Mediation Financial Worksheet
The detailed financial disclosure form required for foreclosure mediation — income, expenses, assets, and a realistic modification proposal.
The Mediation Financial Worksheet is the detailed financial disclosure document submitted as part of your foreclosure mediation request. While the Mediation Request Form tells the court you want to mediate, the Financial Worksheet tells the mediator and lender what you can actually afford. It details: monthly income from all sources, monthly expenses (housing, utilities, food, medical, transportation, child care, debt payments), total assets (cash, bank accounts, retirement, vehicles, other property), total liabilities (mortgage debt, credit cards, auto loans, student loans, tax debt, other), and your proposed resolution — typically a modified monthly payment amount you can afford. The accuracy and completeness of this form directly affects whether mediation results in a workable modification.
Purpose of This Form
- 1Provide a complete, accurate picture of your current financial situation
- 2Demonstrate your capacity (or lack thereof) to pay a modified mortgage
- 3Support your proposal for a specific modification amount or other resolution
- 4Identify the gap between your current payment and what you can afford
- 5Create a financial baseline that guides the mediation negotiation
Form Sections & How to Complete
Monthly Income
List all sources of monthly income: employment (gross and net), self-employment income, rental income, Social Security, disability, pension, unemployment, child support/alimony, contributions from household members, and any other income. Provide documentation (pay stubs, bank statements, benefit letters) for each source.
Monthly Expenses
List all monthly household expenses: first mortgage payment, second mortgage/HELOC, property taxes, homeowner's insurance, HOA dues, utilities (electric, gas, water, sewer), phone/internet, food, medical/dental, transportation (car payment, gas, insurance, maintenance), child care, clothing, personal care, and any other regular expenses. Be complete — expenses you forget to list can't be considered.
Assets
List all assets with current values: cash on hand, checking and savings accounts, retirement accounts (401k, IRA), stocks/bonds/mutual funds, vehicles (make, model, year, value, loan balance), real property other than residence, and personal property of significant value. Retirement funds generally cannot be required to be liquidated for modification.
Liabilities
List all debts: first mortgage (balance, monthly payment, interest rate, status), second mortgage/HELOC, credit cards (each with balance and minimum payment), auto loans, student loans, tax debt, medical debt, personal loans, and any other obligations.
Proposed Resolution
State your proposed resolution: 'I propose a modified monthly payment of $X based on Y% of my gross monthly income.' Be realistic — propose what you can actually afford, not what you wish you could pay. An unrealistic proposal undermines your credibility.
Filing Requirements
Where to File
Submit with your Mediation Request Form to the court or mediation program administrator.
Filing Fees
No separate filing fee.
Copies Required
Original to court/mediation program + copy to lender's attorney + keep a copy. Bring multiple copies to the mediation session.
Timing / Deadlines
Submit with your Mediation Request Form — typically within 15-30 days of service of the complaint.
Other Mediation Forms
Related Forms
Foreclosure Mediation Request Form
Mediation
loss-mitigation-package-request
Coming soon
Affidavit of Indigency (State Court Fee Waiver)
State Court
Frequently Asked Questions
What happens if I overstate or understate my income?▼
Both are dangerous. Overstating makes modification harder (you appear able to pay more). Understating (if discovered) destroys your credibility and may result in the lender refusing to negotiate. Be completely accurate and provide supporting documentation for every figure. The lender will verify your information against credit reports, tax returns, and bank records.
Should I include income from household members who aren't on the mortgage?▼
Generally, include ALL household income if you rely on it to pay expenses. If your spouse or partner (not on the mortgage) contributes to household expenses, their income is relevant to your overall financial picture. However, non-borrower income is typically not required to be counted for modification eligibility calculations. Disclose it but note that it is non-borrower income.
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