LWCF Proposal Description and Environmental Screening Form
The purpose of this Proposal Description and Environmental Screening Form (PD/ESF) is to provide descriptive information
about Land and Water Conservation Fund (LWCF) proposals for NPS review and decision. This form also serves as the
administrative record that supports the pathway used to document the National Environmental Policy Act (NEPA) analysis for
LWCF proposals. States and/or project sponsors should use this PD/ESF early in the planning process for any proposal that
will be submitted for NPS review and decision. The ESF portion is a tool for use during project planning that will help to
identify potential environmental impacts and issues that will ultimately inform the decision to use a categorical exclusion (CE),
or to conduct an Environmental Assessment (EA) or Environmental Impact Statement (EIS) process. The ESF can also be used
to document potential impacts and planned mitigation from previously conducted and still viable environmental reviews.
Except for the proposals listed below, the completed PD/ESF must be completed and signed by the State and accompany
each new federal application for LWCF assistance (Standard Form 424), and amendments for scope changes that alter or add
facilities and/or acres, including proposals for conversions, public facility exceptions, sheltering outdoor facilities, and
changing the original intended use of an area from that which was approved in an earlier LWCF agreement. Consult the
LWCF Grants Manual (www.nps.gov/lwcf) for detailed guidance on additional information required for your type of proposal
and for further guidance on how to comply with NEPA.
For the following types of proposals, only this cover page is required because these proposals are categorically excluded
from further NEPA environmental analysis. NPS will complete the NEPA Categorical Exclusion Form for you. Simply check
the applicable box below, and complete and submit this Cover Page to NPS along with the other items required for your type of
proposal as explained in the LWCF Grants Manual.
□ SCORP planning proposal
□ Time extension with no change in project scope or with a reduction in project scope
□ To delete work and no other work is added back into the project scope
□ To change project cost with no change in project scope or with a reduction in project scope
Date:
Name of LWCF Project:
Prior LWCF Project Number(s) List all prior LWCF project numbers and other park names associated with site(s):
Local or State Sponsoring Agency:
Local or State Sponsor Contact:
Name/Title:
Office/Address:
Phone/Fax:
Email:
Cover Page
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Use a separate sheet for narrative descriptions and explanations. Address each item and question in the
order it is presented, keying it to the associated item, such as Step 1-A1, A2; Step 3-B1;Step 6-A1, A29; etc.
Step 1. Type of LWCF Proposal
____
____
New Project Application
Acquisition
Development
Combination (Acquisition & Development)
Go to Step 2A
Go to Step 2B
Go to Step 2C
Project Amendment
Increase in scope or change in scope from original agreement.
Complete Steps 3A, and 5 through 7.
6(f) conversion proposal. Complete Steps 3B, and 5 through 7.
Request for public facility in a Section 6(f) area. Complete Steps 3C, and 5 through 7.
_____
Request for temporary non-conforming use in a Section 6(f) area.
Complete Steps 4A, and 5 through 7.
_____
Request for significant change in use/intent of original LWCF application.
Complete Steps 4B, and 5 through 7.
_____
Request to shelter existing/new facility within a Section 6(f) area regardless of who
funds the work. Complete Steps 4C, and 5 through 7.
Step 2. New Project Application (See LWCF Manual for guidance.)
A. For an Acquisition Project
1. Provide a brief narrative about the proposal that provides the reasons for the acquisition, number of acres to be
acquired with LWCF assistance, and describes the property. Describe and quantify the types of existing
resources and features on the site (for example, 50 acres wetland, 2,000 feet beachfront, 200 acres forest,
scenic views, 100 acres riparian, vacant lot, special habitat, any unique or special features, recreation
amenities, historic/cultural resources, hazardous materials/ contamination history, restrictions, institutional
controls, easements, rights-of-way, above ground/underground utilities, including wires, towers, etc.)
2. Will this acquisition create a new public park/recreation area where none previously existed and is not an
addition to an existing public park/recreation area? Yes ____ (go to #4) No ____ (go to #3)
3. a. What is the name of the pre-existing public area that this newly acquired site will be added to?
b. Is the pre-existing public park/recreation area already protected under Section 6(f)? Yes ___ No ___
If no, will it now be included in the 6(f) boundary? Yes ___ No ___
4. What will be the name of this new public park/recreation area?
5. How will the site be made immediately open and accessible for public outdoor recreation use (signage, entries,
parking, site improvements, allowable activities, etc.)?
6. Describe future development plans, if any, proposed for the site(s) within the next three (3) years.
7.
