CHIPS Full-Application Information Collection

Template for CHIPS Incentive Request
Full Application stage
	A) CHIPS Incentive Request Summary
	A1. CHIPS Direct Funding Request
	Funding Request
	Are you requesting Direct Funding?	Select One
	Amount requested for CHIPS Direct Funding	0.00
	A2. CHIPS Loan Request
	Funding Request
	Are you requesting a CHIPS Loan?	Select One
	Amount requested for the CHIPS Loan	0.00
	Requested tenor for the CHIPS Loan
	Financing Structure2	Select One
	Provide other requested terms (e.g., details on amortization schedule, deferred interest option, pre-payment, seniority, collateralization, fixed vs floating interest rate type) for the requested CHIPS Loan. To the extent that requested terms differ from the baseline terms in Section I.B.8 of the NOFO, the summary should include a justification.
	A3. CHIPS Loan Guarantee Request
	Funding Request
	Are you requesting for a CHIPS Loan Guarantee(s)	Select One
	Number of Loans to be Guaranteed	0
	Loan Guarantee Summary (Calculated)
	Third-party Loans Guaranteed by CHIPS Program	0.00
	Unguaranteed portion of Third-Party Loans Guaranteed by CHIPS Program	0.00
	CHIPS Loan Guarantee Request Details	Loan 1	Loan 2	Loan 3	Loan 4	Loan 5
	Total size of the Loan	0.00	0.00	0.00	0.00	0.00
	Amount of Loan requested to be guaranteed through CHIPS program (up to 80%)	0.00	0.00	0.00	0.00	0.00
	Requested tenor for the Loan
	Third Party Lender, if known (please include all if multiple)
	Provide other requested terms (e.g., details on amortization schedule, deferred interest option, pre-payment, seniority, collateralization, fixed vs floating interest rate type) for the requested CHIPS Loan Guarantee(s). To the extent that requested terms differ from the baseline terms in Section I.B.8 of the NOFO, the summary should include a justification.
	B) Credit Rating Summary1
	Borrowing Entity and Corporate Parent Details	Entity Name	Entity Unique SAM.gov ID number (if available)	Entity address (if available)	Entity website (if available)
	Borrowing Entity for Project
	Corporate Parent / Sponsoring Entity (if applicable)
	Credit Rating of Borrowing Entity	Agency Providing Credit Rating	Corporate Credit Rating	Date of Rating
	Long-term Corporate Credit Rating 1 (if applicable)
	Long-term Corporate Credit Rating 2 (if applicable)
	Long-term Corporate Credit Rating 3 (if applicable)
	Credit Rating of Corporate Parent / Sponsoring Entity (if applicable)	Agency Providing Credit Rating	Corporate Credit Rating	Date of Rating
	Long-term Corporate Credit Rating 1 (if applicable)
	Long-term Corporate Credit Rating 2 (if applicable)
	Long-term Corporate Credit Rating 3 (if applicable)
	Notes
	1: Provide the most recent credit rating for any agency which has provided a report for the borrowing entity and / or the corporate parent or sponsoring entity to the borrowing entity (if available)
	2: Corporate Finance implies debt is incurred at the parent of development company level, with debt secured at the development company level. Project Finance implies that debt is secured at the project company level to finance the project