NDI Assistive Technology (AT) Loan Application Checklist
Visit the AT Loan web page at this link: http://bit.ly/NDI-AT-Loan
Checklist:
1. Assistive Technology (AT) Selection:
Assistive Technology includes the purchase of vision, hearing and
speech/communication devices; learning/cognition/developmental tools;
mobility/seating/positioning items; environmental adaptations/home modifications;
vehicle modifications; computers; recreation/sports/leisure equipment; and other items
and services that promote productivity and quality of life.
There are places in your community where you can participate in AT demonstrations,
borrow AT and find funding to help you pay for AT. Please refer to either the New York
or New Jersey Resource Guide on the AT Loan web page to find these resources.
2. Participate in AT Orientation webinar and complete the Spending Plan:
If you are at least 18 years of age and need an AT loan or would like to participate in a
financial information session, please complete the NDI AT Loan Orientation. This
session is designed to help applicants complete the application, take steps to improve
their credit and improve the likelihood that their AT application will be pre-approved.
3. Complete Loan Application:
Please take a moment to review the following instructions for completing and submitting
your loan application, required documentation and $20 application fee. Upon
submission, you will receive an intake appointment to review your application and credit
report to ensure that your loan application summary is ready for submission to the Loan
Committee for review and consideration for pre-approval in a timely manner. Please
note: Additional documentation may be required for pre-approved loans.
Complete all sections of the Loan Application. If you need your household members’
income to afford your monthly expenses and the loan, please remember to add their
information as a co-applicant.
If a question is not applicable, enter N/A next to the question, indicating that you have
read the question and did not inadvertently skip the question. Remember, your budget
should have a number for each expense and possible source of income.
Assistance is available at your local Center for Independent Living. To find a center near
you, visit the New York State CIL Directory.
4. Attach the following items with your application and submit through the NDI AT
Loan portal:
 $20 Application Fee
NDI Loan Application pages:
 Applicant and Co-Applicant Application forms
 Signed NDI AFP Disclosure Statement
 Signed NDI Right & Responsibilities form
 Signed Authorization for Disclosure of Protected Health Information (HIPAA)
 Spending Plan
 HMDA Demographic form (for housing modification loans only)
 Signed Intake, Housing and Employment Verification form
 Signed Loan Applicant Reference form
 Personal Statement (do not add any names)
Proof of Identity:
 Copy of Social Security Card for each applicant
 Photo ID(s) for applicant(s) and person with a disability, such as a valid driver’s
license, non-driver’s license or Passport
Proof of Income for all applicants, including the person with a disability (Include all that
apply):
 3 most recent paystubs
 IRS Tax Return for the past two years (if self-employed)
 Supplemental Security Income (SSI) Award Letter(s)
 Social Security Disability (SSDI) Award Letter(s)
 Child Support/Alimony history of benefit statement (You are not required to
disclose income from alimony, child support, or separate maintenance payments
unless you are using this as a basis for repayment.)
Proof of Monthly Expenses (Include all that apply):
 Most recent heat, electric or telephone bills
 Rent or mortgage receipts for one year (proof paid on time)
 An official quote from your vendor, providing a breakdown of costs, the vendor’s
business name, address and phone number. Approved loan checks endorsed by
applicant(s) and the vendor.
5. Loan pre-approval or denial:
Please keep in mind that not all loan applications will be approved. Applications are preapproved based upon sufficient disposable income, debt-to-income ratios, credit history
and demonstration of intent to repay. The loan servicing financial institution will provide
additional loan documents, requiring loan notarized signature(s). The servicing bank
prepares the loan check(s) to the applicant(s) and retailer/vendor.
6. Purchasing the AT item/service:
The borrower will give the check to the retailer/vendor, who will deposit the check. In
cases of home modification, an initial deposit and multiple checks may be available for
issue at agreed upon points following the applicant’s indication that the repairs are
satisfactorily completed. Any checks not deposited within 30 days are void.
7. Loan Repayment:
Loan recipients will have the opportunity to set up payments directly to the partnering
bank, credit union or CDFI that issues the loan through the Automated Clearing House
(ACH). With authorization, the electronic payments will be made on time to the servicing
financial institution each month. Loan recipients are encouraged to explore the services
that the financial institution has to offer, such as checking, savings and investment
accounts that will meet their needs.
AT Loan web page: http://bit.ly/NDI-AT-Loan