SLO must complete the State Appraisal Review certification in Step 7 certifying that the appraisals meet the
“Uniform Appraisal Standards for Federal Land Acquisitions.” State should retain copies of the appraisals and
make them available if needed.
8. Address each item in “D” below.
B. For a Development Project
1. Describe the physical improvements and/or facilities that will be developed with federal LWCF assistance,
including where and how the public will access the site, including parking, if any. Indicate access points on 6(f)
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map. Indicate to what extent the project involves new development, rehabilitation, and/or replacement of
existing facilities.
2. Will this proposed development create a new park for the first time on land that has not been previously
designated as park and recreation land, such as public vacant or undeveloped land? (Do not count
development on land previously dedicated for public park and recreation use.) Yes _____ No _____
3. When will the project be completed and the public allowed onto the improved site?
4. Address each item in “D” below.
C. For a Combination Project
1. For the acquisition part of the proposal:
a. Provide a brief narrative about the proposal that that provides the reasons for the acquisition, number of
acres to be acquired with LWCF assistance, and describes the property. Describe and quantify the types of
existing resources and features on the site (for example, 50 acres wetland, 2,000 feet beachfront, 200 acres
forest, scenic views, 100 acres riparian, vacant lot, special habitat, any unique or special features, recreation
amenities, historic/cultural resources, hazardous materials/ contamination history, restrictions, institutional
controls, easements, rights-of-way, above ground/underground utilities, including wires, towers, etc.)
b. Will this acquisition create a new public park/outdoor recreation area where non previously existed and is
not an addition to an existing public park/recreation area? Yes ____ (go to ”e” below) No ____ (go to “c”)
c. What is the name of the pre-existing public park/recreation area to which this newly acquired site will be
added?
d. Is the pre-existing public park/recreation area already protected under Section 6(f)? Yes ___ No ___.
If no, will it now be included in the 6(f) boundary? Yes ___ No ___.
e. What will be the name of this new public park/recreation area?
f. How will the site be made immediately open and accessible for public outdoor recreation use (signage,
entries, parking, site improvements, allowable activities, etc.)?
g. Describe future development plans, if any, proposed for the site(s) within the next three (3) years.
h. SLO must complete the State Appraisal Review certification found in the box at Step 7 certifying that the
appraisals meet the “Uniform Appraisal Standards for Federal Land Acquisitions.” State should retain copies
of the appraisals and make them available if needed.
2. For the development part of the proposal:
a. Describe the physical improvements and/or facilities that will be developed with federal LWCF assistance,
including where and how the public will access the site, including parking, if any. Indicate access points on
6(f) map. Indicate to what extent the project involves new development, rehabilitation, and/or replacement
of existing facilities.
b. When will the project be completed and the public allowed onto the improved site?
3. Address each item in “D” below.
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D. Additional items to address for a new application and amendments
1. a. Who will hold title to the property benefiting from LWCF assistance?
b. What is the type of control/tenure? Check one:
____ Fee simple ownership
____ Less than fee simple. Explain:
____ Lease. Describe terms of lease including renewable clauses and number of years remaining on
lease. Submit copy of lease with this PD/ESF. (See LWCF Manual for detailed guidance on leases.
Only leases between public agencies are allowed.)
2. Explain who, other than public agency owner, will retain any rights/easements to the area to be placed under
Section 6(f)? Also indicate on 6(f) map.
3. Who will manage and operate the site(s)?
4. As a result of this project, describe new types of outdoor recreation opportunities and capacities, and short and
long term public benefits.
5. Explain any existing non-recreation and non-public uses that will continue on the site(s) and/or proposed for the
future within the 6(f) boundary.
6. Describe the planning process that led to the development of this proposal. Your narrative should address the
following:
a. How was the interested and affected public notified and provided opportunity to be involved in planning for
and developing your LWCF proposal? Who was involved and how were they able to review the completed
proposal? Include state, local, federal agency professionals, subject matter experts, members of the public
and Indian Tribes. Describe any public meetings held and/or formal public comment periods, including dates
and length of time provided the public to participate in the planning process and/or to provide comments.
b. What information was made available to the public for review and comment?
7. How does this proposal implement statewide outdoor recreation goals as presented in the Statewide
Comprehensive Outdoor Recreation Plan (SCORP) (include references), and explain why this proposal was
selected using the State’s Open Project Selection Process (OPSP).
