FY2026 DLT Checklist.pdf

Section Description Complete Schedule

A Completed Standard Form 424

B Site Worksheet

C Executive Summary of the Project, including Publicly Releasable Project Description

D Scoring Criteria Documentation

D-1 Rurality

D-2 Economic Need

D-3 Service Needs and Benefits

E Matching Requirements

F Scope of Work

1 - Specific Activities to be performed

2 - Who will carry out activities

3 - Timeframes for accomplishing objectives

4 - Budget for all capital expenditures

G Financial Information and Sustainability

H Statement of Experience

I Telecommunications Systems Plan

1 - Capabilities & Description of Telecommunications Equipment

2 - Complete Listing of all Telecommunications Equipment

3 - Description of the consultations with telecommunications carriers 4 - A diagram or map of the project's service area displaying an overlay of the proposed distance learning or telemedicine system

5 - Sites (hub, hub/end-users, or end-users that will participate in the project and where equipment is located).

Note: Any non-tribal applicant with end-user sites on tribal lands must include Tribal Consent (see Application Guide for additional details)

J Compliance with Other Federal Statutes and Regulations

1. Certificate Regarding Flood Hazard Area Precautions (check appropriate box below) J-1

The Project is not located in a 100-yr Flood Plain. No flood insurance is required.

The Project is located in a 100-yr Flood Plain. See attached statement regarding who is or will be providing the flood insurance.

2. Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 Certification J-2

3. Certificate Regarding Architectural Barriers J-3

4. Non-Duplication of Services Certificate J-4

K Evidence of Legal Existence and Authority to Contract with the Federal Government

1. Evidence of Legal Existence

2. SAM.gov registration with Financial Assistance General Certifications & Representations

L Environmental Impact and Historic Preservation

Provide a narrative to include the following:

1 - Project Description

2 - Project Location(s)

3 - Proposed NEPA class of Action

M Consultation with State Director for each state where there will be end-users

Date

FY2026 DLT - Application Checklist

By signing this certification, you are agreeing to the language in schedules J-1, J-2, J-3, and J-4, as shown in the application guide. If a box checked in Section J-1 above requires an attachment, the attachment is provided with this application. If you have any questions about your application, please contact RUS prior to submitting this application and certification.

Signature

Name of Entity

Print Name and Title

DLT FY2026 Checklist