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[]
[null,null,"According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number."]
[null,null," The valid OMB control number for this information collection is 0572-0032.  The time required to complete this information collection is estimated to average 30 minutes per response, including the time for "]
[null,null,"reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information."]
[null,null,null,"UNITED STATES DEPARTMENT OF AGRICULTURE",{"$nulls":10},"BORROWER NAME"]
[null,null,null,"RURAL UTILITIES SERVICE"]
[]
[null,null,"DISTRIBUTION LOAN APPLICATION CHECKLIST ",{"$nulls":11},"LOAN DESIGNATION"]
[null,null,"AND INDEX"]
[]
[]
[null,null,null,"YES","NO","NA","DATE"]
[null,null,"1.",{"$nulls":4},"Transmittal Letter to RUS with additional items (see attached instructions) (7 CFR 1710.401(a)(1))"]
[null,null,"2.",{"$nulls":4},"Transmittal Letter to Supplemental Lender (if required - 7 CFR 1710.110)"]
[null,null,"3.",{"$nulls":4},"Board Resolution requesting loan and release of information  (sample form available) (7 CFR 1710.401(a)(2))"]
[null,null,"4.",{"$nulls":4},"RUS Form 740c - Cost Estimate & Loan Budget (7CFR 1710.401(a)(3))"]
[{"$nulls":7},"a.",null,"Reimbursement schedule (if applicable) (7 CFR 1710.401(a)(3)(iii)"]
[{"$nulls":7},"b.",null,"Useful life - statement certifying that at least 90% of the loan funds are for facilities with a useful life of"]
[{"$nulls":9},"33 years or longer or attach schedule showing the costs and useful life of those facilities with a useful life"]
[{"$nulls":9},"less than 33 years. (see attached instructions) (7 CFR 1710.115)  "]
[{"$nulls":7},"c.",null,"Location of Consumers, if applicable (if density exceeds 17) ( 7 CFR 1710.401(a)(3)(iv)"]
[null,null,"5.",{"$nulls":4},"RUS Form 740g - Application for Headquarters Facilities  (if needed) (7 CFR 1710.401(a)(4))"]
[null,null,"6.",{"$nulls":4},"RUS Form 7  -  Financial & Statistical Report:   (not more than 60 days old) (7 CFR 1710.401(a)(5))"]
[null,null,"7.",{"$nulls":4},"Area Coverage & Line Extension Policy (s).  (see attached instructions, Item #2 of transmittal letter) (7 CFR 1710.401(b))"]
[null,null,"8.",{"$nulls":4},"Current Load Forecast Study:  (attach Board Resolution adopting if not previously submitted) (7 CFR 1710.401(c)(2)(i))"]
[null,null,"9.",{"$nulls":4},"Long Range Financial Forecast with Board Resolution (sample form available) and assumptions (7 CFR 1710.401(c)(1))"]
[null,null,"10.",{"$nulls":4},"Sensitivity Analysis  (if required - see 7 CFR 1710, subpart G) (7 CFR 1710.401(c)(1))"]
[null,null,"11.",{"$nulls":4},"Copy of all Retail Rates (only if amended since last loan)"]
[null,null,"12.",{"$nulls":4},"Rate Comparison at average residential usage (see instructions)"]
[{"$nulls":9},"Include a narrative statement concerning recent and/or planned changes in retail rates (7 CFR 1710.401(a)(17))"]
[null,null,"13.",{"$nulls":4},"Attorney Opinion to include, but not limited to:  property owned, corporate status, authorized place of business, borrower's legal name,"]
[{"$nulls":9},"debt limit, State regulatory approvals and subsidiaries (see attached instructions- sample form available)"]
[{"$nulls":7},"Debt Limit Amount",null,"(7 CFR 1710.401(a)(7))"]
[{"$nulls":8},"a.","Property description marked as Schedule B attached (page 4 of Mortgage)"]
[{"$nulls":8},"b.","Debt Limit - date established and amount.  "]
[{"$nulls":8},"c.","Board Resolution attached (needed whenever the debt limit is different than that contained in last mortgage"]
[{"$nulls":9}," or an increase is required)"]
[{"$nulls":8},"d.","Name of Power Supplier, Power Contract name and Date of Power Contract included as item \"j\""]
[null,null,"14.",{"$nulls":4},"Special Resolution as required: (use of contractors, corrective action plans, etc..)"]
