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

Form Approved
Expires 11/30/2024

Form RD 4280-3C
(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 $200,000 AND GREATER
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 for the application to be considered a complete. 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
II.

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

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:
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:

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 not plans to
publish information collected under 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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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:

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. Financial Information: For projects with total project costs of $200,000 or more, attach required financial information for the total
operation and all entity(ies) it controls or is controlled by. If business assets are held personally, prepare financials using only the assets
and liabilities attributable to the business.
A.

B.

C.

Historical Financial Statements for the past three years:
Income Statement -Year:

Attached:

Balance Sheet – Date:

Attached:

Income Statement -Year:

Attached:

Balance Sheet – Date:

Attached:

Income Statement -Year:

Attached:

Balance Sheet – Date:

Attached:

Current Financial Statements:
Income Statement -Year:

Attached:

Balance Sheet – Date:

Attached:

Pro Forma Financial Statements (include assumptions):
Pro Forma Balance Sheet at Start-up of Operation (include grant award or loan proceeds): Date:

Attached:

Year 1 Pro-Forma Balance Sheet: Date:

, Income Statement:Year:

, Cash Flow: Year:

Attached:

Year 2 Pro-Forma Balance Sheet: Date:

, Income Statement:Year:

, Cash Flow: Year:

Attached:

VIII. Project Information: The REAP Federal grant share is up to a maximum of 25 percent 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; 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 GHGH)
; with storage component
Please indicate applicable renewable energy technology.
Solar: Electric (PV)
Hydroelectric

or Thermal

Geothermal: Direct Use

Hydrogen sourced with:

Solar

Retrofit of existing RES (Non-GFGE)

or Wind

or Geothermal

C. Renewable Energy System (emits GHGE)
; with storage component
Please indicate applicable renewable energy technology.
Anaerobic Digester
Biomass: Biodiesel

Biogas (including landfill gas)
or Ethanol

or Solid Fuel

Wind

or Electric Generation

Ocean Energy

OR

Retrofit of existing RES

Hydrogen sourced with: Biomass
or Thermal Conversion

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:

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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 Construction and Equipment Information. Describe how the design, engineering, testing, and monitoring are sufficient
to demonstrate that the proposed project will meet its intended purpose, ensure public safety, and comply with applicable laws,
regulations, agreements, permits, codes and standards. Describe how all equipment required is available and able to be
procured and delivered within the proposed project development schedule.

G.

Commercially Available Equipment. Provide a detailed description of all major equipment to be installed and any applicable
processes related to feedstock conversion, list recognized industry organization which certified renewable energy system
equipment if applicable:

H.

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 on
Form SF-424C, “Budget Information-Construction 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 a 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.

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:

-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.

b. Unit: kWh

or BTU

c. Price/Unit:

or

$

d. $ Value (a x c):$
e. Name of Utility/Offtaker:

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

a. Direct Use Energy:
b. Unit: kWh

or BTU

c. Price/Unit:

or

$

d. $ Value (a x c):$

-Attach documentation of conventional energy price for
direct use new construction or off-grid applications.
iii.

By-product/other revenue quantity, description, unit of a. By-product/other revenue
measurement, documented fair market price per unit,
quantity:
and dollar value:
b. Description:
-Do not include government or utility incentives or
renewable energy credits that will not be received
c. Unit: kWh
or BTU
or
annually for the life of the project.
-Attach documentation on quantity and price of byproduct/other revenue.

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

c. Unit: kWh
d. Price/Unit:

or

$

e. $Value (a x d): $
iv.

Historical annual average energy used by business,
unit of measurement, average retail price historically
paid per unit, and dollar value:

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

or BTU

or

5
- Attach at least 12 months of utility bills to document
average historical price paid for business energy;

c. Price/Unit:

$

d. $ Value (a x c): $

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:

a. Historical Residential Energy Use:

b. Unit: kWh

or BTU

or

-Attach annual residential energy use summary with
a detailed list of assumptions.
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.
A separate meter will be installed:

A separate meter may also be installed.
vi.

Yes

Annual percentage of energy being replaced:

a. (ia÷ iv a x 100) =

If energy replaced exceeds 150 percent of historical
energy use, the project will score as an energy
generation project.
vii.

Generation Value: Annual dollar value of proposed
renewable energy sold and by-products sold.
(Aggregate of F 2 a ii d(s) and F 2 a iii e(s))

$

viii. Replacement Value: Annual dollar value of historical
energy consumption.(F 2 a iv (d ))

$

or No
%

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.)
$

÷$

=

years

b. Simple Payback RES Replacement: $

÷$

=

years

a. Simple Payback RES Generation:

b. For Energy Efficiency Improvements: Simple payback is calculated in Section IX F.
I.

Qualifications of the Project Team (include information on all service providers, 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:
Individual’s Name:

Title:

Address:
City/State/Zip Code:

Phone:

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:

6

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:

Phone:

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:

IX. Renewable Energy System Projects - Technical Requirements: Prepare technical report in accordance with Appendix C of 7
CFR 4280-B. *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.)
Technical Report Attached:

7
A.

Agreements and Permits:
1.

B.

