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.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0575-0120. The time required to complete this information collection 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
Department of Agriculture, Clearance Officer, OIRM, AG Box 7630, Washing ton, D.C. 20250; and to the Office of Management and Budget, Paper work Reduction Project (OMB No.
0575-0120), Washington, D.C. 20503. Please DO NOT RETURN this form to either of these addresses. Forward to Rural Development 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)