**Rural Development**

**United States Department of Agriculture**

**RURAL DEVELOPMENT**

**UTILITIES PROGRAMS**

***Community Connect***

***Broadband Program***

***Grant Application Guide***

***Fiscal Year 2008***

![](media/image1.png){width="6.497916666666667in"
height="2.5319444444444446in"}

***Committed to the future of rural communities***

**Contents:**

**Page No.**

**Introduction and General Information** 2

Applying for a Grant 7

Completing the Grant Application 11

Putting It All Together 26

Final Rule 7 CFR 1739 -- August 3, 2007 27

Federal Forms and Attachments 40

**Rural Development Utilities Programs**

**Community-Oriented Connectivity Broadband Grant Program**

The Community-Oriented Connectivity Broadband Grant Program is designed
to provide financial assistance to furnish broadband service in rural,
economically-challenged communities where such service does not
currently exist. Grant funds may be utilized to deploy broadband
transmission service to critical community facilities, rural residents,
and rural businesses and to construct, acquire, or expand, equip, and
operate a community center that provides free access to broadband
services to community residents for at least two years. Grants will be
awarded, on a competitive basis, to entities serving communities of up
to 20,000 inhabitants to ensure rural consumers enjoy the same quality
and range of telecommunications service as are available in urban and
suburban communities.

**For additional information concerning this grant program, please
contact:**

**Kenneth Kuchno, Director, Broadband Division, Telecommunications
Program, (202) 690-4673 or Email: <community.connect@usda.gov>.
Information about Rural Development Utilities Programs and this
application/guide can be retrieved *via the internet* at:**

[**http://www.usda.gov/rus/telecom/commconnect.htm**](http://www.usda.gov/rus/telecom/commconnect.htm)

**When and Where to Submit your Application**:

**GRANT** applications must be postmarked by:

An **[original and two copies]{.underline}** of a **completed**
**application** must be posted, shipped, or hand-delivered by the
deadline date. **Applications must be submitted to:**

**Director, Broadband Division**

**Rural Development Utilities Programs**

> **STOP 1599, Room 2868**

**1400 Independence Ave., SW**

**Washington, D.C. 20250-1599**

Due to the possible disruptions in mail delivery service, applicants are
strongly encouraged to submit applications via express mail or hand
delivery to our office.

## 

## Applications Delivered by Mail:

Applications must show proof of shipping consisting of one of the
following:

1.  A legibly dated U.S. Postal Service (USPS) postmark;

2.  A legible mail receipt with the date of mailing stamped by the USPS;
    or

3.  A dated shipping label, invoice, or receipt from a commercial
    carrier.

If an application is sent through the USPS, neither of the following
will be accepted as proof of mailing:

1.  A private metered postmark; or

2.  A mail receipt that is not dated by the USPS.

Applicants should note that the USPS does not uniformly provide a dated
postmark. Before relying on this method, an applicant should check with
its local post office.

## 

## Applications Delivered by Hand:

Applications delivered by hand will be accepted daily between 8:00 a.m.
and 4:30 p.m. (Eastern Standard Time), except Saturdays, Sundays, and
Federal holidays. Individuals delivering applications must provide
proper identification to enter the building.

**Late applicants will be notified that their applications will not be
considered for funding and their applications will be returned.**

**Applications Submitted Electronically:**

**Electronic applications will only be accepted when submitted through
the Grants.gov website.** Applications will not be accepted via
facsimile machine transmission or electronic mail.

[www.grants.gov](http://www.grants.gov/)

If you want to submit an application on-line, Rural Development
Utilities Programs strongly encourages you to obtain all the necessary
sign-ups, credentials and authorizations well in advance of the
deadline.

You will need a Central Contractor Registry (CCR) registration before
you can submit electronically.

In addition, Grants.gov requires some one-time credentialing and online
authentication procedures. These procedures may take several business
days to complete. Because several of Grants.gov\'s requirements call for
an annual update, please ensure that your credentials and authorizations
are up-to-date.

The Grants.gov website, like all web facilities, has finite capacity. If
several federal grant programs have the same application deadline date,
periods of site overloading can be experienced. Please plan accordingly.

Please follow the instructions at Grants.gov. If you experience a
technical problem retrieving or submitting an electronic application,
contact the Grants.gov customer support resources (click the \"Customer
Support\" tab on any page of Grants.gov to get started). Rural
Development Utilities Programs staffers do not control the technical
aspects of Grants.gov and won\'t be able to help you if you experience a
problem. However, we are available to answer questions about the Program
and the contents of an application.

With an electronic application you do not need to submit two copies as
required from mailed applications. However, we may request original
signatures on paper later.

**New for 2008:**

Rural Development clarifies that in order to qualify as eligible costs
for grant coverage or matching fund contributions, operating expenses
incurred in providing Broadband Transmission Service to Critical
Facilities for the first two (2) years of operation and in providing
training and instruction must be for the following purposes subject to
the specified maximum amounts:

a.  Salary for operations manager, not to exceed \$30,000 per year;

b.  Salary for technical support staff, not to exceed \$30,000 per year;

c.  Salary for community center staff, not to exceed \$25,000 per year;

d.  Bandwidth expenses, not to exceed \$25,000 per year; and

e.  Training courses on the use of the Internet, not to exceed \$15,000
    per year.

The operating costs to be financed by grant funds and/or used as
matching contributions **cannot exceed in the aggregate of \$250,000 for
the first two years of operation**. Other operating expenses, such as
utilities, are permissible, but they will not be eligible for grant
funding nor to be considered as an acceptable matching contribution.

Note: If any ineligible items are included under the Operating Expenses
Category, they will not be considered for grant funding or as an
eligible matching contribution. At no time is it acceptable to
incorporate benefit packages or transportation subsidies as a portion of
the staff's overall salary.

-   **The minimum grant request amount is: \$50,000**

-   **The maximum grant request amount is: \$1,000,000**

**[Other pertinent information:]{.underline}**

**For individual budget categories, matching contributions plus grant
funds requested can not exceed the monetary limits of the specific
category set forth in the regulation.**

1.  **For the community center, the aggregate total of requested grant
    and matching funds are required to comply with the \$100,000 limit
    set forth in CFR 1739.12 (b)**

2.  **For operating expenses, the aggregate total of requested grant
    plus matching funds cannot exceed \$250,000 and the aggregate total
    for the eligible operating expenses categories cannot exceed the
    amounts set forth in CFR 1739.12 (d)(1) and (2).**

**[Organization of the application]{.underline}:**

We ask that all information relevant to a category be included under
that category\'s tab. The volume of applications makes it impractical
for reviewers to search through the entire application to find required
information. If that information is relevant to another category, it
should be repeated under that category.

**Applying for a Grant**

**Grant Processing**

Completed applications must be postmarked no later than, March 28, 2008,
or be received by Grants.gov by that date to be considered for funding.
Grant applications will be scored in accordance with the provisions of 7
CFR 1739.

**Applicant Eligibility**

To be eligible for a grant, the applicant must:

-   Be legally organized as an incorporated organization, an Indian
    tribe or tribal organization, as defined in [[25 U.S.C. 450b(b) and
    (c)]{.underline}](http://www.westlaw.com/Find/Default.wl?rs=++++1.0&vr=2.0&DB=1000546&DocName=25USCAS450B&FindType=L),
    a state or local unit of government, or other legal entity,
    including cooperatives or private corporations or limited liability
    companies organized on a for profit or not-for profit basis.

-   Have the legal capacity and authority to own and operate the
    broadband facilities as proposed in its application, to enter into
    contracts and to otherwise comply with applicable federal statutes
    and regulations.

**Note: The applicant may not be an individual or partnership.**

**Project Eligibility**

To be eligible for a grant, the Project must:

-   Serve a Rural Area throughout which Broadband Transmission Service
    does not currently exist, to be verified by Rural Development
    Utilities Programs prior to the award of the grant;

-   Serve one and only one Community recognized in the latest decennial
    census as published by the Bureau of the Census or in the most
    recent edition of a Rand McNally Atlas;

-   Deploy Basic Broadband Transmission Service, free of all charges for
    at least 2 years, to all Critical Community Facilities located
    within the proposed Service Area;

-   Offer Basic Broadband Transmission Service to residential and
    business customers within the proposed Service Area; and

-   Provide a Community Center with at least ten (10) Computer Access
    Points within the proposed Service Area, and make Broadband
    Transmission Service available therein, free of all charges to users
    for at least 2 years.

    **!! COMMUNITY CENTER !!**

***The community center must have at least 10 Computer Access Points***

###### Rurality Requirement

The proposed project must provide broadband transmission service to a
rural area that does not currently have such service anywhere in the
proposed service area. A "Rurality Calculation Table" is provided for
this computation (See attachment 2), and should be based upon decennial
Census Data contained in the US Census Bureau of the census at
[http://factfinder.census.gov](http://factfinder.census.gov/) or the
2008 version of Rand McNally Atlas.

If population data is not listed for a community that is recognized in
the Rand McNally Atlas, then that community is not eligible for this
program.

####### Eligible Grant Purposes

Grants funds may be used to finance:

1.  The construction, acquisition, or lease of facilities, including
    spectrum, to deploy broadband transmission services to all critical
    community facilities and to offer such service to all residential
    and business customers located within the proposed service area.

2.  The improvement, expansion, construction, acquisition, or leasing of
    a community center that furnishes free access to broadband Internet
    service, provided that the community center is open and accessible
    to area residents before, during, and after normal working hours and
    on Saturday or Sunday. Grant funds provided for the community center
    are limited to the greater of \$100,000 or 5% of the grant amount
    requested. The costs of the computer access points, their
    installation, or connection to the broadband transmission system are
    not included in this limitation.

> **Note:** The total cost of the community center may exceed the
> maximum limit set forth in CFR 1739.12 (b), but it will be the
> responsibility of the applicant to finance those expenditures which
> exceed \$100,000. The applicant may not include additional costs for
> the community center in excess of \$100,000 in order to satisfy the
> matching contribution requirement.

3.  End-user equipment needed to carry out the project.

4.  All operating expenses incurred in providing broadband transmission
    service to critical community facilities and to provide training and
    instruction for the first two years of operation shall not exceed
    \$250,000 in grant funds requested plus matching contributions.
    Salary and administrative expenses will be subject to review, and
    may be limited, by Rural Development Utilities Programs, for
    reasonableness in relation to the scope of the project.

####### 

####### The purchase of land, buildings, or building construction needed to carry out the project. The acquisition or leasing of land for the community center is not considered a community center expense and should be listed elsewhere on the budget. If you intend to use the budget provided in this application, any land expenses should be listed under the 'Land' section of the budget. 

####### 

####### Ineligible Grant Purposes

Grants funds may not be used to finance:

> 1\. Grant Funds may not be used to finance the duplication of any
> existing broadband services provided by other entities; and
>
> 2\. Facilities financed may not be used, in any way, to provide local
> exchange telecommunications service to any person or entity where it
> currently exists.

###### 

###### Matching Funds Requirement

The applicant's minimum matching contribution must be for **eligible
purposes** and equal 15% of the grant amount requested. All matching
funds must be eligible for funding under the grant program. Matching
funds are subject to dollar amount limitations as provided for the
Community Center and Operating Expenses. The aggregate total of grant
funds and matching contributions can not exceed limitations set forth in
regulation. The total amount available to be used for grant and matching
funds for the community center is \$100,000. The total amount available
to be used for grant and matching funds for operating expenses is
\$250,000.

-   Cash for eligible grant purposes;

-   In-kind contributions of eligible grant purposes; and

-   The rental value of space provided within an existing building to be
    used as the Community Center, provided that the space is free of
    charge to the applicant, for the first 2 years of operation.

```{=html}
<!-- -->
```
-   The value of rental income for donated space in a community center
    must be calculated for the first two years of operation. Rental
    values ***must*** be supported by rental agreements documenting the
    cost of space of a similar size in a similar location.

In-kind contributions must be:

-   New or non-depreciated assets with established monetary values.
    **Manufacturers' or service providers' discounts are not matching
    contributions**.

Cash for eligible grant purposes may include:

-   Bandwidth expenses used to provide Basic Broadband Transmission
    Services to the Community Center for the first 2 years of operation.

-   Salary expenses incurred in operating the Community Center for the
    first 2 years of operation.

**Costs incurred by the applicant, or others on behalf of the applicant,
for facilities or equipment installed, or other services rendered prior
to submission of a completed application, shall not be considered as an
eligible matching contribution.**

The source and amount of matching funds must be identified in the
application. All matching funds provided by the applicant or a third
party, must be documented and the applicants or the third party's
commitment must be included in the application.

Any financial assistance from Federal sources will not be considered as
matching contributions unless there is a Federal statutory exception
authorizing the Federal financial assistance to be considered as a
matching contribution.

**Completing the Grant Application**

This section addresses all of the information that must be submitted for
an application to be complete and considered for financing:

+----------------------------------+-----------------------------------+
| *A. A Completed Application for  | G.  *Financial Information and    |
| Federal Assistance (Standard     |     Sustainability*               |
| Form 424)*                       |                                   |
|                                  | H.  *A Statement of Experience*   |
| B.  *An Executive Summary of the |                                   |
|     Project*                     | I.  *Evidence of Legal Authority  |
|                                  |     and Existence*                |
| C.  *Scoring Criteria            |                                   |
|     Documentation*               | J.  *Funding Commitments from     |
|                                  |     Other Sources*                |
| D.  *System Design*              |                                   |
|                                  | K.  *Compliance with Other        |
| E.  *Scope of Work*              |     Federal Statutes and          |
|                                  |     Regulations*                  |
| F.  *Community-Oriented          |                                   |
|     Connectivity Plan*           |                                   |
+----------------------------------+-----------------------------------+

A. A Completed Standard Form 424, "Application for Federal Assistance"

Use the Standard Form 424, Application for Federal Assistance (SF 424),
to apply for Community Connect Broadband grants. You can find a copy of
the form in the Federal Forms and Attachments section. It is important
that you complete every relevant entry. Please use the following notes
in conjunction with the SF-424 instruction page.

**Block 1:** Select "Application"

**Block 2:** Select "New"

**Block 3:** For Rural Development Utilities Programs use - leave blank

**Block 4:** For Rural Development Utilities Programs use - leave blank

**Block 5: (a) and (b):** For Rural Development Utilities Programs use -
leave blank

**Block 6:** Not Applicable

**Block 7**: Not Applicable

**Block 8**: There are multiple entries in this block. We will use the
contact information provided in this box for all contact and
correspondence. Please complete this in full and attach a sheet if you
want to provide additional contacts. It is crucial that we have accurate
information, including a reliable fax number for rapid correspondence.
If you do not have a fax number, we will need a reliable e-mail address.
Otherwise, correspondence will be sent by mail. You must provide full,
accurate contact information for someone with the authority to answer
any questions Rural Development Utilities Programs staff may have about
your application.

