U.S. USDA Form usda-rd-2033-33
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WWD
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CF
RBEG
WS
RC&D
REC
TYPE OF ASSISTANCE
ENTITY NAME
______________________________
ST/CNTY
__________________
(
) (
) (
) (
)
______________________________
ID NUMBER
______________________
APPL/BORR
TYPE
(
)
CODE
FIPS STATE CODE
FACIL ID
PURPOSE OF FUNDS
FND RQST NO
GR NO
SECURITY (CODE)
PRIORITY WT
NQ. PROJ. MERGED
________________ NAME ___________________________________ MEDIAN INCOME
POPULATION SERVED
FIPS COUNTY CODE ________________ NAME ___________________________________ SOURCE OF FUNDS
FIPS PLACE CODE
LN NO
FUND AUTHORIZATION
________________ NAME ___________________________________ ENVIRONMENTAL IMPACT:
CODE
YR.
DATE PROJECT SUMMARY SENT TO N.O.
EST. VALUE OF EXISTING FACILTIES
FACILITY LOCATION_______________ FIPS PLACE CODE ______________________
ST. INTERGOV’T CONSULTATION ID NO. _________________________________
COUNTY OFFICE
DISTRICT OFFICE CODE
APPLICANT BUSINESS OFFICE
OFFICERS
APPLICANT CONTACT (Name/Title)
LOCAL ATTORNEY
FUNDING DATA
(OBLG)
(CLOS.)
LOAN AMT ...................... $ . _____________
TYPE OF INT:____________ _______________ GRANT AMT ......................... _____________
INT. RATE:
BOR. FND .............................. _____________
MATURITY .............................. _______________
____________ _______________ PRIVATE/COMM. FND. ....... _____________
TOTAL DEOBLG. EPA FUNDS ........................... _____________
LOAN $_____________ REASON_____________ REG. COMM. FND ............... _____________
GRANT $____________ REASON_____________ ST/CNTY FND ...................... _____________
TOTAL DEOBLG. SFY OTHER FUNDS ..................... _____________
LOAN $_____________ REASON_____________ (SOURCES) (
GRANT $____________ REASON_____________ ) (
) (
)
TOTAL FACILITY COST $ ______________
WW SUBSIDIARY FACILITIES
MANAGER
BOND COUNSEL
(COLLECTION) (90)
ENGINEER/ARCHITECT
(TREATMENT) (91)
LOAN AMT ...................... $ . _____________
LOAN AMT......................$ . _________________
GRANT AMT ......................... _____________
GRANT AMT........................_________________
BOR. FND .............................. _____________
BOR. FND .............................. _________________
PRIVATE/COMM. FND. ....... _____________
PRIVATE/COMM. FND. ....... _________________
EPA FUNDS ........................... _____________
EPA FUNDS ........................... _________________
REG. COMM. FND ............... _____________
REG. COMM. FND ............... _________________
ST/CNTY FND ...................... _____________
ST/CNTY FND ...................... _________________
OTHER FUNDS ..................... _____________
OTHER FUNDS ..................... _________________
........................................................................................................................................... (FOLD ON DOTTED LINE) ....................................................................................................................................................
CONTRACTOR NAME, CONTRACT NO.
DESCRIPTION OF WORK & AMOUNT
COMPLETION DATES
DATE OF PREFINAL
INSPECTION _________________
DATE OF SUBSTANTIAL
COMPLETION ________________
DATE OF PREFINAL
INSPECTION _________________
DATE OF SUBSTANTIAL
COMPLETION ________________
DATE OF PREFINAL
CURRENT LOAN
STATUS
GRANT
TRACKING INFO.
DATE
AMOUNT
DATE
DATE
AMOUNT
LN. AMT.
GR. AMT.
PREAPPL. REC’D .................... ____________
____________
____________ ____________
AD-622 ISSUED ...................... ____________
____________
____________ ____________
APPL. REC’D ........................... ____________
____________
____________ ____________
OBLIGATED ............................ ____________
____________
____________ ____________
INTERIM FINAN. .................... ____________
____________
____________ ____________
AGENCY CLOSED .................. ____________
____________
____________ ____________
OPERATIONAL ....................... ____________
____________
____________ ____________
COMMENTS:
INSPECTION _________________
JOBS:
HEALTH CARE:
CREATED
PROJECTED DAYS CARE
PROJECTED
OUTPATIENT VISIT
TOTAL
TYPE
_______
_______
_______
TOTAL SQUARE FEET
SIC
__________
__________
__________
NBR
______
______
______
UNIT-CD
__________
__________
__________
SYS
TEM
SAVED
APPEAL IND.
