RD 4280-3A Application for Renewable Energy Systems and Energy Effi

Form Approved
Expires 11/30/2024

Form RD 4280-3A
(Rev 3-2023)

OMB No. 0570-0067
U.S. DEPARTMENT OF AGRICULTURE
Rural Development – Rural Business-Cooperative Service

RURAL ENERGY FOR AMERICA PROGRAM
APPLICATION FOR RENEWABLE ENERGY SYSTEMS AND ENERGY EFFICIENCY IMPROVEMENT PROJECTS
TOTAL PROJECT COSTS OF $80,000 OR LESS
The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Act of 1995, as amended. The authority for requesting the
following information is Section 9007 of the Agricultural Act of 2014 (Public Law 113-79). This information may be provided to other agencies, Internal Revenue Service,
Department of Justice, or other State and Federal law enforcement agencies, and in response to a court magistrate or administrative tribunal. The provisions of criminal
and civil fraud statutes, including 18 USC 286, 287, 371, 641, 1001; 1014, 15 USC 714m; and 31 USC 3729, may be applicable to the information provided.

NOTE:

SUBMIT THIS COMPLETED FORM TO THE USDA RURAL DEVELOPMENT OFFICE IN THE STATE IN WHICH THE PROJECT IS LOCATED.

Attached to this form are detailed Instructions for each section. Please refer to the Instructions for guidance when
completing this form. Use attachments as necessary.
I. A. Applicant Legal Name (Block 8a of SF 424):
** The purpose of these questions is to gather race, ethnicity, and gender information about persons who apply and participate in this USDA program. The information
provided will not be used when reviewing the application or when determining eligibility to participate in this program. The answers provided are voluntary and are not
required to be considered a complete application. The information provided will be used to improve the operation of this program, to help USDA design additional
opportunities for program participation, and to monitor enforcement of laws that require equal access to this program for eligible persons. For entities, check all that
apply. The information will be kept private to the extent permitted by law.

**I. B.What is Applicant’s race (check all that apply)? **I. C. What is Applicant’s Gender?

I.E. Is Applicant a Veteran?

American Indian or Alaska Native

Male

Yes

Asian

Female

No

Black or African American

**I. D. What is Applicant’s Ethnicity?

Native Hawaiian or
Other Pacific Islander

Hispanic or Latino
Not Hispanic or Latino

White

I.F. Is Applicant a member of a
Socially Disadvantaged group?
Yes
No

II.

Project Title (Block 15 of SF 424):

III.

System for Awards Management (SAM) Registration: Provide a Unique Entity Identifier (UEI) number upon successful SAM
UEI:
registration.

IV. Provide the name(s) for the Executive Director and person(s) who will be accepting or distributing Federal funds.

V.

Type of Applicant (check one):

Applicant must certify to meeting the definition of either an Agricultural Producer or Rural Small Business, per 7 C.F.R. 4280.103.
A.

Applicant is applying as and hereby certifies to meeting the definition of (check one):
Agricultural Producer

B.

or Rural Small Business

Provide primary North American Industry Classification System (NAICS) code for operation:
NAICS Code:

Corresponding NAICS size limitation:

VI. Applicant Description: Describe the ownership of the applicant, including:
A. The project’s relationship to the applicant’s operations. Describe how the proposed project fits into or operates separately from
the applicant’s overall business or agricultural production operation:

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information
subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this
information collection is 0570-0067. Public reporting for this collection of information is estimated to be approximately 10 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information.
All responses to this collection of information are voluntary, however in order to obtain or retain a benefit the information in this form is required. Rural Development has no plans to
publish information collected under the provisions of this program. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to: Information Collection Clearance Officer, Rural Development Innovation Center, Regulations Management Division at
[email protected].

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B. Describe how the applicant, at the time of application, award, and through the useful life, owns the project and owns or controls
the site for the project:

C. For each entity(ies) the applicant controls or entity(ies) it is controlled by, provide a list of the owners with their contact information.
Describe the relationship between the applicant and the other entity(ies), including percent of ownership and control, management,
passive investor ownership and any products exchanged. Organizational charts should be submitted when available:

D. Advise if the applicant is a Tribal entity, describe the location of the project and whether it will be located on Tribal Lands.