If you wish to supply a contact from outside your organization, attach a
letter immediately behind the SF-424 listing these items: person\'s
name, organization, contact information (phone, fax, e-mail, mailing
address), relationship to your organization. Make sure the letter
contains language granting authority to the person to answer our
questions or provide additional information on your behalf, and any time
limit you wish to apply to that person\'s authority. This letter must be
signed by the signatory on the SF-424.

As required by the Office of Management and Budget, **all applicants for
grants must supply a Dun and Bradstreet Data Universal Numbering System
(DUNS) number**. Call Dun and Bradstreet (1-866-705-5711) to obtain a
DUNS number. Please see this website for more information:

<http://www.whitehouse.gov/omb/grants/duns_num_guide.pdf>

**Block 9**: Refer to Instructions; Select Appropriate Letter (A-X)

**Block 10:** The Name of the Federal Agency is Rural Utilities Service

**Block 11**: The Catalog of Federal Assistance Number is **10.863**

**Block 12:** Funding Opportunity Number is **RDUP-08-01-CC**

The Title is "**Community Connect Grant Program**"

**Block 13:** Not Applicable

**Block 14:** Please provide the name of the community, county, and
state where the grant funds will be used.

**Block 15:** Brief descriptive title of project

**Block 16:** Please provide the Congressional District of the community
you are in, and if different provide the Congressional District for the
community you are proposing to service in your project.

**Block 17:** Self Explanatory

**Block 18:** (Estimated Funding)

a\. Federal Show the amount requested from Rural Development Utilities
Programs as grant

b\. Applicant Show the total matching contributions, regardless of
source

c, d, e, & f. Leave Blank

g\. TOTAL Show *Total Eligible Community Connect Grant + Matching
Purposes* (this should be the sum of a. and b. above - and it should
also equal the Total Eligible Grant and Matching Purposes shown in your
budget under the Scope of Work Section E.)

**Block 19:** Please select "C" "Program is not covered by E.O. 12372".
Per regulation 7 CFR 1739-Supplementary Information, this program is not
subject to the requirements of Executive Order 12372.

**Block 20:** You must supply an explanation of the delinquency if you
check \"yes\".

**Block 21: Please be sure to check "I agree".** The application must be
signed by an authorized representative of the organization that will own
and operate the project if a grant is awarded. If the signer is not a
corporate officer, you must include evidence that the signer is
authorized to obligate the organization.

*Please note: Additional instructions can be found with the SF-424.*

**B. An Executive Summary of the Project**

The Executive Summary of the project is one of the most important parts
of the application. It gives reviewers their first overall view of the
area to be served, what problems the residents face, and how the
proposed project will help alleviate those problems, increase quality of
life, and provide enhanced opportunities for rural residents. This is
your opportunity to discuss the core aspects of the project. Be clear
and provide convincing links between the project and the benefits to the
community.

**[The Executive Summary must provide a general project overview
covering the following six categories:]{.underline}**

> **Number each paragraph as shown below:**

1.  A description of the community and why the project is needed;

2.  A description of the applicant;

3.  The goals of the project;

4.  A general overview of the telecommunications system to be developed,
    including the types of equipment, technologies, and facilities used;

5.  Documentation describing the procedures used to determine the
    unavailability of existing broadband service; and

6.  A description of the participating community organizations and
    partners (such as schools, health care providers, police and fire
    departments, etc.).

**C. Scoring Criteria Documentation**

There are three scoring categories that must be addressed by the
applicant in order to be considered for funding. They are:

1.  The rurality of the community served by the project as determined by
    the population of the community, included in the U.S. Bureau of the
    Census, U.S. Department of Commerce, at
    [http://factfinder.census.gov](http://factfinder.census.gov/), or
    the 2008 edition of the Rand McNally Atlas (up to 40 points);

2.  The economic need of the project's service area as determined by
    median household income (MHI) of the community, included in the U.S.
    Bureau of the Census, U.S. Department of Commerce, at
    [http://factfinder.census.gov](http://factfinder.census.gov/) (up to
    30 points); and

3.  The benefits derived from the proposed service area (up to 30
    points).

The first two categories are objective criteria. The objective criteria
are straightforward indicators that measure the rurality and economic
need of the service area.

**Note: It is not permitted to utilize the U.S. Bureau of the Census and
the latest edition of the Rand McNally Atlas as multiple sources of
information for the same community. The U.S. Bureau of the Census must
be used if it recognizes the proposed community. Data obtained from the
Rand McNally Atlas is only acceptable if the community can not be
identified on U.S. Bureau of the Census Website. If utilizing the 2008
Rand McNally Atlas to validate a community, only communities that
include population data are permissible. Zip Code tabulations are not
acceptable substitutes.**

**If an applicant submits scores based off of the Rand McNally Atlas and
the Agency locates that community on the U.S. Census Bureau webpage, the
score will then be recalculated using the data retrieved from**
[http://factfinder.census.gov](http://factfinder.census.gov/).

**It is important that applicants include their method of acquiring
population data on the rurality calculation table (Attachment 2).**

***1. Rurality of the Project Service Area:***

A rurality table is provided in this application guide to assist you
with this process (Attachment 3). An applicant must base this
calculation on 2000 U.S. Census data contained in the US Census Bureau
of the census at
[http://factfinder.census.gov](http://factfinder.census.gov/) and/or the
most recent version of Rand McNally Atlas. Instructions for determining
the correct census data:

**U.S. Bureau of the Census:**

1.  Go to [http://factfinder.census.gov](http://factfinder.census.gov/)

2.  Locate the heading \"Fast Access to Information\" and the search box
    titled \"Get a fact sheet for your community\". Enter your community
    and select your state from the state list, then click on \"go\"

3.  At the top of your community fact sheet, check to confirm that your
    community is: city, town, village, borough, or CDP

4.  Select the year "2000" tab

5.  The total population for your community is listed at the top in the
    first row of data of the fact sheet

**Rand McNally Atlas:**

1.  Choose a 2008 Rand McNally Atlas

2.  Find the section of the atlas that includes Index of Places, with
    Statistics. This section will be categorized alphabetically by state

3.  Go to the applicable page for your state. Only communities that
    display a population number will be considered eligible for this
    program. The total population should be listed for that community

The following table outlines the definitions used in evaluating
rurality:

  ------------- ----------------- --------------------- --------------------
  Community                                             
  Having a                                              
  Population:                                           

  Level         Over              Not in Excess of      Points

  1                               499                   40

  2             499               1,000                 35

  3             1,000             2,000                 30

  4             2,000             3,000                 25

  5             3,000             4,000                 20

  6             4,000             5,000                 15

  7             5,000             10,000                10

  8             10,000            20,000                5
  ------------- ----------------- --------------------- --------------------

Points are awarded based on the population of the community located
within the service area:

**For example, a project proposes to serve the town of Belle Haven,
Virginia. In accordance with U.S. Bureau of the Census statistics, the
town of Belle Haven, Virginia has a population of 480. A population of
480 is a Level 1 community eligible to receive 40 points, as follows:**

**U.S. Bureau of the Census**

  ------------------------------------ ------------------------------ ------------------------- --------------------------
  **[Service Area                      **[Population]{.underline}**   **[Level]{.underline}**   **[Points]{.underline}**
  Community]{.underline}**                                                                      

  **Belle Haven town, Virginia**       **480**                        **1**                     **40**
  ------------------------------------ ------------------------------ ------------------------- --------------------------

**In the next example, the community of Ransomville, North Carolina
could not be located on the U.S. Census Bureau webpage, but was
recognized using the Rand McNally Atlas.**

**The town of Ransomville, North Carolina has a population of 70. A
population of 70 is a level 1 community eligible to receive 40 points,
as follows:**

**[Rand McNally Atlas]{.underline}**

  ------------------------------------ ------------------------------ ------------------------- --------------------------
  **[Service Area                      **[Population]{.underline}**   **[Level]{.underline}**   **[Points]{.underline}**
  Community]{.underline}**                                                                      

  **Ransomville, North Carolina**      **70**                         **1**                     **40**
  ------------------------------------ ------------------------------ ------------------------- --------------------------

Instructions for Native American Indian Reservations: If your eligible
community is an Indian Reservation (per explanation on page 6 of this
application guide), follow these instructions for determining the
correct population:

1.  Go to [http://factfinder.census.gov](http://factfinder.census.gov/)

2.  Scroll down the web page to find the \"Special Interest\" heading on
    the bottom and click on \"American Indian and Alaska Native data and
    links\"

3.  Under the \"Census 2000\" heading, click on \"Fast access to popular
    data\"

4.  Select the state where the reservation is located and type an
    asterisk \"\*\" in the reservation box

5.  Select your reservation from the list

6.  The total population for your reservation is listed at the top in
    the first row of data of the fact sheet

7.  Use the rurality evaluation table above to determine the correct
    points for your reservation\'s population

***2. Economic Need of the Project Service Area (up to 30 points):***

An "Economic Need Calculation Worksheet" is provided in this application
guide to assist you in this calculation (Attachment 4). This criterion
measures the economic need of the service area based upon the median
household income (MHI) for the Community as a percentage of the state
MHI, as determined by the U.S. Bureau of the Census at
[http://factfinder.census.gov](http://factfinder.census.gov/). If the
community is qualified using the Rand McNally Atlas, the applicant must
use the MHI contained in the decennial census of the county in which the
Community resides as the Community MHI.

+-----------------------------------------------------------------------+
| !Note!                                                                |
|                                                                       |
| The economic need will no longer be based on                          |
|                                                                       |
| the Per Capita Personal Income of the community.                      |
+-----------------------------------------------------------------------+

**U.S. Bureau of the Census**

1.  Go to [http://factfinder.census.gov](http://factfinder.census.gov/)

2.  Locate the heading \"Fast Access to Information\" and the search box
    titled \"Get a fact sheet for your community\". Enter your community
    and select your state from the state list, then click on \"go\"

3.  Select the year "2000" tab

4.  Scroll down to \"Economic Characteristics\" and look for \"Median
    Household Income (dollars)\" for your community

5.  Next, retrieve a fact sheet for the state your community resides in
    and look for "Median Household Income (dollars)" listed for the
    entire state.

6.  Now, use the community\'s MHI as a percentage of the state MHI using
    Attachment 4 of this guide

**Rand McNally Atlas:**

1\. After the community has been chosen from the 2008 Rand McNally
Atlas, it is necessary to determine which county the community is
located.

2\. Go to [http://factfinder.census.gov](http://factfinder.census.gov/).
Instead of retrieving a fact sheet for the community, retrieve a fact
sheet for the county in which the community resides in.

3\. Select the year "2000" tab

4\. Scroll down to \"Economic Characteristics\" and look for \"Median
Household Income (dollars)\" for the county

5\. Next, retrieve a fact sheet for the state the community resides in
and look for "Median Household Income (dollars)" listed for the entire
state.

6.  Now, use the county\'s MHI as a percentage of the state MHI using
    Attachment 4 of this guide

Points are awarded for service provided in a Community where the MHI is
less than 75 percent of the state median household income (SMHI). The
following table outlines the definitions used in evaluating economic
need:

  --------------------- ----------------------------- -------------------
  Median Household                                    
  Income (MHI) is:                                    

  Percent (%) of MHI    Percent (%) of MHI Greater    Points Awarded
  Less Than:            Than or Equal To:             

                        75                            0

  75                    70                            5

  70                    65                            10

  65                    60                            15

  60                    55                            20

  55                    50                            25

  50                                                  30
  --------------------- ----------------------------- -------------------

**For example, a project proposes to serve the town of Belle Haven,
Virginia. In accordance with U.S. Bureau of the Census statistics, the
town of Belle Haven, Virginia has a MHI of \$33,500. The state of
Virginia has a SMHI of \$46,677. Belle Haven as a percentage of the
state of Virginia's MHI is 72%, eligible to receive 5 points (33,500 ÷
46,677 = .717 or 72%) as follows:**

**U.S. Bureau of the Census**

+----------------+-----------------+-----------------+-----------------+
| **Service Area | **(a)**         | **(b)**         | **(a) ÷ (b)**   |
| Community or   |                 |                 |                 |
| County**       | **Belle Haven   | **(VA)MHI in    | **MHI as % of   |
|                | town MHI in     | Dollars**       | (VA)MHI**       |
|                | Dollars**       |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| Belle Haven    | \$33,500        | \$46,677        | 72%             |
| town, Virginia |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+

**Now, here is an example of a community that can not be located in the
U.S. Bureau of the Census. The community of Ransomville has been located
by a 2008 Rand McNally Atlas. Ransomville is located in the County of
Beaufort, North Carolina. In accordance with U.S. Bureau of the Census,
the County of Beaufort, North Carolina has a MHI of \$31,066. The state
of North Carolina has a SMHI of \$39,184. Beaufort County as a
percentage of the state of North Carolina's MHI is eligible to receive 0
points (31,066 ÷ 39,184 = .792 or 79%) as follows:**

**Rand McNally Atlas**

+----------------+-----------------+-----------------+-----------------+
| **Service Area | **(a)**         | **(b)**         | **(a) ÷ (b)**   |
| Community or   |                 |                 |                 |
| County**       | **Beaufort      | **(NC)MHI in    | **MHI as % of   |
|                | County MHI in   | Dollars**       | (NC)MHI**       |
|                | Dollars**       |                 |                 |
+----------------+-----------------+-----------------+-----------------+
| Ransomville    | \$31,066        | \$39,184        | 79%             |
|                |                 |                 |                 |
| County of      |                 |                 |                 |
| Beaufort,      |                 |                 |                 |
| North Carolina |                 |                 |                 |
+----------------+-----------------+-----------------+-----------------+

Instructions for Native American Indian Reservations: If the eligible
community is an Indian Reservation (per explanation on page 6), follow
these instructions for determining the correct median household income.