[{"$nulls":7},"List:"]
[null,null,"15.",{"$nulls":4},"Articles of Incorporation (only if amended since last loan) (7 CFR 1710.401(a)(14)(i))"]
[null,null,"16.",{"$nulls":4},"Bylaws (only if amended since last loan)(7 CFR1710.401(a)(14)(ii))"]
[null,null,"17.",{"$nulls":4},"CWP, Board Resolution approving the CWP, and BER (if not previously submitted)(7 CFR 1710.401(c)(2)(ii) & (iii))"]
[null,null,"18.",{"$nulls":4},"Statement concerning inclusion of facilities in rate base (see attached instructions)(7 CFR 1710.401(a)(15))"]
[null,null,"19.",{"$nulls":4},"Certification Regarding Debarment, Suspension & Other (Form AD 1047-Form available)(7 CFR 1710.401(a)(10))"]
[null,null,"20.",{"$nulls":4},"Lobbying Certification (Form available) (7 CFR 1710.401(a)(12))"]
[null,null,"21.",{"$nulls":4},"Uniform Relocation Act Assurance Statement (if not previously provided)(Form available)(7 CFR 1710.401(a)(11))"]
[null,null,"22.",{"$nulls":4},"Debt Delinquency Certification (Form available)(7 CFR 1710.401(a)(13))"]
[null,null,"23.",{"$nulls":4},"DSM or IRP Study (required for a loan for DSM or IRP facilities or equipment)(7 CFR 1710.401(c)(2)(iv))"]
[null,null,"24.",{"$nulls":4},"Copy of Standard Form 100 (if in excess of 100 employees)(7 CFR 1710.401(a)(9))"]
[null,null,"25.",{"$nulls":4},"Borrower's Statistical Profile-include comments (Only comment on adverse flags-GFR will assist with selection of adverse flags)"]
[null,null,"26.",{"$nulls":4},"Rural Development Activities (see sample format provided in form \"Rural Development Activities.doc\")"]
[null,null,"27.",{"$nulls":4},"Other (list - 7 CFR 1710.401 (a)(18))"]
[]
[{"$nulls":5},"THE FOLLOWING ITEMS ARE COMPLETED BY THE GENERAL FIELD REPRESENTATIVE"]
[]
[null,null,"28.",{"$nulls":4},"RUS Form 602 - Analysis of Prior Loan Funds:  (Only required if there is a balance in reserve)"]
[null,null,"29.",{"$nulls":4},"RUS Form 324 - Financial Forecast Review and Evaluation Worksheet (Not needed if the information is contained in the FAR)."]
[null,null,"30.",{"$nulls":4},"RUS Form 138- GFR Checklist and Report for Electric Loan Application"]
[null,null,"31.",{"$nulls":4},"Trendbux Analysis "]
[null,null,"32.",{"$nulls":4},"RELRA Worksheet (not required for Guaranteed applications)"]
[{"$nulls":8},"Rate Disparity and Consumer Data (if needed, density greater than 5.5)"]
[{"$nulls":9},"Note: In those cases where the borrower's density may go over 5.5 in the near future, this information "]
[{"$nulls":9},"should be provided even though the density is under 5.5.  If density exceeds 17, the location of consumers"]
[{"$nulls":9},"must also be provided as attachment to RUS Form 740c (see item 4, c. above)."]
[null,null,"33.",{"$nulls":4},"Civil Rights Field Activity Review Report (Form 9 - if not previously submitted)"]
[]
[]
[]
[]
[null,null,"A total of 5 loan packets are needed for concurrent loan applications. RUS receives the original signature loan documents and one copy. The Supplemental lender receives one"]
[null,null,"copy. The GFR receives one copy and one copy is for the borrower's records. The GFR loan packet and the RUS loan packets are sent to the GFR for final review."]