VII. Project Information: The REAP Federal grant share is up to a maximum of 25% unless the project meets one of the following
criteria: a) is located in a designated energy community; b) is proposed by a Tribal entity; c) is an energy efficiency improvement
project; or d) is a renewable energy system or retrofit of a renewable energy system that produces zero greenhouse gas emissions
(GHGE) at the project level. Identify the type of energy project to be funded, supported by attached energy assessment or
audit, technical report or vendor certification, or feasibility study as applicable.
A. Energy Efficiency Improvement

OR

B. Renewable Energy System (Non-GHGE)

Please indicate applicable renewable energy technology:

;

with storage component

Solar: Electric (PV)
or Thermal
Geothermal: Direct Use
Hydroelectric
Hydrogen sourced with: Solar
or Wind
C. Renewable Energy System (emits GHGE)

Please indicate applicable renewable energy technology:

Anaerobic Digester
Biomass: Biodiesel

;

Retrofit of existing RES (Non-GHGE)

or Electric Generation
OR

or Geothermal

with storage component

Wind

Ocean Energy

Retrofit of existing RES

Biogas (including landfill gas)
or Ethanol

or Solid Fuel

or Thermal Conversion

Hydrogen sourced with: Biomass

OR

D. Hybrid (two or more technologies supporting a single system), select technologies above and describe how they work together
to support a single system:

E. Project Description. Provide a detailed description of the technology and its intended purpose (energy replacement, netmetered, sold, self-use energy), the project location (address) and the specific site of the project at the project location. Describe
utility relationships (interconnection, net metering, power purchase agreements, etc.) and attach agreements to document
established rates to be paid for energy being sold or replaced.

F. Project Economic Assessment:
1.

Project Cost Breakdown:

a. Construction Item: (Break down total project costs by providing a list of major equipment,
labor costs, fees, and other costs associated with the project. Provide useful life information on
major system components. Detailed bids may be attached to support total project costs.):

Useful
Life

Cost

$
$
$
$
$
$
$
b. Total Project Costs:
(Total Project Costs should be the same as in Form SF-424C, “Budget InformationConstruction Programs.”)

$

c. Eligible Project Costs: (See Instructions to determine eligible project costs.)

$

d. In-Eligible Project Costs: Provide details for any known in-eligible project costs, including but not limited to, down payments
made prior to date of application or the prorated portion of residential related renewable energy system costs.

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2.

Estimated Project Energy Generation or Savings and Cost of Energy. The Agency may request additional
information to substantiate energy quantity, units, and rates if necessary.
a.

For Renewable Energy Systems:
i.

Annual amount of renewable energy to be generated
and unit of energy:
-Attach Vendor/Installer certified projections,
renewable energy site assessment, or other
documentation to validate the total amount of energy to
be generated, including the quality and availability of the
renewable resource to the project.
ii. Documented use (renewable energy sold,
metered/credited, or for direct-use, unit of measurement,
price per unit, dollar value and name of utility/offtaker, as
applicable.
-Attach power purchase agreement to document
quantity of energy sales and price/unit to be paid for
energy.

-Attach utility net metering, virtual net metering, energy
crediting policies or agreements, or letter from utility
which shows rate to be paid for excess energy.

a. Total Estimated Generation:
b. Unit: kWh

or BTU

or

a. Energy Sold:
b. Unit: kWh

or BTU

c. Price/Unit:

$

or

d. Value (a x c): $
e. Name of Utility/Offtaker:
a. Energy Metered/Credited:
or BTU

b. Unit: kWh
c. Price/Unit:

or

$

d. $ Value (a x c): $
Direct Use Energy:
- Must have at least 12 months of historical energy use
to score as replacement. Attach at least 12 months
of utility bills to document average historical price paid
for direct use replacement energy;
When calculating the actual average price per unit
of energy, only include energy charges directly reduced
by the unit of energy being replaced or saved, e.g. do
not include monthly service fees, demand or other
charges if not directly reduced; or
-Attach documentation of conventional energy price for
direct use new construction or off-grid applications.
iii. By-product/other revenue quantity , description,
unit of measurement, documented fair market price per
unit, and dollar value:
-Do not include government or utility incentives or
renewable energy credits that will not be received
annually for the life of the project.
-Attach documentation on quantity and price of byproduct/other revenue.