1.  Go to [http://factfinder.census.gov](http://factfinder.census.gov/)

2.  Scroll down the web page to find the \"Special Interest\" heading on
    the right and click on \"American Indian and Alaska Native\"

3.  Under the \"Census 2000\" heading, click on \"Fast access to popular
    data\"

4.  Select the state where the reservation is located and type an
    asterisk \"\*\" in the box

5.  Select your reservation from the list

6.  Scroll down to page with the heading \"Profile of Selected Economic
    Characteristics\" (usually page 3 of the fact sheet) and locate the
    median household income (dollars) - usually on the lower right of
    the table. Use that figure to calculate the community\'s MHI as a
    percentage of the state using Attachment 4 of this guide

***3. Benefits derived from the proposed service (up to 30 points):***

The "benefits derived from the proposed service area" is a subjective
scoring category for which applicants may receive up to 30 points. This
criterion will be scored based on the documentation in support of the
need for services, benefits derived from the services proposed by the
project, and local community involvement in planning and implementing
the project.

Rural Development Utilities Programs will consider:

1.  The extent of the applicant's documentation explaining the economic,
    educational, health care, and public safety issues and challenges
    facing the community and the applicant's proposed plan to address
    these challenges on a community-oriented basis;

2.  The extent of the project's planning, development, and support by
    local residents,

> institutions, and community facilities. This includes evidence of\
> community-oriented involvement, as exemplified in community meetings,
> public forums, and surveys. In addition, applicants should provide
> evidence of local residents' participation in the project planning and
> development;

3.  The extent to which the community center will be used for
    educational or instructional purposes; and

4.  Web-based community resources enabled or provided by the applicant,
    such as community bulletin boards, directories, public web-hosting,
    notices, etc.

In addressing this scoring criterion, applicants must describe the
unique circumstances involving their proposed project and how they
propose to utilize Federal financing provided from this program in
conjunction with any other resources to meet their community's needs.
When addressing this criterion, applicants should specifically discuss
all aspects of the application that contribute to the scoring criterion.

Applicants should attempt to quantify benefits in terms of outcomes from
the project; that is, ways in which peoples' lives, or the community,
will be improved. Try to provide estimates of the number of people
affected by the benefits arising from the project.

Use as many pages as is necessary to address the subjective criterion.

**D. System Design**

The system design must contain the following information:

1.  A narrative discussing the proposed community center and all costs
    of the project, all existing and proposed facilities that are a part
    of the project, the services to be provided by the project, and the
    proposed service area;

2.  Engineering design studies providing an economical and practical
    engineering design of the project, including a detailed description
    of the facilities to be funded, technical specifications, data
    rates, and costs; and

3.  A map of the proposed service area reflecting the proposed location
    of the community center and critical community facilities.

**E. A Scope of Work**

The scope of work must include, at a minimum:

1.  The specific activities and services to be performed under the
    project;

2.  Who will carry out the activities and services;

3.  The time-frames for accomplishing the project objectives and
    activities; and

4.  A budget for all capital and operating expenditures reflecting the
    line item costs for eligible purposes for the grant funds, the
    matching contributions, and other sources of funds necessary to
    complete the project.

> **A sample budget has been provided on the following page. A fill in
> the blank budget sheet has been provided in the Application Guide as
> Attachment 6. We strongly recommend you use the budget provided. A
> brief description of each of the seven categories is supplied on the
> sample budget sheet to assist you in determining which items should
> fall under each category. We encourage you to delete this information
> and input your specific line items once you have determined your
> budget.**
>
> **It is important that the total matching and grant funds requested
> listed on the budget equal the total of those amounts listed on the SF
> 424.**

+---------------------------+---------+--------+----------------------+
| **BUDGET ITEM**           | **E     |        | **Remarks**          |
|                           | STIMATE |        |                      |
|                           | OF      |        |                      |
|                           | COSTS** |        |                      |
+---------------------------+---------+--------+----------------------+
|                           | **      | > **G  |                      |
|                           | Match** | rant** |                      |
+---------------------------+---------+--------+----------------------+
| **[NETWORK & ACCESS       |         |        |                      |
| EQUIPMENT]{.underline}**  |         |        |                      |
+---------------------------+---------+--------+----------------------+
| Base Station              |         | 10,000 |                      |
+---------------------------+---------+--------+----------------------+
| CPE                       |         | 5,000  |                      |
+---------------------------+---------+--------+----------------------+
| Router(s)                 |         | 1,000  |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Network & Access  | **-**   | **16   |                      |
| Equipment**               |         | ,000** |                      |
+---------------------------+---------+--------+----------------------+
| **[OUTSIDE                |         |        |                      |
| PLANT]{.underline}**      |         |        |                      |
+---------------------------+---------+--------+----------------------+
| Generally N/A for         |         |        |                      |
| Wireless                  |         |        |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Outside Plant**   | \-      | \-     |                      |
+---------------------------+---------+--------+----------------------+
| **                        |         |        | \$800 at 24 months   |
| [BUILDINGS]{.underline}** |         |        |                      |
+---------------------------+---------+--------+----------------------+
| Community Center Rent     | 19,200  |        |                      |
+---------------------------+---------+--------+----------------------+
| Renovations               | 10,000  |        |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Buildings**       | **2     | \-     |                      |
|                           | 9,200** |        |                      |
+---------------------------+---------+--------+----------------------+
| **[LAND]{.underline}**    |         |        |                      |
+---------------------------+---------+--------+----------------------+
| Land for Tower            | 3,500   |        |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Land**            | **      | \-     |                      |
|                           | 3,500** |        |                      |
+---------------------------+---------+--------+----------------------+
| **[TOWERS]{.underline}**  |         |        |                      |
+---------------------------+---------+--------+----------------------+
| Cost of Tower             |         | 50,000 |                      |
| Construction              |         |        |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Towers**          | **-**   | **50   |                      |
|                           |         | ,000** |                      |
+---------------------------+---------+--------+----------------------+
| **[OPERATING              |         |        | Community Paying     |
| EXPENSES]{.underline}**   |         |        | first year of Salary |
|                           |         |        | Grant funds Paying   |
|                           |         |        | Second year          |
|                           |         |        |                      |
|                           |         |        | Two year Salary      |
|                           |         |        |                      |
|                           |         |        | Two years of         |
|                           |         |        | Bandwidth            |
|                           |         |        |                      |
|                           |         |        | \*\*\*Note grant and |
|                           |         |        | match funds must not |
|                           |         |        | exceed the           |
|                           |         |        | limitations          |
|                           |         |        | set\*\*\*            |
+---------------------------+---------+--------+----------------------+
| Community Center          | 25,000  | 25,000 |                      |
| Personnel                 |         |        |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| Technician Salary         |         | 60,000 |                      |
+---------------------------+---------+--------+----------------------+
| Bandwidth                 |         | 25,000 |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Operating         | **2     | **110  |                      |
| Expenses**                | 5,000** | ,000** |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **[OPERATING              |         |        | 10 Computers and     |
| EQUIPMENT]{.underline}**  |         |        | Printers             |
|                           |         |        |                      |
|                           |         |        | 10 workstations      |
+---------------------------+---------+--------+----------------------+
| Computers                 |         | 15,000 |                      |
+---------------------------+---------+--------+----------------------+
| Office Furniture          |         | 10,000 |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **[Total Operating        | **-**   | **25   |                      |
| Equipment]{.underline}**  |         | ,000** |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **SUMMARY OF BUDGET       | **E     |        |                      |
| CATEGORIES**              | STIMATE |        |                      |
|                           | OF      |        |                      |
|                           | COSTS** |        |                      |
+---------------------------+---------+--------+----------------------+
|                           | **      | **G    |                      |
|                           | Match** | rant** |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        | \*\*\*Remember match |
|                           |         |        | must be 15% or more  |
|                           |         |        | of the grant funds   |
|                           |         |        | requested! If you    |
|                           |         |        | have questions call  |
|                           |         |        | our office\*\*\*     |
+---------------------------+---------+--------+----------------------+
| NETWORK & ACCESS          | \-      | 16,000 |                      |
| EQUIPMENT                 |         |        |                      |
+---------------------------+---------+--------+----------------------+
| OUTSIDE PLANT             | \-      | \-     |                      |
+---------------------------+---------+--------+----------------------+
| BUILDINGS                 | 29,200  | \-     |                      |
+---------------------------+---------+--------+----------------------+
| LAND                      | 3,500   | \-     |                      |
+---------------------------+---------+--------+----------------------+
| TOWERS                    | \-      | 50,000 |                      |
+---------------------------+---------+--------+----------------------+
| OPERATING EXPENSES        | 25,000  | 1      |                      |
|                           |         | 10,000 |                      |
+---------------------------+---------+--------+----------------------+
| OPERATING EQUIPMENT       | \-      | 25,000 |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| TOTAL                     |         |        |                      |
+---------------------------+---------+--------+----------------------+
|                           | 57,700  | 2      |                      |
|                           |         | 01,000 |                      |
+---------------------------+---------+--------+----------------------+

**F. Community-Oriented Connectivity Plan**

The provision of broadband service is vital to the economic development,
education, health, and safety of rural Americans. To further this
objective, Rural Development Utilities Programs will provide financial
assistance to eligible entities that propose, on a "community-oriented
connectivity" basis, to provide broadband service that fosters economic
growth and delivers enhanced educational, health care, and public safety
services. The "community-oriented connectivity" concept integrates the
deployment of broadband infrastructure with the practical, everyday uses
and applications of the facilities.

Specifically, Rural Development Utilities Programs will provide
financial assistance to eligible entities that are proposing to deploy
broadband transmission service in a rural community where such service
does not currently exist; who will connect the critical community
facilities including the local schools, libraries, hospitals, police,
fire and rescue services; and who will operate a community center that
provides free and open access to residents. A state-of-the-art community
center will not only provide improved access but will aid rural
residents in developing on-line businesses and will allow them to reap
the benefits of Internet-based advanced placement courses, and
continuing adult education. Priority will be given to rural areas that
have the greatest need for broadband services. The applicant must
provide a community-oriented connectivity plan consisting of the
following:

1.  A listing of all critical community facilities located in the
    service area, including public schools, public libraries, public
    medical clinics, public hospitals, community colleges, public
    universities, law enforcement, and fire and ambulance stations. The
    applicant must provide documentation of consultation with these
    groups, including commitments to participate in the proposed
    project;

2.  A description of the services available to local residents through
    the use of the community center;

3.  A listing of the proposed telecommunications terminal equipment,
    telecommunications transmission facilities, data terminal equipment,
    interactive video equipment, computer hardware and software systems,
    and components that process data for transmission via
    telecommunications, computer network components, communication
    satellite ground station equipment, or any other elements of the
    telecommunications system designed to further the deployment and use
    of broadband services, that the applicant intends to build or fund
    using Rural Development Utilities Programs grant funds and matching
    contributions; and

4.  A description of the consultations with the appropriate
    telecommunications carriers (including inter-exchange carriers,
    cable television operators, enhanced service providers, providers of
    satellite services, and telecommunication equipment manufacturers
    and distributors) and the anticipated role of such providers in the
    proposed telecommunications system.

**G. Financial Information and Sustainability**

The applicant must provide a narrative description demonstrating
sustainability of the project, including having sufficient resources and
expertise necessary to undertake and complete the project and how the
project will be sustained following completion. The following financial
information is required:

1.  Certified financial statements, if available; otherwise, the most
    current income statement and balance sheet for existing operations;
    and

2.  5 years of pro-forma financial information for the project, or for
    the applicant taking into consideration the conclusion of the
    project, including income statements, balance sheets, cash flow
    statements. Applicants must include sufficient pro-forma financial
    data to demonstrate the financial capability of the project
    participants to continue a sustainable project for a minimum of 5
    years after completion of the project.

This documentation should include non-contingent sources of income or
revenues that are sufficient to pay all operating expenses including
system maintenance, salaries, training, and any other general operating
expenses, and provide for replacement of depreciable items. Applicants
must also include depreciation rates, based upon current industry
standards, for the equipment being financed. All assumptions in support
of the pro-forma must be clearly identified.

> **A sample Income Statement has been provided below. A fill in the
> blank Income Statement has been provided in the Application Guide as
> Attachment 5. We strongly recommend you use the Income Statement
> provided.**

  ----------------------- ------------ -------------- ---------- ---------- ----------
  **Income Statement**    Grantee\'s   ** Broadband                         
                          Name:        Company**                            

                                                                            

                          City, State: ** Rural Town,                       
                                       USA**                                

                                                                            

                          **Year 1**   **Year 2**     **Year 3** **Year 4** **Year 5**

  **Revenues**                                                              

  Data Revenues           \$ 30,000    \$ 33,000      \$ 36,000  \$ 39,000  \$ 42,000

  Installation Revenues   \$ 3,750     \$ 375         \$ 375     \$ 375     \$ 375

  Other Revenues          \$ 1,000     \$ 1,100       \$ 1,210   \$ 1,331   \$ 1,464

  Uncollectible Revenues  \$ 500       \$ 500         \$ 500     \$ 500     \$ 500

                                                                             

  **Total Revenues**      **\$         **\$ 33,975**  **\$       **\$       **\$
                          34,250**                    37,085**   40,206**   43,339**

                                                                             

  **Expenses**                                                               

  Cost of Sales           \$ 4,000     \$ 4,400       \$ 4,840   \$ 5,324   \$ 5,856

  Selling, General, and   \$ 6,000     \$ 6,600       \$ 6,930   \$ 7,277   \$ 7,640
  Administrative                                                            

  Salaries                \$ 22,000    \$ 22,000      \$ 22,000  \$ 22,000  \$ 22,000

  Community Center        \$ 1,800     \$ 1,800       \$ 1,800   \$ 1,800   \$ 1,800

  Other Operating Expense \$ 500       \$ 500         \$ 500     \$ 500     \$ 500

                                                                             

  **Total Operating       **\$         **\$ 35,300**  **\$       **\$       **\$
  Expenses**              34,300**                    36,070**   36,901**   37,797**

  **Net Income (Loss)**   **\$ (50)**  **\$ (1,325)** **\$       **\$       **\$
                                                      1,015**    3,306**    5,542**
  ----------------------- ------------ -------------- ---------- ---------- ----------

**H. A Statement of Experience**

An applicant must provide a written narrative describing its
demonstrated capability and experience, if any, in operating a
telecommunications system, or any project similar to the

proposed project. The applicant must include the owner's and principal
employees' relevant work experience that would ensure the success of the
project.

**I. Evidence of Legal Authority and Existence**

The applicant must provide evidence of its legal existence and authority
to enter into a grant agreement with the Rural Development Utilities
Programs and perform the activities proposed under the grant
application.

Satisfactory documentation of legal authority includes, but is not
limited to: articles of incorporation, bylaws, board resolutions,
excerpts from state statutes, or an attorney's opinion of counsel.

