CHIPS Full-Application Information Collection

S&U - Supply Chain Amendment Full App.xlsx

CHIPS Full-Application Information Collection

OMB: 0693-0094

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Overview

S&U - Project 1
S&U - Project 2
S&U - Summation across projects

Sheet 1: S&U - Project 1

Template for Projects Sources and Uses of Funds - Wafer Manufacturing, Semiconductor Materials, and Semiconductor Manufacturing Equipment Projects
Full Application Stage

	Project 1 Sources and Uses template
	Please refer to the Sources & Uses template instruction guide available for download in the pre-application section of the CHIPS Incentives Portal and at this link: https://www.nist.gov/document/full-applicant-sources-and-uses-funds-instructions-semiconductor-materials-semiconductor
	Please complete one template for each proposed project. Shared costs related to infrastructure improvements, workforce development, and other areas should be allocated across projects.
	Add additional rows into the schedules as needed

	Project 1 - Facility Name


	Project 1 - Facility Description


	Schedule A: Project 1 - Uses Schedule			Schedule B: Project 1 - Funding Sources Schedule

	Uses of Funds	Amount (USD)	Percentage eligible for ITC	Sources of Funds	Amount (USD)
	1. Capital Investment	0.00		1. Equity Funding	0.00
	1.a. Land	0.00		Sponsor Equity (Applicant and/or Corporate Parent)
	[Insert description]			Third-Party Equity
	[Insert description]			Other Equity Funding
	[Insert description]			[Insert description]
	1.b. Construction	0.00		[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			2. Debt Funding	0.00
	1.c. Equipment	0.00		Intercompany Debt from Corporate Parent
	[Insert description]			Third-Party Debt (e.g., Bonds or Loans)
	[Insert description]			Unguaranteed portion of Third-Party Loans Guaranteed by CHIPS Program
	[Insert description]			Other Debt Funding
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	1.d. Infrastructure Improvements	0.00		[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			3. Government Support	0.00
	[Insert description]			CHIPS Direct Funding
	1.e. Administrative Expenses directly attributable to facility construction	0.00		CHIPS Loans
	[Insert description]			Third-party Loans Guaranteed by CHIPS Program
	[Insert description]			Investment Tax Credit (estimated)
	[Insert description]			State and Local Government Grants
	[Insert description]			State and Local Government Loans
	[Insert description]			State and Local Tax Credits
	1.f. Other	0.00		Other State and Local Government Incentives
	[Insert description]			Other Federal grants, loans or guarantees
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			4. Other Sources of Funds (examples provided below)	0.00
	2. Operating losses and other cash outflows until project breaks even on a cash flow basis (Complete Schedule C below)	0.00		Equipment Financing
	3. Workforce Development Costs	0.00		Sale Leaseback or Other Real Estate Financing
	Equipment Costs			Customer Funding
	Construction of Training Center			[Insert description]
	Training and Education Costs			[Insert description]
	Wrap-Around Support Costs			[Insert description]
	Childcare Costs			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			Total Project Funding	0.00
	[Insert description]
	[Insert description]
	4. Other Uses of Funds	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	5. Total Project Costs	0.00



	Schedule C: Project 1 - Schedule for Operating Cash Flows until Project breaks even on a Cash Flow basis


		Amount (USD)
	1. Total sales until project breaks even on cash flow basis	0.00
	2. Total operating expenses until project breaks even on a cash flow basis	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	*Operating Income / Losses (excluding other operating income)*	0.00
	3. Other operating income until project breaks even on a cash flow basis	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	*Operating Income / Losses*	0.00
	4. Other cash flow items until project breaks even on a cash flow basis	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	*Earnings Before Interest and Taxes*	0.00
	5. Total financing costs and taxes until project breaks even on a cash flow basis	0.00
	Interest Paid to Service Debt
	Payments to Third-Party Partners
	Other Financing Costs
	[Insert description]
	[Insert description]
	[Insert description]
	Corporate Taxes
	Other Taxes
	[Insert description]
	[Insert description]
	[Insert description]
	Operating losses and other cash outflows until project breaks even on a cash flow basis	0.00