[null,null,"The Supplemental loan packet is sent directly to the Supplemental lender."]
[]
[null,null,"Remarks:"]
{"$rows_empty":8}
[null,"RUS Form 726 (Rev. 9-01) ",{"$nulls":5},"(Version 2, 4-23-01)"]

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["INSTRUCTIONS"]
["FOR COMPLETING"]
["RUS FORM 726"]
[]
["Item #","Description"]
[]
[1,"Transmittal Letter to RUS"]
[null,"Items to be included in the transmittal letter as listed in 7 CFR 1710.401:"]
[null,null,"a. ","Transmittal letter must be signed by the cooperative Manager."]
[null,null,"b.","Include the corporate name of the borrower."]
[null,null,"c.","Include the street address of the corporate headquarters."]
[null,null,"d.","Include the Taxpayer ID of the cooperative."]
[null,null,"e.","The need for flood hazard insurance must be addressed."]
[null,null,"f.","Provide a breakdown of the funds by State."]
[null,null,"g.","List of Counties served."]
[null,null,"h.","Listing of threatened actions by third parties that could adversely effect the "]
[null,null,null,"cooperative's financial condition including annexations or other actions "]
[null,null,null,"affecting service territory, loads, or rates (example: potential loss of a large"]
[null,null,null,"power consumer or large load concentration). "]
[null,null,"i.","Listing of pending regulatory proceedings."]
[]
[null,"A statement that there has been no change in area coverage or line extension policies. "]
[null,"(Note:  If there has been a change then a copy of the new area coverage and/or line  "]
[null,"extension policy(s), as applicable, must be submitted to RUS - see Form 726 item #7)"]
[]
[2,"Transmittal Letter to Supplemental Lender"]
[null,"Contact your supplemental Lender (if any) concerning the format for this letter."]
[]
[3,"Board Resolution requesting loan and release of information"]
[null,"Sample forms are provided.  Please use the form that is appropriate for the type of loan"]
[null,"requested:",null,null,"Municipal Rate Loan - Muni Rate Loan Resolution.doc"]
[{"$nulls":4},"100% Municipal Rate Loan - Muni Rate Loan 100% Resolution.doc"]
[{"$nulls":4},"Hardship Rate Loan - Hardship Rate Loan Resolution.doc"]
[{"$nulls":4},"FFB Guaranteed Loan - FFB Guarantee Loan Resolution.doc"]
[{"$nulls":4},"Treasury Rate Loan - Treasury Rate Loan Resolution.doc"]
[4,"RUS Form 740c"]
[null,"See sample form \"740c.xls\" - instructions are provided with the form."]
["4.a.","Reimbursement Schedule - This schedule lists the date, amount, and identification "]
[null,"number of each inventory of work orders and special equipment summary that form "]
[null,"the basis for the borrower's request for reimbursement of general funds on the RUS Form"]
[null," 740c. See Sec. 1710.109. "]
["4.b.","Useful life statement - A statement must be attached to the 740c certifying that"]
[null," at least 90% of the loan funds requested are for facilities with a useful life of 33"]
[null,"years or longer.  If facilities are included in the loan that have a useful life of "]
[null,"less than 33 years, and represent more than 10% of the loan, attach a schedule"]
[null,"showing the costs and useful life of those facilities (reference 1710.115).  "]
[null,"(Sample statement provided as an attachment to the Form 740c)"]
["4.c.","Location of Consumers - If the application is for a municipal rate loan subject to the interest "]
[null,"rate cap, or for a loan at the hardship rate, and the average number of consumers per mile "]
[null,"of the total electric system exceeds 17, Form 740c must include, as a note, a breakdown "]
[null,"of funds included in the proposed loan to furnish or improve service to consumers located "]
[null,"in an urban area. See 7 CFR 1714.7(c) and 1714.8(d). This breakdown must indicate the "]
[null,"method used by the borrower for allocating loan funds between urban and non urban consumers"]
[]
[5,"RUS Form 740g"]
[null,"This form is only required if a loan is being requested to support the construction of headquarters"]
[null,"facilities - see 7 CFR 1710.401(a)(4) for additional details."]
