2005 Application Guide

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High Energy Cost Grants Rural Communities

2005 Application Guide

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APPLICATION GUIDE
RURAL UTILITIES SERVICE
HIGH ENERGY COST GRANT PROGRAM
MAY 2005
UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT
USDA Nondiscrimination Statement
"The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis
of race, color, national origin, sex, religion, age, disability, political beliefs, sexual orientation, and marital or family
status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for
communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center
at (202) 720-2600 (voice and TDD).
To file a complaint of discrimination write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building,
14th and Independence Avenue, SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice or TDD). USDA is
an equal opportunity provider and employer."

CONTENTS
OVERVIEW

DEVELOPING THE PROPOSAL

BEFORE YOU START

DETERMINING ELIGIBILITY

AM I AN ELIGIBLE APPLICANT?

IS MY COMMUNITY ELIGIBLE?

IDENTIFYING THE TARGET AREA FOR THE GRANT
DETERMINING COMMUNITY ENERGY COSTS

8
10

Demonstrating Eligibility Using Average Annual Household Expenditures

Demonstrating Eligibility Using per Unit Energy costs

Supporting Energy Cost Data

IS MY PROJECT ELIGIBLE?

READY TO PROCEED?

PREPARING THE APPLICATION PACKAGE

Application Checklist

HOW WILL MY APPLICATION BE EVALUATED?

Evaluation Criteria and Weights

SUBMITTING THE APPLICATION

HOW TO SUBMIT AN APPLICATION PACKAGE

DEADLINE FOR SUBMISSION AND LATE APPLICATIONS

APPENDIX A

RESOURCES

TARGET AREA WORKSHEETS

Geographic, Population, Income, and Community Characteristics Worksheet
Community Energy Characteristics Worksheet
EXAMPLES OF ELIGIBLE PROJECTS

1. Electric Distribution System Upgrade and Replacement of Fuel Storage Facilities
2. Rural Electrification Project - Native American Reservation
3. Rural Electrification Project with Distributed Renewable Energy

33
34
35

APPENDIX B

FORMS AND CERTIFICATIONS

STANDARD FORMS
SF-424 Application for Federal Assistance
SF-424A Budget Information - Non-Construction Programs
SF-424B Assurances - Non-Construction Programs

SF-424C Budget Information-Construction Programs
SF-424D Assurances - Construction Programs
SF-LLL Disclosure of Lobbying Activities
SF-LLL-A Disclosure of Lobbying Activities (Continuation Sheet)
OTHER FORMS
Certification Regarding Debarment, Suspension and Other Responsibility Matter
RUS Environmental Profile

Rural Utilities Service
High Energy Cost Grant Program
Application Guide

OVERVIEW
The RUS High Energy Cost Grant Program was created by Congress in November 2000 as a new
program under the Rural Electrification Act of 1936 (7 U.S.C. 918a) to provide financial assistance for
the improvement of energy generation, transmission, and distribution facilities serving rural
communities with home energy costs that are over 275 percent of the national average.
RUS published a Notice of Funds Availability (NOFA) in the Federal Register on May 25, 2005
requesting applications under the High Energy Cost Grant Program. The NOFA sets out the eligibility
and application requirements for these competitive grants. This Application Guide is intended to be
used along with the NOFA. RUS is making available a total of up to $19.5 million in competitive grants
under this NOFA. The number of grants awarded will depend on the number of applications
submitted, the amount of grant funds requested, and the quality and competitiveness of applications
submitted. The maximum amount for a grant request that will be considered for funding under this
notice is $5,000,000. The minimum amount for a grant application is $75,000.
Eligibility
To be eligible to receive a grant under this program:
•
You must be an eligible applicant;
•
The grant project must serve an eligible extremely high energy cost community;
•
The proposed project must improve energy generation, transmission, or distribution facilities
serving an eligible community; and
•
The administrative costs of the project must not exceed 4 percent of grant funds.
Who is an Eligible Applicant?
You are eligible to apply you are any of the following:
•
a legally-organized for-profit or nonprofit organization such as, but not limited to, a
corporation, association, partnership (including a limited liability partnership), cooperative, or
trust;
•
a sole proprietorship;
•
a State or local government, or any agency or instrumentality of a State or local government,
including a municipal utility or public power authority;
•
an Indian tribe, a tribally-owned entity, an Alaska Native Corporation;
•
an individual or group of individuals, or
•
any of the above entities located in a U.S. Territory or other area authorized by law to
participate in programs of the Rural Utilities Service.
Is my Community Eligible?
Your community qualifies as an eligible extremely high energy cost community if average home
energy costs in the area to be served exceed 275 percent of the national average under one or more
RUS high energy cost benchmarks shown below. Eligibility may be established using average annual
household expenditures for individual fuels or for total energy, or average per unit cost for home
energy.

RUS High Energy Cost Benchmarks
Fuel
Average annual household expenditures
Electricity
$2,509
Natural gas
$1,859
Fuel oil
$1,882
LPG/propane
$1,514
Total household energy
$4,013

Average per unit cost
$ 0.239 per kilowatt hour
$26.85 per thousand cubic feet
$ 3.35 per gallon
$ 3.61 per gallon
$43.91 per million Btus

What Kinds of Energy Projects Are Eligible?
Grants under this program may be used for the acquisition, construction, installation, repair,
replacement, or improvement of energy generation, transmission, or distribution facilities in
communities with extremely high energy costs. On-grid and off-grid renewable energy projects, and
energy efficiency, and energy conservation projects are eligible.
How to Apply
You must submit a grant application package prepared according to the directions contained in the
NOFA to apply for a grant under this program. The completed grant application consists of your
narrative grant proposal with supporting documentation and all required forms and certifications. You
must submit an application packages consisting one complete application package with signed
originals of all forms and certifications and two copies. Appendix B includes copies of all required
forms.
Deadline
Applications in hard copy or electronic format must be postmarked or delivered to RUS
headquarters in Washington, DC by Monday, July 25, 2005. RUS will accept all applications
postmarked or delivered to RUS by this deadline. Late applications will not be considered and will be
returned to the Applicant.
Where to Submit Your Application
Hard Copies
A completed application package with original signatures and two copies must be delivered by prepaid
United States Mail, overnight delivery service, or by hand to RUS headquarters in Washington, DC at
the following address:
Assistant Administrator, Electric Program
Rural Utilities Service
U.S. Department of Agriculture
1400 Independence Avenue, SW, STOP 1560
Room 5165 South Building
Washington, DC 20250-1560
Mark the outside of the Envelope: "Attention: High Energy Cost Community Grant Program."
Applicants should be advised that regular mail deliveries to RUS, especially of oversized packages and
envelopes, continue to be delayed because of increased security screening requirements for Federal
buildings. Applicants may wish to consider using Express Mail or a commercial overnight delivery
service instead of regular mail. Applicants wishing to hand deliver or use courier services for delivery
should contact the Agency representative in advance to arrange for building access. RUS advises
applicants that because of intensified security procedures at government facilities, any electronic
media included in an application package may be damaged during security screening. If an applicant
wishes to submit such materials, they should contact the Agency representative for additional
information

Electronic Submission of Applications
RUS is not able to accept applications directly online, by email or fax. Applicants may, however, file
electronically through Grants.gov, the new online Federal grants portal at http://www.Grants.gov.
Applicants should be aware that before they can submit an application through Grants.gov, they must
successfully complete several pre-registration steps with Grants.gov, including registration with the
Central Contract Registry and registration with the Credential Provider prior to completing registration
with Grants.gov.
Evaluation of Applications and Notification of Grant Awards
All timely and complete applications will be reviewed and ranked by an RUS rating panel according to
the evaluation criteria set out in the NOFA. The RUS Administrator will award grants based on rank
order and panel recommendations.
RUS will notify you in writing whether you have been selected for a grant award. You will be advised
of any additional requirements or conditions – such as, for example, environmental reviews -- that
must be completed before a final award decision can be made by RUS. A final award will only be
effective on the RUS Administrator’s approval of the Grant Agreement negotiated between RUS and
the Grantee.
Application Guide
This Application Guide should be used with the NOFA published in the Federal Register to prepare your
application.
This guide provides additional information to help you determine whether your
community is eligible under the program and how to complete your application package. The guide
includes examples of eligible projects and suggested sources for obtaining the energy and population
data that you will need to determine eligibility and support your application. All the required Federal
forms and certifications are included in the Appendices. Copies of the NOFA and required forms are
also accessible on the internet through http://www.Grants.gov under CFDA Number 10.859, or the
RUS website at http://www.usda.gov/rus/electric or may be requested from RUS
For More Information:
Karen Larsen
Management Analyst
Rural Utilities Service
Assistant Administrator, Electric Program
U.S. Department of Agriculture
1400 Independence Avenue, SW, STOP 1560
Room 5165 South Building
Washington, DC 20250-1560
Telephone:
Fax:
Email:

202-720-9545
202-690-0717
[email protected]

IMPORTANT: If there are any differences between this guide and the requirements in the
NOFA, the NOFA provisions will govern.

DEVELOPING THE PROPOSAL
BEFORE YOU START
Read the Notice of Funds Availability (NOFA) published in the Federal Register on May 25,
2005 and become familiar with its requirements. The NOFA is available on the internet at
Grants.gov Grants.gov or on the RUS website at http://www.usda.gov/rus/electric.) You may also
request a copy directly from RUS.
This Application Guide MUST be used with the NOFA. If there are any differences in interpretation of
this Application Guide and the NOFA, the NOFA takes precedence over information contained in this
Application Guide. If there are any differences between the NOFA and USDA regulations, the
regulations take precedence over the information contained in the NOFA and this guide. Program
regulations are published in 7 CFR Part 1709 (The final regulations were published on January 23,
2004 at 69 FR 3,317.)
Your application may be rejected if it does not include the information, forms, and certifications
required in the NOFA or if you do not include information to support your eligibility.

DETERMINING ELIGIBILITY
AM I AN ELIGIBLE APPLICANT?
Eligibility for these grants is established by law and regulation. Under section 19 eligible applicants
include “persons, States, political subdivisions of States, and other entities organized under the laws
of States” (7 U.S. C. 918a). Under section 13 of the RE Act, the term “person” means “any natural
person, firm, corporation, or association” (7 U.S.C. 913).
You are eligible to apply for a grant under this program if you are any of the following:
•
•
•
•
•

a for-profit or nonprofit organization such as, but not limited to, a corporation, association,
partnership (including a limited liability partnership), cooperative, trust or other entity
organized under State law;
a sole proprietorship;
a State or local government, or any agency or instrumentality of a State or local government,
including a municipal utility or public power authority;
an Indian tribe, a tribally-owned entity, an Alaska Native Corporation; or
an individual or group of individuals.

Entities or persons located in U.S. Territories, possessions or other areas authorized to receive the
services and programs of the Rural Utilities Service or the Rural Electrification Act of 1936, as
amended, are also eligible under this program.
In addition, you, the Applicant, must demonstrate the legal authority and capacity to enter into a
binding grant agreement with the Federal Government at the time of the award and to carry out the
proposed grant funded project according to its terms to be an eligible applicant. Your application must
include information and/or documentation supporting your eligibility, legal existence, and capacity to
enter into a grant agreement
If you have any questions as to whether you may be an eligible applicant or what additional
information you must submit to establish your capability to contract with the Federal Government,
please contact the Agency.
Individuals are eligible grant applicants under this program. However, any proposed grant project
must provide community benefits and not be for the sole benefit of you or your household. As a
practical matter, because this program addresses community energy needs and to facilitate

compliance with Federal grant requirements, individuals will likely find it preferable to establish an
independent legal entity, such as a corporation to actually carry out the grant project if they are
selected.
Individuals or other applicants who intend to form a new, separate legal entity to carry out the grant
project should indicate their intent in their applications. The new entity must be in existence and
legally competent to enter into a grant agreement with the Federal Government under appropriate
State and Federal laws before a final grant award can be made. It does not have to be in existence
when you submit an application.