Sheet 2: S&U - Project 2

Template for Projects Sources and Uses of Funds - Wafer Manufacturing, Semiconductor Materials, and Semiconductor Manufacturing Equipment Projects
Full Application Stage

	Project 2 Sources and Uses template
	Please refer to the Sources & Uses template instruction guide available for download in the pre-application section of the CHIPS Incentives Portal and at this link: https://www.nist.gov/document/full-applicant-sources-and-uses-funds-instructions-semiconductor-materials-semiconductor
	Please complete one template for each proposed project. Shared costs related to infrastructure improvements, workforce development, and other areas should be allocated across projects.
	Add additional rows into the schedules as needed

	Project 2 - Facility Name


	Project 2 - Facility Description


	Schedule A: Project 2 - Uses Schedule			Schedule B: Project 2 - Funding Sources Schedule

	Uses of Funds	Amount (USD)	Percentage eligible for ITC	Sources of Funds	Amount (USD)
	1. Capital Investment	0.00		1. Equity Funding	0.00
	1.a. Land	0.00		Sponsor Equity (Applicant and/or Corporate Parent)
	[Insert description]			Third-Party Equity
	[Insert description]			Other Equity Funding
	[Insert description]			[Insert description]
	1.b. Construction	0.00		[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			2. Debt Funding	0.00
	1.c. Equipment	0.00		Intercompany Debt from Corporate Parent
	[Insert description]			Third-Party Debt (e.g., Bonds or Loans)
	[Insert description]			Unguaranteed portion of Third-Party Loans Guaranteed by CHIPS Program
	[Insert description]			Other Debt Funding
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	1.d. Infrastructure Improvements	0.00		[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			3. Government Support	0.00
	[Insert description]			CHIPS Direct Funding
	1.e. Administrative Expenses directly attributable to facility construction	0.00		CHIPS Loans
	[Insert description]			Third-party Loans Guaranteed by CHIPS Program
	[Insert description]			Investment Tax Credit (estimated)
	[Insert description]			State and Local Government Grants
	[Insert description]			State and Local Government Loans
	[Insert description]			State and Local Tax Credits
	1.f. Other	0.00		Other State and Local Government Incentives
	[Insert description]			Other Federal grants, loans or guarantees
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			4. Other Sources of Funds (examples provided below)	0.00
	2. Operating losses and other cash outflows until project breaks even on a cash flow basis (Complete Schedule C below)	0.00		Equipment Financing
	3. Workforce Development Costs	0.00		Sale Leaseback or Other Real Estate Financing
	Equipment Costs			Customer Funding
	Construction of Training Center			[Insert description]
	Training and Education Costs			[Insert description]
	Wrap-Around Support Costs			[Insert description]
	Childcare Costs			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			Total Project Funding	0.00
	[Insert description]
	[Insert description]
	4. Other Uses of Funds	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	5. Total Project Costs	0.00



	Schedule C: Project 1 - Schedule for Operating Cash Flows until Project breaks even on a Cash Flow basis


		Amount (USD)
	1. Total sales until project breaks even on cash flow basis	0.00
	2. Total operating expenses until project breaks even on a cash flow basis	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	*Operating Income / Losses (excluding other operating income)*	0.00
	3. Other operating income until project breaks even on a cash flow basis	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	*Operating Income / Losses*	0.00
	4. Other cash flow items until project breaks even on a cash flow basis	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	*Earnings Before Interest and Taxes*	0.00
	5. Total financing costs and taxes until project breaks even on a cash flow basis	0.00
	Interest Paid to Service Debt
	Payments to Third-Party Partners
	Other Financing Costs
	[Insert description]
	[Insert description]
	[Insert description]
	Corporate Taxes
	Other Taxes
	[Insert description]
	[Insert description]
	[Insert description]
	Operating losses and other cash outflows until project breaks even on a cash flow basis	0.00