8. List the source(s) and amounts of financial match to the LWCF federal share of the project. The value of the
match can consist of cash, donation, and in-kind contributions:
Source
Type of Match
Value
$
$
$
9. Is this LWCF project/proposal part of a larger effort not reflected on the SF-424 (Application for Federal
Assistance) and grant agreement? If so, briefly describe the larger effort, funding amount(s) and source(s).
This will capture information about partnerships and how LWCF plays a role in leveraging funding for projects
beyond the scope of this federal grant.
10. List all required permits from federal, state, and local agencies and explain their purpose and status of approval
as it pertains to the proposal.
Proceed to Steps 5 through 7
Step 3. Project Amendment (See LWCF Manual for guidance.)
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A. Increase/Change in Project Scope
1.
For Acquisition Projects: To acquire additional property that was not described in the original project
proposal and NEPA documentation, follow Step 2A-Acquisition Project and 2D.
2.
For Development Projects: To change the project scope for a development project that alters work from the
original project scope by adding elements or enlarging facilities, follow Step 2B-Development Project and 2D.
3.
For Combination Projects: Follow Step 2C as appropriate.
B. Section 6(f) Conversion Proposal
Prior to developing your Section 6(f) conversion proposal, you must consult the LWCF Manual and36 CFR 59 for
complete guidance on conversions. Local sponsors are encouraged to consult early with the State LWCF manager
when a conversion is under consideration or has been discovered. States are also encouraged to consult with their
NPS-LWCF manager as early as possible in the conversion process for guidance and to sort out and discuss
details of the conversion proposal to avoid mid-course corrections and unnecessary delays. An important first step
is for the State and NPS to agree on the size of the Section 6(f) parkland impacted by any non-recreation, nonpublic use, especially prior to any appraisal activity.
For NPS review and decision, the following elements are required to be included in the State’s completed
conversion proposal to be submitted to NPS:
1. A letter of transmittal from the SLO recommending the proposal.
2. Describe in detail the sponsor’s need to convert the Section 6(f) parkland including all efforts to consider other
practical alternatives to this conversion, how they were evaluated, and the reasons they were not pursued.
3. Provide a statement on how the conversion is in accord with the State Comprehensive Outdoor Recreation Plan
(SCORP).
4. Complete the State Appraisal Review certification in Step 7 for both the converted and replacement parcels
certifying that the appraisals meet the “Uniform Appraisal Standards for Federal Land Acquisitions.” States
should retain copies of the appraisals and make them available if needed.
5. For the parkland proposed for conversion:
a. Identify the specific location, 9-digit zip code, and name of park or recreation area proposed for conversion.
b Describe the area proposed for the conversion including the acreage to be converted and any acreage
remaining. For determining the size of the conversion, consider not only the physical footprint of the nonrecreation development/activities but how the development/activities will impact the entire 6(f) park area.
Describe the recreation resources, facilities, and recreation opportunities that will be impacted, displaced or
lost by the proposed conversion. For proposals to partially convert a Section 6(f) park area, the remaining
6(f) parkland must remain recreationally viable and not be impacted by the non-recreation activities that are
triggering the conversion. If it is anticipated that the non-recreation activities overlap and impact the
remaining Section 6(f) area, the proposed area for the conversion should be expanded to encompass all
impacted parkland.
c Describe the community and population served by the park, including who uses the park and how?
d. For partial conversions, where only a portion of the Section 6(f) area is proposed for conversion, produce a
revised 6(f) map clearly indicating both the portion that is being converted and the portion remaining intact
under Section 6(f).
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6. For the proposed replacement site(s):
a. Produce a location map indicating specific location of site(s) and associated 9-digit zip code(s), clearly
indicating major roadways and waterways. If site(s) will be added to an existing public park/outdoor
recreation area, indicate on map. Show geographical relationship between replacement site(s) and Section
6(f) converted parkland.
b Describe the site’s physical characteristics and resource attributes by describing and quantifying the types of
resources and features on the site (for example, 15 acres wetland, 2,000 feet beachfront, 50 acres forest,
scenic views, 75 acres riparian, vacant lot, special habitat, any unique or special features, structures,
recreation amenities, historic/cultural resources, hazardous materials/contamination history, restrictions,
institutional controls, easements, rights-of-way, overhead/underground utilities including overhead wires,
towers, etc.
c. Identify the replacement site (s) owner(s) and its recent history of use/function up to the present.
d. Explain in detail how the proposed replacement site(s) is of reasonably equivalent usefulness and location as
the property being converted. Describe the recreation needs that will be met by the new replacement parks,
populations to be served, and new outdoor recreation resources, facilities, and opportunities to be provided.
e. Who will own and manage the new replacement park(s)?
f. What will be the name(s) of the new replacement park(s)? If replacement park(s) will be added to
an existing public park area, will the existing area be included within the 6(f) boundary? What is
the name of the existing public park area?
g. Provide a timeframe for completing the new park area(s) and making it available for public outdoor
recreation use.
h. Produce new Section 6(f) map(s) for the new replacement park(s).