Describe the necessary agreements and permits (including any for local zoning requirements) required for the project and
the anticipated schedule for securing those agreements and permits:

Resource Assessment: (Additional information may be requested by the Agency to determine feasibility.)
1.

Provide adequate and appropriate data to demonstrate the amount of renewable resource available. For hybrid projects
you must address each technology being proposed. Describe the quality, availability and seasonality (if applicable) of the
renewable energy resource. The assessment should include if applicable, historical residential energy use documentation,
per section (VII)(F)(2)(a)(v):

2.

Basis of determination: There are several methods to determine resource potential on the site, describe below as
applicable and attach as necessary:
Online Estimating Tool:
Resource References
(Wind Roses, Thematic
Maps, etc.):

Yes; List Resource Reference:

Site-Specific Evaluation
Devices or Site Surveys:

Yes; List device:
No

Photographs of Site:

Yes; Attached to application.
No

Other:

C.

Yes; List name of Tool:
No

No

Attach documentation if applicable.

Project Development:
1.

Project Development Schedule. Describe the overall project development method including how free and open
competition will be met, include the key project development activities and the proposed schedule:
Development Activity:

Proposed start date:

Proposed end date:

Development Activity:

Proposed start date:

Proposed end date:

Development Activity:

Proposed start date:

Proposed end date:

Development Activity:

Proposed start date:

Proposed end date:

8

Development Activity:

Proposed start date:
D.

E.

Proposed end date:

Equipment Procurement and Installation:
1.

Describe the availability of the equipment required by the system, including its procurement and delivery schedules:

2.

Describe the plan for site development and system installation, including any special equipment requirements:

Operations and Maintenance:
1.

Describe the operations and maintenance requirements of the system, including warranties, major rebuilds and
component replacements necessary over system’s useful life:

2.

Warranties provide protection against both breakdown and degradation of performance:

3.

Describe how the system will be monitored for performance:

Yes

No

F. Feasibility Study:
1. 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.

X. Energy Efficiency Improvement Projects - Technical Requirements: Prepare technical report in accordance with Appendix A of 7
CFR 4280-B. Attach Energy Audit or Energy Assessment to application. (For Renewable Energy System project, complete Block VIII)
EEI Technical Report is attached:

Yes

No

Energy Audit or Energy Assessment attached:

Yes

No

A.

Existing usage as per the Energy Audit:
Energy Used
Propane/LP (gal)
Natural Gas (therm)
Diesel (gal)
Other

Cost

(converting to BTU)

Electricity (kWh)

x 3,412btu/kWh=

$

x 91,502btu/gal=

$

x 100,000btu/therm=

$

x 139,000btu/gal=

$

x
Total BTU Existing:

$

=
$

Total Existing Energy Cost:

9
B.

Proposed (estimated) usage following completion of the project as per the Energy Audit:
Cost

(converting to BTU)

Energy Used
Electricity (kWh)

x 3,412btu/kWh=

$

Propane/LP (gal)

x 91,502btu/gal=

$

x 100,000btu/therm=

$

Natural Gas (therm)
Diesel (gal)

$

x 139,000btu/gal=

Other

x

$

=

Total BTU Proposed:
C. Total Energy Savings: Total BTU Existing

– Total BTU Proposed

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

$

= Total BTU Savings
=

/ Total BTUs Existing
- Total Proposed Energy Cost

Total Proposed Energy Cost:

% Savings

= Dollars Saved

/ Annual energy savings value (Vlll E.) $

F. EEI Simple Payback: (Total project costs (F1 b) $

=

years

XI. Environmental Benefits: 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?

XII. 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:$
XIII: 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:
XIV. Previous Funding:
I, the applicant, have

or

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

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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:

XV. Good Standing:
I, the applicant, being a legal entity, am
or am not
in good standing and operating in accordance with the laws of the State(s)
or Tribe where I, the applicant, have a place of business.
Not applicable, I am applying as a sole proprietor.
XVI. Certifications:
The applicant certifies to each of the following: (Check and certify to all that are applicable to your project. The Agency reserves the
right to request additional information to substantiate the certification.)
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. The proposed project will use only commercially available technology as defined in 7 C.F.R. 4280.103.
D. 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 as
the initiation of construction. If taken, it could result in project ineligibility.
E. Construction planning and performing development will be performed in compliance with 7 C.F.R. 4280.125.
F. The applicant will maintain insurance coverage as required under 7 C.F.R. 4280.123(b).
G. 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.
H. The project will be constructed in accordance with applicable laws, regulations, agreements, permits, codes, and standards.
I. 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.
XVII. 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.
Renewable Energy Resource documentation.
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 with a minimum of 12 months historical utility bills (An Energy Audit is required for energy
efficiency projects over $200,000 Total Project Costs).
Matching funds documentation.
Financial Statements, for projects with Total Project Costs over $200,000.
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 V and XIII-XVI of this
application.
AGRICULTURAL PRODUCER \ RURAL SMALL BUSINESS

AGRICULTURAL PRODUCER \ RURAL SMALL BUSINESS NAME
Signature
By: ____________________________
(Officer, Member, Partner, Proprietor)
Title: ___________________________

Date: _________________