**WORK PLAN TEMPLATE**

for

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Submitted to Rural Development \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Amount of IRP funds requested**:

Amount of matching funds to the IRP funds:

***Total IRP Revolving Loan Funds***:

[Geographical area coverage of the IRP]{.underline}:

Name of Organization:

Address:

Phone:

Fax:

E-mail:

Website:

**A written work plan and other evidence the Agency requires to
demonstrate the feasibility of the intermediary's program to meet the
objectives of this program.**

Document the intermediary's ability to administer the IRP in accordance
with the provisions of 4274-D.

**Introductory and/or Historical statement from
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.**

**[4274.343 (a) (2) (i)]{.underline} -- Personnel to administer the IRP
revolving loan fund program**

A complete listing of all personnel responsible for administering the
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ IRP program is:

  --------------- ------------ -------------------- ----------------- -----
  Name            Job Title    Qualifications       Experience        M, E,
                                                                      or
                                                                      C\*

                                                                      

                                                                      

                                                                      

                                                                      

                                                                      
  --------------- ------------ -------------------- ----------------- -----

-   M -- member of organization

-   E -- employee of organization, or

-   C -- contract employee hired for IRP program

> \_\_\_\_\_\_ Attached (Tab \_\_\_\_) is a copy of the contract for
> each contract employee for Agency review.

**[4274.343 (a) (2) (ii) and (v) and (vi)]{.underline} -- Commitment of
other financial resources**

The ability of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ to
commit financial resources to the establishment of the IRP is as follows
[from non-Agency sources]{.underline}:

+-----------------+--------+----------+--------+------+-----+--------+
| Source of Funds | [P     | Amount   | Funds  | F    | or  | Letter |
|                 | ublic] | of Funds | to be  | inan | Bo  | of     |
|                 | {.unde |          | used   | cial | th? | Comm   |
|                 | rline} |          | for    | as   |     | itment |
|                 | agency |          |        | sist |     | At     |
|                 | or     |          | Ad     | ance |     | tached |
|                 | [Pr    |          | minist | for  |     |        |
|                 | ivate] |          | ration | p    |     |        |
|                 | {.unde |          | of     | roje |     |        |
|                 | rline} |          | opera  | cts? |     |        |
|                 | o      |          | tions? |      |     |        |
|                 | rganiz |          |        |      |     |        |
|                 | ation? |          |        |      |     |        |
+-----------------+--------+----------+--------+------+-----+--------+
| 1\.             |        |          |        |      |     | Tab    |
|                 |        |          |        |      |     | \_\_\_ |
+-----------------+--------+----------+--------+------+-----+--------+
| 2\.             |        |          |        |      |     | Tab    |
|                 |        |          |        |      |     | \_\_\_ |
+-----------------+--------+----------+--------+------+-----+--------+
| 3\.             |        |          |        |      |     | Tab    |
|                 |        |          |        |      |     | \_\_\_ |
+-----------------+--------+----------+--------+------+-----+--------+
| 4\.             |        |          |        |      |     | Tab    |
|                 |        |          |        |      |     | \_\_\_ |
+-----------------+--------+----------+--------+------+-----+--------+
| 5\.             |        |          |        |      |     | Tab    |
|                 |        |          |        |      |     | \_\_\_ |
+-----------------+--------+----------+--------+------+-----+--------+
| 6\.             |        |          |        |      |     | Tab    |
|                 |        |          |        |      |     | \_\_\_ |
+-----------------+--------+----------+--------+------+-----+--------+
| 7\.             |        |          |        |      |     | Tab    |
|                 |        |          |        |      |     | \_\_\_ |
+-----------------+--------+----------+--------+------+-----+--------+
| 8\.             |        |          |        |      |     | Tab    |
|                 |        |          |        |      |     | \_\_\_ |
+-----------------+--------+----------+--------+------+-----+--------+
|                 |        |          |        |      |     |        |
+-----------------+--------+----------+--------+------+-----+--------+
|                 |        |          |        |      |     |        |
+-----------------+--------+----------+--------+------+-----+--------+

Other evidence that \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_has
a proven record of obtaining private or philanthropic funds for the
operation of similar programs to the IRP is:

**[4274.343 (a) (2) (iii]{.underline}) -- Demonstrate a need for loan
funds**

1\. Proposed or known ultimate recipients on hand to justify Agency
funding of its loan request:

OR

2\. Targeting criteria for ultimate recipients consistent with the
intermediary's mission and strategy for the IRP, along with supporting
statistical or narrative evidence that such prospective recipients exist
in sufficient numbers to justify Agency funding of the loan request.

