Form 61 - Needs Assessment Template
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1
2February 2016
Form 61
ACCESS DOWNPAYMENT AND CLOSING
COST ASSISTANCE PROGRAM
Needs Assessment Form
Date: ____________________________________________
Series: ______________________________________
Borrower: ________________________________________
SS#: _______________________________________
Co-Borrower: _____________________________________
SS#: _______________________________________
**Round All Amounts Off To The Nearest Dollar**
Purchase Price $_____________________________
Mortgage Amount $_________________________
ELIGIBLE DOWN PAYMENT AND
ASSETS
CLOSING COST FOR ASSISTANCE
Lender
PHFA
Lender
PHFA
Cash Deposit Paid
(*1)
$
$
Total Closing Costs From
*Loan Estimate (*)
(exclude FHA Upfront
MIP, VA Funding & RD
Guarantee Fee (B)
Checking/Savings
(*2)
$
$
$
$
Gifts, CD’s, etc.
Profit Sharing
(*3)
$
$
Deduct Closing Costs
Paid by Seller or other
Entity
(C)
$
$
Other
(*4)
$
$
SUBTOTAL
$
$
Total Cash
Requirement
Deduct required
(*)
(D)
$
$
Downpayment
(*5)
$(
)
$(
)
TOTAL ASSETS
(A)
$
$
*Refer to numbered or lettered instructions on back of form.
“PHFA” for PHFA use only.
Please Note: No Closing Cost Assistance will be granted on less than maximum financed loans. Any additional dollars the
borrower has must go towards closing costs before additional down payment.
CALCULATION OF TOTAL AMOUNT OF ASSISTANCE NEEDED
Lender
PHFA
1) - Total Assets (From Line "A" Above)
$
$
2) - Less Asset Allowance
$(5,000.00)
$(5,000.00)
3) - Total Assets Available
$
$
4) - Total Eligible Costs for Assistance-(From Line “D” above)
$
$
5) - Additional Amount for Affordability/Downpayment
$
$
6) - Subtotal
$
$
7) - Less Total Assets Available (Line 3)
$
$
8) - Total Amount of Assistance Needed
$
$
(May not exceed $15,000 or be less than $1,000)
PLEASE NOTE: (If line 8 is less than $1,000, NO ASSISTANCE SHALL BE GRANTED.)
Preliminary Lender Certification
I certify that the "Total Amount Of Assistance Needed" for the above referenced borrower(s) is $_________________
______________________________
___________________________
Name of Originating Lender
Signature of Officer
Agency Set-Aside
For PHFA Use Only
B.A.
_______ Approved $______________ or __________ Rejected because _________________________________
___________________________________________________________________________
_____________________
Date: ____________________
By:
______________________________
LSAMS#:
If PHFA’s Assistance does not cover the total amount needed, borrower(s) are required to document additional sources of funds
needed to cover their required investment and closing costs.
The Closing Disclosure will be used to verify the actual amount of Down payment and Closing Cost Assistance disbursed at loan
closing. When submitting the loan for Purchase, please include a check made payable to PHFA for any unused portion of assistance
provided.
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