Sheet 3: S&U - Summation across projects

Template for Projects Sources and Uses of Funds - Wafer Manufacturing, Semiconductor Materials, and Semiconductor Manufacturing Equipment Projects
Full Application Stage

	Summation across Projects Sources and Uses template
	Please refer to the Sources & Uses template instruction guide for available for download in the full application section of the CHIPS Incentives Portal and at https://www.nist.gov/document/full-applicant-sources-and-uses-funds-instructions-semiconductor-materials-semiconductor
	Each cell in the "Summation across Projects Sources and Uses" template should be a basic summation across each of the corresponding cells in every project template completed.
	Add additional rows into the schedules as needed

	Schedule A: Summation across projects - Uses Schedule			Schedule B: Summation across projects - Funding Sources Schedule

	Uses of Funds	Amount (USD)	Percentage eligible for ITC	Sources of Funds	Amount (USD)
	1. Capital Investment	0.00		1. Equity Funding	0.00
	1.a. Land	0.00		Sponsor Equity (Applicant and/or Corporate Parent)
	[Insert description]			Third-Party Equity
	[Insert description]			Other Equity Funding
	[Insert description]			[Insert description]
	1.b. Construction	0.00		[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			2. Debt Funding	0.00
	1.c. Equipment	0.00		Intercompany Debt from Corporate Parent
	[Insert description]			Third-Party Debt (e.g., Bonds or Loans)
	[Insert description]			Unguaranteed portion of Third-Party Loans Guaranteed by CHIPS Program
	[Insert description]			Other Debt Funding
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	1.d. Infrastructure Improvements	0.00		[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			3. Government Support	0.00
	[Insert description]			CHIPS Direct Funding
	1.e. Administrative Expenses directly attributable to facility construction	0.00		CHIPS Loans
	[Insert description]			Third-party Loans Guaranteed by CHIPS Program
	[Insert description]			Investment Tax Credit (estimated)
	[Insert description]			State and Local Government Grants
	[Insert description]			State and Local Government Loans
	[Insert description]			State and Local Tax Credits
	1.f. Other	0.00		Other State and Local Government Incentives
	[Insert description]			Other Federal grants, loans or guarantees
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			4. Other Sources of Funds (examples provided below)	0.00
	2. Operating losses and other cash outflows until project breaks even on a cash flow basis (Complete Schedule C below)	0.00		Equipment Financing
	3. Workforce Development Costs	0.00		Sale Leaseback or Other Real Estate Financing
	Equipment Costs			Customer Funding
	Construction of Training Center			[Insert description]
	Training and Education Costs			[Insert description]
	Wrap-Around Support Costs			[Insert description]
	Childcare Costs			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			[Insert description]
	[Insert description]			Total Project Funding	0.00
	[Insert description]
	[Insert description]
	4. Other Uses of Funds	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	5. Total Project Costs	0.00



	Schedule C: Project 1 - Schedule for Operating Cash Flows until Project breaks even on a Cash Flow basis


		Amount (USD)
	1. Total sales until project breaks even on cash flow basis	0.00
	2. Total operating expenses until project breaks even on a cash flow basis	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	*Operating Income / Losses (excluding other operating income)*	0.00
	3. Other operating income until project breaks even on a cash flow basis	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	*Operating Income / Losses*	0.00
	4. Other cash flow items until project breaks even on a cash flow basis	0.00
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	[Insert description]
	*Earnings Before Interest and Taxes*	0.00
	5. Total financing costs and taxes until project breaks even on a cash flow basis	0.00
	Interest Paid to Service Debt
	Payments to Third-Party Partners
	Other Financing Costs
	[Insert description]
	[Insert description]
	[Insert description]
	Corporate Taxes
	Other Taxes
	[Insert description]
	[Insert description]
	[Insert description]
	Operating losses and other cash outflows until project breaks even on a cash flow basis	0.00

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File Created	0000-00-00