IS MY COMMUNITY ELIGIBLE?
The grant project must benefit communities with extremely high energy costs. The RE Act defines an
extremely high energy cost community as one in which “the average residential expenditure for home
energy is at least 275 percent of the national average residential expenditure for home energy” as
determined by the Energy Information Administration (EIA) using the most recent data available (7
U.S.C. 918a).
To qualify, average annual household expenditures for all energy must meet one or more of the RUS
high energy cost benchmarks published in the NOFA and shown in Table 1.
To establish community eligibility:
•
You must clearly define the geographic areas that will be included in the grant’s target area,
and
•
You must demonstrate that each of the communities in the proposed target area meets one or
more of the RUS high energy cost benchmarks.
Identifying the Target Area for the Grant
You must identify and describe the target areas and target communities to be served by the proposal
and include this information in the application. Box A includes Internet information resources that
may be helpful in assembling information on your community and home energy costs.
The target area may consist of all or part of one or more counties, cities, towns, villages or
unincorporated areas. A target area may include localities in more than one State. The smallest area
that may be designated as a target area is a 2000 Census block. Using Census blocks allows
applicants and RUS to locate the area easily and to determine its population.
Identify the target area and all communities in the target area by county, name of city, town, village
or other incorporated unit of local government, and any Census Designated Places (CDPs) in
unincorporated areas. RUS is requesting that applicants provide Census 2000 population figures for
their proposed target areas, including population of all cities, towns, villages, and CDPs in the target
area. If your proposed target area includes rural unincorporated areas, consult the census maps at
the U.S. Census Bureau website to determine if any part of the target area includes any CDPs. For
unincorporated areas that are outside of cities towns and CDPs, applicants may report population
estimates based on total population of included census tracts/blocks or by reporting the county
population outside of places.
For unincorporated areas that are not CDPs, provide a project name description that allows RUS
reviewers to identify the approximate location of the target area. These areas may be identified by
Census blocks or by zip code. You must include community identification and Census 2000 population
information in your project description in the narrative proposal.
Appendix A contains a worksheet that may be helpful for collecting and presenting target community
information in table form.
The population of each Census identified community in your target area will be important in qualifying
for priority points based on the rurality of the target community. RUS will give priority to small rural
communities by awarding additional points based on population.

Box A
Information Resources
U.S. Census Bureau Population Information
Census Bureau Home Page
American FactFinder -- get population data, locate census blocks, and create Reference
Maps, Thematic Maps, and Custom Tables containing Census 2000 Census Tract data:
http://factfinder.census.gov/servlet/BasicFactsServlet

EIA Residential Energy Information
EIA Residential Energy Information -- http://www.eia.doe.gov/residential.html
EIA Residential Energy Consumption and Expenditure Surveys 2001 Data and Reports
http://www.eia.doe.gov/emeu/recs/recs2001/detailcetbls.html#total
Electricity
Retail Sales and Average Revenues per Kilowatt Hour by Sector, State, and Utility -http://www.eia.doe.gov/cneaf/electricity/page/at_a_glance/sales_tabs.html
Natural Gas
Natural Gas Prices by Sector, Nationwide and by State:
U.S. Total Natural Gas Consumer Prices
http://tonto.eia.doe.gov/dnav/ng/ng_pri_top.asp
Fuel Oil
Annual Residential Heating Oil Prices by PADD and State
http://www.eia.doe.gov/oil_gas/petroleum/info_glance/sector.html
Propane
Propane Prices by Sales Type and Federal Petroleum Allocation District (PADD)
http://www.eia.doe.gov/pub/oil_gas/petroleum/data_publications/petroleum_marketing
_monthly/current/pdf/pmmtab38.pdf
United States Department of Agriculture
RUS Electric Program Homepage http://www.usda.gov/rus/electric/index.htm
Economic Research Service -- State and County Median Income
http://www.ers.usda.gov/data/unemployment/.

Census Information Online. To obtain Census-related information from the Internet, go to the
Census “Gateway to Census 2000” at http://www.census.gov/main/www/cen2000.html.
To find information on a specific geographic area, you can go to the Census Bureau’s “American Fact
Finder on the Web” at http://factfinder.census.gov/servlet/BasicFactsServlet. You can determine the
boundaries of any CDPs and Census blocks in your target area by selecting “Reference Maps” under
“Maps” or under the Census data sets. Locate your target area on the map and then go to the
“Options” pull-down menu. Select “boundaries” and then click on “place” or the area of interest. For
ease of viewing it is helpful to turn off other features or boundaries that are not needed. You can also
generate a map from a specific address under the Census “Reference Maps” feature. You can use the
printed map in your application.
In addition to population figures, the 2000 Census data also can provide current information on
household size, housing units, and major heating fuels in your local community that can serve as a
credible source for estimated energy use or expenditures.
Census Information by Telephone. If you do not have access to the Internet or if you have
questions concerning the Census population figures, you may contact the Census Bureau Population
Division for assistance at 301-763-2422 between 8:30 am and 5:00 pm EST.

Determining Community Energy Costs
After identifying the target area, the next step is determining whether the target area is eligible. Your
target area will qualify as an extremely high energy cost community if you establish that it has home
energy costs that exceed 275 % of the national average under one or more RUS high energy cost
benchmarks. The NOFA gives you several options for demonstrating eligibility based on local
community energy characteristics.
The statutory definition of an extremely high energy cost community sets a very high threshold for
eligibility. Based on available published information on residential energy costs, RUS anticipates that
only those communities with the highest energy costs across the country will qualify under this
standard.
RUS has calculated high energy cost benchmarks based on national average home energy
expenditures. The benchmarks are shown in Table 1. Communities must meet at least one of the
benchmarks to qualify as an eligible beneficiary of a grant under this program. These benchmarks are
calculated from EIA’s estimates of national average residential energy expenditures for 1997, the
latest survey available.
Your application must demonstrate that each community in the proposed target area exceeds one or
more of these high energy cost benchmarks to be eligible for assistance under this program. Your
must investigate and provide credible, documented local energy cost information in your application to
support your eligibility under this program. The information resources in Box A may be useful in
developing information on community energy costs for your application.
Appendix A includes a worksheet that may be helpful in collecting and presenting this community
energy information in tabular form. Appendix A also includes several examples of eligible projects and
community eligibility determinations.
NOTE: A target community may include identifiable portions of larger utility service territories, or
subunits of local governments that are not otherwise eligible, as long as the target area itself is
characterized by extremely high energy costs

Table 1
EIA Average Annual Household Energy Expenditures and
RUS Extremely High Energy Cost Eligibility Criteria Benchmarks
Average annual household
expenditure
Fuel

$938 per year
$702 per year

$1,859 per year

Fuel Oil

10,656 kilowatt
hours (kWh)
70 thousand cubic
feet
589 gallons

Extremely high
energy cost
benchmark
$2,509 per year

$737 per year

$1,882 per year

LPG/Propane

440 gallons

$605 per year

$1,514 per year

Total Household Energy
Use

92.2 million Btus

$1,493 per year

$4.013 per year

Annual Average Per Unit
Residential Energy Costs
Fuel

National Average

Electricity

$0.088 per kWh

Extremely High
Energy Cost
Benchmark
$0.239 per kWh

Natural Gas

$26.85 per thousand
cubic feet

Fuel Oil

$9.98 per
thousand cubic
feet
$1.24 per gallon

LPG/Propane

$1.36 per gallon

$3.61 per gallon

Total Household Energy
cost per Btus

$16.19 per
million Btus

$43.91 per million
Btus

Electricity
Natural Gas

Average total
Consumption

National average

$3.35 per gallon

Sources: United States Department of Energy, Energy Information Administration, Residential Energy
Consumption and Expenditure Surveys 2001, available online at
http://www.eia.doe.gov/emeu/recs/contents.htm. The RUS benchmarks calculations include
adjustments to reflect the uncertainties inherent in EIA’s statistical methodology for estimating home
energy costs. The benchmarks are set based on the EIA’s lower range estimates using the specified
EIA methods.

Demonstrating Eligibility Using Average Annual Household Expenditures
The RUS annual expenditure benchmarks reflect the average yearly household cost for major
commercial energy sources for the typical household in eligible extremely high energy cost
communities. There are a variety of methods for establishing average community home energy costs.
This section provides guidance in determining your community energy costs for eligibility purposes. In

calculating annual home energy use, fuels used in subsistence activities in remote areas may be
included, but other transportation fuel uses should be excluded.
Electricity. EIA estimates that the average annual household expenditure for electricity is $938
based on annual usage of 10,656 kilowatt hours (kWh) at an average price of about $0.88 per kWh.
To qualify as an extremely high energy cost community under this benchmark, you must show that
the community average annual residential electricity expenditure in your target area exceeds the RUS
electricity expenditure benchmark of $2509 per household.
For communities with commercial electric service, applicants may demonstrate eligibility using any
one of three alternative approaches:
1. Actual average annual household expenditure data from the local electricity provider or
regulatory authority; or
2. Average annual revenues per residential customer for the local electric utility as reported to or
by the EIA, other government agencies, or commercial utility data sources; or
3. Estimated average annual household electricity expenditures based on available information
on community housing characteristics, standardized residential energy consumption profiles,
local energy cost data, and local climate conditions affecting energy use. (Applicants using
this alternative should clearly explain the methodology and data sources used and why
localized electric utility information is not available.)
Adjustments to historical community electricity costs are appropriate to account for variations in
weather conditions, fuel prices, or unusual circumstances causing a substantial divergence of present
or future residential electricity costs from historical patterns. If you are relying on adjusted data, be
sure to include an explanation for why historical data has been adjusted and the methodology used.
Special note for rural communities in Alaska that receive Power Cost Equalization (PCE)
payments for residential customers. The household annual expenditure for electricity should
include the PCE credits to reflect the actual cost of providing electricity. EIA information on residential
electric revenues for electric systems in Alaska includes PCE payments in the residential revenues. For
example, a local electric system reported average residential revenues per kilowatt hour of $0.45
cents which reflects a PCE payment for eligible loads of $0.23 per kWh. Because of the PCE payment
the actual average cost to residential customers is reduced $0.22 per kilowatt hour. For purposes of
determining eligibility, applicants should use the actual cost to serve of $0.45 cents per kWh, not the
subsidized PCE rate.
Natural Gas. EIA estimates that the national average household expenditure for natural gas is $702
reflecting consumption of about 70 thousand cubic feet of natural gas at a cost of about $9.98 per
thousand cubic feet. To qualify as an extremely high energy cost community under this benchmark,
you must show that the community average annual residential natural gas expenditure in your target
area exceeds the RUS natural gas benchmark of $1,859 per household;
Applicants may demonstrate eligibility using any one of three alternative approaches:
1. Actual average annual household expenditure data from the local natural gas distributor or
regulatory authority; or
2. Average annual revenues per residential customer for the local natural gas utility as reported
to or by the EIA, other government agencies, or commercial utility data sources; or
3. Estimated average annual household natural gas expenditures based on available information
on community housing characteristics, standardized residential energy consumption profiles,
local energy cost data, and local climate conditions affecting energy use. (Applicants using
this alternative should clearly explain the methodology and data sources used and why
localized natural gas utility information is not available.)
Adjustments to historical community household expenditures for natural gas are appropriate to
account for variations in weather conditions, fuel prices, or unusual circumstances causing a
substantial divergence of present or future residential energy costs from historical patterns. If you are
relying on adjusted data, be sure to include an explanation for why historical data has been adjusted
and the methodology used.

