TILA: Forms

Table of Contents

H-4(D) Variable-Rate Model Clauses

H-4(D)(1) Adjustable-Rate Mortgage Model Form (§ 1026.20(c))

H-4(D)(2) Adjustable-Rate Mortgage Sample Form (§ 1026.20(c))

H-4(D)(3) Adjustable-Rate Mortgage Model Form (§ 1026.20(d))

H-4(D)(4) Adjustable-Rate Mortgage Sample Form (§ 1026.20(d))

H-28(A) Sample Form of Periodic Statement

H-28(B) Sample Form of Periodic Statement with Delinquency Box

H-28(C) Sample Form of Periodic Statement for a Payment-Options Loan

H-28(D) Sample Clause for Housing Counselor Contact Information

This model clause would be deleted:

Model clause to be deleted

H-4(D)(1) Model Form for § 1026.20(c)

H-4(D)(1) Model Form for § 1026.20(c)

H-4(D)(2) Sample Form for § 1026.20(c)

H-4(D)(2) Sample Form for § 1026.20(c)

H-4(D)(3) Model Form for § 1026.20(d)

H-4(D)(3) Model Form for § 1026.20(d), page 1

H-4(D)(3) Model Form for § 1026.20(d), page 2

H-4(D)(4) Sample Form for § 1026.20(d)

H-4(D)(4) Sample Form for § 1026.20(d), page 1

H-4(D)(4) Sample Form for § 1026.20(d), page 2

H-28(A) Sample Form of Periodic Statement

H-28(A) Sample Form of Periodic Statement

H-28(B) Sample Form of Periodic Statement with Delinquency Box

H-28(B) Sample Form of Periodic Statement with Delinquency Box


H-28(C) Sample Form of Periodic Statement for a Payment-Options Loan

H-28(C) Sample Form of Periodic Statement for a Payment-Options Loan

H-28(D) Sample Clause for Housing 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 counseling agencies or programs in your area, go to http://www.hud.gov/offices/hsg/sfh/hcc/hcs.cfm or call 800-569-4287.
  • Tennessee Housing Development Agency
    404 James Robertson Pkwy, Ste 1200
    Nashville, TN 37243-0900
    615-815-2200 or 1-800-228-THDA
    www.thda.org