e. Name of Utility/Offtaker:
a. Direct Use Energy:
b. Unit: kWh

or BTU

c. Price/Unit:

or

$

d. $ Value (a x c): $

a. By-product/other revenue quantity:
b. Description:
c. Unit:kWh

or BTU

d. Price/Unit:

or

$

e. $ Value (a x d): $
a. By-product/other revenue quantity:
b. Description:
c. Unit:kWh

or BTU

d. Price/Unit:
e. $ Value (a x d): $

$

or

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iv.

Historical annual average energy used by
business, unit of measurement, average retail price
historically paid per unit, and dollar value:
-Attach at least 12 months of utility bills to
document average historical price paid for business
energy.
When calculating the actual average price per
unit of energy, only include energy charges directly
reduced by the unit of energy being replaced or
saved, e.g. do not include monthly service fees,
demand or other charges if not directly reduced.
v. If RES project will be connected to a shared meter
that connects both the business and a residence, or if
the project will virtually net meter or credit energy to be
generated by the RES project to a residence off-site
from the project, yet owned by the applicant, provide
amount of historical residential energy use and unit of
measurement:
- Attach annual residential energy use summary with
a detailed list of assumptions.

a. Historical Business Energy Use:
b. Unit kWh

or BTU

c. Price/Unit:

or

$

d. $ Value (a x c): $

a. Historical Residential Energy Use:
b. Unit:kWh

or BTU

or

Note: 50% or more of projected renewable energy to
be generated must benefit the business operation in
order for the project to be eligible. Eligible project costs
are prorated based on historical business energy
consumption.
c. A separate meter will be installed:

A separate meter may also be installed.

Yes

vi. Annual percentage of energy being replaced:
If energy replaced exceeds 150 percent of historical
energy use, the project will score as an energy generation
project.

or No
%

a. (ia.÷ iv.a. x 100) =

vii. Generation Value: Annual dollar value of proposed
renewable energy sold and by-products sold. (Aggregate of E
2 a ii d(s) and E 2 a iii e(s))
viii. Replacement Value: Annual dollar value of historical
energy consumption.(E 2 a iv (d ))
ix. Simple payback. (Total project costs / annual dollar value of energy units sold, credited, replaced or
directly used and the fair market value of byproducts.)
a. Simple Payback RES Generation:

$

÷$

=

years

b. Simple Payback RES Replacement: $

÷$

=

years

b. For Energy Efficiency Improvements: Simple Payback is calculated in section Vlll. F

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G. Qualifications of Service Providers. Provide information on personnel and companies that will be working to construct and
install the project, such as: energy auditor, site assessor, contractor, installer, electrician, etc.
Project Role:
Company Name:
Name:

Title:

Address:
Phone:

City/State/Zip Code:

Qualifications (Either attach a resume or complete below):
Number performed on a similar system as proposed:
Years of Relevant experience:
Professional credentials (include training and/or
education related to work, certificates, etc.):
Licenses:
Project Role:
Company Name:
Name:

Title:

Address:
Phone:

City/State/Zip Code:

Qualifications (Either attach a resume or complete below):
Number performed on a similar system as proposed:
Years of Relevant experience:
Professional credentials (include training and/or
education related to work, certificates, etc.):
Licenses:
Project Role:
Company Name:
Name:

Title:

Address:
Phone:

City/State/Zip Code:

Qualifications (Either attach a resume or complete below):
Number performed on a similar system as proposed:
Years of Relevant experience:
Professional credentials (include training and/or
education related to work, certificates, etc.):
Licenses:
Project Role:
Company Name:
Name:

Title:

Address:
City/State/Zip Code:

Qualifications (Either attach a resume or complete below):
Number performed on a similar system as proposed:
Years of Relevant experience:
Professional credentials (include training and/or
education related to work, certificates, etc.):
Licenses:

Phone:

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VIII.

