Rd Form Letter 3570-B-1 - United States Department Of Agriculture printable pdf download

Rd Form Letter 3570-B-1 - United States Department Of Agriculture

RD Form Letter 3570-B-1

UNITED STATES DEPARTMENT OF AGRICULTURE

RURAL DEVELOPMENT

Date _____________

Subject: Request for Community Facilities Grant Funds from the National Office

TO: Administrator, RHS, Washington, D.C. 20250-3222

Attention: Community Programs Division STOP 0787

State ___________________ Name of Applicant _____________________________________________________

Type of Project: ________________________________________________________________________________

Select type of grant (one or more)

____ Regular Program ,

____ EZ/EC Grant,

____ Economic Impact Initiative,

_____ Disaster

____ Tribal College,

____ Other Grant (describe) _______________________________________

A. Amount of CF Grant funds being requested from the National Office Reserve: $______________

B. Other CF funding in project:

Direct Loan $______________ Guaranteed Loan $_________________

C. Other non-RHS funding and amounts _______________________________________________________

_______________________________________________________________________________________

D. Provide the priority of this application in relation to all others on hand at the time of submission of the

request for funds from the National Office. ____________________

(1, 2, or 3)

E. Are the other funds proposed for this project committed and is there evidence that the funds are available

and will be used for this project?

______ Yes

______ No

F. Is this application ready for obligation?

______ Yes

______ No

If No, give the estimated date the application will be ready for obligation of funds and the reason for the

delay. ________________________________________________________________________________

G. Has the appropriate environmental review, including public notice requirements for a Class II action, been

completed for the project?

______ Yes

______ No

H. Has a Civil Rights Impact Analysis (Form RD 2006-38) been conducted and certified? ____ Yes ____ No

I. Is the project a special initiative? ____ Yes ____ No If so, what special initiative?

_______________________________

J. Is the project in an EZ/EC area? ____ Yes ____ No or a targeted community? ____ Yes ____ No

K. If so, list the area or community

____________________________________________________________.

___________________________________________________

________________________

Approval Official

Date

Directions:

To request funds from the National Office, complete this form letter and send it

along with Form RD 3570-1, “Project Selection Priorities” for each project in which funds are

being requested.

(04-18-07)

PN 408

Rd Form Letter 3570-B-1 - United States Department Of Agriculture

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