Satisfactory documentation of legal existence includes, but is not
limited to, certificates from the Secretary of State, state statutes or
laws establishing your organization. Letters from the IRS awarding
tax-exempt status are not considered adequate evidence.

**J. Funding Commitments from Other Sources**

If the project requires additional funding from other sources in
addition to the Rural Development Utilities Programs grant, the
applicant must provide evidence that funding agreements have been
obtained to ensure completion of the project. These agreements shall be
sufficient to ensure:

1.  Payment of all proposed expenditures for the project;

2.  All required matching contributions;

3.  Any additional matching funding; and

4.  Any other funds necessary to complete the project.

A letter from the organization providing the matching funds or in-kind
contributions is an example of the evidence required. In the case of
in-kind contributions of equipment, the letter should include a
description of the items, value, and date purchased. For donations of
space for the community center, the letter should include the dimensions
of the space and a calculation of the value of the foregone rental
income, and a commitment to provide the space for a minimum of two (2)
years. For donations of space, evidence of the value of the donation is
required. For operating and administrative expenses of the community
center, the letter should include detailed calculations of the
individual expense line items used to determine the value.

**K. Compliance with Other Federal Statutes and Regulations**

The applicant is required to submit evidence that it is in compliance
with other Federal statutes and regulations as follows:

-   E.O. 11246, Equal Employment Opportunity, as amended by E.O. 11375
    and as supplemented by regulations contained in 41 CFR part 60,
    Attachment 4;

-   Architectural barriers, Attachment 5;

-   Flood hazard area precautions, Attachment 6;

-   Assistance and Real Property Acquisition Policies Act of 1970,
    Attachment 7;

-   Drug-Free Workplace Act of 1998 (41 U.S.C. 701), Attachment 8;

-   E.O.s 12549 and 12689, Debarment and Suspension; **(See 7 CFR
    3017.510)**, Attachment 9;

-   Byrd Anti-Lobbying Amendment (31 U.S.C. 1352), Attachment 10;

```{=html}
<!-- -->
```
-   If the applicant is engaged in lobbying activities, the applicant
    must submit a completed disclosure form, "Disclosure of Lobbying
    Activities" **(See 7 CFR Part 3018)**";

```{=html}
<!-- -->
```
-   Non Duplication of Services Certificate, Attachment 11;

-   Federal Obligations Certification on Delinquent Debt, Attachment 12;
    and

-   Environmental Impact Report, in accordance with 7 CFR 1794,
    Attachment 13 (see further information below).

    ***Environmental Impact and Historic Preservation:***

> *Details of the project's impact on the environment and historic
> preservation must be provided. The application must contain a separate
> section entitled "Environmental Impact of the Project."*
>
> *An "Environmental Questionnaire/Certification" may be used by
> applicants to assist in complying with the requirements of this
> section. Attachment 13.*
>
> ***For a proposed project that only involves internal modifications or
> equipment additions to buildings or other structures,** the
> environmental information normally required includes a description of
> the internal modifications or equipment additions, the size of the
> site in hectares, and the general nature of the proposed use of the
> facilities once the project is completed, including any hazardous
> materials to be used, created or discharged, any substantial amount of
> air emissions, wastewater discharge, or solid waste that will be
> generated.*

**Putting It All Together**

The GRANT application should be **assembled** and **tabbed** in the
following order listed below. Material not located under the proper tab
will not be considered by reviewers. If material is relevant under more
than one tab, it should be repeated under each relevant tab. Any
supplemental information that the applicant wants to submit should be
included under the relevant tab. Numbered attachments are provided at
the end of this guide for your use. Use only the applicable attachments
listed below.

A.  An Application for Federal Assistance: Completed Standard Form 424,
    Attachment 1

B.  An Executive Summary of the Project

C.  Scoring Criteria Documentation

    1.  Rurality Calculation Table, Attachment 2

    2.  Economic Need Calculation Worksheet, Attachment 3

    3.  The Benefits Derived from Services

D.  System Design

E.  Scope of Work

F.  Community-Oriented Connectivity Plan

G.  Financial Information and Sustainability

    1.  Certified Financial Statements, if available

    2.  Pro-Forma Financial Statements

```{=html}
<!-- -->
```
H.  Statement of Experience

I.  Evidence of Legal Existence & Legal Authority to Contract with the
    Government

J.  Evidence of Funding Commitments from all sources, if applicable

K.  Compliance with Other Federal Statutes and Regulations

    1.  Equal Opportunity and Nondiscrimination Certification,
        Attachment 4

    2.  Certificate Regarding Architectural Barriers, Attachment 5

    3.  Certificate Regarding Flood Hazard Area Precautions, Attachment
        6

    4.  Uniform Relocation Assistance and Real Property Acquisition
        Policies Act of 1970 Certification, Attachment 7

    5.  Certification Regarding Drug-Free Workplace Requirements,
        Alternative I -- For Grantees Other than Individuals, Attachment
        8

    6.  Certification Regarding Debarment and Suspension, and Other
        Responsibility Matters -- Primary Covered Transactions,
        Attachment 9

    7.  Certification Regarding Lobbying for Contracts, Grants, Loans,
        and Cooperative Agreements, Attachment 10

        -   If the applicant is engaged in lobbying activities, the
            applicant must submit a completed disclosure form,
            "Disclosure of Lobbying Activities" **(See 7 CFR Part
            3018)**"

    8.  Non Duplication of Services Certificate, Attachment 11

    9.  Federal Obligations Certification on Delinquent Debt, Attachment
        12

    10. Environmental Questionnaire/Certification, Attachment 13

*Sample certificates and forms are included at the end of this
application for your use*

**DEPARTMENT OF AGRICULTURE**

**Rural Utilities Service**

**7 CFR Part 1739**

**RIN 0572--AC09**

**Community Connect Broadband Grant**

**Program**

**AGENCY:** Rural Utilities Service, USDA.

**ACTION:** Direct final rule.

**SUMMARY:** The Rural Utilities Service, an agency delivering the
United States Department of Agriculture (USDA) Rural Development
Utilities Program, hereinafter referred to as Rural Development and/or
the Agency, amends its regulations for the

Community-Oriented Connectivity Broadband Grant Program (Community
Connect Grant Program). Since the inception of the Community Connect
Grant Program, the Agency has faced the challenge of identifying
eligible rural communities. The Agency has reviewed its method of
identifying eligible communities and has determined that modifications
to the program regulations are required in order to expand the resource
material used to identify eligible communities. The use of additional
resources should increase the number of communities eligible for grant
funding. Additionally, the Agency has changed the test for economic
hardship. The current regulations compare an applicant community's per
capita personal income to the national per capita personal income.
Because of the varying costs of living among the states, it was
determined that a better measure of economic distress would be a
comparison of the applicant community's median household income to that
of its state. This change is also expected to increase the number of
eligible grant applicants. Lastly, this rule amends the current
regulations by specifying operating expenses which the Agency has
approved for grant funding. These changes have been determined to be non
controversial and are being enacted as a direct final rule. This rule is
not applicable to Community Connect grant applications filed for funding
during fiscal year 2007.

**DATES:** *Effective Date:* This rule is effective September 17, 2007,
without further action, unless the Agency receives adverse comments
within September 4, 2007. If adverse comments are received, the Agency
will publish a timely **Federal Register** document withdrawing this
rule. *Comment Due* *Date:* Comments must be received on or before
September 4, 2007.

**ADDRESSES:** Submit comments by either of the following methods:

• *Federal eRulemaking Portal:* Go to *http://www.regulations.gov* and,
in the lower ''Search Regulations and Federal Actions'' box, select
''Rural Utilities Service'' from the agency drop-down menu, then click
on ''Submit.'' In the Docket ID column, select RUS--07--Telecom--0008 to
submit or view public comments and to view supporting and related
materials available electronically. Information on using
Regulations.gov, including instructions for accessing documents,
submitting comments, and viewing the docket after the close of the
comment period, is available through the site's ''User Tips'' link.

• *Postal Mail/Commercial Delivery:* Please send your comment addressed
to Michele Brooks, Acting Deputy Director, Program Development and
Regulatory Analysis, USDA Rural Development, STOP 1522, Room 5159, 1400
Independence Avenue, Washington, DC 20250--1522. Please state that your
comment refers to Docket No. RUS--07-Telecom--0008. Other Information:
Additional information about Rural Development and its programs is
available at *http://www.rurdev.usda.gov/index.html.*

**FOR FURTHER INFORMATION CONTACT:**

Kenneth Kuchno, Director, Broadband

Division, USDA Rural Development

Utilities Program, STOP 1599, 1400

Independence Avenue, SW.,

Washington, DC 20250--1599,

Telephone (202) 690--4673, Facsimile

\(202\) 690--4389. E-mail address:

*kenneth.kuchno@usda.gov.*

**SUPPLEMENTARY INFORMATION:**

**Executive Order 12866**

This final rule has been determined to be not significant for purposes
of Executive Order 12866, and therefore has not been reviewed by the
Office of Management and Budget (OMB).

**Catalog of Federal Domestic Assistance** The Catalog of Federal
Domestic Assistance (CFDA) Program number assigned to the Community
Connect Grant Program is 10.863. The Catalog is available on a
subscription basis from the Superintendent of Documents, the United
States Government Printing Office, Washington, DC 20402--9325; telephone
(202) 512--1800.

**Executive Order 12372**

This program is not subject to the requirements of Executive Order
12372, ''Intergovernmental Review of Federal Programs,'' as implemented
under USDA's regulations at 7 CFR part 3015.

**Executive Order 12988**

This rule has been reviewed under Executive Order 12988, Civil Justice
Reform. The Agency has determined that this rule meets the applicable
standards provided in section 3 of the Executive Order. In addition, all
state and local laws and regulations that are in conflict with this rule
will be preempted, no retroactive effect will be given to this rule,
and, in accordance with Sec 212(e) of the Department of Agriculture
Reorganization Act of 1994 (7 U.S.C. 6912(e)), administrative appeal
procedures, if any, must be exhausted before an action against the
Department or its agencies may be initiated.

**Executive Order 13132, Federalism**

The policies contained in this rule do not have any substantial direct
effect on states, on the relationship between the national government
and the states, or on the distribution of power and responsibilities
among the various levels of government. Nor does this final rule impose
substantial direct compliance costs on state and local governments.
Therefore, consultation with states is not required.

**Regulatory Flexibility Certification**

Pursuant to 5 U.S.C. 553(a)(2), this final rule related to grants is
exempt from the rulemaking requirements of the Administrative Procedure
Act (5 U.S.C. 551 *et seq.*), including the requirement to provide prior
notice and an opportunity for public comment. Because this final rule is
not subject to a requirement to provide prior notice and an opportunity
for public comment pursuant to 5 U.S.C. 553, or any other law, the
analytical requirements of the Regulatory Flexibility Act (5 U.S.C. 601
*et seq.*) are inapplicable.

**Unfunded Mandates**

This final rule contains no Federal mandates (under the regulatory
provision of Title II of the Unfunded Mandates Reform Act of 1995) for
State, local, and tribal governments or the private sector. Therefore,
this final rule is not subject to the requirements of sections 202 and
205 of the Unfunded Mandates Reform Act of 1995.

**Environmental Impact Statement**

This final rule has been examined under Agency environmental regulations
at 7 CFR part 1794. The Administrator has determined that this action is
not a major Federal action significantly affecting the environment.
Therefore, in accordance with the National Environmental Policy Act of
1969 (42 U.S.C. 4321 *et seq.*), an Environmental Impact Statement or
Assessment is not required.

**Information Collection and Recordkeeping Requirements**

This rule contains no new reporting or recordkeeping burdens under OMB
control number 0572--0127 that would require approval under the
Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35).

**Background**

*Overview*

The USDA Rural Development Utilities Programs (the Agency) improve the
quality of life in rural America by providing investment capital, in the
form of loans and grants, for the deployment of rural telecommunications
infrastructure. Financial assistance is provided to rural utilities;
municipalities; commercial corporations; limited liability companies;
public utility districts; Indian tribes; and cooperative, nonprofit,
limited dividend, or mutual associations. In order to achieve the goal
of increasing economic opportunity in rural America, the Agency finances
infrastructure that enables access to a seamless, nation-wide
telecommunications network. With access to the same advanced
telecommunications networks of its urban counterparts, especially
broadband networks designed to accommodate distance learning, telework
and telemedicine, rural America will see improving educational
opportunities, health care, economies, safety and security, and
ultimately higher employment. Of particular concern to the Agency are
communities where broadband service is not available and where
population densities are such that the cost of deployment to them is
high and buildout of infrastructure is unlikely. The Agency is committed
to ensuring rural communities will have access to affordable, reliable,
advanced communications services, comparable to those available
throughout the rest of the United States, to provide a healthy, safe and
prosperous place to live and work. The Community Connect Grant Program
was started as a Pilot Program with the Fiscal Year 2002 budget and has
been funded ever since through the appropriations process. After
administering the program as a pilot program for two years, the Agency
proposed rules for the program, and on July 28, 2004, the current rules
were published, and the program was formally implemented. Since then
more than 670 requests for grant funds totaling over \$410 million were
requested through Fiscal Year 2006. Of those requests, 129 were granted
for \$57 million to bring broadband service to 129 communities in 26
states and Puerto Rico. While the Agency is proud of the results
achieved in the Community Connect Grant Program thus far, it believes
that the overall effectiveness of the program can be improved by
modifying the existing rules. Through these changes, the Agency is
increasing eligibility criteria to include communities that clearly meet
the intent of the program. Specifically, this rule will: (1) Add the
Rand McNally Atlas as a community locator; (2) change the income measure
for eligibility from a national comparison to a state comparison; and
(3) clarify the items that are eligible to be considered as operating
expenses.

*Discussion of Changes*

1\. Adding the Rand McNally Atlas as a community locator. Currently the
regulation states that a project must serve an incorporated or
unincorporated town, village, or borough recognized in the latest
decennial census of the Bureau of the Census to be eligible for funding.
While this program has been successful in reaching much of rural
America, the Agency recognizes that areas not identified in the 2000
census are excluded from funding. It is advisable to add another
resource, updated more frequently than the decennial census and
including communities not found in the census, to identify rural
communities. The Agency therefore adds the Rand McNally Atlas as a
resource to identify rural communities. It is anticipated that the
addition of the Rand McNally Atlas as a community locator will increase
the number of communities eligible for funding.