Fuel Oil. According to EIA, the average household expenditure for fuel oil is $737 per year for 589
gallons of number 2 fuel oil at approximately $1.24 per gallon. To qualify as an extremely high
energy cost community under this benchmark, you must show that the community average annual
residential fuel oil expenditure in your target area exceeds the RUS natural gas benchmark of $1,882
per household.
Applicants may demonstrate eligibility using any one of three alternative approaches:
1. Actual average annual household expenditure data from a local fuel oil distributor; or
2. Average annual household fuel oil expenditures based on data reports or surveys from EIA,
other government agencies, private agencies, or commercial data sources; or
3. Estimated average annual household fuel oil expenditures based on available information on
community housing characteristics, standardized residential energy consumption profiles, local
energy cost data, and local climate conditions affecting energy use. (Applicants using this
alternative should clearly explain the methodology and data sources used and why localized
fuel oil information is not available.)
Adjustments to historical community household expenditures for fuel oil are appropriate to account for
variations in weather conditions, fuel prices, or unusual circumstances causing a substantial
divergence of present or future residential energy costs from historical patterns. If you are relying on
adjusted data, be sure to include an explanation for why historical data has been adjusted and the
methodology used.
Special Note for communities that use kerosene, gasoline, or diesel as major household
energy fuels: EIA does not report or calculate national average residential expenditures for
kerosene, gasoline, or diesel as major household fuels and RUS has not established benchmarks for
those fuels. Applicants with communities that have substantial reliance on these fuels as household
energy sources, may use the benchmark for fuel oil, or may include expenditures for these fuels in
qualifying under total energy expenditures.
Propane/LPG. EIA estimates that the average annual residential expenditure on propane or liquefied
petroleum gas (LPG) as a primary home energy source is $605 per year based on annual consumption
of 440 gallons at approximately $1.36 per gallon. The RUS extremely high energy cost benchmark for
average annual expenditures for communities that use propane as a major home energy source is
$1,514 per household.
Applicants may demonstrate eligibility using actual or estimated community average propane
consumption and expenditures. Adjustments to actual prices for the effects of weather patterns or
changes in propane prices are appropriate. Because there are few published sources for residential
propane prices in rural areas, applicants must provide adequate documentation for actual or estimated
local propane prices and the methodology they used to estimate average household expenditures.
Total Household Energy Use.
EIA has estimated the national average household energy
expenditure for all non-transportation energy sources is $1,493 per year based on consumption of
92.2 million Btus at an average cost of $16.19 per million Btu. To qualify as an extremely high energy
cost community under the RUS benchmark, average annual residential energy expenditure (for all
non-transportation uses) must exceed $4,013 per household.
A community that does not meet the benchmarks for individual home energy sources may
nevertheless qualify based on total expenditures for all home energy use. For example, a community
with an average annual household fuel oil cost of $1,800 and an annual average household electricity
cost of $2,400 would not qualify as an extremely high energy cost community under the benchmarks
for fuel oil or electricity. However, the community is eligible under program because the combined
average total household energy expenditure of $4,200 exceeds the $4,013 extremely high energy cost
benchmark for total household expenditures.
Applicants should refer to the discussion above for guidance on energy expenditure and consumption
information sources for individual energy sources used to determine total household energy use and
expenditures.

Special note on wood use: For communities where residents rely on fire wood for a substantial
portion of their household energy needs, applicants may include an estimate of equivalent commercial
household expenditure needed to supply the energy provided by wood use to provide a more accurate
profile of community energy costs.
For example, the Denali Commission adopted the following measure for determining community
eligibility under its existing RUS high energy cost grant.
Where there is incomplete consumption or cost data, such as where wood gathered by the
household members is the primary fuel for space heating or where residences are only
partially heated as an economizing measure, the annual expenditure per household for energy
is determined by engineering heat loss calculations on the communities’ typical residence to
maintain a 68 degree Fahrenheit indoor temperature.
The resulting calculated energy
requirement, certified by a duly licensed Professional Engineer, is then added to other data
obtained from the communities electric utilities and fuel distributors or government agency
surveys, where available, to arrive at a total household expenditures
If you include an adjustment or estimate for wood use in total household expenditures, clearly identify
what the adjustment is and how it was calculated. Reference any source material you use to derive
the estimates.
Demonstrating Eligibility Using Per Unit Energy Costs
The RUS per unit energy cost benchmarks reflect the average annual per unit cost for major
commercial household energy sources in extremely high energy cost communities. To be eligible
under this grant program, the average residential per unit cost for major commercial energy sources
in the target area or community must exceed at least one of the RUS per unit energy cost benchmarks
shown in Table 1. Applicants generally should use historical residential energy cost data where
available. Estimates may be used if actual data is not available or does not adequately represent the
costs of providing home energy services in the target area.
Electricity. To be eligible under this benchmark, the average per unit cost of electricity must exceed
$0.239 per kWh... There are a variety of acceptable measures that can be used to establish that
community costs meet the eligibility benchmark. Common measures include the local utility’s
standard residential per kWh rate or annual average revenues per kilowatt hour for residential
customers. Sources of actual per unit costs include the local electric provider, Federal and State
agencies, and commercial energy information services. Estimates may be used if actual information is
not available, the target area does not have on-grid electric service, or the historical price information
is not an adequate reflection of the community home energy costs. The example projects in Appendix
A provide examples where per unit electricity costs were estimated. As discussed for the total
expenditure benchmarks above, adjustments to historical data are appropriate to account for
differences in weather, fuel prices, or other circumstances.
Natural Gas. The per unit cost of natural gas must exceed $26.85 per thousand cubic feet to be
eligible under this benchmark. Acceptable sources for natural gas information and appropriate
adjustments are the same as indicated in the above discussion of annual expenditures benchmarks.
Fuel Oil. The per unit cost of residential fuel oil must exceed $3.35 per gallon to be eligible under
this benchmark. Acceptable sources for fuel oil information and appropriate adjustments are the same
as indicated in the above discussion of annual expenditures benchmarks
Propane/LPG. The per unit cost of propane or LPG as a primary home energy source must exceed
$3.61 per gallon to be eligible under this benchmark. Acceptable sources for propane/LPG information
and appropriate adjustments are the same as indicated in the above discussion of annual expenditures
benchmarks

Total Household Energy. Communities may also qualify if the total annual average residential
energy cost exceeds the RUS benchmark of $43.91 per million Btu.1 This figure is 275 percent of the
national average. To derive this estimate, you should determine the annual consumption and
expenditures for common home energy services including space heating, cooling, water heating, water
pumping, refrigeration and food preservation, cooking, lighting, appliances, and laundry. In many
instances home energy services may be delivered differently in remote rural areas and the costs may
not be reflected in a typical residential bill.
Where community energy consumption or energy cost data is incomplete or lacking, the applicant may
substitute estimates based on engineering standards and available community, regional, or local data
on energy expenditures, consumption, housing characteristics and population.
Per Btu expenditures are calculated by adding together total expenditures for all energy sources and
dividing by average total home energy use on a Btu basis. Applicants should use the conversion
factors in Box B to estimate home energy usage in Btus in making these calculations.

Box B
Converting Energy Fuel Units to British Thermal Units (Btus)
In estimating total average household per unit energy costs, it is necessary to convert common home
energy sources to a standard BTU basis.
A Btu (British thermal unit): is defined as the amount of energy required to increase the temperature
of 1 pound of water by 1 degree Fahrenheit, at normal atmospheric pressure. By expressing energy
consumption in Btu, different energy sources can be compared and aggregated in common units.
Applicants should use the following EIA BTU conversion factors for residential energy use:
Energy Source
Electricity
(delivered/on site)
Natural gas
Fuel Oil No.1
Kerosene
Fuel Oil No.2
LPG (propane)
Wood

Btu Equivalent

Unit

3,412

kilowatthour

1,027
135,000
135,000
138,690
91,330
20,000,000

cubic foot
gallon
gallon
gallon
gallon
cord

Supporting Energy Cost Data
Your application must include information that demonstrates eligibility under the RUS high energy cost
benchmarks for your target area. You must supply documentation or references for actual or
estimated home energy expenditures or per unit energy costs that you are relying on to meet the RUS
eligibility benchmarks.
Historical residential energy cost or expenditure information from the local commercial energy
providers are the preferred sources of information. However, in some cases, local commercial energy
1

NOTE: Btu is the abbreviation for British Thermal Unit, a standard energy measure. A Btu is the quantity of heat
needed to raise the temperature of one pound of water 1 degree Fahrenheit at or near 39.2 degrees Fahrenheit. In
estimating average household per unit energy cost on a Btu basis, different home energy sources are converted to
a standard Btu basis.

provider data may be unavailable or may not present an adequate measure of energy costs in the
target area. Other potential sources of home energy related information include Federal and State
agencies, local community energy providers such as electric and natural gas utilities and fuel dealers,
and commercial publications. Estimates are appropriate if these sources are not adequate as
discussed below.
Use of estimated home energy costs. Where community data are incomplete or lacking or where
community-wide data do not accurately reflect the costs of providing home energy services, you may
substitute estimates based on available community energy data and engineering standards. The
estimates should use available community, local, or regional data on energy expenditures,
consumption, housing characteristics and population. Estimates are appropriate where, for example,
the target area is without electric service. For example, engineering cost estimates reflecting the
incremental costs of extending service could be used to establish eligibility for areas without gridconnected electric service.
Information to support high energy cost is subject to independent review by RUS. Applications that
contain information that is not reasonably based on credible sources of information or sound estimates
will be rejected. Where appropriate, RUS may consult standard sources to confirm the reasonableness
of information and estimates provided by applicants in determining eligibility, technical feasibility, and
adequacy of proposed budget estimates.
Why alternative measures are appropriate. RUS concluded following its review of the EIA RECS
data and the LIHEAP program information that eligibility criteria should provide several alternative
measures of extremely high energy costs to accommodate the lack of a standardized national data
base of local community energy consumption and price.
Reliance on total annual household energy expenditure alone does not provide an adequate measure
of residential high energy costs in many rural communities. Total energy expenditures reflect the
amounts and type of energy used, per unit costs of energy. These measures are in turn influenced by
the size and condition of the housing units, family size and income, appliance use, climate, and annual
weather variations. For example, on average lower income families tend to spend less on energy on a
per household basis than upper income families because they tend to live in smaller homes with fewer
energy consuming appliances, and have less disposable income. However, lower income families
spend a much higher portion of their total family income on energy than upper income families. On
average, families who live in regions with both high heating and high cooling demand tend to have
higher energy bills than those in more moderate climate zones.
Reliance on historical commercial household energy expenditures or per unit energy costs alone in
determining eligibility could ignore one of the most adverse impacts of extremely high energy costs in
rural communities. Rural consumers, particularly those with low or modest incomes, may limit or do
without commercial energy sources either because of the extremely high cost or its limited availability.
Examples include homes without on-grid or any electric service; homes dependent on firewood for
heating and homes left unheated or uncooled because of the expense or lack of service.
Use of average “out-of-pocket” household energy cost data may also yield a misleading picture of
extremely high energy costs in some rural areas where some or all of home energy expenditures are
not paid directly by the residential consumers. These include communities where some or all
residential energy costs are paid by the landlord or housing service, or through heating or energy
assistance payments, or by welfare or other community programs. For example, some Native
American communities have a single electric meter, and service to all connected homes is paid for by
the tribe directly to the electric utility. In some extremely high energy cost communities in Alaska, as
a further example, critical household energy services such bathing, laundry, and food storage are
provided and paid for through shared community facilities rather than by individual households. In
these localities, household commercial energy expenditures would not capture the costs of all home
energy uses. In such cases, it would be appropriate for applicants to estimate the equivalent localized
costs of providing home energy services comparable to national or regional usage standards using
available local data.

IS MY PROJECT ELIGIBLE?
Grants under this program may be used for the acquisition, construction, installation, repair,
replacement, or improvement of energy generation, transmission, and distribution facilities in
communities with extremely high energy costs.
Examples of eligible activities include:

Acquisition, construction, replacement, repair, or improvement of:
o Electric generation, transmission, and distribution facilities, equipment, and materials,
including associated and supporting activities; land or right of way acquisition,
engineering and professional expenses, permitting costs,
o Natural gas distribution or storage facilities and associated equipment and activities
serving residential customers or community use; or
o Petroleum product storage and handling facilities serving residential or community
use.
o Renewable energy facilities used for on-grid or off-grid electric power generation,
water or space heating, or process heating and power (renewable energy sources
include solar, wind, hydropower, or biomass technologies).
o Backup up or emergency power generation or energy storage equipment, included
distributed generation installed on consumer premises.

Implementation of energy efficiency, energy conservation measures such as weatherization of
residences and community facilities, energy-efficient or energy saving appliances and devices
as part of a coordinated demand management or energy conservation program.