Renewable Energy System Projects - Technical Requirements: Prepare technical report in accordance with 7 C.F.R.
4280.120 (b) (4). *If Hybrid project, submit specific technical information for each technology. If project includes one of the following
renewable energy technologies, or a technology as amended in via Federal Register publication, a full technical report is not
required: solar, wind, micro-hydro, and geothermal direct use. (For Energy Efficiency Improvement Projects Complete Block IX.)
1.

Provide a vendor/installer certification that:
a. the RES project meets the requirements for being commercially available;
b. the RES system will operate and perform over the project’s useful life in a reliable and cost-effective manner,
noting associated warranties;
c. the vendor/installer is qualified to complete the project as intended, noting the number of similar systems installed
and any professional credentials, licenses and relevant experience; and
d. includes a resource assessment with certified projections on energy to be replaced and/or generated once the
proposed system is operating at its steady state operating level, including the quality and availability of the
renewable resources to the project. The assessment should include if applicable, historical residential energy use
documentation, per section VI(D)(2)(a)(v)).
Technical Certification or Report (as applicable) attached.___

2 . For renewable energy systems applications, the Agency may require a feasibility study based on the scope of the project to
the applicant’s overall operations, including new facilities with significant impacts to an existing operation, or when the
application information does not provide sufficient documentation and analysis of the project’s engineering, technical, financial,
or market feasibility, or the economic viability of the project including any feedstock or off-take agreements, that in total can
determine the basis for a successful project. The elements of an acceptable feasibility study may vary by project scope. The
feasibility study should be prepared by a qualified independent third party.
Feasibility study for project has been conducted and is attached to support the project.
IX. Energy Efficiency Improvement Projects - Technical Requirements: Prepare technical report in accordance with 7 C.F.R.
4280.120 (b) (3). (If project is a Renewable Energy System, go to Block VIII.)
1.

Provide a vendor/installer certification that:
a. the EEI meets the requirements for being commercially available;
b. the EEI system will operate and perform over the project’s useful life in a reliable and cost-effective manner,

c. the vendor/installer is qualified to complete the project as intended, noting the number of years experience with
the proposed EEI technology.
Technical Certification or Report (as applicable) attached __
2. Provide energy assessment (or energy audit) as required under Section C of Appendix A and qualifications of person or
entity completing the audit/assessment. Energy Assessment or Energy Audit (as applicable) attached __
A.

Existing usage as per Energy Assessment or Energy Audit:
Energy Used

Cost

(converting to BTU)

Electricity (kWh)

x 3,412btu/kWh=

$

Propane/LP (gal)

x 91,502btu/gal=

$

Natural Gas (therm)

x 100,000btu/therm=

$

Diesel (gal)

x 139,000btu/gal=

$

Other

x
Total BTU Existing:

=

$
Total Existing Energy Cost:
$

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B.

Proposed (estimated) usage following completion of the project as per Energy Assessment or Energy Audit:
(converting to BTU)

Energy Used

Cost

Electricity (kWh)

x 3,412btu/kWh=

$

Propane/LP (gal)

x 91,502btu/gal=

$

Natural Gas (therm)

x 100,000btu/therm=

$

Diesel (gal)

x 139,000btu/gal=

Other

$
$

=

x

Total Proposed Energy Cost:
$

Total BTU Proposed:
- Total BTU Proposed

C. Total Energy Savings: Total BTU Existing

=
Total BTU Savings

D. Percent Energy Savings: Total BTU Savings
E. Dollar Savings: Total Existing Energy Cost

/ Total BTU Existing

=

- Total Proposed Energy Cost

F. EEI Simple Payback: (Total project costs (D 1 b) $

/

% Savings
Dollars Saved

= $

annual energy savings value (Vlll E.) $
=

years

X. Environmental Benefits: Please provide a detailed narrative or analysis where applicable to support the project's impact on the
following:
A. Will the project convert farmland and if so, how many acres?