2\. Change the income measure from a national comparison to a state
comparison. Rural communities that would otherwise be eligible for grant
funding have been previously excluded because their per capita personal
income is relatively high in comparison to the national average.
However, using the communities median household income compared to their
state's median household income, these communities would qualify as
economically challenged. Given the variable cost of living among the
states, the comparison of state statistics is a better indicator of
economic distress. The intent of this program is to allow all rural
communities without broadband service facing economic hardship to fairly
compete for funding. By comparing a community's median household income
to their state's median household income, all rural economically
challenged communities may compete fairly for funding.

3\. Clarify the items that are eligible to be considered as operating
expenses. Currently the regulation states that operating expenses
incurred in providing broadband transmission service to critical
facilities is an eligible purpose and that the salaries and
administrative costs associated with these expenses may be limited by
the Agency. Through the course of this program, applicants have not
clearly understood what operating expenses are eligible. Many applicants
have requested funds for ineligible operating expenses and had to be
eliminated from the grant competition. To assist the applicant with
better understanding what operating expenses are considered eligible,
the Agency is specifically defining the eligible operating expenses.
Other corresponding changes were made throughout the regulation to
reflect the addition of the Rand McNally Atlas and the change to state
income measures.

**List of Subjects in 7 CFR 1739**

Broadband, Grant programs --- Communications, Rural Areas,
Telecommunications, and Telephone.

For reasons set forth in the preamble, the Rural Utilities Service
amends Chapter XVII of title 7 of the Code of Federal Regulations by
revising part 1739 as follows:

**PART 1739---BROADBAND GRANT**

**PROGRAM**

**Subpart A---Community Connect Grant**

**Program**

Sec.

1739.1 Purpose.

1739.2 Funding availability and application dates and addresses.

1739.3 Definitions.

1739.4--1739.9 \[Reserved\]

1739.10 Eligible applicant.

1739.11 Eligible project.

1739.12 Eligible grant purposes.

1739.13 Ineligible grant purposes.

1739.14 Matching contributions.

1739.15 Completed application.

1739.16 Review of grant applications.

1739.17 Scoring of applications.

1739.18 Grant documents.

1739.19 Reporting and oversight requirements.

1739.20 Audit requirements.

1739.21 OMB control number.

**Subpart B---\[Reserved\]**

**Authority:** Title III, Pub. L. 108--199, 118 Stat. 3.

**Subpart A---Community Connect Grant Program**

**§ 1739.1 Purpose.**

\(a\) The provision of broadband transmission service is vital to the
economic development, education, health, and safety of rural Americans.
The purpose of the Community Connect Grant Program is to provide
financial assistance in the form of grants to eligible applicants that
will provide, on a ''community-oriented connectivity'' basis, broadband
transmission service that fosters economic growth and delivers enhanced
educational, health care, and public safety services. The Agency will
give priority to rural areas that it believes have the greatest need for
broadband transmission services, based on the criteria contained herein.
(b) Grant authority will be used for the deployment of broadband
transmission service to extremely rural, lower-income communities on a
''community-oriented connectivity'' basis. The ''community-oriented
connectivity'' concept will stimulate practical, everyday uses and
applications of broadband by cultivating the deployment of new broadband
transmission services that improve economic development and provide
enhanced educational and health care opportunities in rural areas. Such
an approach will also give rural communities the opportunity to benefit
from the advanced technologies that are necessary to achieve these
goals.

**§ 1739.2 Funding availability and application dates and submission.**

\(a\) The Agency will publish, annually in the **Federal Register**, a
Notice of Funds Availability (hereinafter ''NOFA'') that will set forth
the total amount of funding available; the maximum and minimum funding
for each grant; the application submission dates; and the appropriate
addresses and agency contact information. The NOFA will also outline and
explain the procedures for submission of applications, including
electronic submissions. The Agency may publish more than one NOFA should
additional funding become available.

\(b\) Notwithstanding paragraph (a) of this section, the Agency may, in
response to a surplus of qualified eligible applications which could not
be funded from the previous fiscal year, decline to publish a NOFA for
the following fiscal year and fund said applications without further
public notice.

**§ 1739.3 Definitions.**

As used in this subpart:

*Agency* shall mean the Rural Utilities Service, which administers the
United States Department of Agriculture (USDA) Rural Development
Utilities Programs.

*Bandwidth* means the capacity of the radio frequency band or physical
facility

needed to carry the Broadband Transmission Service.

*Basic Broadband Transmission Service* means the broadband transmission
service level provided by the applicant at the lowest rate or service
package level for residential or business customers, as appropriate,
provided that such service meets the requirements of this part.

*Broadband Transmission Service* means providing an information-rate
equivalent to at least 200 kilobits/ second in the consumer's connection
to the network, both from the provider to the consumer (downstream) and
from the consumer to the provider (upstream).

*Community* means any incorporated or unincorporated town, village, or
borough recognized in the latest decennial census as published by the
Bureau of the Census or in the most recent edition of a Rand McNally
Atlas that is located in a Rural Area. *Community Center* means a public
building, or a section of a public building with at least ten (10)
Computer Access Points, that is used for the purposes of providing free
access to and/or instruction in the use of broadband Internet service,
and is of the appropriate size to accommodate this purpose. The
community center must be open and accessible to area residents before,
during, and after normal working hours and on Saturday or Sunday.

*Computer Access Point* means a new computer terminal with access to
Basic Broadband Transmission Service.

*Critical Community Facilities* means the Community Center and every
public school or education center, public library, public medical
clinic, public hospital, community college, public university, or law
enforcement, fire and ambulance stations in the proposed Service Area.

*Eligible Applicant* shall have the meaning as set forth in § 1739.10.

*Eligible Grant Purposes* shall have the meaning as set forth in §
1739.12.

*End-User Equipment* means computer hardware and software, audio or
video equipment, computer network components, telecommunications
terminal equipment, inside wiring, interactive video equipment, or other
facilities required for the provision and use of Broadband Transmission
Service.

*Matching Contribution* means the applicant's qualified contribution to
the Project, as outlined in § 1739.14 of this part.

*Project* means the applicant's proposed Basic Broadband Transmission
Service financed by the grant and Matching Contribution for the proposed
Service Area.

*Rural Area* means any area, as verified by the latest decennial census
of the Bureau of the Census or the latest edition of the Rand McNally
Atlas, which is not located within the boundaries of any incorporated or
unincorporated city, village, or borough having a population in excess
of 20,000 inhabitants.

*Service Area* means a single Community, and may include the
unincorporated areas located outside and contiguous to the Community's
boundaries, in which the applicant proposes to provide Broadband
Transmission Service.

*Spectrum* means a defined band of frequencies that will accommodate the
Broadband Transmission Service.

*Telecommunications Terminal Equipment* means the assembly of
telecommunications equipment at the end of a circuit or path of a
signal, including but not limited to facilities that receive or transmit
over-the-air broadcast, satellite, and microwave, normally located on
the premises of the end user, that interfaces with telecommunications
transmission facilities, and that is used to modify, convert, encode, or
otherwise prepare signals to be transmitted via such telecommunications
facilities, or that is used to modify, reconvert, or carry signals
received from such facilities, the purpose of which is to accomplish the
goal for which the circuit or signal was established.

**§§ 1739.4--1739.9 \[Reserved\].**

**§ 1739.10 Eligible applicant.**

To be eligible for a grant, the applicant must:

\(a\) Be legally organized as an incorporated organization, an Indian
tribe or tribal organization, as defined in *25 U.S.C. 450b (b) and
(c),* a state or local unit of government, or other legal entity,
including cooperatives or private corporations or limited liability
companies organized on a for-profit or not-for-profit basis.

\(b\) Have the legal capacity and authority to own and operate the
broadband facilities as proposed in its application, to enter into
contracts and to otherwise comply with applicable federal statutes and
regulations.

**§ 1739.11 Eligible project.**

To be eligible for a grant, the Project must:

\(a\) Serve a Rural Area where Broadband Transmission Service does not
currently exist, to be verified by the Agency prior to the award of the
grant;

\(b\) Serve one Community recognized in the latest U.S. Census or the
latest edition of the Rand McNally Atlas;

\(c\) Deploy Basic Broadband Transmission Service, free of all charges
for at least 2 years, to all Critical Community Facilities located
within the proposed Service Area;

\(d\) Offer Basic Broadband Transmission Service to residential and
business customers within the proposed Service Area; and

\(e\) Provide a Community Center with at least ten (10) Computer Access
Points within the proposed Service Area, and make Broadband Transmission
Service available therein, free of all charges to users for at least 2
years.

**§ 1739.12 Eligible grant purposes.**

Grant funds may be used to finance:

\(a\) The construction, acquisition, or leasing of facilities, including
spectrum, to deploy Broadband Transmission Service to all participating
Critical Community Facilities and all required facilities needed to
offer such service to residential and business customers located within
the proposed Service Area;

\(b\) The improvement, expansion, construction, or acquisition of a
Community Center that furnishes free access to broadband Internet
service, provided that the Community Center is open and accessible to
area residents before, during, and after normal working hours and on
Saturday or Sunday. Grant funds provided for such costs shall not exceed
the greater of five percent (5%) of the grant amount requested or
\$100,000;

\(c\) End-User Equipment needed to carry out the Project;

\(d\) (1) Operating expenses incurred in providing Broadband
Transmission Service to Critical Community Facilities for the first 2
years of operation and in providing training and instruction. In order
to qualify as eligible costs for grant coverage or as matching fund
contributions, operating expenses for providing broadband transmission
service to Critical Community Facilities must:

> \(i\) Be incurred for the purpose of providing broadband service to
> the Critical Community Facilities and be for costs incurred during the
> first two years of operation; and
>
> \(ii\) Be for the following purposes subject to the specified maximum
> amounts:
>
> \(A\) Salary for operations manager, not to exceed \$30,000 per year.
>
> \(B\) Salary for technical support staff, not to exceed \$30,000 per
> year.
>
> \(C\) Salary for community center staff, not to exceed \$25,000 per
> year.
>
> \(D\) Bandwidth expenses, not to exceed \$25,000 per year.
>
> \(E\) Training courses on the use of the Internet, not to exceed
> \$15,000 per year.
>
> \(2\) The operating costs to be funded by the grant or used as
> matching contributions cannot exceed in the aggregate \$250,000. No
> other operating expenses are eligible for grant funding or to be
> considered as matching funds; and

\(e\) The purchase of land, buildings, or building construction needed
to carry out the Project.

**§ 1739.13 Ineligible grant purposes.**

\(a\) Grant funds may not be used to finance the duplication of any
existing Broadband Transmission Service provided by another entity.

\(b\) Facilities financed with grant funds cannot be utilized, in any
way, to provide local exchange telecommunications service to any person
or entity already receiving such service.

**§ 1739.14 Matching contributions.**

\(a\) The grant applicant must contribute a Matching Contribution which
is at least fifteen percent (15%) of the grant amount requested and
shall be in the form of:

> \(1\) Cash for eligible grant purposes.
>
> \(2\) In-kind contributions for purposes that could have been financed
> with grant funds under this part. In-kind contributions must be new or
> nondepreciated assets with established monetary values. Manufacturers'
> or service providers' discounts shall not be considered as a Matching
> Contribution.
>
> \(3\) The rental value of space provided within an existing building
> to be used as the Community Center, provided that the space is free of
> charge to the applicant, for the first 2 years of operation.

\(b\) Costs incurred by the applicant, or by others on behalf of the
applicant, for facilities, installed equipment, or other services
rendered prior to submission of a completed application shall not be
considered as an Eligible Grant Purpose or Matching Contribution.

\(c\) Rental values of space provided must be substantiated by rental
agreements documenting the cost of space of a similar size in a similar
location.

\(d\) Any financial assistance from federal sources shall not be
considered as a Matching Contribution unless there is a federal
statutory exception specifically authorizing the federal financial
assistance to be considered as such.

**§ 1739.15 Completed application.**

A completed application must include the following documentation,
studies, reports and information in form satisfactory to the Agency.
Applications should be prepared in conformance with the provisions of
this part and applicable USDA regulations including 7 CFR parts 3015,
3016, and 3019. Applicants must use the Agency's Application Guide for
this program, found at *http://www.usda.gov/rus/telecom/* containing
instructions and all necessary forms, as well as other important
information, in preparing their application. Paper copies of the
application guide can be requested by contacting the Director, Broadband
Division at the following address: Stop 1599, South Agriculture
Building, Room 2868, Washington, DC 20250. Completed applications must
include the following:

\(a\) *An Application for Federal Assistance.* A completed Standard Form
424.

\(b\) *An executive summary of the Project.* The applicant must provide
the Agency with a general project overview that addresses the following
categories:

> \(1\) A description of why the Project is needed;
>
> \(2\) A description of the applicant;
>
> \(3\) An explanation of the total Project cost;
>
> \(4\) A general overview of the broadband telecommunications system to
> be developed, including the types of equipment, technologies, and
> facilities to be used;
>
> \(5\) Documentation describing the procedures used to determine the
> unavailability of existing Broadband Transmission Service; and
>
> \(6\) A description of the participating Critical Community
> Facilities.

\(c\) *Scoring criteria documentation.* Each grant applicant must
address and provide documentation on how it meets each of the scoring
criteria detailed in § 1739.17.

\(d\) *System design.* The applicant must submit a system design that
contains the following, satisfactory to the Agency:

> \(1\) A narrative discussing the proposed Community Center, all costs
> of the Project, all existing and proposed facilities that are a part
> of the Project, the services to be provided by the Project, and the
> proposed Service Area;
>
> \(2\) Engineering design studies providing an economical and practical
> engineering design of the Project, including a detailed description of
> the facilities to be funded, technical specifications, data rates, and
> costs; and
>
> \(3\) A map of the proposed Service Area reflecting the proposed
> location of the Community Center and all participating Critical
> Community Facilities.

\(e\) *Scope of work.* The scope of work must include, at a minimum:

> \(1\) The specific activities and services to be performed under the
> Project;
>
> \(2\) Who will carry out the activities and services;
>
> \(3\) The time-frames for accomplishing the Project objectives and
> activities; and
>
> \(4\) A budget for all capital and administrative expenditures
> reflecting the line item costs for Eligible Grant Purposes, the
> Matching Contribution, and other sources of funds necessary to
> complete the Project.

