RUS Form 726 Distribution Loan Application Checklist and Index

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 0572-0032. The time required to complete this information collection is estimated to
average 30 minutes per response, including the time for reviewing instructions, searching exisitng data sources, gathering and maintaining the data needed, and completing and
FORM APPROVED
UNITED STATES DEPARTMENT OF AGRICULTURE
OMB NO. 0572-0032
RURAL UTILITIES SERVICE
EXPIRES 00/2016
BORROWER NAME

DISTRIBUTION LOAN APPLICATION CHECKLIST
AND INDEX

LOAN DESIGNATION

See Instructions Included With This Form for a Detailed Explanation of the Items Required
YES
1.
2.
3.
4.

5.
6.
7.
8.
9.
10.
11.

12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.

NO

NA

DATE
Transmittal Letter to RUS with additional items (see attached instructions) (7 CFR 1710.401(a)(1))
Transmittal Letter to Supplemental Lender (if required - 7 CFR 1710.110)
Board Resolution requesting loan and release of information (sample form available) (7 CFR 1710.401(a)(2))
RUS Form 740c - Cost Estimate & Loan Budget (7CFR 1710.401(a)(3))
Reimbursement schedule (if applicable) (7 CFR 1710.401(a)(3)(iii)
a.
b.
Useful life - statement certifying that at least 90% of the loan funds are for facilities with a useful life of
33 years or longer or attached schedule showing the costs and useful life of those facilities with a useful life
less than 33 years. (see attached instructions) (7 CFR 1710.115)
Location of Consumers, if applicable (if density exceeds 17) ( 7 CFR 1710.401(a)(3)(iv)
c.
RUS Form 740g - Application for Headquarters Facilities (if needed) (7 CFR 1710.401(a)(4))
RUS Financial & Operating Report Electric Distribution: (not more than 60 days old) (7 CFR 1710.401(a)(5))
Area Coverage & Line Extension Policy (s). (see attached instructions, Item #2 of transmittal letter) (7 CFR 1710.401(b))
Current Load Forecast Study: (attach Board Resolution adopting if not previously submitted) (7 CFR 1710.401(c)(2)(i))
Long Range Financial Forecast with Board Resolution (sample form available) and assumptions (7 CFR 1710.401(c)(1))
Sensitivity Analysis (if required - see 7 CFR 1710, subpart G) (7 CFR 1710.401(c)(1))
Attorney Opinion concerning property owned, corporate status, authorized place of business, borrower's legal name,
debt limit, State regulatory approvals and subsidiary (7 CFR 1710.401), standard form provided by GFR.
(see attached instructions- sample form available) (7 CFR 1710.401(a)(7))
Special Resolution as required: (use of contractors, corrective action plans, etc..)
List:
Articles of Incorporation (only if amended since last loan) (7 CFR 1710.401(a)(14)(i))
Bylaws (only if amended since last loan)(7 CFR1710.401(a)(14)(ii))
CWP, Board Resolution approving the CWP, and BER (if not previously submitted)(7 CFR 1710.401(c)(2)(ii) & (iii))
Statement concerning inclusion of facilities in rate base (see attached instructions)(7 CFR 1710.401(a)(15))
Certification Regarding Debarment, Suspension & Other (Form AD 1047-Form available)(7 CFR 1710.401(a)(10))
Lobbying Certification (Form available) (7 CFR 1710.401(a)(12))
Uniform Relocation Act Assurance Statement (if not previously provided)(Form available)(7 CFR 1710.401(a)(11))
Debt Delinquency Certification (Form available)(7 CFR 1710.401(a)(13))
Copy of Standard Form 100 (if in excess of 100 employees)(7 CFR 1710.401(a)(9))
Borrower's Statistical Profile-include comments(Only comment on adverse flags-GFR will assist with selection of adverse flags)
Interconnection of Distributed Resources (IDR) Policy adopted by the Board. Date last updated
(Note: Policy must be reconsidered/updated every 5 years. Attach copy of Board Resolution adopting) 7 CFR 1730, Subpart C
Representations Regarding Felony Conviction and Tax Delinquent Status For Corporate Applicants (Form AD-3030)
Other (list - 7 CFR 1710.401 (a)(18))
THE FOLLOWING ITEMS ARE COMPLETED BY THE GENERAL FIELD REPRESENTATIVE

26.
27.
28.
29

30.

RUS Form 602 - Analysis of Prior Loan Funds: (Only required if there is a balance in reserve)
RUS Form 324 - Financial Forecast Review and Evaluation Worksheet (Not needed if the information is contained in the FAR).
RUS Form 138- GFR Checklist and Report for Electric Loan Application
RELRA Worksheet (not required for Guaranteed applications)
Rate Disparity and Consumer Data (if needed, density greater than 5.5)
Note: In those cases where the borrower's density may go over5.5 in the near future, this information
should be provided even though the density is under 5.5. If density exceeds 17, the location of consumers
must also be provided as attachment to RUS Form 740c (see item 4, c. above).
Civil Rights Field Activity Review Report (Form 9 - if not previously submitted) and new Form 266.
THE FOLLOWING ITEMS ARE ASSOCIATED WITH ENERGY EFFICIENCY LOANS

31
32

Energy Efficiency Business Plan
Energy Efficiency Quality Assurance Plan

A total of 5 loan packets for concurrent loan applications. RUS receives the original loan documents and one copy. The Supplemental lender receives one
copy. The GFR one copy. One copy for the Cooperative's files. The RUS loan packets and the GFR loan packet are sent to the GFR for final review.
The Supplemental loan packet is sent directly to the Supplemental lender.
Remarks:

RUS Form 726

(V12, 01/08/13)