Repowering Assistance Program - Private Sector

Instructions for RD Form 4288-04

Repowering Assistance Program � Reporting Form

This form is use to apply for the Repowering Assistance Payment Program.

Prepared by applicant.� Submit the one original.

Original signed by applicant’s approval official.

Original should be sent to the appropriate USDA RD Energy Division in Washington DC.

Fld Name / Item No.	Instruction
1. Name of Biorefinery	Enter name.
2A. Mail Address	Enter mailing address.
2B.� Congressional District	Enter the congressional district.
3. �IRS Tax Identification Number	Enter the tax identification number.
4A. Contact Person	Enter contact person name.
4B Contact Person Title	Enter contact person title.
5. Telephone No.	Enter contact person telephone number.
6. �Fax Number	Enter contact person fax number (include area code)
7. Email Address	Enter contact person email address.
8. DUN Number	Enter DUN number.
9. Certification required by the notice attached.	Check yes or no indicating if the certification(s) required by applicable Notice or regulations as amended attached.
10. Feasibility Study required by the notice attached.	Check yes or no indicating if the feasibility study� required by applicable Notice or regulations as amended attached.

Table A: Biorefinery Information

Fld Name / Item No.	Instruction
1. Typical Operating Schedule	Enter the typical operating schedule hours/day day/year for the Biorefinery.
2. Electric use data.	Enter information on the electric service.
3. Fuel use data.	Enter information on the current fuel use.
4. Thermal loads.	Enter information on existing thermal loads.
5. Existing equipment.	Enter information on the existing heating and cooling equipment.
6. Site-specific data.	Enter information on other site-specific issues.
7. Biofuel/ Bioproduct production	Enter information on the biofuels/bioproduct production.
8. Simple Payback	Enter information on the projected simple payback.
9. Projected Reduction of Fossil Fuel	Enter information on the projected reduction in fossil fuel based on actual fuel use.

Table B: Repowering Project Information

1a: Identify the total project cost.

Fld Name / Item No.	Instruction
Source and use of funds.	If construction financing is used, describe the financing arrangement, including repayment terms and security.

1b: Identify the total project cost.

Fld Name / Item No.	Instruction
1. Administrative and legal expense	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
2. Land, structures, rights-of-way, appraisals, etc.�	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
3. Relocation expenses and payment	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
4. Architectural and engineering fees	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
5. Other architectural and engineering fees	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
6. Project inspection fees	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
7. Site Work	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
8. Demolition and removal	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
9. Construction	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
10. Equipment	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
11. Miscellaneous	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
12. Subtotals	Column a � Enter the sum of lines 1-11. Column b � Enter the sum of lines 1-11. Column c. Enter total allowable cost for administrative and legal expense. (Sum from columns a-b).
13. Contingencies	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense. (columns a-b)
14. Subtotal	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense (columns a-b).
15. Project (program) income	Column a - Enter the total cost. Column b � Enter cost not allowable for participation. Column c. Enter total allowable cost for administrative and legal expense (columns a-b).
16. Total Project Costs	Column a � Enter total cost (subtract #15 from #14). Column b � Enter cost not allowable for participation (subtract #15 from #14). Column c. Enter total allowable cost for administrative and legal expense (columns a-b).

Table B - Federal Funding

Fld Name / Item No.	Instruction
Federal Assistance request calculation	Enter the eligible cost from line 16c multiply by Federal percent shares.
Enter amount	Enter calculated amount results here.

Table B - 3

Fld Name / Item No.	Instruction
Dollar amount of Repowering Assistance to be requested.	Enter the maximum payment amount is the lesser of $5 million dollars or 50 percent of the eligible project cost.

Table B - 4

Fld Name / Item No.	Instruction
Expected schedule of the repowering project	Enter the estimate date the repowering project will be initiated, the estimated calendar time to complete the project, the projected completion date, and the project date by which full energy production will be reached.

Table B - 5

Fld Name / Item No.	Instruction
Percentage of energy produced from renewable biomass that will be used.	Enter check mark in one of the following: steam production, direct heat, process heat or electricity generation.

Table B - 6

Fld Name / Item No.	Instruction
Production of energy from renewable Biomass	Describe how energy from renewable biomass will be uniform through the year.

Table B - 7

Fld Name / Item No.	Instruction
Type of renewable biomass feedstock to be used.	Enter the types of biomass feedstock to be used.� If more than one type of biomass feedstock is expected to be used, give the estimated percentage of each type.

Table B - 8

Fld Name / Item No.	Instruction
Estimated number of hours for repowering project. �	Enter the estimated number of jobs created, saved and lost.

Part C: Certification

Fld Name / Item No.	Instruction
1a. Producer Name	Enter biorefinery producer name.
1b.	Signature Field.
1c. Title	Enter the person who will sign document title.
1c. Date	Enter the date.