\(f\) *Community-Oriented Connectivity Plan.* The applicant must provide
a Community-Oriented Connectivity Plan consisting of the following:

> \(1\) A listing of all participating Critical Community Facilities to
> be connected. For those Critical Community Facilities in the Service
> Area which will not be included in the Project, an explanation of why
> they are not being included should be provided. The applicant must
> also provide documentation that it has consulted with agents of all
> Critical Community Facilities in the Service Area, and must provide
> statements as to their willingness to participate, or not to
> participate, in the proposed Project;
>
> \(2\) A description of the services available to local residents
> through the use of the Community Center;
>
> \(3\) A listing of the proposed Telecommunications Terminal Equipment,
> telecommunications transmission facilities, data terminal equipment,
> interactive video equipment, computer hardware and software systems,
> and components that process data for transmission via
> telecommunications, computer network components, communication
> satellite ground station equipment, or any other elements of the
> Project designed to further the deployment and use of Broadband
> Transmission Service, that the applicant intends to build or fund
> using the Agency's grant funds and the Matching Contribution; and
>
> \(4\) If other telecommunications carriers (including interexchange
> carriers, cable television operators, enhanced service providers,
> providers of satellite services and telecommunications equipment
> manufacturers and distributors) are participating in the delivery of
> services, a description of the consultations and the anticipated role
> of such providers in the proposed Project.

\(g\) *Financial information and sustainability.* The applicant must
provide a narrative description demonstrating the sustainability of the
Project during the first two years and after completion and the
sufficiency of resources and expertise necessary to undertake and
complete the Project. The following financial information is required:

> \(1\) Certified financial statements, if available; otherwise, the
> most current income statement and balance sheet for existing
> operations; and
>
> \(2\) Pro-forma financial information for 5 years, evidencing the
> sustainability of the Project.

\(h\) *A statement of experience.* Information on the owners' and
principal employees' relevant work experience that would ensure the
success of the Project. The applicant must provide a written narrative
describing its demonstrated capability and experience, if any, in
operating a broadband telecommunications system.

\(i\) *Evidence of legal authority and existence.* The applicant must
provide evidence of its legal existence and authority to enter into a
grant agreement with the Agency and to perform the activities proposed
under the grant application.

\(j\) *Funding commitment from other sources.* If the Project requires
additional funding from other sources in addition to the Agency's grant,
the applicant must provide evidence that funding agreements have been
obtained to ensure completion of the Project.

\(k\) *Compliance with other federal statutes.* The applicant must
provide evidence of compliance with other federal statutes and
regulations, including, but not limited to the following:

> \(1\) 7 CFR part 15, subpart A--- Nondiscrimination in Federally
> Assisted Programs of the Department of Agriculture---Effectuation of
> Title VI of the Civil Rights Act of 1964.
>
> \(2\) 7 CFR part 3015---Uniform Federal Assistance Regulations.
>
> \(3\) 7 CFR part 3017--- Governmentwide Debarment and Suspension
> (Non-procurement).
>
> \(4\) 7 CFR part 3018---New Restrictions on Lobbying.
>
> \(5\) 7 CFR part 3021--- Governmentwide Requirements for Drug-Free
> Workplace (Financial Assistance).
>
> \(6\) Certification regarding Architectural Barriers.
>
> \(7\) Certification regarding Flood Hazard Precautions.
>
> \(8\) An environmental report, in accordance with 7 CFR 1794.
>
> \(9\) Certification that grant funds will not be used to duplicate
> lines, facilities, or systems providing Broadband Transmission
> Service.
>
> \(10\) Federal Obligation Certification on Delinquent Debt.

**§ 1739.16 Review of grant applications.**

\(a\) All applications for grants must be delivered to the Agency at the
address and by the date specified in the NOFA (see § 1739.2) to be
eligible for funding. The Agency will review each application for
conformance with the provisions of this part. The Agency may contact the
applicant for additional information or clarification.

\(b\) Incomplete applications as of the deadline for submission will not
be considered. If an application is determined to be incomplete, the
applicant will be notified in writing and the application will be
returned with no further action.

\(c\) Applications conforming with this part will then be evaluated
competitively by a panel of the Agency's employees selected by the
Administrator of the Agency, and will be awarded points as described in
the scoring criteria in § 1739.17. Applications will be ranked and
grants awarded in rank order until all grant funds are expended.

\(d\) Regardless of the score an application receives, if the Agency
determines that the Project is technically or financially infeasible,
the Agency will notify the applicant, in writing, and the application
will be returned with no further action.

**§ 1739.17 Scoring of applications.**

\(a\) All eligible applications will receive points for the following
scoring criteria:

> \(1\) The rurality of the Project (up to 40 points);
>
> \(2\) The economic need of the Project's Service Area (up to 30
> points); and
>
> \(3\) The ''community-oriented connectivity'' benefits derived from
> the proposed service (up to 30 points).

\(b\) Scoring criteria:

> \(1\) *The rurality of the project*---up to 40 points.
>
> \(i\) This criterion will be used to evaluate the rurality of the
> Community served by the Project, in accordance with the following
> method of scoring. If a Community is identified in the latest
> decennial Census, the applicant must use the Census information. If a
> Community is not identified in the Census but is identified in the
> latest edition of the Rand McNally Atlas, the applicant will use the
> Rand McNally Atlas information.

Rurality shall be determined by the following criteria:

> \(A\) The 2000 population data contained in the U.S. Bureau of the
> Census at *http://factfinder.census.gov:*

or

> \(B\) The population data contained in the latest edition of the Rand
> McNally Atlas. If no population data is contained in the Rand McNally
> Atlas for a community that is recognized in the Atlas, then that
> community is not eligible for a grant.

\(ii\) The following categories are used in the evaluation of rurality:

> \(A\) Level 1 means any Community having a population of less than 500
> inhabitants.
>
> \(B\) Level 2 means any Community having a population of at least 500
> and not in excess of 1,000 inhabitants.
>
> \(C\) Level 3 means any Community having a population over 1,000 and
> not in excess of 2,000 inhabitants.
>
> \(D\) Level 4 means any Community having a population over 2,000 and
> not in excess of 3,000 inhabitants.
>
> \(E\) Level 5 means any Community having a population over 3,000 and
> not in excess of 4,000 inhabitants.
>
> \(F\) Level 6 means any Community having a population over 4,000 and
> not in excess of 5,000 inhabitants.
>
> \(G\) Level 7 means any Community having a population over 5,000 and
> not in excess of 10,000 inhabitants.
>
> \(H\) Level 8 means any Community having a population over 10,000 and
> not in excess of 20,000 inhabitants.
>
> \(iii\) Each application will receive points based on the location of
> the facilities financed using the definitions in paragraphs (b)(1)(i)
> and (b)(1)(ii) of this section.
>
> \(A\) For a Service Area that includes a Level 1 Community, it will
> receive 40 points.
>
> \(B\) For a Service Area that includes a Level 2 Community, it will
> receive 35 points.
>
> \(C\) For a Service Area that includes a Level 3 Community, it will
> receive 30 points.
>
> \(D\) For a Service Area that includes a Level 4 Community, it will
> receive 25 points.
>
> \(E\) For a Service Area that includes a Level 5 Community, it will
> receive 20 points.
>
> \(F\) For a Service Area that includes a Level 6 Community, it will
> receive 15 points.
>
> \(G\) For a Service Area that includes a Level 7 Community, it will
> receive 10 points.
>
> \(H\) For a Service Area that includes a Level 8 Community, it will
> receive 5 points.
>
> \(2\) *The economic need of the Project Service Area*---up to 30
> points. This criterion will be used to evaluate the economic need of
> the Service Area. Applicants must utilize the median household income
> (MHI) for the Community serviced and the state in which the Community
> is located, as determined by the U.S. Bureau of the Census at
> *http://factfinder.census.gov.* If the community was qualified using
> the Rand McNally Atlas, the applicant must use the MHI, contained in
> the decennial census, of the county in which the Community resides as
> the Community MHI. Applicants will be awarded points as outlined below
> for service provided in the Community where the MHI is less than 75
> percent of the state MHI:
>
> \(i\) MHI is 75 percent or greater of state MHI; 0 points;
>
> \(ii\) MHI is less than 75 percent and greater than or equal to 70
> percent of state MHI; 5 points;
>
> \(iii\) MHI is less than 70 percent and greater than or equal to 65
> percent of state MHI; 10 points;
>
> \(iv\) MHI is less than 65 percent and greater than or equal to 60
> percent of the state MHI; 15 points;
>
> \(v\) MHI is less than 60 percent and greater than or equal to 55
> percent of the state MHI; 20 points;
>
> \(vi\) MHI is less than 55 percent and greater than or equal to 50
> percent of the state MHI; 25 points;
>
> \(vii\) MHI is less than 50 percent of the state MHI; 30 points;
>
> \(3\) *The ''community-oriented connectivity'' benefits derived from
> the proposed service*---up to 30 points.
>
> \(i\) This criterion will be used to score applications based on the
> documentation in support of the need for services, benefits derived
> from the services proposed by the Project, and local community
> involvement in planning and implementation of the Project. Applicants
> may receive up to 30 points for documenting the need for services and
> benefits derived from service as explained in this section.
>
> \(ii\) The Agency will consider:
>
> \(A\) The extent of the applicant's documentation explaining the
> economic, education, health care, and public safety issues facing the
> community and the applicant's proposed plan to address these
> challenges on a community-wide basis;
>
> \(B\) The extent of the Project's planning, development, and support
> by local residents, institutions, and community facilities will be
> considered. This includes evidence of communitywide involvement, as
> exemplified in community meetings, public forums, and surveys. In
> addition, applicants should provide evidence of local residents'
> participation in the Project planning and development;
>
> \(C\) The extent to which the Community Center will be used for
> instructional purposes including Internet usage, Web-based curricula,
> and Web page development; and
>
> \(D\) Web-based community resources enabled or provided by the
> applicant, such as community bulletin boards, directories, and public
> web-hosting.

**§ 1739.18 Grant documents.**

The terms and conditions of grants shall be set forth in grant documents
prepared by the Agency. The documents shall require the applicant to own
all equipment and facilities financed by the grant. Among other matters,
the Agency may prescribe conditions to the advance of funds that address
concerns regarding the Project feasibility and sustainability. The
Agency may also prescribe terms and conditions applicable to the
construction and operation of the Project and the delivery of Broadband
Transmission Service to Rural Areas, as well as other terms and
conditions applicable to the individual Project.

**§ 1739.19 Reporting and oversight requirements.**

\(a\) A project performance activity report will be required of all
recipients on an annual basis until the Project is complete and the
funds are expended by the applicant. Recipients are to submit an
original and one copy of all project performance reports, including, but
not limited to, the following:

> \(1\) A comparison of actual accomplishments to the objectives
> established for that period;
>
> \(2\) A description of any problems, delays, or adverse conditions
> which have occurred, or are anticipated, and which may affect the
> attainment of overall Project objectives, prevent the meeting of time
> schedules or objectives, or preclude the attainment of particular
> Project work elements during established time periods. This disclosure
> shall be accompanied by a statement of the action taken or planned to
> resolve the situation; and
>
> \(3\) Objectives and timetable established for the next reporting
> period.

\(b\) A final project performance report must be provided by the
recipient. It must provide an evaluation of the success of the Project
in meeting the objectives of the program. The final report may serve as
the last annual report.

\(c\) The Agency will monitor recipients, as it determines necessary, to
assure that Projects are completed in accordance with the approved scope
of work and that the grant is expended for Eligible Grant Purposes.

\(d\) Recipients shall diligently monitor performance to ensure that
time

> schedules are being met, projected work within designated time periods
> is being accomplished, and other performance objectives are being
> achieved.

**§ 1739.20 Audit requirements.**

A grant recipient shall provide the Agency with an audit for each year,
beginning with the year in which a portion of the financial assistance
is expended, in accordance with the following:

\(a\) If the recipient is a for-profit entity, an existing
Telecommunications or Electric Borrower with the Agency, or any other
entity not covered by the following paragraph, the recipient shall
provide an independent audit report in accordance with 7 CFR part 1773,
''Policy on Audits of the Agency's Borrowers.''

\(b\) If the recipient is a State or local government, or non-profit
organization, the recipient shall provide an audit in accordance with 7
CFR part 3052, ''Audits of States, Local Governments, and Non-Profit
Organizations.''

**§ 1739.21 OMB Control Number.**

The information collection requirements in this part are approved by the
Office of Management and Budget (OMB) and assigned OMB control number
0572--0127.

**Subpart B---\[Reserved\]**

Dated: July 19, 2007.

**James M. Andrew,**

*Administrator, Rural Utilities Service.*

\[FR Doc. E7--15106 Filed 8--2--07; 8:45 am\]

> **BILLING CODE 3410--15--P**

**Rural Development Utilities Programs**

***Community Connect***

***Broadband Grant Program***

***Federal Forms and Attachments***

***Fiscal Year 2008***

**Contents :**

**Attachment** **Page No.**

1 Application for Federal Assistance 41

2 Survey Ensuring Equal Opportunity for Applicants 42

3 Rurality Calculation Table 44

4 Economic Need Calculation Worksheet 45

5 Income Statement 46

6 Budget 47 7 Equal Opportunity and Nondiscrimination Certification 48

> 8 Certificate Regarding Architectural Barriers 49

9 Certificate Regarding Flood Hazard Area Precautions 50

> 10 Uniform Relocation Assistance and Real Property\
> Acquisition Policies Act of 1970 Certification 51
>
> 11 Certification Regarding Drug-Free Workplace\
> Requirements 52
>
> 12 Certification Regarding Debarment, Suspension, and Other
> Responsibility Matters -- Primary Covered Transactions 54
>
> 13 Certification Regarding Lobbying for Contracts,\
> Grants, Loans, and Cooperative Agreements 55

14 Non Duplication of Services Certificate 56

15 Federal Obligations Certification on Delinquent Debt 57

> 16 Community-Oriented Connectivity Environmental\
> Questionnaire/Certification 58

###### 

###### 

###### 

**Placeholder for SF424 Instructions Page**

**(The official version of the SF424 is only available as a PDF
document. Please see The PDF version of this application guide for a
copy. The SF424 is six pages in length**

**Applicant's (Organization) Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Applicant's DUNS Number:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Federal Program:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_CFDA
Number: \_\_\_\_\_\_\_\_\_\_\_**

1\. Has the applicant ever received a grant or contract from the Federal
government?

Yes No

2\. Is the applicant a faith-based organization?

Yes No

3\. Is the applicant a secular organization?

Yes No

4\. Does the applicant have 501(c)(3) status?

Yes No

5\. Is the applicant a local affiliate of a national\
organization?