[]
[6,"RUS Form 7"]
[null,"Financial and statistical report. The form shall contain the most recent data available, which"]
[null,"shall not be more than 60 days old when received by RUS."]
[]
[7,"Area Coverage and Line Extension Policy(s)"]
[null,"Attach a copy of the current Area Coverage and Line Extension Policy(s) only if there has been"]
[null,"in the policy(s) since that last loan application."]
[]
[8,"Current Load Forecast Study"]
[null,"Attach a copy of the Board Resolution approving the most recent Load Forecast Study used to "]
[null,"support this loan requested only if it has not been previously submitted."]
[]
["9 & 10","Long Range Financial Forecast with Board Resolution/Sensitivity Analysis"]
[null,"Along with the loan application, the borrower shall submit to RUS a Long-Range Financial "]
[null,"Forecast (LRFF), that meets the requirements of 7 CFR 1710, subpart G. The forecast "]
[null,"shall include any sensitivity analysis or analysis of alternative scenarios required by"]
[null,"subpart G of 7 CFR 1710, and shall be accompanied by a certified board resolution"]
[null,"adopting, and indicating the board of directors' approval of, the LRFF, and directing"]
[null,"management to take whatever steps may be necessary, including the filing for rate"]
[null,"increases, to achieve the TIER goals set forth in the LRFF."]
[null,"A sample Board resolution is available (see Financial Forecast Resolution.doc)."]
[]
[11,"Copy of all Retail Rates"]
[null,"Attach a copy of all retails rates only if a change in the rates has taken place since the last"]
[null,"loan application."]
[]
[12,"Rate Comparison at average residential rates"]
[null,"Comparison of rates with neighboring and/or competing utilities (IOU's and Muni's only).  "]
[null,"The Comparison should be based upon the average residential usage. This comparison "]
[null,"should also include an explanation of any recent or planned changes in retail rates."]
[]
[13,"Attorney Opining"]
[null,"Submit an opinion of counsel (see sample form \"Attorney Opinion.doc\") which provides "]
[null,"and opines to the accuracy of information relating to:"]
[null,"(a)","Counties where the borrower has personal or real property (existing facilities and "]
[null,null,"new facilities)."]
[null,"(b)","The completeness and accuracy of the property schedule (Property Scheduled "]
[null,null,"attached to this opinion as Schedule B)."]
[null,"(c)","The suitability of the property descriptions for inclusion in a mortgage."]
[null,"(d)","The borrower's corporate status."]
[null,"(e)","The borrower's authorized places of business."]
[null,"(f)","The borrower's true and correct legal name."]
[null,"(g)","The borrower's corporate debt limit."]
[null,null,"NOTE:  A new Board Resolution will be required (attach) whenever the debt limit is "]
[null,null,"different than that contained in the last mortgage or whenever the debt limit is "]
[null,null,"inadequate to cover all debt (past plus current application)."]
[null,"(h)","State Regulatory Approvals (loan documents would or would not require)"]
[null,"(i)","Taxpayer ID number"]
[null,"(j)","The name(s) of your Power Supplier(s), name(s) of the related contracts and date of "]
[null,null,"the contracts.  Note: These dates should be the last full, complete, contract, not "]
[null,null,"amendments."]
[null,"(k)","Statement concerning pending litigation or claims.  If claims or pending litigation exist, "]
[null,null,"provide a list including levels of related insurance coverage and potential effect."]
[null,"(l)","Whether the borrower has one or more subsidiaries"]
[]
[14,"Special Resolution"]
[null,"Submit all resolutions as required (GFR will provide information concerning this item)."]
[]
[15,"Articles of Incorporation"]
[null,"Attach a copy of the current Articles of Incorporation only if modified since the last "]
[null,"loan submittal."]
