Increased Access to Rural Community Investment Opportunities for Investors in Rural Water and Waste Water Projects

OMB Control No. 0503-0021

Expiration Date: 2/2018

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 0503-0021. The time required to complete this information is estimated to average 10 minutes 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.

WEP SURVEY

Increased Access to Rural Community Investment Opportunities

For

Investors in Rural Water and Waste Water Projects

1. Water/Waste System Name

2. Type of Entity

(Select only one.)

Municipality

Tribal Government

Non-profit

3. Contact Information

Name:

Title:

Headquarters Mailing Address:

Telephone:

Email Address:

4. Type of Project

(Select only one.)

Water

Sewer

Solid Waste

Upgrade

New Construction

Retrofitting existing system

5. Population of Proposed Project Service Area

10,000 to 20,000

20,001 to 50,000

6. Estimated Project Cost



Cost ______

7. Timeframe to Begin Construction

(Select only one.)

0 to 12 months

13 to 23 months

2 to 3 years

more than 3 years

8. Affordable Term

(Select only one.)

10-19 years

20-29 years

30 years

9. Anticipated Interest Rate

Rate ____

10. Miscellaneous

Are you a prior RUS Water and Waste Program borrower?

Yes

No

Are you currently seeking funding from other lenders for this project?

Yes

No

If yes, please describe the type of lender

Public

Private