employer’s name, address and phone number; current wage, hours worked and how often paid.
  2. Non-employment income (current award letters / court orders) – Social Security, SSI, pensions and annuities, veteran’s benefits, alimony/child support, support for foster children, workmen’s compensation, trade union benefits, unemployment insurance, and other public assistance (LEAP, Food Stamps, TANF, AND, etc.).
  3. Bank statements – three months of statements, or a verification of deposit showing a three-month average balance, for the most recent checking, savings, retirement and other investment accounts.
  4. Expense information – most recent credit card statements; medical insurance expense and proof of out-of-pocket medical expenses.
  5. Utility bills – the last twelve months of gas/heating, electricity, phone/cell phone, cable or dish TV/internet/streaming, and other (water, sewer, trash) bills.
  6. Income tax information – your most current income tax return.
  7. Additional information – current property tax statement; current homeowner’s policy or payment statement; a copy of the driver’s license or state ID for all adults in the household; current auto insurance and/or auto loan statements; and your most recent mortgage or rent statement.

Call 719-275-8350 if you need assistance or need copies made.

Applicant Information
Encrypted and never sent by email.
Co-Applicant Information
Encrypted and never sent by email.
Dependents / Other Residents
Property Information
Enter a dollar amount.
Employment Information - Applicant
Enter a dollar amount.
Previous Employer
Complete this section if you have been at your current job less than two years.
Enter a dollar amount.
Employment Information - Co-Applicant
Enter a dollar amount.
Other Sources of Income
List all other sources of income – Social Security, retirement, VA, alimony, child support, TANF, wages, tips, overtime, rental properties, interest and so on.
Enter a dollar amount.
Enter a dollar amount.
Enter a dollar amount.
Enter a dollar amount.
Assets
Real property or other capital investments not listed above.
Equity is the estimated current market value less the unpaid balance on loans and less reasonable costs that would be incurred in selling the asset, such as broker fees.
Enter a dollar amount.
Equity is the estimated current market value less the unpaid balance on loans and less reasonable costs that would be incurred in selling the asset, such as broker fees.
Enter a dollar amount.
Equity is the estimated current market value less the unpaid balance on loans and less reasonable costs that would be incurred in selling the asset, such as broker fees.
Enter a dollar amount.
Stocks, Bonds and Other Investments
Stocks, bonds, savings certificates, money market funds and/or other investment securities.
Enter a dollar amount.
Enter a dollar amount.
Bank Accounts
Encrypted and never sent by email.
Enter a dollar amount.
Encrypted and never sent by email.
Enter a dollar amount.
Encrypted and never sent by email.
Enter a dollar amount.
Encrypted and never sent by email.
Enter a dollar amount.
Monthly Housing Expenses
Leave a row blank if it does not apply to you. UAACOG calculates the total – you do not need to add it up.
Monthly Living Expenses
Average your annual costs to get a monthly figure. UAACOG calculates the total.
Enter a dollar amount.
Enter a dollar amount.
Enter a dollar amount.
Your monthly home phone, cell phone and internet bill.
Enter a dollar amount.
Enter a dollar amount.
Enter a dollar amount.
Enter a dollar amount.
Enter a dollar amount.
Enter a dollar amount.
For example pet food or tobacco.
Other Monthly Expenses
Mortgage loans, auto loans, credit cards, charge accounts, doctor bills and similar.
Encrypted and never sent by email.
Encrypted and never sent by email.
Encrypted and never sent by email.
Encrypted and never sent by email.
Encrypted and never sent by email.
Encrypted and never sent by email.
Payroll Taxes Withheld
UAACOG calculates the combined figures.
Additional Information Requested
This voluntary information is for HUD statistical purposes only.
Authorization and Hold Harmless Agreement

AUTHORIZATION AND HOLD HARMLESS AGREEMENT

I/We accept the services of UAACOG Housing Rehabilitation and authorize UAACOG to act as a technical assistant and advisor in connection with the services selected above, on the property described in the Property Information section of this application.

I/We further agree to hold harmless the employees, members, board members, and officers of the UAACOG and the Housing Rehabilitation Program in connection with acts performed by them which would be associated with consultation, technical advice, financial counseling, loan processing, property inspection, and other related activities.

I/We authorize the Housing Rehabilitation staff to obtain specific reports, such as personal income reports, property title and tax searches, inspection reports, repair specifications, cost estimates, contractor bids, and such other reports which said staff deems necessary to perform its functions.