Environmental analysis must be conducted for converted and replacement sites.
Proceed to Steps 5 through 7
C. Proposal for a Public Facility in a Section 6(f) Area
Prior to developing this proposal, you must consult the LWCF Manual for complete guidance. In summary, NPS
must review and decide on requests to construct a public facility within a Section 6(f) area. In certain cases NPS
approval may be given to construct public facilities within a Section 6(f) area where it can be shown that there is a
gain or increased benefit to public recreational opportunity. In most cases, development of non-recreation public
facilities within a Section 6(f) area constitutes a conversion. Describe in detail the public facility proposed and
include the following information, if appropriate:
1. A letter of transmittal from the SLO recommending the proposal.
2. Indicate the location of the proposed public facility on a Section 6(f) map.
3. Describe the design of the proposed public facility and explain how it will be compatible with outdoor recreation,
how it supports the outdoor recreation resources of the site whether existing or planned, how it will increase
outdoor recreation use, and how outdoor recreation use remains the primary function of the site. (The public’s
outdoor recreation use must continue to be greater than that expected for any indoor use, unless the site is a
single facility, such as a swimming pool, which virtually occupies the entire site.)
4. Explain the location alternatives considered for the public facility and why they were not pursued.
5. When will the facility be open to the public and what will they be able to do there? Describe all functions of the
facility including any offices, residential uses or lodging.
6. Explain any memberships or user fees that will be instituted, including the fee structure.
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7. Consult the LWCF Manual for any additional requirements and guidelines prior to developing the proposal.
Proceed to Steps 5 through 7
Step 4. Proposals for Temporary Non-Conforming Use, Significant Change in
Use, and Sheltering Facilities (See LWCF Manual for guidance.)
A. Proposal for Temporary Non-Conforming Use
Prior to developing this proposal, you must consult the LWCF Manual for complete guidance. NPS must review and
decided on requests for temporary uses that do not meet the requirements of allowable activities within a Section
6(f) area. A temporary non-conforming use is limited to a period of six months (180 days) or less. Continued use
beyond six-months will not be considered temporary, and may result in a Section 6(f)(3) conversion of use requiring
the replacement of converted parkland. For NPS review, describe the temporary non-conforming use (activities
other than public outdoor recreation) in detail including the following information:
1. A letter of transmittal from the SLO recommending the proposal.
2. Describe in detail the proposed temporary non-conforming use, why it is needed, and alternative locations that
were considered and why they were not pursued.
3. Explain length of time needed for the temporary non-conforming use and why.
4. Describe the size of the parkland area affected by a temporary non-conforming use and the impacts to public use
of the Section 6(f) area. The proposal should explain efforts to keep the size of the area impacted by the nonrecreation use to a minimum. Indicate the location of the non-conforming use on the site’s 6(f) map.
5. Describe any anticipated temporary/permanent impacts to the Section 6(f) area and how the sponsor will mitigate
them during and after the non-conforming use ceases.
6. Consult the LWCF Manual for additional requirements and guidelines before developing the proposal.
Proceed to Steps 5 through 7
B. Proposal for Significant Change in Use
Prior to developing the proposal, you must consult the LWCF Manual for complete guidance. NPS approval must
be obtained prior to any change from one eligible use to another when the proposed use would significantly
contravene the original plans or intent for the area outlined in the original LWCF application for federal assistance.
NPS approval is not required for each and every facility use change. For proposals that will significantly change
the use of a LWCF-assisted site (e.g., from passive to active recreation), address the following points:
1. A letter of transmittal from the SLO recommending the proposal.
2. Describe proposed changes and how they significantly contravene the original plans or intent of LWCF
agreements.
3. Explain the need for the change in use and how the change is consistent with local plans and the SCORP.
4. Consult the LWCF Manual for additional requirements and guidelines before developing the proposal.
Proceed to Steps 5 through 7
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C. Proposal for Sheltering Facilities
Prior to developing this proposal, you must consult the LWCF Manual for complete guidance. NPS must review
and decide on all proposals to shelter an existing outdoor recreation facility or construct a new sheltered recreation
facility within a Section 6(f) area with or without LWCF assistance. The proposal must demonstrate that there is a
gain or increased benefit to public recreation opportunity. Describe the sheltering proposal in detail, including the
following information:
1. A letter of transmittal from the SLO recommending the proposal.
2. Describe the proposed sheltered facility, how it would operate, how the sheltered facility will include recreation
uses that could typically occur outdoors, and how the primary purpose of the sheltered facility is recreation use.