Yes No

6\. How many full-time equivalent employees does the applicant have?
*(Check only one box).*

> 3 or Fewer 15-50
>
> 4-5 51-100
>
> 6-14 over 100

7\. What is the size of the applicant's annual budget? *(Check only one
box.)*

Less Than \$150,000

\$150,000 - \$299,999

\$300,000 - \$499,999

\$500,000 - \$999,999

\$1,000,000 - \$4,999,999

\$5,000,000 or more

# Survey Instructions on Ensuring Equal Opportunity for Applicants

# 

# Provide the applicant's (organization) name and DUNS number and the grant name and CFDA number.

1.  Self-explanatory.

2.  Self-identify.

3.  Self-identify.

> 4\. 501(c)(3) status is a legal designation provided on application to
> the Internal Revenue Service by eligible organizations. Some grant
> programs may require nonprofit applicants to have 501(c)(3) status.
> Other grant programs do not.
>
> 5\. Self-explanatory.
>
> 6\. For example, two part-time employees who each work half-time equal
> one full-time equivalent employee. If the applicant is a local
> affiliate of a national organization, the responses to survey
> questions 2 and 3 should reflect the staff and budget size of the
> local affiliate.
>
> 7\. Annual budget means the amount of money your organization spends
> each year on all of its activities.

**Paperwork Burden Statement**

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control
number for this information collection is 1890-0014. The time required
to complete this information collection is estimated to average five (5)
minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review
the information collection. **If you have any comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form,
please write to:** The Agency Contact listed in this grant application
package.

OMB No. 1890-0014 Exp. 02/28/09

**Attachment 2**

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Rurality Calculation Table***

Please list the proposed Community to be served with the proceeds of the
Community Connect Broadband Grant, its population based upon 2000 Census
data, and its rurality level.

  ------------------------------------ ------------------------------ --------------------------- --------------------------
  **[Service Area                      **[Population]{.underline}**   **[Level\*]{.underline}**   **[Points]{.underline}**
  Community]{.underline}**                                                                        

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

*\* Denote Level based on the following table:*

  ------------- ----------------- --------------------- --------------------
  Community                                             
  Having a                                              
  Population:                                           

  Level         Over              Not in Excess of      Points

  1                               499                   40

  2             499               1,000                 35

  3             1,000             2,000                 30

  4             2,000             3,000                 25

  5             3,000             4,000                 20

  6             4,000             5,000                 15

  7             5,000             10,000                10

  8             10,000            20,000                5
  ------------- ----------------- --------------------- --------------------

**Source of Information**:
[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

**Attachment 3**

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Economic Need Calculation Worksheet***

Applicants are awarded points for providing service in a Community where
the Median Household Income (MHI) is less than 75% of the State Median
Household Income (SMHI). Enter the Community name (County name if
applicable) and it's MHI in dollars and calculate the percentage of the
SMHI in the table below.

+---------------+----------------+----------------+------------------+
| **Service     | **(a)**        | **(b)**        | **(a) ÷ (b)**    |
| Area          |                |                |                  |
| Community or  | **Community or | **(S)MHI in    | **MHI as % of    |
| County**      | County MHI in  | Dollars**      | (S)MHI**         |
|               | Dollars**      |                |                  |
+---------------+----------------+----------------+------------------+
|               | \$\_           | \$             | \_\_\_\_\_\      |
|               | \_\_\_\_\_\_\_ | \_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_% |
|               | \_\_\_\_\_\_\_ | \_\_\_\_\_\_\_ |                  |
+---------------+----------------+----------------+------------------+

***Using the scale below, award the appropriate number of points in the
box below for the community on MHI as a percent of (S)MHI:***

**0 pts**. if 75%

**5 pts.** If 70% but \< 75%

**10 pts**. if 65% but \< 70%;

**15 pts.** if 60% but \< 65%;

**20 pts**. if 55% but \< 60%;

**25 pts.** if 50% but \< 55%;

**30 pts**. if \< 50%.

**Source of Information:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

**Attachment 4**

  ----------------------- ------------ -------------- --------- ---------- ---------
  **Income Statement**    Grantee\'s   ** Broadband                        
                          Name:        Company**                           

                                                                           

                          City, State: ** Rural Town,                      
                                       USA**                               

                                                                           

                          **Year 1**   **Year 2**     **Year    **Year 4** **Year
                                                      3**                  5**

  **Revenues**                                                             

  Data Revenues                                                            

  Installation Revenues                                                    

  Other Revenues                                                           

  Uncollectible Revenues                                                   

                                                                            

  **Total Revenues**                                                       

                                                                            

  **Expenses**                                                              

  Cost of Sales                                                            

  Selling, General, and                                                    
  Administrative Expense                                                   

  Salaries                                                                 

  Community Center                                                         

  Other Operating Expense                                                  

                                                                            

  **Total Operating                                                        
  Expenses**                                                               

  **Net Income (Loss)**                                                    
  ----------------------- ------------ -------------- --------- ---------- ---------

**Attachment 5**

+---------------------------+---------+--------+----------------------+
| **Budget**                | **E     |        | **Remarks**          |
|                           | STIMATE |        |                      |
|                           | OF      |        |                      |
|                           | COSTS** |        |                      |
+---------------------------+---------+--------+----------------------+
|                           | **      | > **G  |                      |
|                           | Match** | rant** |                      |
+---------------------------+---------+--------+----------------------+
| **[NETWORK & ACCESS       |         |        |                      |
| EQUIPMENT]{.underline}**  |         |        |                      |
+---------------------------+---------+--------+----------------------+
| Any electronic equipment  |         |        |                      |
| used to provide access to |         |        |                      |
| broadband services. This  |         |        |                      |
| includes, but is not      |         |        |                      |
| limited to, ADSL          |         |        |                      |
| equipment, wireless       |         |        |                      |
| equipment (including      |         |        |                      |
| CPE), fiber equipment,    |         |        |                      |
| etc.                      |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Network & Access  | **-**   | **-**  |                      |
| Equipment**               |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **[OUTSIDE                |         |        |                      |
| PLANT]{.underline}**      |         |        |                      |
+---------------------------+---------+--------+----------------------+
| Any cable construction    |         |        |                      |
| related to providing      |         |        |                      |
| broadband service.        |         |        |                      |
| Includes fiber or copper  |         |        |                      |
| (coaxial or twisted pair) |         |        |                      |
| construction. This        |         |        |                      |
| category will not be      |         |        |                      |
| applicable to all         |         |        |                      |
| projects.                 |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Outside Plant**   | \-      | \-     |                      |
+---------------------------+---------+--------+----------------------+
| **                        |         |        | (Community Center    |
| [BUILDINGS]{.underline}** |         |        | may not exceed       |
|                           |         |        | \$100,000 in match   |
|                           |         |        | and grant funds      |
|                           |         |        | combined)            |
+---------------------------+---------+--------+----------------------+
| Any buildings costs,      |         |        |                      |
| including renovations or  |         |        |                      |
| new construction, if      |         |        |                      |
| applicable.               |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Buildings**       | **-**   | \-     |                      |
+---------------------------+---------+--------+----------------------+
| **[LAND]{.underline}**    |         |        |                      |
+---------------------------+---------+--------+----------------------+
| Any land costs, if        |         |        |                      |
| applicable.               |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Land**            | **-**   | \-     |                      |
+---------------------------+---------+--------+----------------------+
| **[TOWERS]{.underline}**  |         |        |                      |
+---------------------------+---------+--------+----------------------+
| The cost of building a    |         |        |                      |
| new communications tower  |         |        |                      |
| goes in this category, if |         |        |                      |
| applicable.               |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Towers**          | **-**   | **-**  |                      |
+---------------------------+---------+--------+----------------------+
| **[OPERATING              |         |        | (Aggregate Operating |
| EXPENSES]{.underline}**   |         |        | Expenses may not     |
|                           |         |        | exceed \$250,000 in  |
|                           |         |        | match and grant      |
|                           |         |        | funds requested.     |
|                           |         |        | \*\* Refer to the    |
|                           |         |        | NOFA for the dollar  |
|                           |         |        | limits placed on     |
|                           |         |        | each of these items) |
+---------------------------+---------+--------+----------------------+
| 1\. [Operations           |         |        |                      |
| Manager]{.underline}      |         |        |                      |
|                           |         |        |                      |
| [2. Technical Support     |         |        |                      |
| Staff]{.underline}        |         |        |                      |
|                           |         |        |                      |
| [3. Community Center      |         |        |                      |
| Staff]{.underline}        |         |        |                      |
|                           |         |        |                      |
| [4. Bandwidth             |         |        |                      |
| Expenses]{.underline}     |         |        |                      |
|                           |         |        |                      |
| [5. Internet Training     |         |        |                      |
| Courses]{.underline}      |         |        |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **Total Operating         | **-**   | **-**  |                      |
| Expenses**                |         |        |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **[OPERATING              |         |        |                      |
| EQUIPMENT]{.underline}**  |         |        |                      |
+---------------------------+---------+--------+----------------------+
| Includes, but is not      |         |        |                      |
| limited, to the computer  |         |        |                      |
| equipment used in the     |         |        |                      |
| Community Center,         |         |        |                      |
| furniture purchased as    |         |        |                      |
| part of the grant         |         |        |                      |
| project, and any other    |         |        |                      |
| piece of equipment used   |         |        |                      |
| in the day-to-day         |         |        |                      |
| operation of the grant    |         |        |                      |
| project.                  |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **[Total Operating        | **-**   | **-**  |                      |
| Equipment]{.underline}**  |         |        |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| **SUMMARY OF BUDGET       | **E     |        | **REMARKS**          |
| CATEGORIES**              | STIMATE |        |                      |
|                           | OF      |        |                      |
|                           | COSTS** |        |                      |
+---------------------------+---------+--------+----------------------+
|                           | **      | **G    |                      |
|                           | Match** | rant** |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| NETWORK & ACCESS          | \-      | \-     |                      |
| EQUIPMENT                 |         |        |                      |
+---------------------------+---------+--------+----------------------+
| OUTSIDE PLANT             | \-      | \-     |                      |
+---------------------------+---------+--------+----------------------+
| BUILDINGS                 | \-      | \-     |                      |
+---------------------------+---------+--------+----------------------+
| LAND                      | \-      | \-     |                      |
+---------------------------+---------+--------+----------------------+
| TOWERS                    | \-      | \-     |                      |
+---------------------------+---------+--------+----------------------+
| OPERATING EXPENSES        | \-      | \-     |                      |
+---------------------------+---------+--------+----------------------+
| OPERATING EQUIPMENT       | \-      | \-     |                      |
+---------------------------+---------+--------+----------------------+
|                           |         |        |                      |
+---------------------------+---------+--------+----------------------+
| TOTAL                     |         |        |                      |
+---------------------------+---------+--------+----------------------+

**Attachment 6**

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Equal Opportunity and Nondiscrimination Certification***

All grants made under the Community-Oriented Connectivity Broadband
Grant Program are subject to the nondiscrimination provisions of Title
VI of the Civil Rights Act of 1964, as amended, (7 CFR Part 15); Section
504 of the Rehabilitation Act of 1973, as amended, (29 U.S.C. 901 *et
seq*; 7 CFR Part 15b); and Age Discrimination of 1975, as amended (42
U.S.C. 6101 *et seq.*; 45 CFR Part 90); and as amended by Executive
Order 11375 Amending Executive Order 11246, Relating to Equal Employment
Opportunity (3 CFR, 1966, 1970 Comp., p. 684).

All recipients of financial assistance from Rural Development Utilities
Programs, the prospective primary participant commits to carry out Rural
Development Utilities Programs established policy to comply with the
requirements of the above laws and executive orders to the effect that
no person in the United States shall, "on the basis of race, color,
national origin, handicap, or age, be excluded from participation in, be
denied the benefits of, or be otherwise subjected to discrimination
under the Community-Oriented Connectivity Broadband Grant Program.

The
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Grantee)

hereby certifies that, as a prospective recipient under the said
Community-Oriented Connectivity Broadband Grant Program, it will comply
with the above reference laws and executive orders.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

*(Date (Authorized Representative's Signature)*

*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

*(Name Typed or Printed)*

*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

*(Title)*

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

**Attachment 7**

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Certificate Regarding Architectural Barriers***

All facilities financed with Rural Development Utilities Programs grants
that are open to the public, or in which physically handicapped persons
may be employed or reside, must be designed, constructed, and/or altered
to be readily accessible to, and usable by handicapped persons.
Standards for these facilities must comply with the Architectural
Barriers Act of 1968, as amended, 42 U.S.C. 4151 *et seq.*) and with the
Uniform Federal Accessibility Standards (UFAS), (Appendix A to 41 CFR
subpart 101-19.6).

As a prospective primary participant recipient of financial assistance
from Rural Development Utilities Programs, this organization commits to
carry out Rural Development Utilities Programs established policy to
comply with the requirements of the above referenced law to the effect
that all facilities must be readily accessible to and usable by
handicapped persons.

The
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Grantee) hereby certifies, that, as a prospective recipient under the
Community-Oriented Connectivity Broadband Grant Program, it is in
compliance, or will be in compliance upon completion of the project,
with the above referenced law.

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

*(Date)* *(Authorized Representative's Signature)*

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

*(Name Typed or Printed)*

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

(*Title)*

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

**Attachment 8**

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Certificate Regarding Flood Hazard Area Precautions***

If the project is located in an area subject to flooding, flood
insurance must be provided to the extent available and required under
the National Flood Insurance Act of 1968, as amended by the Flood
Disaster Protection Act of 1973, as amended (42 U.S.C. 4001 through
4128). If applicable, the insurance must cover, in addition to the
buildings, any machinery, equipment, fixtures, and furnishings contained
in the buildings. Rural Development Utilities Programs will comply with
Executive Order 11988, Floodplain Management (3 CFR, 1977 Comp., p.
117), and 7 CFR 1794.41, of this chapter in considering the application
for the project.

Please check the appropriate line below:

\_\_\_ a) The project is not located in a 100 year flood plain;
therefore, no Flood Insurance is required.

\_\_\_ b) The project is located in a 100 year flood plain and the
required insurance is or will be provided by:

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

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

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

The
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Grantee) hereby certifies, that, as a prospective recipient under the
Community-Oriented Connectivity Broadband Grant Program, it is in
compliance, or will be in compliance during construction and/or
installation of equipment and upon completion of the project, with the
above referenced law.

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

*(Date)* *(Authorized Representative's Signature)*

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

*(Name Typed or Printed)*

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

*(Title)*

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

**Attachment 9**

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Uniform Relocation Assistance and Real Property Acquisition***

***Policies Act of 1970 Certification***

The
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Grantee) assures that it will comply with the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970, as
amended (Uniform Act), 42 U.S.C. 4601-4655, and with implementing
Federal regulations in 49 CFR Part 24 and 7 CFR Part 21.