I/We have been informed that the Upper Arkansas Area Council of Governments, which administers the Housing Rehabilitation Program, has a Section 504/Americans with Disabilities Act Grievance Procedure that is available upon request at the receptionist’s desk.

Privacy Act Notice

NOTICE TO APPLICANT REGARDING PRIVACY ACT INFORMATION

The information requested on this form is authorized to be collected by the Upper Arkansas Area Council of Governments (UAACOG) (the agency).

Disclosure of information requested is voluntary. However, failure to disclose certain items of information requested, including your Social Security Number or Federal Identification Number, may result in a delay in the processing of an application or its rejection. Information provided may be used outside of the agency for the following purposes:

  1. When a record on its face, or in conjunction with other records, indicates a violation or potential violation of law, whether civil, criminal or regulatory in nature, and whether arising by general statute or particular program statute, or by regulation, rule, or order issued pursuant thereto, disclosure may be made to the appropriate agency, whether Federal, foreign, State, local, or tribal, or other public authority responsible for enforcing, investigating, or prosecuting such violation or charged with enforcing or implementing the statute, or rule, regulation, or order issued pursuant thereto, if the information disclosed is relevant to any enforcement, regulatory, investigative, or prosecutive responsibility of the receiving entity.
  2. A record from this system of records may be disclosed to a Member of Congress or to a congressional staff member in response to an inquiry of the congressional office made at the written request of the constituent about whom the record is maintained.
  3. Referral of names, home addresses, social security numbers, and financial information to a collection or servicing contractor, financial institution, or a local, State, or Federal agency, when UAACOG determines such referral is appropriate for servicing or collecting the borrower’s account or as provided for in contracts with servicing or collection agencies.
  4. It shall be a routine use of the records in this system of records to disclose them in a proceeding before a court or adjudicative body, when: (a) the agency or any component thereof; or (b) any employee of the agency in his or her official capacity; or (c) any employee of the agency in his or her individual capacity where the agency has agreed to represent the employee; or (d) the UAACOG is a party to litigation or has an interest in such litigation, and by careful review, the agency determines that the records are both relevant and necessary to the litigation, provided; however, that in each case, the agency determines that disclosure of the records is a use of the information contained in the records that is compatible with the purpose for which the agency collected the records.
  5. Referral of names, home addresses, and financial information for selected borrowers to financial consultants, advisors, lending institutions, packagers, agents and private or commercial credit sources, when UAACOG determines such referral is appropriate to encourage the borrower to refinance the UAACOG indebtedness as required by title V of the Housing Act of 1949, as amended (42 U.S.C. 1471), or assist the borrower in the sale of the property.
  6. Referral of names, home addresses, and financial information to lending institutions when UAACOG determines the individual may be financially capable of qualifying for credit with or without a guarantee.
  7. Disclosure of names, home addresses, social security numbers, and financial information to lending institutions that have a lien against the same property as UAACOG for the purpose of the collection of the debt.
  8. Referral to private attorneys under contract with the Upper Arkansas Area Council of Governments for the purpose of foreclosure and possession actions and collection of past due accounts in connection with UAACOG.
  9. Referral of names, home addresses, social security numbers, and financial information to the Department of Labor, State Wage Information Collection Agencies, and other Federal, State and local agencies, as well as those responsible for verifying information furnished to qualify for Federal benefits, to conduct wage and benefit matching through manual and/or automated means, for the purpose of determining compliance with Federal regulations and appropriate servicing actions against those not entitled to program benefits, including possible recovery of improper benefits.
  10. Referral of names, home addresses, and financial information to financial consultants, advisors, or underwriters, when UAACOG determines such referral is appropriate for developing packaging and marketing strategies involving the sale of UAACOG loan assets.
  11. Upper Arkansas Area Council of Governments, in accordance with 31 U.S.C. 3711(e)(5), will provide to consumer reporting agencies or commercial reporting agencies information from this system indicating that an individual is responsible for a claim that is current.
  12. Referral of names, home and work addresses, home telephone numbers, social security numbers, and financial information to escrow agents (which also could include attorneys and title companies) selected by the applicant or borrower for the purpose of closing the loan.
  13. Disclosures pursuant to 5 U.S.C. 552a(b)(12): Disclosures may be made from this system to consumer reporting agencies as defined in the Fair Credit Reporting Act (15 U.S.C. 1681a(f)) or the Federal Claims Collection Act (31 U.S.C. 3701(a)(3)).
Certification and Signature
A typed name is a legal representation of your signature.
Required only if there is a co-applicant.

* Required field