Please read and sign below indicating that you have read this Disclosure Form and been provided a complete copy of the Form.
Fee Schedule
The price for each counseling internet session is $30 for a single session and $40 for a joint counseling session.
Telephone counseling is also available for $50 (single or joint).
Payment may be made by debit card, credit card or money order.
There is no separate fee to generate your certificate. All certificates will be sent via e-mail without any
additional charges. You can also choose to have your certificate sent to you via facsimile, regular mail or FEDEX.
Fees for faxing or mailing your certificate of completion are $3 and the FEDEX charge is $40.
Faxing, mailing or FEDEX are optional.
Ability to Pay
The session is being offered to you regardless of your ability to pay for the course. In order to qualify, counselee must
complete the attached Waiver Request Form and return to us as instructed on the Form. In order to qualify for a complete or
partial waiver, counselee must have income below 150% of the current poverty guidelines as defined by the U.S. Department
of Health and Human Services. Please complete the information below to determine your qualification for a waiver.
Waiver Qualifications
A waiver or reduced fee will be granted under the following circumstances:
Total Income is less than 150% of the Poverty Guidelines as defined by the U.S. Department of Health and Human Services.
Click here for tables.
If you do not wish to be considered for a waiver,
please click this box
Please enter the following information to be considered for a waiver:
Current Annual Income:
Household Size:
(include all people in your home including yourself)
to determine if you may be eligible for a waiver.
In addition, a waiver or reduced fee may be granted if the counselee is receiving pro bono legal services in connection with a filed or anticipated bankruptcy case.
Please contact us by sending an e-mail to questions@a123cc.org
or by calling us at (305) 269-9201 or Toll Free 1-888-412-2123 if you would like to request a waiver of the fee.
Alternative Payment Schedule
The counselee has the opportunity to negotiate an alternative payment schedule with regard to each unsecured
consumer debt under terms in 11 U.S.C. 502(k). We do not provide such negotiation services.
We may refer the counselee to another approved agency that does provide such services and additional fees
may be due in connection with such referral.
Counselor Qualification
All counselors must meet certain guidelines established by the US Trustee's office
and US Bankruptcy Administrator's Program office.
At a minimum, all counselors must be accredited or certified by:
the National Foundation for Credit Counseling ("NFCC");
the Association of Independent Consumer Credit Counseling Agencies ("AICCCA"); or
the counselor has successfully completed a course of study acceptable to the United States
Trustee and has worked a minimum of six months in a related area, including personal finance,
budgeting, and debt management.
All of our counselors have successfully completed a course of study acceptable by the United
States Trustee and have worked for a minimum of 6 months in credit counseling and
personal finance.
Qualifications of the Course
The Agency has been approved to issue certificates in compliance with the Bankruptcy Code. Approval does not endorse or assure the quality of an Agency's services.
Limited English Proficiency Policy
123 Credit Counselors, Inc. (123) will take reasonable steps to ensure that persons with Limited English Proficiency (LEP)
have meaningful access and an equal opportunity to successfully complete our course.
The policy of 123 is to ensure meaningful communication with LEP students involving the
completion of their credit counseling session.
Language assistance will be provided through use of competent bilingual staff and by providing our course in the Spanish language.
123 will conduct a regular review of the language access needs of our students, as well as update and monitor the implementation of this policy and these procedures, as necessary.
Impact on Credit Reports
No information gathered or the results of the Credit Counseling session will be disclosed to a Credit Reporting Agency.
Counselors will discuss alternatives to addressing your debt issues including filing bankruptcy or enrolling in debt management plans.
Both of these options if undertaken may have a negative impact on your credit report.
Funding Sources
The Agency is funded 100% by Counselee contributions.
Referral Fees
Referral fees have not or will not be paid to any person (individual or company) for referring
individuals to this Agency. In addition, no referral fees will be accepted for referring Counselees
to any third party for purposes of resolving their credit and debt problems.
Disclosure of Student/Debtor Information to Executive Office for U.S. Trustees (EOUST)
& US Bankruptcy Administrator's Program (USBAP)
The Agency may disclose debtor information to the EOUST or USBAP in connection with the United States
Trustee's oversight of the agency, or during the investigation of complaints, during on-site visits,
or during quality of service review.
Review of Other Services Provided by Agency
The EOUST or USBAP has not reviewed or approved any other services provided by the Agency.
The EOUST and USBAP review is limited to the credit counseling
services provided pursuant to the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005.
Counseling Session Certificate
Upon completion of the credit counseling online course, the counselee will be required to speak with a credit counselor
via chat. This is a verification of identity, as well as a verification that the counselee
understands the course materials and has had an adequate counseling session. Immediately following the chat session,
the Certificate of Credit Counseling will be prepared and sent out accordingly.
123 is obligated to provide a Certificate of Credit Counseling upon completion of counseling services.
A certificate will only be issued if the counselee completes the credit counseling session including speaking
with a credit counselor via chat.
IF YOU MUST RECEIVE YOUR CREDIT COUNSELING CERTIFICATE BEFORE A SPECIFIC DEADLINE, YOU MUST CALL OUR OFFICE BETWEEN 9:00 a.m.
(EST-Eastern Standard Time) and 5:30 p.m. EST TO ENSURE A COUNSELOR WILL BE AVAILABLE WHEN YOU COMPLETE THE INTERNET PORTION
OF YOUR COUNSELING SESSION.
Register here for your Credit Counseling Session.
COUNSELING SESSION.
IF THIS IS A JOINT COUNSELING SESSION AND YOU WISH TO REGISTER YOUR SPOUSE AT
THIS TIME, PLEASE CHECK THE BOX BELOW TO COMPLETE YOUR SPOUSE'S REGISTRATION.
IF YOUR SPOUSE REGISTERS SEPARATELY AT A LATER TIME, AN ADDITIONAL COURSE FEE
WILL BE REQUIRED.
IF YOUR SPOUSE IS COMPLETING THE COURSE WITH A DIFFERENT CREDIT COUNSELING
PROVIDER OR REGISTERING AT A LATER TIME, PLEASE DO NOT CHECK THIS BOX.
Your name should be entered as it appears on your social security card.
Middle Initial:
*Last Name:
*DOB:
*Last 4 Digits SSN:
*Address:
Suite/Unit #:
*City:
*State:
*Zip:
*Phone:
Fax:
Email:
If you have an email address, enter it in the above box.
This is where your certificate will be sent.
If you do not have an email address, please leave this box blank.
PLEASE DO NOT ENTER YOUR ATTORNEY'S EMAIL IN THIS BOX.
If you would like a copy sent to a third party (e.g. attorney, trustee, etc.)
you may enter this email address in the space provided below.
Joint User Information
*Desired Login:
*Password:
*Password Verify:
*First Name:
Your name should be entered as it appears on your social security card.
Middle Initial:
*Last Name:
*DOB:
*Last 4 Digits SSN:
Same Address?
*Address:
Suite/Unit #:
*City:
*State:
*Zip:
*Phone:
Fax:
Email:
If you have an email address, enter it in the above box.
This is where your certificate will be sent.
If you do not have an email address, please leave this box blank.
PLEASE DO NOT ENTER YOUR ATTORNEY'S EMAIL IN THIS BOX.
If you would like a copy sent to a third party (e.g. attorney, trustee, etc.)
you may enter this email address in the space provided below.
Do not enter the same email address as 1st user. Leave blank if you
share the same email.
*How do you want to Receive your Certificate?:
Attorney Code:
- OR -
Attorney/Administrator Name:
Required (If an attorney is not being used, then write "NA")
Attorney/Administrator Email:
Recommended (If an attorney is not being used, then write "NA")
