Short Assessment Form – Fill Out and Use This PDF

The Short Assessment form is a crucial document used primarily for evaluating the potential environmental impact of proposed actions classified as "Unlisted Actions" under the State Environmental Quality Review (SEQR) process. This form enables applicants or project sponsors to provide detailed information about their project, including its location, nature, and potential environmental impacts, to facilitate a thorough environmental review by the lead agency. By breaking down project details and expected environmental effects, the form serves as an initial step in ensuring that projects comply with state environmental standards.

Filling out the Short Assessment form accurately and comprehensively is essential for any project sponsor or applicant who is initiating projects that may have environmental implications. Click the button below to start filling out the form and ensure your project proceeds smoothly within environmental review processes.

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Short Assessment Form PDF Details

The Short Assessment form serves as a critical tool in evaluating the environmental impacts associated with various project proposals, particularly those categorized as Unlisted Actions under the State Environmental Quality Review (SEQR) process. This comprehensive form meticulously guides the applicant or project sponsor through a series of detailed questions, ranging from basic project information, including the applicant's details, project name, and exact location, to more complex inquiries about the potential environmental implications of the proposed action. It probes whether the proposed action is new, an expansion, or a modification and delves into the specifics of land use, compliance with existing zoning or other restrictions, and whether the action necessitates permits or approvals from any governmental agencies. Further, the form transitions into an Impact Assessment section, aimed to be filled out by the lead agency, which scrutinizes the project's potential to exceed Type I thresholds, demands coordinated review, and its possible adverse effects on air and water quality, traffic patterns, natural resources, and more. Ultimately, the Determination of Significance segment mandates a thorough evaluation of identified adverse effects, ensuring all environmental impacts have been adequately considered. This meticulous process underscores the form's pivotal role in guarding against unintended environmental consequences of proposed projects, underscoring its importance in the SEQR process.

Question	Answer
Form Name	Short Assessment Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	short environmental assessment form fillable, seqra form, environmental assessment forms, seqr short environmental assessment form

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PROJECT ID NUMBER

PART 1 - PROJECT INFORMATION

617.20	SEQR
APPENDIX	C

STATE ENVIRONMENTAL QUALITY REVIEW

SHORT ENVIRONMENTAL ASSESSMENT FORM

for UNLISTED ACTIONS Only

( To be completed by Applicant or Project Sponsor)

1. APPLICANT / SPONSOR

2. PROJECT NAME

3.PROJECT LOCATION:

Municipality

County

4. PRECISE

LOCATION: Street

Addess and Road Intersections, Prominent landmarks etc - or provide map

5. IS PROPOSED ACTION :

New

Expansion

Modification / alteration

6. DESCRIBE PROJECT BRIEFLY:

7. AMOUNT OF LAND

AFFECTED:

Initially

acres

Ultimately

acres

8. WILL PROPOSED ACTION COMPLY

WITH EXISTING ZONING OR OTHER RESTRICTIONS?

Yes

If no, describe briefly:

9. WHAT IS PRESENT LAND USE IN

VICINITY OF PROJECT? (Choose as many as apply.)

Residential

Industrial

Commercial

Agriculture

Park / Forest / Open Space

Other (describe)

10. DOES

ACTION

INVOLVE A PERMIT APPROVAL, OR FUNDING,

NOW OR ULTIMATELY FROM

ANY OTHER GOVERNMENTAL

AGENCY (Federal, State or

Local)

Yes

yes,

list

agency

name

and

permit /

approval:

11. DOES

ANY ASPECT OF THE ACTION

HAVE

A CURRENTLY VALID PERMIT OR APPROVAL?

Yes

yes,

list agency name and permit

/ approval:

12. AS A RESULT OF

PROPOSED ACTION WILL

EXISTING PERMIT / APPROVAL REQUIRE MODIFICATION?

Yes

I CERTIFY

THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

Applicant

/ Sponsor

Name

Date:

Signature________________________________________________________

If the action is a Costal Area, and you are a state agency,

complete the Coastal Assessment Form before proceeding with this assessment

PART II - IMPACT ASSESSMENT (To be completed by Lead Agency)

A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4?			If yes, coordinate the review process and use the FULL EAF.
	Yes	No
	Yes	No

B.WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency.

Yes		No

C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)

C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly:

C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:

C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:

C4. A community’s existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly:

C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:

C6. Long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly:

C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly:

D.WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly:

Yes		No

E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain:

Yes		No

PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency)

INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA.

Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.

Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination.

Name of Lead Agency		Date

Print or Type Name of Responsible Officer in Lead Agency		Title of Responsible Officer

Signature of Responsible Officer in Lead Agency

Signature of Preparer (If different from responsible officer)

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With regards to the blanks of this specific PDF, here's what you should know:

1. You will want to complete the environmental assessment forms form properly, thus take care when filling out the segments containing these blank fields:

Stage no. 1 in filling out short environmental form

2. Just after completing the last section, head on to the subsequent part and fill in the necessary particulars in all these fields - AMOUNT OF LAND AFFECTED, Initially acres Ultimately acres, WILL PROPOSED ACTION COMPLY WITH, Yes No If no describe briefly, WHAT IS PRESENT LAND USE IN, Residential Industrial Commercial, DOES ACTION INVOLVE A PERMIT, Yes No If yes list agency name and, DOES ANY ASPECT OF THE ACTION, and AS A RESULT OF PROPOSED ACTION.

Part number 2 for completing short environmental form

3. The next step is straightforward - fill out all the fields in I CERTIFY THAT THE INFORMATION, Applicant Sponsor Name Date, Signature, and If the action is a Costal Area and to complete the current step.

Guidelines on how to prepare short environmental form step 3

4. You're ready to begin working on the next section! In this case you'll get all of these A DOES ACTION EXCEED ANY TYPE I, If yes coordinate the review, Yes, B WILL ACTION RECEIVE COORDINATED, declaration may be superseded by, Yes, C COULD ACTION RESULT IN ANY, C Existing air quality surface or, potential for erosion drainage or, C Aesthetic agricultural, C Vegetation or fauna fish, C A communitys existing plans or, and C Growth subsequent development or blanks to fill in.

short environmental form completion process outlined (step 4)

5. The very last point to conclude this PDF form is integral. You'll want to fill out the required form fields, consisting of C Long term short term cumulative, C Other impacts including changes, D WILL THE PROJECT HAVE AN IMPACT, ENVIRONMENTAL AREA CEA If yes, Yes, E IS THERE OR IS THERE LIKELY TO, Yes, PART III DETERMINATION OF, INSTRUCTIONS For each adverse, and Check this box if you have, prior to submitting. Or else, it could result in a flawed and probably incorrect form!

short environmental form conclusion process outlined (part 5)

When it comes to ENVIRONMENTAL AREA CEA If yes and C Long term short term cumulative, be certain you review things in this current part. These two are certainly the most important ones in the form.

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Short Assessment Form – Fill Out and Use This PDF

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