The above examples are illustrative and are not meant to limit the projects that you may propose in
your application. An activity that meets the objectives of improving energy service or reducing the
costs of energy services to eligible communities is an acceptable grant purpose.
Under the related Denali Commission High Energy Cost Program, RUS has provided grants that have
financed a variety of projects in rural Alaskan villages: the replacement and upgrade of bulk fuel
storage and handling facilities to Clean Water Act standards; repairs to electric generation equipment
and associated structures; and upgrades and extensions of electric distribution lines and transformers.
Ineligible Grant Purposes
Certain activities and expenses cannot be financed out of grant funds. You may not use grant funds
for: preparation of the grant application, fuel purchases, routine maintenance or other operating
costs, and purchase of equipment, structures, or real estate not directly associated with provision of
residential energy services. In general, grant funds may not be used to support projects that
primarily benefit areas outside of eligible target communities. However, grant funds may be used to
finance an eligible target community’s proportionate share of a larger energy project.
This grant program is not generally intended to support research, development or demonstration
projects. You must be able to demonstrate that a proposed project is both economically and
technically feasible as a condition of selection. However, use of grant funds will be considered for
projects that involve the innovative use or adaptation of commercially proven energy-related
technologies to improve energy service in extremely high cost communities.
Other Limitations on use of grant funds:
Section 19 requires that the planning and administrative expenses for grant projects may not exceed
4 percent of project costs. RUS will not approve use of grant funds for expenses that exceed this
limit.
For More Information See Appendix A for examples of eligible projects and different
approaches to demonstrating community energy costs.

READY TO PROCEED?
If you believe that you are an eligible applicant, your target community is an eligible
extremely high energy cost community, and your proposed project is eligible, feasible, and
benefits your community, you are ready to prepare your project proposal and application
package.

PREPARING THE APPLICATION PACKAGE
The NOFA describes what your application package must include. Refer to and follow the NOFA
section on “What to Include in the Application” in preparing your application. For your convenience,
The Application Checklist below shows the required contents of the application package in the order
specified in the NOFA.
Generally, the application package consists of your narrative grant proposal including a project
description, applicant qualifications and experience, information and documentation establishing
applicant, community, and project eligibility, a proposed project work plan, schedule, and budget, plus
required forms and certifications. Copies of all forms and certifications may be found in Appendix B,
on Grants.gov and on the RUS website http://www.usda.gov/rus/electric.
Your application package should provide information in sufficient detail to support finding of economic
and technical feasibility. RUS does not expect applicants to have detailed project information or
engineering plans at a level that would actually support project permitting or construction approvals.
To the extent the proposal deals with routine or common energy projects simple descriptions,
references to RUS or other technical standards will be sufficiently descriptive. For example, a proposal
for a relatively straightforward project upgrading local electric distribution facilities would require a
fairly simple description to establish technical feasibility:
The project will involve the repair or replacement of approximately 3 miles of existing
electric 15 kV distribution lines (poles, conductors, transformers) and the construction
of a new substation to support a line extension project totaling 6 miles that will
provide providing service to about 75 families currently without electric service. The
project will be built according to RUS engineering standards using approved materials.
Location of the project is shown in attached maps. A break out of equipment,
materials, and construction costs is provided in the budget section.
Proposals involving more substantial energy distribution system projects, generation or transmission
projects will generally require substantially more detail to support feasibility determinations.
As you prepare your project narrative and application package, you should also determine whether
your community or project qualifies for any additional priority selection points. Refer to the section in
the NOFA on “Review of Applications” and the discussion below on ”How Will My Application Be
Evaluated?” for information on scoring of proposals.

Application Checklist
The application package should contain an original signed application and two complete copies.

Application Contents
A completed application will contain the following parts assembled in order and paginated sequentially
or by section:

Part A. SF 424 “Application for Federal Assistance”

Part B Narrative Grant Proposal.

Executive Summary.

Table of Contents

Applicant Eligibility

Community Eligibility

Coordination with State Rural Development Initiatives.

Project Overview
Project Design
Project Management.
Regulatory and Other Approvals.
Goals of the Project and Performance Measures
Proposed Project Budget.
Attach either SF-424A, “Budget Information - Non-Construction Programs” or
SF-424C “Budget Information-Construction Programs”

Supplementary Materials. Include in this section any additional information documents
relevant to the application that you wish reviewers to consider in evaluating your
application even if the information is not specifically requested in the NOFA. Please
include a cover page indicating the contents of this section.

Part C. Additional Required Forms and Certifications

SF-424B, “Assurances - Non-Construction Programs” or SF-424D, “Assurances Construction Programs” (as applicable)

SF LLL, "Disclosure of Lobbying Activities" and Form SF-LLLA (continuation, if needed)

"Certification Regarding Debarment, Suspension and Other Responsibility Matter - Primary
Covered Transactions"

Environmental Profile

HOW WILL MY APPLICATION BE EVALUATED?
Your application will be reviewed by a rating panel selected by RUS. The rating panel will award
points to each application based on the evaluation criteria set out in the NOFA. Read the section of
the NOFA on “Selection Criteria and Weights” carefully as well as this section of the Guide.
Careful attention to the project evaluation criteria in the NOFA is a critical part of preparing your
proposal. An RUS ratings panel will review all complete applications according to the evaluation
criteria set forth in the NOFA. RUS will use the panel’s ratings and recommendations to rank
applicants against other applicants. The rankings and recommendations will then be forwarded to the
Administrator for final review and selection.
Evaluation Criteria and Weights
The maximum number of points that can be awarded to a proposal under the selection criteria
established in the NOFA is 100 points. RUS will award up to 65 points for project design and technical
merit criteria and up to 35 points based on priority criteria for project or community characteristics.
Table 2 shows the maximum points available under each the evaluation criterion.
In preparing your proposal, be sure that you address all the criteria pertaining to technical merit,
project feasibility, and community need and provide supporting data and documentation where
indicated. Proposals that do not fully address these criteria will not be ranked as highly as those that
do. RUS will award up to 65 points for these criteria.
Up to 35 points can be awarded to applicants based on priority evaluation criteria. Your project may
be eligible to receive priority consideration under one or more of these criteria. To receive the points
to which you may be entitled, include supporting information in your application. If your project or
community qualifies and be clear in stating that your believe your application is seeking such
recognition in your executive summary.
RUS will use the selection criteria described below to evaluate and rate applications and will award
points up to the maximum number indicated under each criterion. Applicants should carefully read
more information on the rating criteria in this NOFA and the Application Guide and address all criteria.
In writing your proposal, use as many pages as is necessary to address the evaluation criteria. In
addition, don’t be concerned about covering the same aspect of the application in more than one
scoring criterion if the aspect fits more than one criterion.
Project Design and Technical Merit Criteria
Your narrative project proposal should demonstrate the technical feasibility of the project, the
adequacy of financial and other resources, the competence and experience of the applicant and its
team, the project goals and objectives, and community needs and benefits. A total of 65 points may
be awarded under criteria for project design and technical merit.
A. Comprehensiveness and feasibility of approach. (Up to 30 points) In addressing this criteria,
include sufficient information and documentation in your project description so that rating panel can
conclude that your proposed project is both technically feasible and financially sustainable. State
clearly how your proposed project will benefit the extremely high energy cost target community.
B. Demonstrated experience. (Up to 10 points) Your narrative and supporting materials should
describe the relevant experience and training of your project team. If you do not have experience in
administering and carrying out projects similar to your proposal, describe how experience from other
types of endeavors is relevant, or the experience of any partners. If an element of your project
involves developing community capacity and expertise, be sure to describe how the proposed program
design compensates for lack direct experience by the primary applicant.
An example of a
compensating mechanism would be a project that would be carried out in the coordination with related

activities of an experienced partner.

EVALUATION CRITERIA

Maximum
Points

Project Design and Feasibility Criteria (up to 65 total points)
Comprehensiveness and Feasibility of project
Demonstrated Experience
Assessment of Community Needs
Project Evaluation Measures
Coordination with State rural development initiatives
USDA Priority Criteria (up to 35 total points)
Economic Hardship
A. Economically Disadvantaged Counties
County median household income:
(1) less than 70 percent of the State median household income
(2) 70 to 80 percent of the State median household income
(3) 80 to 90 percent of the State median household income
(4) 90 to 95 percent of the State median household income
(5) over 95 percent the State median household income

30
10
15
5
5

15
15 points;
12 points;
10 points;
5 points; or
0 points.

OR:
B. Other substantial economic hardship

up to 15 points.

Rurality
Population of largest community in target area:

2,500 or less
Between 2,501 and 5,000, inclusive

Between 5,001 and 10,000, inclusive
Between 10,001 and 15,000, inclusive

Between 15, 001 and 20,000, inclusive
Over 20,000,
Unserved energy needs
Imminent Hazard Or Critical Energy
Cost Sharing
Maximum Possible Score

14
14 points
12 points
8 points
5 points
2 points
0 points

2
2
2
100 points

C. Community Needs. (Up to 15 points). Under this criterion, reviewers will consider the applicant's
assessment of community needs and how the grant project addresses those needs. You should also
describe why your proposal project should be funded ahead of competing applications. You should
describe the severity of physical and economic challenges affecting eligible communities with
supporting data and documentation. The NOFA describes three categories of information that the
rating panel will consider:
a) the burden placed on the community and individual households by extremely high energy
costs as evidenced by such quantitative measures as, for example, total energy expenditures,
per unit energy costs, energy cost intensity for occupied space, or energy costs as a share of
average household income, and persistence of extremely high energy costs compared to
national or statewide averages.
b) the hardships created by limited access to reliable and affordable energy services; and

c) the availability of other resources to support or supplement the proposed grant funding.
Your narrative proposal should address all three directly to receive a high score under this criterion.
Important: The potential benefit to the community, or how the project responds to
community needs, is one of the critical elements that the rating panel will consider in
evaluating and scoring proposals. Careful attention to the benefits that will accrue from the
project and effective measurements of success will increase the likelihood that your
proposal will rate highly on this criterion.
Note on measuring energy cost intensity. If you are considering providing information on energy
cost intensity as a quantitative measure for demonstrating the hardship that extremely high energy
costs impose on your community, the EIA Residential Energy Consumption Survey includes energy
intensity data and energy cost among its estimates. See the EIA website for additional information
http://www.eia.doe.gov/emeu/recs/recs97_ce/97tblce.html on how to calculate household energy
intensity.
D. Project Evaluation Methods. (Up to 5 points) Describe how you plan to evaluate and report on the
success and cost-effectiveness of your project. Describe how the results from your project evaluation
could contribute to program improvements nor be helpful to other entities considering similar
programs.
E. Coordination with Rural Development Initiatives. (Up to 5 points) USDA encourages coordination
among State and Federal rural development activities. In support of these efforts, RUS requests
applicants to describe whether and how the proposed project is coordinated with or supports State
rural development initiatives. RUS will consider the documentation submitted by the applicant
evidencing its coordination efforts, community support, and State or local government
recommendations in awarding points under this criterion. Be sure to identify whether your proposed
grant project is dependent on or tied to other rural development initiatives, funding, and approvals.
USDA Priority Criteria
Reviewers may award up to 35 points under various priority selection criteria. These priority criteria
are based on characteristics of the project or the target community. RUS will award additional points
to projects that benefit smaller rural communities, areas experiencing economic hardship, persistent
poverty, or unserved community energy needs or to projects correcting an imminent hazard to public
health or safety. Priority points will also be awarded for proposals that include cost sharing, or that
serve a Federally designated Empowerment Zone or Enterprise Community (EZ/EC) or a USDA
Champion Community.
Your narrative proposal and documentation should include information to support the award of these
points.
IMPORTANT: Be sure to indicate in your application’s Executive Summary that you are
requesting additional points under the priority evaluation criteria and specify all criteria
that apply to your proposal.
Economic Hardship. (Up to 15 points) Raters will award up to 15 priority points for projects that
serve communities facing one or more economic hardship conditions that impair the ability of the
community and/or its residents to provide basic energy services or to reduce or limit the costs of
these services. You may use one of two alternative approaches to demonstrate community economic
hardship.
IMPORTANT:
Whichever alternative you choose, be sure to indicate clearly in your
application that you are seeking additional points for Economic Hardship.
A. Economically Distressed Communities (up to 15 points) Raters will award points on the following
sliding scale based on the median household income of the county in which the target community is
located as a percentage of State median household income. Target areas located within recognized

Indian reservations may use reservation median household income instead of county income for this
criterion.
County median household income as
percentage of State median household income

Points awarded

less than 70 percent
70 to 80 percent
80 to 90 percent
90 to 95 percent
over 95 percent

15 points
12 points
10 points
5 points
0 points

Under this objective measure, for example, proposals that serve a county with median household
income less than 70 percent of the State average will receive 10 points.
Information on State and county median income is available online from the USDA Economic Research
Service at http://www.ers.usda.gov/data/unemployment/.
B. Other Economic Hardship (up to 15 points) Raters can award up to 15 points for community
economic hardship based on other community characteristics identified and documented in your
application. Examples include but are not limited to natural disasters, financially distressed local
industry, loss of major local employer, outmigration, or other condition adversely affecting the local
economy, or contributing to unserved or underserved energy infrastructure needs that affect the
economic health of the community
3. Rurality. (Up to 14 points) In order to direct Federal funds to rural communities with significant
needs and limited alternative resources, USDA Rural Development Programs generally provide a
priority to smaller rural communities that are often comparatively disadvantaged in seeking
assistance. RUS reviewers will award priority points for projects serving target communities based on
the population of the largest incorporated cities, towns, or villages, or census designated places
included within the grant’s proposed target area.
Points will be awarded based on the population of the largest target community within the proposed
target area as follows:
(1)
(2)
(3)
(4)
(5)
(6)

2,500 persons or less, 14 points;
Between 2,501 and 5,000 persons, inclusive, 12 points;
Between 5,001 and 10,000 persons, inclusive, 8 points;
Between 10,001 and 15,000 persons, inclusive, 5 points;
Between 15, 001 and 20,000 persons, inclusive, 2 points;
Above 20,000 persons, 0 points.

