UNITED STATES BANKRUPTCY ADMINISTRATOR
APPLICATION FOR APPROVAL AS A NONPROFIT BUDGET
AND CREDIT COUNSELING AGENCY
An application package is complete if all questions/items have been responded to and original or
conformed copies of the documents requested in the application are attached. Failure to file a
complete application may result in the delay or denial of the application. Responses to the
questions on this application are continuing and the applicant must promptly notify the
Bankruptcy Administrator of any circumstances that would cause an answer to any question to
change. If additional space is required to complete an answer, attach a separate page with the
name of the organization, the federal tax identification number, and the question number
indicated at the top, right-side of the page.
Section 1. General Information Concerning the Organization
Agency is seeking:
(a)_____ Initial Approval
(c)_____ Amends Application dated ____________*
*If seeking re-approval or submitting an amendment, the Agency must designate any
changes in its previous responses with an asterisk.
Agency is a (n):
_____ Unincorporated Association
_____ Limited Liability Partnership
_____ Limited Liability Corp._____ Other___________________
Name(s) under which the Agency conducts business, including any d/b/a:
Primary business address (include street and mailing address):
State of organization ___________________
Date of organization:_____________
Federal Tax ID No.:_____________ Telephone No.:__________ Fax No.:____________
Name, street address, telephone number, Email address, and fax number of the principal
contact for the Agency.
Name, street address, telephone number, Email address, and fax number of the registered
agent for the Agency.
The date on which the board of di