[]
[16,"Bylaws"]
[null,"Attach a copy of the current Bylaws only if modified since the last loan submittal."]
[]
[17,"CWP Board Resolution"]
[null,"Attach a copy of the Board Resolution approving the supporting CWP if not previously"]
[null,"submitted."]
[]
[18,"Statement concerning inclusion of facilities in rate base"]
[null,"To fulfill the requirements of 7 CFR 1710.151(f):  Submit a statement from management"]
[null,"or an opinion of counsel indicating that, based upon available information, there is no"]
[null,"reason to anticipate that any of the facilities included in the loan application will be"]
[null,"excluded from the borrower's rate base by State regulatory authorities.  This statement"]
[null,"may be based upon the provisions of State law, rules and policies of State regulatory"]
[null,"authorities, prior experience, and the recent experience of other utilities in the State."]
[null,"NOTE:  If provided by Management, the statement may be included in the "]
[null,"transmittal letter."]
[]
[19,"Certificate Regarding Debarment"]
[null,"Form AD-1047, Certification Regarding Debarment, Suspension, and Other"]
[null,"Responsibility Matters--Primary Covered Transactions. This statement certifies that the "]
[null,"borrower will comply with certain regulations on debarment and suspension required "]
[null,"by Executive Order 12549, Debarment and Suspension (3 CFR, 1986 Comp., p. 189)."]
[null,"See 7 CFR part 3017 and Sec. 1710.123. (See sample form \"Debarment.doc\")"]
[]
[20,"Lobbying Certification"]
[null,"This statement certifies that the borrower shall comply with certain requirements"]
[null,"with respect to restrictions on lobbying activities. There are two forms of certification"]
[null,"required.  Form \"Lobbying FFB.doc should be used in support of FFB guaranteed"]
[null,"loan applications.  Form \"Lobbying.doc\" should be used for all other applications."]
[]
[21,"Uniform Relocation Act Assurance Statement"]
[null,"This assurance, which need not be resubmitted if previously submitted,"]
[null,"provides that the borrower shall comply with 49 CFR part 24, which implements"]
[null,"the Uniform Relocation Assistance and Real Property Acquisition Policy Act"]
[null,"of 1970, as amended by the Uniform Relocation Act Amendments of 1987"]
[null,"and 1991.  See Sec. 1710.124. (See also sample form \"Relocation.doc\")"]
[]
[22,"Debt Delinquency Certification"]
[null,"Federal debt delinquency requirements. See 1710.126. This report indicates"]
[null,"whether or not a borrower is delinquent on any Federal debt."]
[null,"(See sample certification \"Debt Certification.doc\")"]
[]
[23,"DSM or IRP study"]
[null,"See 7 CFR 1710, Subpart H, for details relating to loans for demand side management"]
[null,"and associated Integrated Resources Plans."]
[]
[24,"Standard Form 100"]
[null,"Equal Employment Opportunity Employer Report EEO--1. This form, required by"]
[null,"the Department of Labor, sets forth employment data for borrowers with 100 or"]
[null,"more employees. A copy of this form, as submitted to the Department of Labor, is"]
[null,"to be included in the application for an insured loan if the borrower has more than 100"]
[null,"employees. See Sec. 1710.122."]
[]
[25,"Borrower's Statistical Profile and Comments"]
[null,"Attach a copy of the current Borrower's Statistical Profile (BSP).  Also attach comments"]
[null,"explaining each ratio that is flagged and considered adverse.  The GFR will assist with "]
[null,"determining which ratios are considered adverse."]
[]
[26,"Rural Development Activities"]
[null,"Attach a narrative discussion of all rural development activities support by the borrower."]
[null,"(See sample format \"Rural Development Activities.doc\")"]
[]
[27,"Other"]
[null,"Attach other documents as required.  The GFR will advise as to any other required"]
[null,"documents."]
[]
["Please be as specific as possible with your responses to the above items.  If you need any "]
["assistance with addressing any item, please contact your GFR."]