Applicants must use the latest available population figures from Census 2000 available at
http://www.census.gov/main/www/cen2000.html for every incorporated city, town, or village, or
Census designated place included in the target area.
IMPORTANT: You must indicate that you are seeking a priority based on rurality in your
application and provide the Census information to support your request in order to receive
these points. RUS will not independently review applications to determine population and
award rurality points if applicants have not indicated they are seeking a priority.
4. Unserved Energy Needs (2 points) The Rural Electrification Program is directed at providing and
improving electric service in rural areas. Consistent with these statutory purposes, the rating panel
will award 2 points to projects that meet unserved or underserved energy needs. Examples of
proposals that may qualify under this priority include projects that that extend or improve electric or
other energy services to communities or customers that do not have reliable centralized or commercial
energy service or where many homes remain without such service because the costs are unaffordable.
IMPORTANT: You must request a priority under this criterion and identify how the project
is meeting the unserved energy need to receive these points.

5. Imminent hazard (2 points) Raters may award 2 points for projects that correct conditions
creating an imminent hazard to public safety, welfare, the environment, or to a critical community or
residential energy facility. Examples include community energy facilities in immediate danger of
failure because of deteriorated condition, capacity limitations, damage from natural disasters or
accidents, or other conditions where failure would create a substantial threat to public health or
safety, or to the environment.
IMPORTANT: You must identify the imminent hazard condition and indicate that you are
seeking a priority under this criterion in your application to receive the additional points.
6. Cost Sharing (2 points) There is no cost sharing requirement under this grant program. Raters
will award 2 points for any proposal that include a cost share exceeding 10 percent of project costs.
Examples of cost sharing include supplemental contributions of funds, property, equipment, services,
or other in kind contributions that support the project and demonstrate the applicant and/or
community commitment to the project. Be sure to clearly indicate that your project budget includes a
cost contribution and that you are seeking additional points.

SUBMITTING THE APPLICATION
Applicants should follow the directions in NOFA and this Application Guide in preparing their
application packages. The completed application should be assembled in the order specified with all
pages numbered sequentially. Your application may be rejected if it does not include the information,
forms, and certifications required in the NOFA or if you do not include information to support your
eligibility.
Applicants that are submitting paper applications should submit one original application that includes
original signatures on all required forms and certifications and two copies. Applications should be
submitted on 8 1/2 by 11 inch white paper. Supplemental materials, such as maps, charts, plans, and
photographs may exceed this size requirement.
Applicants that are submitting applications online through Grants.gov should follow directions on that
site (http://www.Grants.gov) to complete the application forms and to attach their narrative and other
materials to the application package for electronic filing.

HOW TO SUBMIT AN APPLICATION PACKAGE
PAPER APPLICATIONS
The completed application package must be delivered to RUS headquarters at:
Assistant Administrator, Electric Program
Rural Utilities Service
U.S. Department of Agriculture
1400 Independence Avenue, SW, STOP 1560
Room 5165 South Building
Washington, DC 20250-1560
Mark the outside of the Envelope: "Attention: High Energy Cost Community Grant Program"
Application packages should be delivered post paid using United States Mail, overnight delivery
service, or by hand. RUS will not accept applications by email or fax.
Applicants should be advised that regular mail deliveries to Federal Agencies, especially of oversized
packages and envelopes, continue to be delayed because of increased security screening

requirements. Applicants may wish to consider using Express Mail or a commercial overnight delivery
service instead of regular mail. Applicants wishing to hand deliver or use courier services for delivery
should contact the Agency representative in advance to arrange for building access. RUS advises
applicants that because of intensified security procedures at government facilities that any electronic
media included in an application package may be damaged during security screening. If an applicant
wishes to submit such materials, they should contact the Agency representative for additional
information.
ELECTRONIC APPLICATIONS
RUS will accept applications submitted through the Federal Government’s online application portal,
Grants.gov. You can search for grant opportunities, download application materials, complete your
application, upload additional information for your application, and submit your application
electronically at Grants.gov. RUS will not accept applications by electronic mail.
Please follow the instructions for preparing and submitting applications under the “Apply” tab at
Grants.gov. All the forms that you need to submit your application are available there. Follow
Grant.gov directions for uploading additional information for your application.
If you encounter a technical problem retrieving or submitting an electronic application, contact the
Grants.gov customer support resources directly (click the "Customer Support" tab on any page of
Grants.gov to get started). RUS does not control the technical aspects of Grants.gov and we won't be
able to help you if you experience a problem.
We can, however, answer questions about the
application materials posted there and what we require.
If you want to submit an application on-line, RUS strongly encourages you to obtain all the necessary
sign-ups, credentials and authorizations well in advance of the deadline. You will need a Central
Contractor Registry (CCR) registration before you can submit electronically. In addition, Grants.gov
requires some one-time credentialing and online authentication procedures. These procedures may
take several business days to complete. Please make sure that your credentials and registration are
up to date. Some or all of Grants.gov's requirements require an annual update.
If you are applying through Grants.gov, you do not need to submit two copies as required for mailed
applications. We may, however, request that you provide original signatures on paper as part of the
pre-award review if your project is selected.

DEADLINE FOR SUBMISSION AND LATE APPLICATIONS
VERY IMPORTANT: Your application package must be postmarked or delivered to RUS by
Monday, July 25, 2005. Electronic Applications must also be filed with Grants.gov before
midnight, Monday, July 25, 2005.
RUS will accept for review all applications postmarked or delivered to RUS by this deadline.
Late applications will not be considered and will be returned to the Applicant.
#

APPENDIX A

RESOURCES

Appendix A

APPENDIX A

RESOURCES

TARGET AREA WORKSHEETS
Many applicants find it useful to present information in tabular format. These worksheets
are provided for the convenience of applicants in assembling and organizing community
information to support their applications. Applicants are not required to use these forms in
their applications.
Geographic, Population, Income, and Community Characteristics Worksheet
This worksheet is useful for presenting descriptive information about the target
community that can be used to support the award of additional priority points for
rurality and economic hardship.
Community Energy Characteristics Worksheet
This worksheet is useful for presenting information about community energy use and
costs necessary for establishing eligibility.

This Page Left Blank

Appendix A

Applicant:_____________________________________
Project:_______________________________________

Page________ of ________

RUS Extremely High Energy Cost Community Grant Program
Target Area Worksheet
GEOGRAPHIC, POPULATION, INCOME, AND COMMUNITY CHARACTERISTICS
COMMUNITY NAME
City, town, village, Census
designated place, or local name for
each community in the target area

County

Incorporated
Area?
Yes/No

Census 2000
Population

County Median Income as
Percent of State Median
Income

Appendix A

This Page Left Blank

Appendix A

Applicant:_____________________________________
Project:_______________________________________

Page________ of ________

RUS Extremely High Energy Cost Community Grant Program
Target Area Worksheet
COMMUNITY ENERGY CHARACTERISTICS
COMMUNITY
City, town, village, Census designated
place or local name

Local Energy Provider

Fuel or
Energy
Source

Notes:

Annual Household
Consumption

Annual
Household
Expenditure

Average
Per unit
cost

Appendix A

This Page Left Blank

Appendix A

Examples of Eligible Projects
RUS has developed three examples of communities and projects that may qualify under this program.
The examples are illustrative only and do not reflect any actual grant proposals. The examples
demonstrate how the eligibility requirements of this NOFA can be satisfied using alternative measures
for a variety of projects.
Example 1.
Example 2.
Example 3.

Electric Distribution System Upgrade and Replacement of Bulk Fuel Storage Facilities
Rural Electrification Project - Native American Reservation
Rural Electrification Project with Renewable Energy

Example 1. Electric Distribution System Upgrade and Replacement of Bulk Fuel Storage
Facilities in a Rural and Remote Village
Target Community A is a remote rural Alaskan village of less than 2,000 inhabitants. It is served by a
municipal utility. Its county median household income is 75 percent of the statewide average.
The primary residential energy sources used in the community are electricity and fuel oil. The average
revenue per kilowatt hour (kWh) for residential customers is 21 cents per kilowatt-hour. The typical
residential customer uses 500 kilowatt hours per month. Annual household electricity bills average
$1,260. Because of its remote location, fuel oil is more than twice as expensive in this community as
in more urban areas. In recent years fuel oil has averaged over $2.50 per gallon, delivered. Because
of the harsh climate, the average household uses over 1,000 gallons of fuel oil per year and the
average annual household fuel oil bill totals over $2,500.
The local government-owned utility of Community A submits a proposal to repair and replace
segments of its electric distribution system and to replace and upgrade the village’s deteriorated fuel
oil storage tanks and bulk fuel handling system to comply with Federal environmental requirements.
Use of grant funds for the project will avoid increases in home energy costs, enhance the reliability of
the village energy infrastructure, and remedy an imminent environmental hazard. Total cost of the
project is estimated at $ 1.5 million. The applicant proposes to contribute $250,000 towards project
costs from a combination of loan funds and a State grant.
Is Community A an eligible applicant?
Yes. A local government body is an eligible applicant.
Is Community A an eligible extremely high energy cost community?
Yes. The average annual household consumption in Community A totals over 1,000 gallons of fuel oil
per year and the average annual household fuel oil bill is over $2,500. This expenditure is
substantially over the RUS benchmark of $1,882 per year representing 275 percent of the national
average annual household expenditure for fuel oil.
Therefore, the community qualifies as an
extremely high energy cost under this NOFA based on average commercial energy costs for fuel oil.
The reported average per unit household energy cost of $0.21 per kWh for electricity in Community A,
while substantially above the national average, do not meet the RUS eligibility benchmark of $0.239
per kWh shown in Table 1 in the NOFA.
Is Community A’s proposed grant project an eligible purpose?
Yes. Repair, replacement, and upgrades to bulk fuel storage facilities and to electric distribution
systems are eligible purposes under this program.

Appendix A

Does Community A qualify for priority points?
Yes. Under the provisions of the NOFA, Community A would qualify for 14 points for rurality based on
its population of less than 2,500 persons. Its median household income would qualify it for 12 points
as an economically distressed community. Because the proposal involves urgent repairs to correct an
imminent hazard to public safety and the environment, it qualifies for 2 points. Because the
applicant’s proposed cost contributions exceed 10 percent of the project costs, the application will
receive 2 points. Community A qualifies for 30 priority points in its project score.

Example 2. Rural Electrification Project - Native American Reservation
Target Community B is located in an extremely rural area of an Indian Reservation that currently does
not have central station electric service. Less than 5,000 people live within the boundaries of this
Federally-recognized reservation. The largest Census Designated Place (CDP) within the reservation
has a population of 1,100 people. The median household income of the county in which the
reservation is located is 75 percent of the statewide average. Median household incomes on the
reservation are less than 60 percent of the statewide average. About 3,000 people live in the
proposed target area.
Households in the target area rely on a variety of fuels and technologies for energy services. Some
households rely on gasoline-driven electric generators to provide electricity for their individual homes.
Members of the community also rely on wood, kerosene, and propane for heating and cooking. A
small, densely settled area on the boundaries of the reservation receives electric service from a
neighboring investor-owned electric system under the utility’s state-approved residential rate.
Monthly electricity use in this area averages about 500 kWh.
Three quarters of the homes on the reservation lack on-grid electric service. Because of the
widespread lack of commercial energy services, there is little available information on average
community energy costs. Surveys of a representative sample of homes indicate that residents rely on
a combination of gasoline generators, propane, kerosene, and fire wood to meet their energy needs.
Average household energy costs are estimated to be in excess of $3,000 per year exclusive of the
costs of firewood. In the most recent year, costs of running a gasoline powered generator averages in
excess of $0.75 per kilowatt hour.
The Indian Tribe proposes to create a tribal utility to construct and operate an electric distribution
system within the unserved areas of the reservation. The Tribal Government submits an application
for grant funds for system design and planning, development of a management and expansion plan,
construction of the first phase of the electric distribution system with a substation and interconnection
with the neighboring utility system to serve community facilities and approximately 300 residences.
Utility revenues and conventional financing will support subsequent expansion of the system. The
Tribe believes that an important benefit of the project will be that the availability of modern utility
infrastructure on the reservation will support economic development and encourage younger members
of the tribe to make their homes on the reservation.
A preliminary engineering study is available providing cost estimates for building the tribal distribution
system, future wholesale power costs, and projected electricity demand. If the project is completed,
electricity is expected to be the major source of home energy.
The estimated costs of constructing phase I of the distribution system to serve 300 residential
customers are $5,000,000. Estimated monthly electricity use for new residential customers after
project completion is about 421 kWh based on characteristics of similar communities. The engineering
study reports the average regional cost of wholesale power is $0.042 and the average cost of
distribution expenses is $0.016 kWh for residential customers. Assuming that the $5,000,000 project
cost is financed at 6 percent interest over a period of 35 years, estimated costs to serve the target
area (excluding margins) can be calculated as follows:

Appendix A

Annual system electric usage (including losses)
1,515,600 kWh
Net annual system electric usage
1,439,820 kWh
Annual debt service
$342,113
Annual power purchase costs (Net)
$ 60,472
Annual distribution system expenses (Net)
$ 23,037
Total Costs
$425,623
Cost per kWh

$0.296

Is Community B an eligible applicant?
Yes. An Indian tribe or a tribal utility owned, controlled by, or sanctioned by the tribal government is
an eligible applicant under this program.
Is Community B an eligible extremely high energy cost community?
Yes. Because the target
eligibility will have to be
procuring power supplies
household energy services
kerosene.

community does not have established energy utilities, determination of
based either the projected costs of constructing the new system and
or the estimated average annual costs of providing typical levels of
using existing combination of gasoline generators, propane, firewood, and

In this example, Community B is able to demonstrate that the average revenue per kWh cost for a
new on-grid electric distribution system with a small customer base is projected to be $0.296 per
kWh. This estimated residential electric cost exceeds the RUS benchmark for per unit electricity costs
of $0.239 per kWh. Community B’s target area qualifies as an extremely high energy cost community
under this program.
Alternatively, in this example, estimated annual costs of providing household energy services using
the existing combination of energy fuels does not meet the total expenditure benchmark of $4,013.
However, the cost of providing electricity via gasoline generators is over $0.75 per kWh –well in
excess of the benchmark of $0.239 per kWh and the target community also qualifies by this method.
Is Community B’s proposed grant project an eligible purpose?
Yes. The proposed construction of a distribution system under the tribe’s electrification project
qualifies as an eligible purpose.
Does Community B’s proposed project qualify for priority points?
Yes. Community B would qualify for 14 points for rurality because the population of the largest place
in its target area is less than 2,500 persons. Because the project is located within the boundaries of
the reservation, economic hardship is based on the median household income of the reservation,
which is less than 60 percent of the statewide average. The project qualifies for 15 points as an
economically distressed community. Because the project is bringing electricity to unserved areas, it
qualifies for 2 points. The project may also qualify for 2 points for cost contribution if the project
budget documents that customer revenues will provide more than 10 percent of project costs. The
project may qualify for up to 33 priority points.

Example 3. Rural Electrification Project with Distributed Renewable Energy
Target Area C is located in a sparsely populated rural area and encompasses portions of an Indian
Reservation.
Applicant C a local electric distribution utility that serves the reservation and
surrounding areas, proposes to provide electricity to unserved areas in its service territory by

Appendix A

providing a package of an off-grid renewable generator and energy efficient electric appliances to
provide basic home energy services in lieu of extending distribution lines and central station service.
The grant would help reduce the costs for participating households. The grant will benefit scattered
rural communities of predominantly Native Americans that, although they live within the service area
of an existing electric utility, do not have any central station electric service. Together these scattered
households comprise the grant’s proposed target areas. These unserved areas consist of clusters of
up to ten single-family units in close proximity. These household clusters are isolated from each other
and are located over a large geographical area. Some of these households have gasoline-driven
electric generators that serve their individual homes or family-communities. Other sources of energy,
such as wood, oil, and propane are also used for heating and cooking. Because of the lack of
centralized utility services, there is little available information on total household energy costs.
Eligibility of the target community will be determined based on the estimated incremental costs of
extending service to these new customers and/or the costs of providing off-grid (distributed) energy
service.
The service area extends over several counties has more than 15,000 customers. Most of the service
area, including all of the proposed target area, however, is located outside CDPs. The largest
incorporated town in the target area has a population of 3,400 persons. County median household
income is 74 percent of the statewide average.
The utility’s planning and engineering studies document the high costs of extending service to these
remote settlements in sparsely populated areas. The utility estimates that costs of extending its
distribution system to connect these settlements will range from $15,000 to $60,000 per household,
excluding costs of power supply. Extending service is not cost-effective for the local utility. The
average household with electric service uses 350 kWh per month at a residential rate of $0.084 per
kWh and the average monthly bill averages about $30. Annual revenues from typical residential loads
in the unserved areas would likely fall substantially below the $100/month or more needed to recover
the initial investment to extend distribution service. The inability of many low incomes residents to
afford the additional customer contribution above the utility’s standard line extension allowance has
proved to be a significant deterrence to electrification. The utility could not average service extension
costs to all unserved areas across its customer rate base without substantially raising consumer rates
to other mostly low-income consumers.
The utility estimates that it could provide a modest level of electric service to a typical off-grid home
by installing individual renewable energy generation systems (such as solar or wind) plus back up
energy systems to provide electricity for a single family or cluster of households. The cost of a solar
power installation is estimated at approximately $10,000 per household – significantly less than the
costs of line extension. Even so, the utility estimates that cost recovery for the solar system would
require a payment of slightly over $100 per month over a 15 year period – or more than triple the
average residential electric bill.
The grant application proposes to use a combination of customer revenues, utility cost contributions,
and grant funds to support the off-grid electrification project. As an additional benefit, the project will
create several new community-based jobs in installing and servicing the household energy systems.
The project also benefits the utility and its existing ratepayers by avoiding the higher costs of
extending the utility’s distribution system into these sparsely-populated areas and the costs of
procuring wholesale power to serve the new loads.
The applicant documents that distributed generation is the lowest cost option for providing basic
electric service to residences in the target area. The applicant’s engineering study clearly describes
the units that will be required and the costs associated with operating the facilities. Because these
solar units will be operated off-grid, the costs of providing and operating each unit will not vary
greatly. Therefore, an analysis of one unit will be sufficient to show feasibility and cost of service.
Each installation is assumed to have a total project cost of about $10,000 and will supply average
household electricity usage of 210 kWh per month. The analysis assumes costs will be recovered over
a 15 year period at an interest rate of 6 percent with a monthly payment of $111. Total annual
household electricity use is 2520 kWh at an annual cost of $1,332. The cost of electric service is thus
$0.529 per kWh. This exceeds the RUS benchmark of $0.239 per kWh and establishes the target area

Appendix A

as an eligible extremely high energy cost area even though it is located in the service territory with
per unit electricity costs that are close to the national average.
Is Applicant C an eligible applicant?
Yes. Applicant C as a local electric utility organized under State law is an eligible applicant.
Is Applicant C’s proposed target community an eligible extremely high energy cost community?
Yes. The annual average cost for providing a modest level of electric service to the households in the
target area is $0.529 per kWh and exceeds 275 percent of the national average on a per unit basis.
The target community qualifies as an extremely high energy cost community.
Is Applicant C’s proposed off-grid electrification project an eligible purpose?
Yes. Applicant C proposes to extend and improve household energy services through a combination of
off-grid renewable generation, battery storage, and efficient appliances. This is an eligible purpose
under this program.
Does Community C’s proposed project qualify for priority points?
Yes. Community C would qualify for 12 points for rurality because the population of the largest place
in its target area is between 2,501 and 5,000 persons. Based on its median household income, it
would qualify it for 12 points as an economically distressed community. Because the project is
bringing electricity to unserved areas, it qualifies for 2 points. In addition, if the project budget
documents that the utility and customer cost contributions exceed 10 percent of project costs, an
additional 2 points will be awarded. The project may qualify for up to 28 priority points.

###

APPENDIX B
FORMS AND CERTIFICATIONS

Version 7/03

APPLICATION FOR
FEDERAL ASSISTANCE
1. TYPE OF SUBMISSION:
Application

2. DATE SUBMITTED

Applicant Identifier

3. DATE RECEIVED BY STATE

State Application Identifier

4. DATE RECEIVED BY FEDERAL AGENCY

Federal Identifier

Pre-application

Construction

Non-Construction
5. APPLICANT INFORMATION
Legal Name:

Non-Construction
Organizational Unit:
Department:

Organizational DUNS:

Division:

Address:
Street:

Name and telephone number of person to be contacted on matters
involving this application (give area code)
Prefix:
First Name:

City:

Middle Name

County:

Last Name

State:

Zip Code

Suffix:

Country:

Email:

6. EMPLOYER IDENTIFICATION NUMBER (EIN):

Phone Number (give area code)

Fax Number (give area code)

7. TYPE OF APPLICANT: (See back of form for Application Types)

8. TYPE OF APPLICATION:
New
Continuation
If Revision, enter appropriate letter(s) in box(es)
(See back of form for description of letters.)

Revision
Other (specify)

Other (specify)

9. NAME OF FEDERAL AGENCY:

10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:

11. DESCRIPTIVE TITLE OF APPLICANT’S PROJECT:

TITLE (Name of Program):

12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.):

13. PROPOSED PROJECT
Start Date:

14. CONGRESSIONAL DISTRICTS OF:
a. Applicant
b. Project

Ending Date:

15. ESTIMATED FUNDING:
00

a. Federal

b. Applicant

c. State

d. Local

e. Other

16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
THIS PREAPPLICATION/APPLICATION WAS MADE
a. Yes.
AVAILABLE TO THE STATE EXECUTIVE ORDER 12372
PROCESS FOR REVIEW ON
DATE:
b. No.

f. Program Income

g. TOTAL

PROGRAM IS NOT COVERED BY E. O. 12372

OR PROGRAM HAS NOT BEEN SELECTED BY STATE
FOR REVIEW
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?

Yes If “Yes” attach an explanation.

18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Authorized Representative
Prefix
First Name
Middle Name
Last Name

Suffix

b. Title

c. Telephone Number (give area code)

d. Signature of Authorized Representative

e. Date Signed

Previous Edition Usable
Authorized for Local Reproduction

Standard Form 424 (Rev.9-2003)
Prescribed by OMB Circular A-102

Reset Form

INSTRUCTIONS FOR THE SF-424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE
ADDRESS PROVIDED BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required face sheet for pre-applications and applications submitted for Federal
assistance. It will be used by Federal agencies to obtain applicant certification that States which have established a review and comment
procedure in response to Executive Order 12372 and have selected the program to be included in their process, have been given an
opportunity to review the applicant’s submission.
Item:
1.

Entry:
Select Type of Submission.

Item:
11.

Date application submitted to Federal agency (or State if applicable)
and applicant’s control number (if applicable).

12.

State use only (if applicable).

Enter the proposed start date and end date of the project.

Enter Date Received by Federal Agency
Federal identifier number: If this application is a continuation or
revision to an existing award, enter the present Federal Identifier
number. If for a new project, leave blank.
Enter legal name of applicant, name of primary organizational unit
(including division, if applicable), which will undertake the
assistance activity, enter the organization’s DUNS number
(received from Dun and Bradstreet), enter the complete address of
the applicant (including country), and name, telephone number, email and fax of the person to contact on matters related to this
application.

14.

List the applicant’s Congressional District and any District(s)
affected by the program or project

Amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in kind
contributions should be included on appropriate lines as
applicable. If the action will result in a dollar change to an
existing award, indicate only the amount of the change. For
decreases, enclose the amounts in parentheses. If both basic
and supplemental amounts are included, show breakdown on
an attached sheet. For multiple program funding, use totals
and show breakdown using same categories as item 15.
Applicants should contact the State Single Point of Contact
(SPOC) for Federal Executive Order 12372 to determine
whether the application is subject to the State
intergovernmental review process.
This question applies to the applicant organization, not the
person who signs as the authorized representative. Categories
of debt include delinquent audit disallowances, loans and
taxes.

Enter Employer Identification Number (EIN) as assigned by the
Internal Revenue Service.

16.

Select the appropriate letter in
the space provided.
I.
State Controlled
A. State
Institution of Higher
B. County
Learning
C. Municipal
J. Private University
D. Township
K. Indian Tribe
E. Interstate
L. Individual
F. Intermunicipal
M. Profit Organization
G. Special District
N. Other (Specify)
H. Independent School
O. Not for Profit
District
Organization
Select the type from the following list:
•
"New" means a new assistance award.
•
“Continuation” means an extension for an additional
funding/budget period for a project with a projected completion
date.
•
“Revision” means any change in the Federal Government’s
financial obligation or contingent liability from an existing
obligation. If a revision enter the appropriate letter:
A. Increase Award
B. Decrease Award
C. Increase Duration
D. Decrease Duration
Name of Federal agency from which assistance is being requested
with this application.

17.

10.

Entry:
Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g., construction or real
property projects), attach a map showing project location. For
preapplications, use a separate sheet to provide a summary
description of this project.
List only the largest political entities affected (e.g., State,
counties, cities).

To be signed by the authorized representative of the applicant.
A copy of the governing body’s authorization for you to sign
this application as official representative must be on file in the
applicant’s office. (Certain Federal agencies may require that
this authorization be submitted as part of the application.)

Use the Catalog of Federal Domestic Assistance number and title of
the program under which assistance is requested.

SF-424 (Rev. 7-97) Back

OMB Approval No. 0348-0044

BUDGET INFORMATION - Non-Construction Programs
SECTION A - BUDGET SUMMARY
Grant Program
Function
or Activity
(a)

Catalog of Federal
Domestic Assistance
Number
(b)

Estimated Unobligated Funds
Federal
(c)

Non-Federal
(d)

New or Revised Budget

Federal
(e)

Non-Federal
(f)

Total
(g)

0.00

Totals

0.00

SECTION B - BUDGET CATEGORIES
GRANT PROGRAM, FUNCTION OR ACTIVITY

6. Object Class Categories
a. Personnel

Total

(1)

(2)

(3)

(4)

(5)

0.00

b. Fringe Benefits

0.00

c. Travel

0.00

d. Equipment

0.00

e. Supplies

0.00

f. Contractual

0.00

g. Construction

0.00

h. Other

0.00

i. Total Direct Charges (sum of 6a-6h)

0.00

j. Indirect Charges
k. TOTALS (sum of 6i and 6j)

7. Program Income

0.00

Authorized for Local Reproduction
Previous Edition Usable

0.00

Standard Form 424A (Rev. 7-97)
Prescribed by OMB Circular A-102

SECTION C - NON-FEDERAL RESOURCES
(b) Applicant
(c) State

(a) Grant Program
8.

(d) Other Sources
$

(e) TOTALS
0.00

0.00

10.

0.00

11.

0.00

12. TOTAL (sum of lines 8-11)

0.00 $

0.00

SECTION D - FORECASTED CASH NEEDS
Total for 1st Year

13. Federal

14. Non-Federal

1st Quarter

0.00 $

2nd Quarter

3rd Quarter

0.00 $

4th Quarter

0.00

15. TOTAL (sum of lines 13 and 14)

0.00 $

0.00

SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program

FUTURE FUNDING PERIODS (Years)
(c) Second
(d) Third

(b) First
16.

0.00 $

(e) Fourth
$

17.
18.
19.
20. TOTAL (sum of lines 16-19)

0.00

SECTION F - OTHER BUDGET INFORMATION
21. Direct Charges:

22. Indirect Charges:

23. Remarks:
Authorized for Local Reproduction

Standard Form 424A (Rev. 7-97) Page 2

INSTRUCTIONS FOR THE SF-424A
Public reporting burden for this collection of information is estimated to average 180 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0044), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
General Instructions
This form is designed so that application can be made for funds
from one or more grant programs. In preparing the budget,
adhere to any existing Federal grantor agency guidelines which
prescribe how and whether budgeted amounts should be
separately shown for different functions or activities within the
program. For some programs, grantor agencies may require
budgets to be separately shown by function or activity. For other
programs, grantor agencies may require a breakdown by function
or activity. Sections A, B, C, and D should include budget
estimates for the whole project except when applying for
assistance which requires Federal authorization in annual or
other funding period increments. In the latter case, Sections A, B,
C, and D should provide the budget for the first budget period
(usually a year) and Section E should present the need for
Federal assistance in the subsequent budget periods. All
applications should contain a breakdown by the object class
categories shown in Lines a-k of Section B.

For continuing grant program applications , submit these forms
before the end of each funding period as required by the grantor
agency. Enter in Columns (c) and (d) the estimated amounts of
funds which will remain unobligated at the end of the grant
funding period only if the Federal grantor agency instructions
provide for this. Otherwise, leave these columns blank. Enter in
columns (e) and (f) the amounts of funds needed for the
upcoming period. The amount(s) in Column (g) should be the
sum of amounts in Columns (e) and (f).
For supplemental grants and changes to existing grants, do not
use Columns (c) and (d). Enter in Column (e) the amount of the
increase or decrease of Federal funds and enter in Column (f) the
amount of the increase or decrease of non-Federal funds. In
Column (g) enter the new total budgeted amount (Federal and
non-Federal) which includes the total previous authorized
budgeted amounts plus or minus, as appropriate, the amounts
shown in Columns (e) and (f). The amount(s) in Column (g)
should not equal the sum of amounts in Columns (e) and (f).

Section A. Budget Summary Lines 1-4 Columns (a) and (b)
Line 5 - Show the totals for all columns used.
For applications pertaining to a single Federal grant program
(Federal Domestic Assistance Catalog number) and not requiring
a functional or activity breakdown, enter on Line 1 under Column
(a) the Catalog program title and the Catalog number in Column
(b).
For applications pertaining to a single program requiring budget
amounts by multiple functions or activities, enter the name of
each activity or function on each line in Column (a), and enter the
Catalog number in Column (b). For applications pertaining to
multiple programs where none of the programs require a
breakdown by function or activity, enter the Catalog program title
on each line in Column (a) and the respective Catalog number on
each line in Column (b).
For applications pertaining to multiple programs where one or
more programs require a breakdown by function or activity,
prepare a separate sheet for each program requiring the
breakdown. Additional sheets should be used when one form
does not provide adequate space for all breakdown of data
required. However, when more than one sheet is used, the first
page should provide the summary totals by programs.
Lines 1-4, Columns (c) through (g)

For new applications , leave Column (c) and (d) blank. For each
line entry in Columns (a) and (b), enter in Columns (e), (f), and
(g) the appropriate amounts of funds needed to support the
project for the first funding period (usually a year).

Section B Budget Categories
In the column headings (1) through (4), enter the titles of the
same programs, functions, and activities shown on Lines 1-4,
Column (a), Section A. When additional sheets are prepared for
Section A, provide similar column headings on each sheet. For
each program, function or activity, fill in the total requirements for
funds (both Federal and non-Federal) by object class categories.
Line 6a-i - Show the totals of Lines 6a to 6h in each column.
Line 6j - Show the amount of indirect cost.
Line 6k - Enter the total of amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total
amount in column (5), Line 6k, should be the same as the total
amount shown in Section A, Column (g), Line 5. For
supplemental grants and changes to grants, the total amount of
the increase or decrease as shown in Columns (1)-(4), Line 6k
should be the same as the sum of the amounts in Section A,
Columns (e) and (f) on Line 5.
Line 7 - Enter the estimated amount of income, if any, expected
to be generated from this project. Do not add or subtract this
amount from the total project amount, Show under the program

SF-424A (Rev. 7-97) Page 3

INSTRUCTIONS FOR THE SF-424A (continued)
narrative statement the nature and source of income. The
estimated amount of program income may be considered by the
Federal grantor agency in determining the total amount of the
grant.

Line 15 - Enter the totals of amounts on Lines 13 and 14.

Section C. Non-Federal Resources

Lines 16-19 - Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or
activity is not necessary. For new applications and continuation
grant applications, enter in the proper columns amounts of Federal
funds which will be needed to complete the program or project over
the succeeding funding periods (usually in years). This section
need not be completed for revisions (amendments, changes, or
supplements) to funds for the current year of existing grants.

Lines 8-11 Enter amounts of non-Federal resources that will be
used on the grant. If in-kind contributions are included, provide a
brief explanation on a separate sheet.
Column (a) - Enter the program titles identical to
Column (a), Section A. A breakdown by function or
activity is not necessary.
Column (b) - Enter the contribution to be made by the
applicant.
Column (c) - Enter the amount of the State’s cash and
in-kind contribution if the applicant is not a State or
State agency. Applicants which are a State or State
agencies should leave this column blank.
Column (d) - Enter the amount of cash and in-kind
contributions to be made from all other sources.
Column (e) - Enter totals of Columns (b), (c), and (d).

Line 12 - Enter the total for each of Columns (b)-(e). The amount
in Column (e) should be equal to the amount on Line 5, Column
(f), Section A.
Section D. Forecasted Cash Needs

Section E. Budget Estimates of Federal Funds Needed for
Balance of the Project

If more than four lines are needed to list the program titles, submit
additional schedules as necessary.
Line 20 - Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate
accordingly and show the overall totals on this line.
Section F. Other Budget Information
Line 21 - Use this space to explain amounts for individual direct
object class cost categories that may appear to be out of the
ordinary or to explain the details as required by the Federal grantor
agency.
Line 22 - Enter the type of indirect rate (provisional, predetermined,
final or fixed) that will be in effect during the funding period, the
estimated amount of the base to which the rate is applied, and the
total indirect expense.
Line 23 - Provide any other explanations or comments deemed
necessary.

Line 13 - Enter the amount of cash needed by quarter from the
grantor agency during the first year.
Line 14 - Enter the amount of cash from all other sources needed
by quarter during the first year.

SF-424A (Rev. 7-97) Page 4

BUDGET INFORMATION - Construction Programs

OMB Approval No. 0348-0041

NOTE: Certain Federal assistance programs require additional computations to arrive at the Federal share of project costs eligible for participation. If such is the case, you will be notified.

11.

10.

SUBTOTAL (sum of lines 1-11)

Miscellaneous

Equipment

Construction

Demolition and removal

Site work

Project inspection fees

Other architectural and engineering fees

Architectural and engineering fees

Relocation expenses and payments

Land, structures, rights-of-way, appraisals, etc.

Administrative and legal expenses

.00

c. Total Allowable Costs
(Columns a-b)

12.
Contingencies

.00

b. Costs Not Allowable
for Participation

13.
SUBTOTAL

a. Total Cost

14.
Project (program) income

.00

COST CLASSIFICATION

15.