Specifically, the
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Grantee) assures that:

> Whenever Federal financial assistance is used to pay for any part of
> the cost of a program or project which will result in the displacement
> of any person:
>
> \(a\) Fair and reasonable relocation payments and assistance shall be
> provided to or for displaced persons in accordance with sections 202,
> 203, and 204 of the Uniform Act;
>
> \(b\) Relocation assistance programs offering the services described
> in section 205 of the Uniform Act shall be provided to displaced
> persons; and
>
> \(c\) Within a reasonable period of time prior to displacement,
> comparable replacement dwellings will be available to displaced
> persons in accordance with section 205(c) (3) of the Uniform Act.

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

*Date* *(Authorized Representative's Signature)*

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

**Attachment 10**

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Certification Regarding Drug-Free Workplace Requirements***

***Alternative I -- For Grantees Other than Individuals***

This certification is required by the regulations implementing Sections
5151-5160 of the Drug-Free Workplace Act of 1988 (P.L. 100-690, Title V,
Subtitle D; 41 U.S.C. 701 *et seq.*), 7 CFR Part 3017, Subpart F,
Section 3017.600, Purpose. The January 31, 1989, regulations were
amended and published as Part II of the May 25, 1990, [Federal
Register]{.underline} (pages 21681-21691). Copies of the regulations may
be obtained by contacting the Department of Agriculture agency offering
the grant.

**ALTERNATIVE I**

A. The grantee certifies that it will or will continue to provide a
drug-free workplace by:

> \(a\) Publishing a statement notifying employees that unlawful
> manufacture, distribution, dispensing, possession, or use of a
> controlled substance is prohibited in the grantee's workplace and
> specifying the actions that will be taken against employees for
> violation of such prohibition;
>
> \(b\) Establishing an ongoing drug-free awareness program to inform
> employees about:
>
> \(1\) The dangers of drug abuse in the workplace;
>
> \(2\) The grantee's policy of maintaining a drug-free workplace;
>
> \(3\) Any available drug counseling, rehabilitation, and employee
> assistance programs; and
>
> \(4\) The penalties that may be imposed upon employees for drug abuse
> violations occurring in the workplace;

\(c\) Making it a requirement that each employee to be engaged in the
performance of the grant be given a copy of the statement required by
paragraph (a);

> \(d\) Notifying the employee in the statement required by paragraph
> (a) that, as a condition of employment under the grant, the employee
> will:

\(1\) Abide by the terms of the statement; and

> \(2\) Notify the employer in writing of his or her conviction for a
> violation of a criminal drug statute occurring in the workplace no
> later than 5 calendar days after such conviction;
>
> \(e\) Notifying the Agency in writing, within 10 calendar days after
> receiving notice under subparagraph (d) (2) from an employee or
> otherwise receiving actual notice of such
>
> conviction. Employers of convicted employees must provide notice,
> including position title, to every grant officer on whose grant
> activity the convicted employee was working, unless the Federal agency
> has designated a central point for the receipt of such notices. Notice
> shall include the identification number(s) of each affected grant;

*Page 1 of 2*

> **Attachment 11**

\(f\) Taking one of the following actions, within 30 calendar days of
receiving notice under subparagraph (d)(2), with respect to any employee
who is so convicted:

> \(1\) Taking appropriate personnel action against such an employee, up
> to and including termination, consistent with the requirements of the
> Rehabilitation Act of 1973, as amended; or
>
> \(2\) Requiring such employee to participate satisfactorily in a drug
> abuse assistance or rehabilitation program approved for such purposes
> by a Federal, State, or local health, law enforcement, or other
> appropriate agency; and

\(g\) Making a good faith effort to continue to maintain a drug-free
workplace through implementation of paragraphs (a), (b), (c), (d), (e),
and (f).

B. The grantee may insert in the space provided below the site(s) for
the performance of work done in connection with the specific grant:

**Place of Performance:**

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

*Street Address City*

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

*County State Zip Code*

**\_\_\_\_ Check if there are workplaces on file that are not identified
here.**

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

*Organization Name*

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

*Authorized Representative's Signature Date*

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

*Name Typed or Printed*

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

*Page 2 of 2*

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Certification Regarding Debarment, Suspension, and Other
Responsibility Matters -- Primary Covered Transactions***

This certification is required by the regulations implementing Executive
Order 12549, Debarment and Suspension, 7 CFR Part 3017, Section
3017.510, Participants' Responsibilities. The regulations were published
as Part IV of the January 30, 1989, [Federal Register]{.underline}
(pages 4722-4733). Copies of the regulations may be obtained by
contacting the Department of Agriculture agency offering the proposed
transaction.

\(1\) The prospective primary participant certifies to the best of its
knowledge and belief, that it and its principals:

> \(a\) are not presently debarred, suspended, proposed for Debarment,
> declared ineligible, or voluntarily excluded from covered transactions
> by any Federal department or agency;
>
> \(b\) have not within a 3-year period preceding this proposal been
> convicted of or had a civil judgment rendered against them for
> commission of fraud or a criminal offense in connection with
> obtaining, attempting to obtain, or performing a public (Federal,
> State, or local) transaction or contract under a public transaction;
> violation of Federal or State antitrust statutes or commission of
> embezzlement, theft, forgery, bribery, falsification or destruction of
> records, making false statements, or receiving stolen property;
>
> \(c\) are not presently indicted for or otherwise criminally or
> civilly charged by a governmental entity (Federal, State, or local)
> with commission of any of the offenses enumerated in paragraph (1)(b)
> of this certification; and
>
> \(d\) have not within a 3-year period preceding this
> application/proposal had one or more public transactions (Federal,
> State, or local) terminated for cause or default.

\(2\) Where the prospective primary participant is unable to certify to
any of the statements in this certification, such prospective
participant shall attach an explanation to this proposal.

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

*Organization Name*

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

*Authorized Representative's Signature Date*

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

*Name Typed or Printed*

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

**Attachment 12**

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Certification Regarding Lobbying for Contracts, Grants,***

***Loans, and Cooperative Agreements***

The undersigned certifies, to the best of his or her knowledge and
belief, that:

> \(1\) No Federal appropriated funds have been paid or will be paid, by
> or on behalf of the undersigned, to any person for influencing or
> attempting to influence an officer or employee of any agency, a Member
> of Congress, an officer or employee of Congress, or an employee of a
> Member of Congress in connection with the awarding of any Federal
> contract, the making of any Federal grant or loan, the entering into
> of any cooperative agreement, and the extension, continuation,
> renewal, amendment, or modification of any Federal contract, grant,
> loan, or cooperative agreement.
>
> \(2\) If any funds other than Federal appropriated funds have been
> paid or will be paid to any person for influencing or attempting to
> influence an officer or employee of any agency, a Member of Congress,
> an officer or employee of Congress, or an employee of a Member of
> Congress in connection with this Federal contract, grant, loan, or
> cooperative agreement, the undersigned shall complete and submit
> Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance
> with its instructions. (Copies of this form may be obtained from Rural
> Development Utilities Programs.)
>
> \(3\) The undersigned shall require that the language of this
> certification be included in the award documents for all sub-awards at
> all tiers (including subcontracts, sub-grants, and contracts under
> grants, loans, and cooperative agreements) and that all sub-recipients
> shall certify and disclose accordingly.
>
> This certification is a material representation of fact upon which
> reliance was placed when this transaction was made or entered into.
> Submission of this certification is a prerequisite for making or
> entering into this transaction imposed by section 1352, title 31, U.S.
> Code. Any person who fails to file the required certification shall be
> subject to a civil penalty of not less than \$10,000 and not more than
> \$100,000 for each such failure.

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

*Organization Name*

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

*Authorized Representative's Signature Date*

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

*Name Typed or Printed*

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

**Attachment 13**

**U.S. Department of Agriculture**

Rural Utilities Service

***Non Duplication of Services Certificate***

As a prospective primary participant recipient of assistance from Rural
Development Utilities Programs, this organization certifies that
facilities financed under the Community-Oriented Connectivity Broadband
Grant Program will provide broadband service only in areas where it does
not currently exist.

The
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Grantee/Borrower) hereby certifies that as a prospective recipient
under the said Community-Oriented Connectivity Broadband Grant Program,
that it will not use Rural Development Utilities Programs grant funds to
duplicate any established broadband services or facilities as referenced
above.

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

*(Date)* *(Signature)*

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

*(Name Typed or Printed)*

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

*(Title)*

(*This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

**Attachment 14**

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Federal Obligations Certification on Delinquent Debt***

**IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? YES NO**

**Note: Example of debts include, but are not limited to, delinquent
taxes, guaranteed or direct government loans (more than 31 days past
due) and other administrative debts.**

**If Yes, provide explanatory information.**

**[APPLICANT CERTIFICATION]{.underline}**

**[FEDERAL COLLECTION POLICIES FOR COMMERCIAL DEBT]{.underline}**

The Federal Government is authorized by law to take any or all of the
following actions in the event that a borrower's loan payments become
delinquent or the borrower defaults on its loan: (1) Report the
borrower's delinquent account to a credit bureau; (2) Assess additional
interest and penalty charges for the period of time that payment is not
made; (3) Assess charges to cover additional administrative costs
incurred by the Government to service the borrower's account; (4) Offset
amounts owed to the borrower under other Federal programs; (5) Refer the
borrower's debt to the Internal Revenue Service for offset against any
amount owed to the borrower as an income tax refund; (6) Refer the
borrower's account to a private collection agency to collect the amount
due; and (7) Refer the borrower's account to the Department of Justice
for litigation in the courts.

All of these actions can and will be used to recover any debts owed when
it is determined to be in the interest of the Government to do so.

**[Certification]{.underline}**

**I have read and understand the actions the Federal Government can take
in the event that I fail to meet my scheduled payments in accordance
with the terms and conditions of my agreements.**

Signed:

Title:

Company:

Date:

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.*

**Attachment 15**

**U.S. Department of Agriculture**

Rural Development Utilities Programs

***Community-Oriented Connectivity Broadband*** ***Grant Program***

***Environmental Questionnaire/Certification***

**Environmental Project Summary:**

***(This description should encompass all construction in the project,
no matter the source of funding. It should provide details of how the
project will impact the environment (wetlands, farmlands, floodplain,
cultural environment, endangered species, environmental quality, and
historic preservation). If additional space is needed, continue on white
bond paper and insert between the first and second pages.)***

***If the construction proposed in this application, as described above,
will not impact the environment or historic preservation, [you may sign
the certification indicating that no adverse impact and skip filling out
the questionnaire]{.underline}***.

**CERTIFICATION**

**I hereby certify that the construction proposed in this application
will not adversely impact the environment or historic preservation.**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**^(Signature\ and\ Date)^**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**^(Print\ or\ Type\ Title)^**

*Page 1 of 4*

> **Attachment 16**

**QUESTIONNAIRE**

*Note: It is extremely important to respond to all questions completely
to ensure expeditious processing of the Community-Oriented Connectivity
Broadband* *Grant Program application. The information herein is
required by Federal law*.

*Important:* *[Any activity related to the project that may adversely
affect the environment or limit the choice of reasonable development
alternatives shall not be undertaken prior to the completion of Rural
Utilities Service's environmental review process]{.underline}*.

Legal Name of Applicant

Signature *(Type, sign, & date)*

*The applicant's representative certifies to the best of his/her
knowledge and belief that the information contained herein is accurate.
Any false information may result in disqualification for consideration
of financial assistance or the rescission of financial assistance.*

**I. Project Description** - **Detailing construction, including, but
not limited to internal modifications of existing structures, and/or
installation of telecommunications transmission facilities including
satellite uplinks or downlinks, microwave transmission towers, and
cabling.**

> 1\. Describe the portion of the project, and site locations (including
> legal ownership of real property), involving internal modifications,
> or equipment additions to buildings or other structures (e.g.,
> relocating interior walls or adding computer facilities) for
> [each]{.underline} site.

*Page 2 of 4*

2\. Describe the portion of the project, and site locations (including
legal ownership or real property), involving construction of
transmission facilities, including cabling, microwave towers, satellite
dishes, or disturbance of property of .99 acres or greater for
[each]{.underline} project site.

3\. Describe the nature of the proposed use of the facilities and
whether any hazardous materials, air emissions, wastewater discharge, or
solid waste will result.

4\. State whether or not any project site(s) contain or are near
properties listed or eligible for listing in the National Register of
Historic Places, and identify any historic properties. (The applicant
must supply evidence that the State Historic Preservation Officer (SHPO)
has cleared development regarding any historical properties).

5\. Provide information whether or not any facility(ies) or site(s) are
located in a 100-year floodplain. A National Flood Insurance Map should
be included reflecting the location of the project site(s).

**II. For projects that involve construction of transmission facilities,
including cabling, microwave towers, satellite dishes, or physical
disturbance of real property of .99 acres or greater, the following
information must be submitted.**

> 1\. A map (*preferably a U.S. Geological Survey map*) of the area for
> each site affected by construction (include as an attachment).
>
> 2\. A description of the amount of property to be cleared, excavated,
> fenced, or otherwise disturbed by the project and a description of the
> current land use and zoning and any vegetation for each project site
> affected by construction.

*Page 3 of 4*

> 3\. A description of buildings or other structures (i.e., transmission
> facilities), including dimensions, to be constructed or modified.
>
> 4\. A description of the presence of wetlands or existing agricultural
> operations and/or threatened or endangered species or critical
> habitats on or near the project site(s) affected by construction.
>
> 5\. Describe any actions taken to mitigate any environmental impacts
> resulting from the proposed project (use attachment if necessary).

*Note: The applicant may submit a copy of any environmental review,
study assessment, report or other document that has been prepared in
connection with obtaining permits, approvals, or other financing for the
proposed project from State, local or other Federal bodies. Such
material, to the extent relevant, may be used to meet the requirements
herein.*

*(This is not an official Government form. It has been prepared to
assist and expedite the application process and is only intended for use
in the Community-Oriented Connectivity Broadband Grant Program.)*

The U.S. Department of Agriculture prohibits discrimination in its
programs on the basis of race, color, National origin, sex, religion,
age disability, political beliefs, and marital or family status. (Not
all bases apply to all programs.) Persons with disabilities who require
alternative means for communications of program information (Braille,
large print, audiotape, etc.) should contact USDA's TARGET Center on
(202) 720-1127 (TDD). USDA is an equal opportunity employer.

*Page 4 of 4*