NEPA COMPLIANCE CHECKLIST
State:Federal Financial Assistance Grant/Agreement/Amendment Number:
Grant/Project Name:
This proposal 9 is; 9 is not completely covered by categorical exclusion _____ in 516 DM 2, Appendix _____; and/or 516 DM 6,
Appendix _____.
(check ( T ) one) (Review proposed activities. An appropriate categorical exclusion must be identified before completing the remainder of the Checklist. If a categorical exclusion cannot be identified, or the proposal cannot meet the qualifying criteria in the categorical exclusion, or an extraordinary circumstance applies (see below), an EA must be prepared.)
Extraordinary Circumstances:
Will This Proposal (check ( T ) yes or no for each item below):
Yes No
9 |
9 |
1. |
Have significant adverse effects on public health or safety. |
9 |
9 |
2. |
Have significant adverse effects on such natural resources and unique geographic characteristics as historic or cultural |
|
|
|
resources; park, recreation or refuge lands; wilderness areas; wild or scenic rivers; national natural landmarks; sole or |
|
|
|
principal drinking water aquifers; prime farmlands; wetlands (Executive Order 11990); floodplains (Executive Order |
|
|
|
11988); national monuments; migratory birds (Executive Order 13186); and other ecologically significant or critical |
9 |
9 |
|
areas under Federal ownership or jurisdiction. |
3. |
Have highly controversial environmental effects or involve unresolved conflicts concerning alternative uses of |
9 |
9 |
|
available resources [NEPA Section 102(2)(E)]. |
4. |
Have highly uncertain and potentially significant environmental effects or involve unique or unknown environmental |
9 |
9 |
|
risks. |
5. |
Have a precedent for future action or represent a decision in principle about future actions with potentially significant |
9 |
9 |
|
environmental effects. |
6. |
Have a direct relationship to other actions with individually insignificant but cumulatively significant environmental |
9 |
9 |
|
effects. |
7. |
Have significant adverse effects on properties listed or eligible for listing on the National Register of Historic Places |
|
|
|
as determined by either the bureau or office, the State Historic Preservation Officer, the Tribal Historic Preservation |
9 |
9 |
|
Officer, the Advisory Council on Historic Preservation, or a consulting party under 36 CFR 800. |
8. |
Have significant adverse effects on species listed, or proposed to be listed, on the List of Endangered or Threatened |
9 |
9 |
|
Species, or have significant adverse effects on designated Critical Habitat for these species. |
9. |
Have the possibility of violating a Federal law, or a State, local, or tribal law or requirement imposed for the |
protection of the environment.
99 10. Have the possibility for a disproportionately high and adverse effect on low income or minority populations (Executive Order 12898).
99 11. Have the possibility to limit access to and ceremonial use of Indian sacred sites on Federal lands by Indian religious
practitioners or significantly adversely affect the physical integrity of such sacred sites (Executive Order 13007).
99 12. Have the possibility to significantly contribute to the introduction, continued existence, or spread of noxious weeds or non-native invasive species known to occur in the area or actions that may promote the introduction, growth, or expansion of the range of such species (Federal Noxious Weed Control Act and Executive Order 13112).
(If any of the above extraordinary circumstances receive a AYes@ check (T) , an EA must be prepared.)
9 Yes 9 No |
This grant/project includes additional information supporting the Checklist. |
Concurrences/Approvals: |
|
Project Leader: |
______________________________________________ |
Date: _______________________ |
State Authority Concurrence: _____________________________________ |
Date: _______________________ |
|
(with financial assistance signature authority, if applicable) |
|
|
|
Within the spirit and intent of the Council of Environmental Quality's regulations for implementing the National Environmental Policy Act (NEPA) and other statutes, orders, and policies that protect fish and wildlife resources, I have established the following administrative record and have determined that the grant/agreement/amendment:
9is a categorical exclusion as provided by 516 DM 6, Appendix 1 and/or 516 DM 2, Appendix 1. No further NEPA documentation will therefore be made.
9is not completely covered by the categorical exclusion as provided by 516 DM 6, Appendix 1 and/or 516 DM 2, Appendix 1. An EA must be prepared.
Service signature approval:
RO or WO Environmental Coordinator: ________________________________ Date: ________________________
Staff Specialist, Division of Federal Assistance: __________________________Date:_________________________
(or authorized Service representative with financial assistance signature authority)
FWS Form 3-2185 |
OMB Control Number 1018-0110 |
Revised 02/2004 |
Expiration Date 06/30/2007 |
OMB Control Number 1018-0110
Expiration Date 06/30/2007
NOTICE
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501et seq.), please be advised that:
1.The gathering of information from potential grant recipients is authorized by The National Environmental Policy Act (NEPA, 42 U.S.C. 4321-4347). NEPA requires that a number of items be considered prior to any activity under a grant.
2.The submission of requested information is required for entities competing for federal assistance grants . This completed checklist is a record that these NEPA issues were considered prior to commencing grant activity.
3.You are not required to respond to a collection of information unless it displays a currently valid OMB control number.
4.This information collection has been approved by OMB and assigned clearance number 1018-0110.
5.The requested information may be subject to disclosure under provisions of the Freedom of Information Act (5 U.S.C. 552).
The public reporting burden for the information collected on this form is 30 minutes. This burden estimate includes time for reviewing instructions, gathering data, and completing and reviewing form. Comments on this form should be mailed to the Information Collection Officer, Mail Stop 222, Arlington Square, U.S. Fish and Wildlife Service, Washington, DC 20240. Thank you.
