| Capital Fund Financing Program | 
		
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		U.S. Department of Housing | 
		
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		 OMB Approval No. 2577-0208 | 
	
	
		| Pooled Transaction: List of  | 
		
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		 and Urban Development  | 
		
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		 (exp. 11/2008) | 
	
	
		| Participating PHAs  | 
		
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		| Name of Pool:______________________________________ | 
		
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		(a) | 
		(b) | 
		(c) | 
		(d) | 
		(e) | 
		(f) | 
		(g) | 
		(h) | 
		(i) | 
		(j) | 
	
	
		
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		Name of PHA | 
		Amount of Issuance | 
		Percentage of Pooled Transaction | 
		Annual Debt Service | 
		Current FY Capital Fund | 
		Debt Service as a Percent of Capital Fund | 
		Debt Service as Percent of Pooled Debt Service | 
		Cost of Issuance as a Percent of Issuance | 
		Number of Properities  Modernized | 
		Current PHAS Score | 
	
	
		
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		TOTAL | 
		
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		| Instructions:  | 
		
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		| 1. Fill in the requested information for each PHA participating in the CFFP Pool.  Cross-collateralization is not permitted. | 
		
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		| 2. Column (d) should include principal and interest payments, plus any other ongoing fees (e.g. trustee fees, rating agency fees, etc.). | 
		
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		| 3. Column (j) use PHAS rating name: High, Standard or Troubled. | 
		
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		| 4. If more that 17 PHAs are participating, use a second form for the remaining PHAS and provide a subtotal for the second form and grand total for the pool.  | 
		
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