Bankruptcy Pre-Filing Disclosure

We understand that you are here because you may be experiencing financial difficulties and might be considering filing for bankruptcy.   Part of the bankruptcy process requires financial counseling before you file. Please be aware that filing for bankruptcy will affect your credit report and credit rating.

This agency has over 40 years of experience helping people with financial problems. Our role is not to be judgmental, but to provide assistance. Specifically, we will do a budget analysis that will examine your financial situation, discuss the factors that may be causing your problems, and assist you with developing a plan for overcoming financial hardship. We will provide you with information about the bankruptcy process, including possible consequences. We will also consider alternatives to bankruptcy in an attempt to resolve any contributing issues.

Prior to any counseling session (in-person, phone interview or online), you will be asked to provide identity verification. If your counseling/education session is to be done at the agency’s physical location, please bring proof  of identity (Driver’s license) to your appointment. If the session is to be provided over the phone or Internet, please be prepared to supply a personal identifier to the session administrator. The administrator may provide you with a combination of access code, user ID or password that should be kept confidential.

Following the successful conclusion of this session, you will be promptly provided with the required certificate, should you decide to proceed with the bankruptcy filing. These certificates are valid for up to 180 days following the completion of the counseling session.

This agency is a member of the National Foundation for Credit Counseling (NFCC). The NFCC has established standards for quality credit counseling and financial education, and the agency complies with those standards. In addition, this agency is accredited by the Council on Accreditation (COA)., An independent third-party organization that reviews and monitors social service agencies. We are a non-profit agency, organized and operating in accordance with section 501 © (3) of the Internal Revenue Service Code.

The consumer credit counselor conducting or supervising this session has been trained and certified in accordance with the NFCC standards, and while he/she has expertise in helping those with financial problems, he/she cannot provide you with legal advice. In fact, this session is designed to provide information and alternatives; it is not intended to take the place of a consultation with an attorney during which you can explore your legal rights and options.

In order to provide individual assessment and instruction, it is essential that you provide information that is accurate, thorough and complete. For that reason, we may ask you to authorize access to your credit history. Any information collected concerning your financial situation and status is strictly confidential. Such information would include, but is not limited to, income, debts, credit accounts, earnings, assets, and employment data. Client information may be disclosed to the Executive Office for the US Trustees (EOUST). EOUST oversees the bankruptcy process and may review client files to insure agency compliance. EOUST has not, and does not, review other counseling services provided by CCCS of the Mid-Ohio Valley with the exception of Debtor Education Instruction.

Your signature below authorizes this agency to provide specific client information to EOUST. We will not disclose any information that you provide orally or in writing to any individual or agency, unless authorized by you in writing or as required by law, such as in response to a subpoena. We compile data and aggregate information that you provide, but information about this session will not be disclosed to a credit reporting agency. If you should decide to enter into a Debt Management Plan (DMP), you will be provided with separate agreement and disclosure documents.

To help cover the cost of providing this course, the agency charges a fee of $40.00 for an individual and $80.00 for couples who are filing joint Bankruptcy. The fee is due upon completion of the course. You may be eligible to have this fee waived or reduced if you meet the Federal Poverty Guidelines provided to you on our website. You can choose not to provide verifiable income information. However, if you elect to "opt out" of providing income information, you are opting out of consideration for a waiver or reduced fees. Fees can be paid with a debit/credit card, cash, personal check, money order or cashier check and made payable to CCCS. Services will not be denied due to the inability to pay nor will certificates be withheld.

CCCS does not pay or receive fees or other consideration for the referral of clients to or by the provider.

This agency may also receive funding in the form of grants from federal government agencies and creditors. A portion of funding for this agency comes from voluntary contributions from creditors who participate in the Debt Management Programs. Since creditors have a financial interest in having debts repaid, most are willing to make a contribution to help fund the overall services of the agency. Again. Should you decide to enter into a Debt Management Program you will receive specific information on how the plan works and how the agency is funded.

For a schedule of courses, times, dates and places, please call CCCS at 304-485-3141, 866-481-4752 or check our website at for updates.

I have read and understand the disclosures made above.

Electronic Signature: