Form RD 1942-54 Applicant's Feasibility Report

Form RD 1942-54
(Rev. 10-96)

U.S. Department of Agriculture
Rural Development

FORM APPROVED
OMB No. 0575-0120

APPLICANT'S FEASIBILITY REPORT
1. Existing Facility. Briefly describe what facilities you currently have or how service is currently provided.

2. Proposed Facility. Describe what you want to purchase or construct. Indicate what the facility will be used for, approximate size,
and expected method of procurement. For buildings indicate location, basic materials or type of construction, and attach a sketch or
working drawings. For items of major equipment, indicate new or used, existing or custom-built, and any special features.

3. Need for the Facility. Indicate why the proposed facility is needed.

4. Service Area. Indicate what area the proposed facility will serve and, if known, the population or number of families served.

Public reporting burden for this collection of information is estimated to average 3 hours per response, including the 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to U.S.
Department of Agriculture, Clearance Officer, OIRM AG Box 7630, Washington, D. C. 20250;and to the Office Management and Budget, Paperwork Reduction Project (OMB No. 0575-0120), Washington, D. C. 20503.
Please DO NOT RETURN this form to this address. Forward to the local USDA office only.

Position 8

Form RD 1942-54 (Rev. 10-96)

5. Cost Estimate.
Development and construction.....................................................................................
Land and rights..........................................................................................................
Legal fees.......................................................................................................................
Architect and Engineer..............................................................................................
Equipment..................................................................................................................
Refinancing................................................................................................................

$

Other (describe) ...............................................................................................
Total.............................................................................................................................

6. Income. List the sources and estimate the amount of expected revenue for a typical year.

7. Other Funds. List the sources and amount of funds that may be available other than from USDA, to fund part of the project (such
as applicant's contributions, commercial loans, or loans or grants from other government agencies).

8. Operating History. If you have operated a similar facility, attach audits, financial statements, or lists of income and expenses for
the past five years.
9. Signature and Title of Applicant Official

Date

RD 1942-54
(Reverse)