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6500  Consumer Financial Protection Bureau
Appendix H to Part 1026—ClosedEnd Model Forms and Clauses
H1 Credit Sale Model Form (§ 1026.18) H2 Loan Model Form (§ 1026.18) H3 Amount Financed Itemization Model Form (§ 1026.18(c)) H4(A) VariableRate Model Clauses (§ 1026.18(f)(1)) H4(B) VariableRate Model Clauses (§ 1026.18(f)(2)) H4(C) VariableRate Model Clauses (§ 1026.19(b))H4(D)(1) AdjustableRate Mortgage Model Form (§ 1026.20(c))
H4(D)(2) AdjustableRate Mortgage Sample Form (§ 1026.20(c))
H4(D)(3) AdjustableRate Mortgage Model Form (§ 1026.20(d))
H4(D)(4) AdjustableRate Mortgage Sample Form (§ 1026.20(d)) H4(E) FixedRate Mortgage Interest Rate and Payment Summary Model Clause (§ 1026.18(s)) H4(F) AdjustableRate Mortgage or StepRate Mortgage Interest Rate and Payment Summary Model Clause (§ 1026.18(s)) H4(G) Mortgage with Negative Amortization Interest Rate and Payment Summary Model Clause (§ 1026.18(s)) H4(H) FixedRate Mortgage with InterestOnly Interest Rate and Payment Summary Model Clause (§ 1026.18(s)) H4(I) AdjustableRate Mortgage Introductory Rate Disclosure Model Clause (§ 1026.18(s)(2)(iii)) H4(J) Balloon Payment Disclosure Model Clause (§ 1026.18(s)(5)) H4(K) No Guarantee to Refinance Statement Model Clause (§ 1026.18(t)) H5 Demand Feature Model Clauses (§ 1026.18(i)) H6 Assumption Policy Model Clause (§ 1026.18(q)) H7 Required Deposit Model Clause (§ 1026.18(r)) H8 Rescission Model Form (General) (§ 1026.23) H9 Rescission Model Form (Refinancing (with Original Creditor)) (§ 1026.23) H10 Credit Sale Sample H11 Installment Loan Sample H12 Refinancing Sample H13 Mortgage with Demand Feature Sample H14 VariableRate Mortgage Sample (§ 1026.19(b)) H15 GraduatedPayment Mortgage Sample H16 Mortgage Sample H17(A) Debt Suspension Model Clause H17(B) Debt Suspension Sample H18 Private Education Loan Application and Solicitation Model Form H19 Private Education Loan Approval Model Form H20 Private Education Loan Final Model Form H21 Private Education Loan Application and Solicitation Sample H22 Private Education Loan Approval Sample H23 Private Education Loan Final Sample
H30(A) Sample Form of Periodic Statement (§ 1026.41)
H30(B) Sample Form of Periodic Statement with Delinquency Box (§ 1026.41)
H30(C) Sample Form of Periodic Statement for a PaymentOption Loan
H30(D) Sample Clause for Homeownership Counselor Contact Information (§ 1026.41)
H4(C)VariableRate Model Clauses
How Your Interest Rate and Payment Are Determined
• Your interest rate will be based on [an index plus a margin] [a formula].
• Your payment will be based on the interest rate, loan balance, and loan term.
Information about the index [formula for rate adjustments] is published [can be found] ______.
How Your Interest Rate Can Change
• Your interest rate can change (frequency).
• Your payment can change (frequency) based on changes in the interest rate.
• [Your payment cannot increase more than (amount or percentage) at each adjustment.]
The example is based on the following assumptions:
H–4(D)(1) Model Form for § 1026.20(c)
Note: To see what your payments would have been during that period, divide your mortgage amount by $10,000; then multiply the monthly payment by that amount. (For example, in 1996 the monthly payment for a mortgage amount of $60,000 taken out in 1982 would be: $60,000 $10,000=6; 6 × _______ = $ _______ per month.)
H–4(D)(2) Sample Form for § 1026.20(c)
H–4(D)(3) Model Form for § 1026.20(d)
H–4(D)(4) Sample Form for § 1026.20(d)
H4(I)Introductory Rate Model Clause
You have a discounted introductory rate of _______ % that ends after (period).
H4(J)Balloon Payment Model Clause
[Final Balloon Payment due (date): $ _______ ]
H4(K)"NoGuaranteetoRefinance" Statement Model Clause
There is no guarantee that you will be able to refinance to lower your rate and payments.[The page following this is 7113]
H9Rescission Model Form (Refinancing With Original Creditor)
(1) the date of this new transaction, which is _______ ; or
(2) the date you received your new Truth in Lending disclosures; or
(3) the date you received this notice of your right to cancel.
If you decide to cancel this new transaction, you may do so by notifying us in writing, at
(Creditor's name and business address).
If you cancel by mail or telegram, you must send the notice no later than midnight of
(or midnight of the third business day following the latest of the three events listed above).
H14VariableRate Mortgage Sample
How Your Interest Rate and Payment Are Determined
• Your interest rate will be based on an index rate plus a margin.
• Your payment will be based on the interest rate, loan balance, and loan term.
Information about the index rate is published weekly in the Wall Street Journal.
How Your Interest Rate Can Change
• Your interest rate can change yearly.
• Your interest rate cannot increase or decrease more than 2 percentage points per year.
How Your Monthly Payment Can Change
The example below shows how your payments would have changed under this ARM program based on actual changes in the index from 1982 to 1996. This does not necessarily indicate how your index will change in the future. The example is based on the following assumptions:
• You will be notified in writing 25 days before the annual payment adjustment may be made. This notice will contain information about your interest rates, payment amount and loan balance.]
H17(A) Debt Suspension Model Clause
[To Enroll, Sign Here]/[To Enroll, Initial Here].
H17(B) Debt Suspension Sample
H–30(A) Sample Form of Periodic Statement
H–30(B) Sample Form of Periodic Statement with Delinquency Box
H–30(C) Sample Form of Periodic Statement for a PaymentOptions
Loan
H–30(D) Sample Clause for Homeownership Counselor Contact Information
Housing Counselor Information: If you would like counseling or assistance, you can contact the following:
* U.S. Department of Housing and Urban Development (HUD): For a list of homeownership counselors or counseling organizations in your area, go to http://www.hud.gov/offices/hsg/sfh/hcc/hcs.cfm or call 8005694287.
[Codified to 12 C.F.R. Part 1026, Appendix H]
[Appendix H amended at 78 Fed. Reg. 110008, February 14, 2013, effective January 10, 2014]
Appendix I to Part 1026 [Reserved]
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Last updated February 28, 2014  regs@fdic.gov 