FEES AND COSTS
COMPLETION ________________
APPEAL FY
DEVELOPMENT
EQUIPMENT
LAND AND RIGHTS
CONTINGENCIES
LEGAL SERVICES
REFINANCING
ARCH/ENG R/FEES
INITIAL O&M
CAPITAL INTEREST
INITIAL RESERVE
ID
DATE OF SUBSTANTIAL
WATER SYSTEM
WASTE SYSTEM
SOLID WASTE
CF SUBSIDIARY TRACKING
BEFORE
AFTER
__________________
____________________
__________________
____________________
__________________
____________________
RURAL DEVELOPMENT
__________________________
__________________________
__________________________
USDA
Form RD 2033-33 (Rev. 2-99)
MANAGEMENT SYSTEM CARD - COMMUNITY PROGRAMS
AMOUNT
_______________________
_______________________
_______________________
AMORTIZED LOAN INST ALLMENT SCHEDULE
INT.
RATE
DATE
AMOUNT OF
NOTE/BOND NOTE/BOND
REPAY.
PERIOD
AMOUNT
DATE
MONTHLY/
AN’L/SEMITYPE
AN’L INSTALL SECURITY
WHITE
RACE/
NAT’L ORIGIN
(User Families)
PAYMENT INSTALLMENTS
LOAN
CODE
NAT. HAW. /OTHER PAC. ISL.
BLACK /AFRICAN AMER.
HISPANIC /LATINO
ASIAN AMER. IND./ALASKAN NAT. UNIT TRACKED:
UNIT TYPE
CODE______
RESIDENTIAL
NON
RESI­
DENTIAL
UNITS
FIXED PRINCIPAL INSTALLMENT SCHEDULE
LOAN CODE
AMOUNT DATE OF BOND TYPE INT. RATE
LOAN CODE AMOUNT DATE OF BOND TYPE INT. RATE USERS BEFORE ........ _______ _______ _______
USERS AGENCY ....... _______ _______ _______
ACTUAL (After) ......... _______ _______ _______
NO. OF
NO. OF
TOTAL
NO. OF
NO. OF
TOTA;
GRANT
YEARS
BONDS
AMOUNT YEARS (Excludes Int.)
YEARS
BONDS
AMOUNT YEARS (Excludes Int.) BENEFITTING ........... _______ _______ _______
USER VERIFICATION :
DATE .............................. _____________________
RESIDENTIAL ............... _____________________
NON-RESIDENTIAL ..... _____________________
GRANT BENEFIT .......... _____________________
NON-BENEFITTED ....... _____________________
SERVICINGUSER CONSIDERA TION
MIN. BILL (mo.) ......... _________
AVG. BILL (mo.) ........ _________
REG. AVG. INCOME ....................
AN’L O&M EXP. ..........................
WATER SOLD ...............................
WATER PROD. ..............................
WATER PURCHASED ..................
SERVICING AND MANAGEMENT ASSIST ANCE SECTION
EXPIRATION AND DUE DATES
DUE
DATE
ITEM
WATER
(Gallons)
_____________
_____________
_____________
_____________
_____________
_____________
_____________
(BORROWER FISCAL YEAR: ENDING__________________)
FOLLOWUP
DATE
ACTIONS PLANNED
DATE
RESERVE REQUIREMENTS:
COMPLETED MO./QRTLY./AN’L ............... _____________________________
SECURITY AGREEMENT NO.
TOTAL REQUIRED ............. _____________________________
AMT. ON HAND .................. _____________________________
AS OF ________________________________
MEETINGS (Governing Body)
GRADUATION INFORMATION
TAXES
FINANCING STATEMENT NO.
FS#
REGULAR
DATE
INITIAL SCREEN
FOR GRAD .................... ______________
ANNUAL
MANAGEMENT AND ANALYSIS RPTS.
442-2 (Statement of Budget)
Quarterly Rpts. Due: 1____2____3____
442-3
THOROUGH REVIEW
FOR GRADUATION ..... ______________
442-4 (District Director)
GRADUATION
REQUESTED ................ ______________
QUARTERLY REPORT
GRADUATION
$_______________
ANNUAL REPORT
DISPOSITION
ANNUAL AUDIT
______________
TYPE
________________
TYPE: A-GRAD IN PROCESS
B-GRAD REL-FIN DETER
C-GRAD REL-OTHER DETER
X-ACCELERATED ACCOUNT
POSITIVE ACTION PLAN TO STATE OFF.
SECURITY INSPECTION
COMPLIANCE REVIEW
GRADUATION REVIEW
AMT. REFINANCED _______________
AMT. PAID OFF
CONSTRUCTION INSPECTION
$_______________
$_______________
FINAL INSPECTION
WARRANTY INSPECTION
CASE # TRANS FROM: __________________
CASE # TRANS TO:
__________________
RETURN PLANS & SPECS. TO BORROWER
REAL
SERVICING INFORMA TION
LIABILITY $
INSURANCE
PUBLIC LIABILITY $
MALPRACTICE $
TRANS/ASSUMPTION
(T-TRANS. M-MERG)
OTHER SRVCG ACTION
1
$
LEGAL ACTION
2
$
3
$
PROPERTY DAMAGE $
DEBT SETTLEMENT
CODE
DATE
$ LOAN AMOUNT
E/I
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(E-Eligible/I-Ineligible)