B. Will the project contribute to deforestation or address fire hazards on forest lands?

C. Will the project conserve water and if so, how much?

D. Does the project comply with the Environmental Protection Agency's renewable fuel standards?

E. Are at least 25 percent of the project components biobased?

XI. Commitment of Funds: Documentation is required to be attached for points under the commitment of funds scoring criteria.
Source:

Amount:$

Attached:

Source:

Amount:$

Attached:

Source:

Amount:$

Attached:

Source:

Amount:$

Attached:

Total:$

XII:

Relationship:
This is to certify that I, as the Applicant, have
employee.

a known or

no known relationship or association with a Rural Development

If there is a known relationship, please indicate the name of the Rural Development employee:

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XIII. Previous Funding:
I, the applicant, have

or

have not, received any grants and/or guaranteed loans under the REAP program.

If grants or guaranteed loans have been received, identify each grant and/or guaranteed loan, date received, and describe the
progress that has been made on each project, including projected schedules and actual completions dates, if applicable:

XIV. Good Standing:
or am not
in good standing and operating in accordance with the laws of the State(s)
I, the applicant, being a legal entity, am
or Tribe where I, the Applicant, have a place of business.
Not applicable, I am applying as a sole proprietor.

XV. Certifications:
The Applicant certifies to each of the following by checking the box below. (The Agency reserves the right to request additional
information to substantiate the certifications(s).)
A. The applicant meets each of the applicant eligibility criteria found in 7 C.F.R. 4280.112.
B. The proposed project meets each of the project eligibility requirements found in 7 C.F.R. 4280.113.
C. Per 7 C.F.R. 4280.113, the applicant acknowledges caution against taking any actions or incurring any obligations prior to
the Agency’s environmental review that limits the range of alternatives or has an adverse effect on the environment, such
initiation of construction. If taken, it could result in project ineligibility.
D. The applicant meets the criteria for submitting an application for projects with Total Project Costs of $80,000 or less.
E. The applicant or the applicant’s prime contractor assumes all risk and responsibilities of project development, including
interim financing, including during construction. The applicant is solely responsible for the execution of all contracts, and
Agency review and approval is not required.
F. Construction planning and performing development will be performed in compliance with 7 C.F.R. 4280.120(c).
G. The applicant agrees not to request reimbursement from funds obligated under this program until after the project has been
completed and is operating in accordance with the information provided in the application for the project.
H. The applicant will maintain insurance coverage as required under 7 C.F.R. 4280.123 (b).
I. The design, engineering, testing, and monitoring will be sufficient to demonstrate that the proposed project will meet its
intended purpose.
J. The equipment required for the project is available, can be procured and delivered within the proposed project development
schedule, and will be installed in conformance with manufacturer’s specifications and design requirements. This would not
be applicable when equipment is not part of the project.
K. The project will be constructed in accordance with applicable laws, regulations, agreements, permits, codes, and standards.
L. The applicant will abide by the open and free competition requirements in compliance with 7 C.F.R. 4280.125(a)(1).
M. The applicant will abide by the equal employment opportunity requirements in compliance with 7 C.F.R. 4280.125(a)(2).
N. For bioenergy projects only, that any and all woody biomass feedstock from National Forest System land or public lands
cannot be used as a higher value wood-based product.

XVI. Attach the following if not already submitted:
Form SF 424, “Application for Federal Assistance”.
Form SF-424C, “Budget Information-Construction Programs”.
Form SF-424D, “Assurances Construction Programs”.
Environmental documentation per 7 C.F.R. 1970.
Vendor/Installer Certification.
Renewable Energy Resource documentation (if not included in vendor/installer certification).
RES Replacement-Minimum of 12 months historical utility bills.
RES Rate & Energy Quantity documentation: PPA/Net metering or crediting policies/Letter from Utility.
Energy Audit or Energy Assessment with a minimum of 12 months historical utility bills.
Matching funds documentation.
Feasibility Study, as necessary, for Renewable Energy System projects.
Other. Describe:

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XVII. Certification of Documentation and Acceptance:
CERTIFICATION AND ACCEPTANCE
I certify that, to the best of my knowledge and belief, the information included with this Application, including all
attachments, are true and correct, and that I certify to each of the conditions specified in Section XII-XVI of this application.
AGRICULTURAL PRODUCER \ RURAL SMALL BUSINESS

Signature

(AGRICULTURAL PRODUCER \ RURAL SMALL BUSINESS NAME)

By: ________________________________
Printed Name (Officer, Member, Partner, Proprietor)

Title: _______________________________
Date: ________________