PLEASE READ THE FOLLOWING IMPORTANT INFORMATION CAREFULLY, SO THAT YOU UNDERSTAND THE PROCEDURES FOR THE COUNSELING SESSION. FOR SIMPLIFICATION THE SINGULAR IS USED EVEN WHEN THE PLURAL MAY APPLY.

The Agency will provide a confidential comprehensive personal money management interview that will be conducted by a certified consumer credit counselor or counselor in training to be certified. A certified consumer credit counselor will review all action plans for all counselors training to be certified. 
        A credit report may be required to be retrieved from a national credit reporting agency. By signing this form you authorize CCCS of Buffalo, Inc. to obtain a credit report for the basis of reviewing your financial situation.
        Services are offered without regard to ability to pay and services will not be withheld because of inability to pay. A fee waiver may be obtained in cases of specific hardship based upon income and must be verified by presentment of pay stubs and/or other proof of income.
        Most of the Agency funding comes from voluntary contributions from creditors who participate in the Debt Management Plan (DMP).
        Since creditors have a financial interest in getting paid, most are willing to make a contribution to help fund our agency. These contributions are usually calculated by each creditor as a percentage of the payment (up to 15%) of each payment received. However, your accounts with your creditors will always be credited with one hundred percent (100%) of the amount you pay through us, and we will work with all of your creditors regardless of whether they contribute to our agency.
 
You will be provided a written assessment outlining a suggested client action plan which will be based on the following options:
a)       You will handle any financial concerns on your own.
b)      Enrollment in a Debt Management Plan (DMP), is an option but may not suitable for everyone. Our DMP's are a voluntary program which serves a dual role of helping you repay your debts and helping the creditors to receive the money owed to them. Your participation in a debt repayment program may change information which is already on your credit report. If your credit report reflects that you have paid creditors as agreed in the past, a DMP could have a negative impact on a creditworthiness decision by a potential creditor, landlord, or employer in the future. In addition, creditors may report that you are on a DMP and are not paying as originally agreed although they have accepted the reduced payment.
c)       Seek legal advice regarding your financial situation. Counselors may answer general questions regarding bankruptcy but cannot provide legal advice. You should be aware that debts to creditors you repay through the plan may be able to be discharged through bankruptcy. Bankruptcy is a personal choice based on individual circumstances.
d)      You may be referred to the other services of the organization or other agencies as appropriate that may be able to assist with particular problems that have been identified. You have the right to use or reject referrals offered, if any.

Client Responsibilities and Bill of Rights

We pledge that our clients have the right:
  • To provide the Agency with accurate information to the best of their knowledge regarding all of their creditors and budget information necessary to assess their financial situation
  • To receive and read the Agency brochure and the Client Handbook
  • To prompt counseling services for managing money based on individual financial situation
  • To treatment with dignity and respect
  • To be actively involved in a comprehensive assessment of their financial situation including an appropriate action plan.
  • To express dissatisfaction through a Complaint Resolution Process. A complete description of our grievance policy is available for review at any time.
  • To discontinue your relationship with our agency at any time, upon proper notice.
  • To ask questions and to have concerns addressed.
  • CCCS serves all members of the community without regard to social/economic status, gender, ethnic, racial or religious affiliation.
Please read our Privacy Policy for more information.
 
I have read and understand all of the above information about CCCS services, funding and my rights and responsibilities. I agree to hold CCCS, its employees, agents and volunteers harmless from any claim, suit, action or demand of my/our creditors, my/ourselves or any other person resulting from advice or counseling. The information I have provided to CCCS is accurate to the best of my knowledge. I understand a neutral third party may contact me to request an evaluation of the agency's services. I understand that that receipt of financial counseling services does not automatically guarantee that I will participate in a Debt Management Plan program.