**[4274.343 (a) (2) (iv) and (vii) --]{.underline} Intermediary's plan
(specific loan purposes)**

**for relending the loan funds.**

The plan must be of sufficient detail to provide the agency with a
complete understanding of what the intermediary will accomplish by
lending the funds to the ultimate recipient and the complete mechanics
of how the funds will get from the intermediary to the ultimate
recipient.

  ------------------ ----------------------------------------------------
  Service Area       

  Eligibility        
  criteria           

  Loan Purposes      

  Fees               

  Other charges      

  Rates              

  Terms              

  Collateral         
  requirements       

  Limits             

  Priorities         

  Application        
  Process            

  Method of          
  disposition of     
  fund to the        
  ultimate recipient 

  Monitoring of the  
  ultimate           
  recipient's        
  accomplishments    

  Reporting          
  requirements by    
  the ultimate       
  recipients         
  management         
  ------------------ ----------------------------------------------------

**[4274.343 (a) (2) (viii)]{.underline} Goals, strategies, and
anticipated outcomes for the IRP program**

*4274.301 (b) The purpose of the intermediary relending program is to
alleviate poverty and increase economic activity and employment in rural
communities, especially disadvantaged and remote communities, through
financing targeted primarily towards smaller and emerging businesses, in
partnership with other public and private resources, and in accordance
with State and regional strategy based on identified community needs.
This purpose is achieved through loans made to intermediaries that
establish programs for the purpose of providing loans to ultimate
recipients for business facilities and community developments in a rural
area.*

Provide a set of goals, strategies, and anticipated outcomes for the
intermediary's program.

+--------------+-------------------------------------------------------+
| **Goals**    |                                                       |
| for IRP      |                                                       |
| revolving    |                                                       |
| loan fund    |                                                       |
+--------------+-------------------------------------------------------+
| **Mission    |                                                       |
| and          |                                                       |
| Strategy**   |                                                       |
| for the IRP  |                                                       |
| revolving    |                                                       |
| loan fund    |                                                       |
+--------------+-------------------------------------------------------+
| *            |                                                       |
| *Anticipated |                                                       |
| outcomes**   |                                                       |
| for the IRP  |                                                       |
| revolving    |                                                       |
| loan fund    |                                                       |
|              |                                                       |
| *(Outcomes   |                                                       |
| should be    |                                                       |
| expressed in |                                                       |
| quantitative |                                                       |
| or           |                                                       |
| observable   |                                                       |
| terms such   |                                                       |
| as jobs      |                                                       |
| created for  |                                                       |
| low-income   |                                                       |
| area         |                                                       |
| residents or |                                                       |
| self         |                                                       |
| empowerment  |                                                       |
| o            |                                                       |
| pportunities |                                                       |
| funded, and  |                                                       |
| should       |                                                       |
| relate to    |                                                       |
| the purpose  |                                                       |
| of IRP*      |                                                       |
+--------------+-------------------------------------------------------+

**[4274.343 (a) (2) (ix)]{.underline} Technical Assistance**

Specific information as to whether and how
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_will ensure that technical
assistance is made available to ultimate recipients and potential
ultimate recipients.

+-----------+---------+--------------+-------------+--------+--------+
| Technical | Organ   | Arrangements | Nature of   | E-     | Amount |
| a         | ization | between      | technical   | Ex     | of     |
| ssistance |         | \_           | assistance  | pected | tec    |
| provider  |         | \_\_\_\_\_\_ | to be       | or     | hnical |
|           |         | and          | provided    |        | assi   |
|           |         | technical    |             | C-Com  | stance |
|           |         | assistance   |             | mitted | f      |
|           |         | provider     |             | Source | unding |
|           |         |              |             | of     |        |
|           |         |              |             | F      |        |
|           |         |              |             | unding |        |
+-----------+---------+--------------+-------------+--------+--------+
|           |         |              |             |        |        |
+-----------+---------+--------------+-------------+--------+--------+
|           |         |              |             |        |        |
+-----------+---------+--------------+-------------+--------+--------+
|           |         |              |             |        |        |
+-----------+---------+--------------+-------------+--------+--------+
|           |         |              |             |        |        |
+-----------+---------+--------------+-------------+--------+--------+
|           |         |              |             |        |        |
+-----------+---------+--------------+-------------+--------+--------+
|           |         |              |             |        |        |
+-----------+---------+--------------+-------------+--------+--------+