Prescribed by OMB Circular A-102

Standard Form 424C (Rev. 7-97)

.00

TOTAL PROJECT COSTS (subtract #15 from #14)

FEDERAL FUNDING
Enter eligible costs from line 16c Multiply X _______%

Authorized for Local Reproduction

16.

17. Federal assistance requested, calculate as follows:
(Consult Federal agency for Federal percentage share.)
Enter the resulting Federal share.

Previous Edition Usable

INSTRUCTIONS FOR THE SF-424C

Public reporting burden for this collection of information is estimated to average 180 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0041), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
This sheet is to be used for the following types of applications: (1) "New" (means a new [previously unfunded] assistance award); (2)
"Continuation" (means funding in a succeeding budget period which stemmed from a prior agreement to fund); and (3) "Revised" (means
any changes in the Federal Government’s financial obligations or contingent liability from an existing obligation). If there is no change in
the award amount, there is no need to complete this form. Certain Federal agencies may require only an explanatory letter to effect minor
(no cost) changes. If you have questions, please contact the Federal agency.

Column a. - If this is an application for a "New" project, enter
the total estimated cost of each of the items listed on lines 1
through 16 (as applicable) under "COST CLASSIFICATION."

Line 4 - Enter estimated basic engineering fees related to
construction (this includes start-up services and preparation of
project performance work plan).

If this application entails a change to an existing award, enter
the eligible amounts approved under the previous award for
the items under "COST CLASSIFICATION."

Line 5 - Enter estimated engineering costs, such as surveys, tests,
soil borings, etc.
Line 6 - Enter estimated engineering inspection costs.

Column b. - If this is an application for a "New" project, enter
that portion of the cost of each item in Column a. which is not
allowable for Federal assistance. Contact the Federal agency
for assistance in determining the allowability of specific costs.

Line 7 - Enter estimated costs of site preparation and restoration
which are not included in the basic construction contract.
Line 9 - Enter estimated cost of the construction contract.

If this application entails a change to an existing award, enter
the adjustment [+ or (-)] to the previously approved costs
(from column a.) reflected in this application.

Column . - This is the net of lines 1 through 16 in columns "a."
and "b."

Line 10 - Enter estimated cost of office, shop, laboratory, safety
equipment, etc. to be used at the facility, if such costs are not
included in the construction contract.
Line 11 - Enter estimated miscellaneous costs.
Line 12 - Total of items 1 through 11.
Line 13 - Enter estimated contingency costs. (Consult the Federal
agency for the percentage of the estimated construction cost to
use.)

Line 1 - Enter estimated amounts needed to cover
administrative expenses. Do not include costs which are
related to the normal functions of government. Allowable
legal costs are generally only those associated with the
purchases of land which is allowable for Federal participation
and certain services in support of construction of the project.

Line 14 - Enter the total of lines 12 and 13.
Line 15 - Enter estimated program income to be earned during the
grant period, e.g., salvaged materials, etc.
Line 16 - Subtract line 15 from line 14.

Line 2 - Enter estimated site and right(s)-of-way acquisition
costs (this includes purchase, lease, and/or easements).
Line 3 - Enter estimated costs related to relocation advisory
assistance, replacement housing, relocation payments to
displaced persons and businesses, etc.

Line 17 - This block is for the computation of the Federal share.
Multiply the total allowable project costs from line 16, column "c."
by the Federal percentage share (this may be up to 100 percent;
consult Federal agency for Federal percentage share) and enter
the product on line 17.

SF-424C (Rev. 7-97) Back

OMB Approval No. 0348-0042

ASSURANCES - CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1.

Has the legal authority to apply for Federal assistance,
and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share
of project costs) to ensure proper planning,
management and completion of the project described in
this application.

Will comply with the Intergovernmental Personnel Act
of 1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded
under one of the 19 statutes or regulations specified in
Appendix A of OPM’s Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).

Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the assistance; and will establish
a proper accounting system in accordance with
generally accepted accounting standards or agency
directives.

Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.

10.

Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race,
color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. §§16811683, and 1685-1686), which prohibits discrimination
on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29 U.S.C.
§794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L. 92-255), as
amended, relating to nondiscrimination on the basis of
drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.

Will not dispose of, modify the use of, or change the
terms of the real property title, or other interest in the
site and facilities without permission and instructions
from the awarding agency. Will record the Federal
interest in the title of real property in accordance with
awarding agency directives and will include a covenant
in the title of real property aquired in whole or in part
with Federal assistance funds to assure nondiscrimination during the useful life of the project.

Will comply with the requirements of the assistance
awarding agency with regard to the drafting, review and
approval of construction plans and specifications.

Will provide and maintain competent and adequate
engineering supervision at the construction site to
ensure that the complete work conforms with the
approved plans and specifications and will furnish
progress reports and such other information as may be
required by the assistance awarding agency or State.

Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.

Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.

Standard Form 424D (Rev. 7-97)
Previous Edition Usable

Authorized for Local Reproduction

Prescribed by OMB Circular A-102

11.

Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of
1970 (P.L. 91-646) which provide for fair and equitable
treatment of persons displaced or whose property is
acquired as a result of Federal and federally-assisted
programs. These requirements apply to all interests in real
property acquired for project purposes regardless of
Federal participation in purchases.

12.

Will comply with the provisions of the Hatch Act (5 U.S.C.
§§1501-1508 and 7324-7328) which limit the political
activities of employees whose principal employment
activities are funded in whole or in part with Federal funds.

13.

Will comply, as applicable, with the provisions of the DavisBacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327333) regarding labor standards for federally-assisted
construction subagreements.

14.

15.

Will comply with flood insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973
(P.L. 93-234) which requires recipients in a special flood
hazard area to participate in the program and to purchase
flood insurance if the total cost of insurable construction
and acquisition is $10,000 or more.
Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

APPLICANT ORGANIZATION

National Environmental Policy Act of 1969 (P.L. 91190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738; (c)
protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodplains in accordance
with EO 11988; (e) assurance of project consistency
with the approved State management program
developed under the Coastal Zone Management Act of
1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation
Plans under Section 176(c) of the Clean Air Act of
1955, as amended (42 U.S.C. §§7401 et seq.); (g)
protection of underground sources of drinking water
under the Safe Drinking Water Act of 1974, as
amended (P.L. 93-523); and, (h) protection of
endangered species under the Endangered Species Act
of 1973, as amended (P.L. 93-205).
16.

Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.

17.

Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).

18.

Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations."

19.

Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.

TITLE

DATE SUBMITTED

SF-424D (Rev. 7-97) Back

DISCLOSURE OF LOBBYING ACTIVITIES

Approved by OMB

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
0348-0046
(See reverse for public burden disclosure.)
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
a. contract
a. bid/offer/application
a. initial filing
b. grant
b. initial award
b. material change
c. cooperative agreement
c. post-award
For Material Change Only:
d. loan
year _________ quarter _________
e. loan guarantee
date of last report ______________
f. loan insurance
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
Subawardee
and Address of Prime:
Prime
Tier ______, if known :

Congressional District, if known :
6. Federal Department/Agency:

Congressional District, if known :
7. Federal Program Name/Description:

CFDA Number, if applicable : _____________
8. Federal Action Number, if known :

9. Award Amount, if known :
$

10. a. Name and Address of Lobbying Registrant
( if individual, last name, first name, MI ):

b. Individuals Performing Services (including address if
different from No. 10a )
( last name, first name, MI ):

requested through this form is authorized by title 31 U.S.C. section
11. Information
1352. This disclosure of lobbying activities is a material representation of fact

Signature:

upon which reliance was placed by the tier above when this transaction was made
or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be reported to the Congress semi-annually and will be available for
public inspection. Any person who fails to file the required disclosure shall be
subject to a civil penalty of not less that $10,000 and not more than $100,000 for
each such failure.

Federal Use Only:

Print Name:
Title:
Telephone No.: _______________________ Date:
Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make
payment to any lobbying entity for influencing or attempting to influence an officer or employeeof any agency, a Member of Congress, an officer or employee of
Congress, or an employeeof a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material
change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter
the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal
action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriateclassification
of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee,e.g., the first subawardee
of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For
example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is
estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington,
DC 20503.

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United States Department of Agriculture

Rural Utilities Service

Certification Regarding Debarment, Suspension, and Other
Responsibility Matters – Primary Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment
and Suspension, 7 CFR Part 3017, Section 3017.510, Participants’ Responsibilities. The
regulations were published as Part IV of the January 30, 1989, Federal Register (pages 47224733). Copies of the regulations may be obtained by contacting the Department of Agriculture
agency offering the proposed transaction.
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it
and its principals:
(a) are not presently debarred, suspended, proposed for Debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency;
(b) have not within a 3-year period preceding this proposal been convicted of or had a civil
judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State, or
local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
(c) are not presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State, or local) with commission of any of the offenses
enumerated in paragraph (1)(b) of this certification; and
(d) have not within a 3-year period preceding this application/proposal had one or more
public transactions (Federal, State, or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal.

______________________________________________________________________________
Organization Name
______________________________________________________________________________
Name and Title of Authorized Representative

______________________________________________________________________________
Signature
Date
(This is not an official Government form. It has been prepared to assist and expedite the application
process and is only intended for use in the RUS Grant Programs for Rural Communities with Extremely
High Energy Costs.)

United States Department of Agriculture
Rural Utilities Service

ASSISTANCE TO HIGH ENERGY COST RURAL COMMUNITIES
ENVIRONMENTAL PROFILE
(To Be Completed by the Grant Applicant)
The Rural Utilities Service (RUS) is required by the National Environmental Policy Act (NEPA)
of 1969, as amended (42 U.S.C. 4321), the Council on Environmental Quality Regulations (40
CFR Parts 1500-1508), and RUS implementing regulations (7 CFR Part 1794) to consider the
potential environmental impacts resulting from providing Federal financial assistance. As an
applicant for Federal financial assistance, your project will be subject to the requirements of
RUS's Environmental Policies and Procedures (7 CFR Part 1794) prior to the release of any grant
or loan funds.
Please complete the following project profile to facilitate RUS's initial environmental review.
RUS will evaluate the requested information as part of the final pre-award review for selected
applicants.

Part I: General Information
1. Describe the project as specifically as possible, i.e. new facilities to be constructed,
capital purchases, equipment purchases or modifications to existing facilities.

2. Is any part of your project located on land owned or under the jurisdiction of a Federal or
state agency?

If yes, please identify the agency(s).

3. Does any part of your project require review and or permitting by any Federal, State,
regional, local, environment, or regulatory agency?

If yes, please provide a list of required reviews and permits.

4. Has an environmental impact review (e.g. NEPA documentation, permits, agency
consultations) related to the project been prepared?
If yes, please provide details. You may be asked to provide a summary or copy of the report
as part of a pre-award review.

5. Is the proposed project part of a larger project?

If yes, please describe.

6. Do you anticipate requesting additional Federal funding for subsequent phases of this
project?

If yes, please describe.

7. If the scope of your project is limited to the installation or replacement of equipment or
facilities located within existing buildings or other structures and does not involve outside
construction or ground disturbance, please skip to Part III. Otherwise continue with Part
II

Part II: Environmental Considerations
Provide the following information, as appropriate, for the construction of new facilities or
modification of existing facilities.
1. The amount of clearing or excavation required. Indicate the estimated number of acres or
length and width of the right-of-way if the project is linear (e.g. pipeline or power line).

2. The amount of dredge and/or fill in wetlands. Indicate the number of acres involved.

3. Describe any pre-existing contamination of the construction site.

4. Areas with special designation that may be impacted (e.g. National Forests, Parks, Trails)

5. Proximity of the project to floodplains, wetlands, coastal management zones, or coastal
barrier resource areas.

Part III: Contact Information
Please provide the name, address, telephone number and email address of the preparer of this
form and a contact person who can answer questions or provide additional information.

(This is not an official Government form. It has been prepared to assist and expedite the
application process and is only intended for use in the RUS Grant Programs for Rural
Communities with Extremely High Energy Costs.)
* * *

File Type	application/pdf
File Modified	2005-05-25
File Created	2005-05-25