Bankruptcy Pre-Discharge Disclosure Form

Welcome! We understand that you have made an inquiry because you are required to complete "an instructional course concerning personal financial management", prior to receiving a bankruptcy discharge.

This agency has over 20 years of experience providing financial education to individuals and families. It is our view that the purpose of this financial management course is to provide you with the knowledge to manage your finances and give you the tools to help build a brighter financial future. We use the American Center for Credit Education (ACCE) course, Money In Motion. Upon your completion of this course, you will be provided with a certificate of course completion.

For limited English proficient clients, Family Service Agency arranges for an interpreter for phone counseling services. Interpreters utilized by FSA are certified to ensure quality care and customer care. We maintain a list of certified interpreters and agencies

This agency is a member of the National Foundation for Credit Counseling ("NFCC"). The NFCC has high standards for quality credit counseling and financial education, and this 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 entities that provide social services. We are a non-profit agency. We are organized and operate in accordance with Section 501(c) (3) of the Internal Revenue Code.

The counselors/educators have 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.

Rest assured that the information concerning your financial condition and status that you provide during this course is strictly confidential except as authorized by you in writing or as required by law, such as a response to a subpoena or the United States Trustee in their oversight of this agency of during the investigation of complaints, during on-site visits or during quality service reviews. We may compile data and aggregate information that you give us, but this information will not be disclosed in any manner that would personally identify you.

Family Service Agency, Inc. does not pay or receive fees or other consideration for the referral of students.

To help with the cost of providing this financial management course to you, this agency charges a fee of $50.00 for a single or $65.00 for a joint filing. A student may be eligible for a fee waiver based on the lack of inability to pay. A fee is waived if the student's current household income is less than 150% of the poverty guidelines for a household or family of the size involved in the fee determination. The poverty guidelines are updated periodically by the US Department of Health and Human Services. To process a waiver, data is gathered. FSA-CCCS will go to the Money-in-Motion Website and create a student account. Once the student has read and agreed to the disclosure, the student will be furnished the user name and password. The student enters the Motion-in-Motion portal as an existing student and proceeds to the course. No one is denied service because of the inability to pay.

Once you complete the online course, including all required questions and worksheets, your certificate of completion will be sent to you promptly via your chosen method (email, fax, or mail) within two business days. You will only receive this certificate if you complete this course of instruction.

The United States Trustee has reviewed only our credit counseling and personal financial management instructional course pursuant to 11 U.S.C. 111(d) and the U S Trustees has not reviewed other non-counseling/instructional services we provide to individuals and families.