PLAN CERTIFICATION

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U.S. DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT
FARM SERVICE AGENCY

USDA
Form RD 1924-25
(Rev. 7-99)

PLAN CERTIFICATION

Form Approved OMB
No. 0575-0042
Exp. Date: MM/DD/YY

(Property Name/Applicants Name and Case Number)

(Property Address)

(City)

(County)

(State)

BUILDING

TYPE:

Single Family

Multi-Family

PLANS:

Original

Modifications

I,

being a

(type or print)

in the State of

(licensed architect, engineer, or authorized building official, etc.)

, hereby certify that I have reviewed:
the plans and specifications dated

prepared by

(name of firm or individual)

for the above property

the thermal performance plans, specifications and calculations dated
prepared by

for the above property

(name of firm or individual)

the seismic design (plans and specifications) dated

(name of firm or individual)

prepared by

for the above property

modifications listed below, that have been clearly indicated on the drawings and specifications
and certified by
dated
prepared by
(name of firm or individual)

(name of firm or individual)

and related to the above property

MODIFICATIONS

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 0575-0042. Public reporting for this collection of information is estimated to be approximately 10 minutes 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 under
Section 7 CFR 1924-A, Planning and Performing Construction and other Development. 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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Based upon this review, to the best of my/our knowledge, information, and belief, these documents comply with the:
and
(name and edition of the applicable development standard)

(name and edition of the applicable energy standards/requirements in accordance with RD Instruction 1924-A, Exhibit D)

designated as the applicable Rural Development or Farm Service Agency development standards for this project.
I understand the purpose of this certification is to induce United States Government to finance the construction of the above project
and plan. I further understand that false certification constitutes a violation of 18 U.S.C. Section 1001 punishable by fine and/or
imprisonment and, in addition, may result in debarment from participating in future government programs.
(Signature)

(Date)

(Type or print name)

(Professional Registration No.)

(Title)

(Expiration Date if applicable)

(Area Code + Telephone Number)

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