3. Explain how the sheltered facility would not substantially diminish the outdoor recreation values of the site
including how the sheltered facility will be compatible and significantly supportive of the outdoor recreation
resources present and/or planned.
4. Explain how the sheltered facility will benefit the total park’s outdoor recreation use.
5. Describe efforts provided to the public to review the proposal to shelter the facility and has local support.
6. Document that the sheltered facility will be under the control and tenure of the public agency which sponsors and
administers the original park area.
7. Consult the LWCF Manual for additional requirements and guidelines before developing the proposal.
Proceed to Steps 5 through 7
Step 5. Summary of Previous Environmental Review
Describe any prior environmental review undertaken at any time for this proposal or related efforts that could be
useful to understanding potential environmental impacts. Consider previous local, state, federal (e.g. HUD, EPA,
USFWS, FHWA, DOT) and other environmental reviews. At a minimum, address the following:
1. Date of review.
2. Purpose for the review and for whom.
3. Project scope and proposed actions and alternatives.
4. Who was involved in identifying resource impact issues and developing the proposal,
including the interested and affected public, government agencies, and Indian tribes.
5. Environmental resources analyzed and determination of impacts.
6. Any mitigation measures stipulated in the plan to be part of the proposed action.
7. Public comment periods (how long, when in the process, who was invited to comment)
and agency response to public comments.
8. Any formal decision regarding degree of potential impacts to the human environment.
9. Was the LWCF federal action and/or any other federal actions analyzed/reviewed in previous environmental
reviews? If so, how and what impacts were identified? Provide specific references.
Use resource impact information generated during previous environmental reviews and from recently conducted
site inspections to complete the Environmental Screening Form (ESF) portion of this PD/ESF under Step 6. Your
responses should indicate your proposal’s potential for impacting each resource as identified in the previous
environmental review, including a reference to where the analysis can be found in the document. If the previous
environmental review proposed actions to mitigate impacts, summarize the mitigation for each resource as
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appropriate. The environmental review document(s) must be included with this PD/ESF in the proposal package
submitted to NPS for federal review.
Proceed to Steps 6 through 7
Step 6. Environmental Screening Form (ESF)
This ESF portion of this PD/ESF is a working tool for planners and decision-makers to use to identify the degree of
potential impacts to resources that may occur as a result of federal approval of the proposal. It also serves as the
administrative record documenting the project sponsor’s efforts to identify and consider impacts during proposal
development. Your ESF responses may change as the planning process refines the proposal that will ultimately be
submitted along with the final completed ESF for federal review and decision.
As early as possible in your planning process, consider how your proposal/project may have direct, indirect and
cumulative impacts on the human environment. By early identification of possible environmental resource impacts,
the information will be useful during proposal development, including ways to lessen impacts. Initiating or
completing environmental analysis after a decision has been made is contrary to both the spirit and letter of the law
of the National Environmental Policy Act.
The ESF should be completed with input from resource experts and in consultation with relevant local, state, tribal
and federal governments, as applicable. The interested and affected public should be notified of the proposal and
invited to provide input as well. At a minimum, a site inspection of the affected area must be conducted by
individuals who are familiar with the type of affected resources, possess the ability to identify potential resource
impacts, and to know when to seek additional data when needed.
At the time of proposal submission to NPS for federal review, the completed ESF should reflect the project
sponsor’s final determination of the extent to which the proposal will impact the list of resources on the form. The
results of the completed ESF will inform the State’s choice of which NEPA pathway to follow, i.e., categorical
exclusion (CE), environmental assessment (EA), environmental impact statement (EIS). Also, the completed ESF
will identify the resource topics and issues that should be presented and analyzed in an EA or an EIS if required.
Consult the LWCF Manual for further guidance on LWCF and NEPA.
The ESF contains two parts that must be completed:
A. Impacts to Environmental Resources
B. Mandatory Criteria
Part A: For each environmental resource topic, choose an impact estimate level (none, negligible, minor, exceeds
minor) that describes the degree of potential negative impact that may occur directly, indirectly and cumulatively as
a result of federal approval of your proposal. These impact levels should be used to estimate specific impact levels
on each separate resource and must be accompanied with a brief explanation of how the resource might be
affected, how the impact level was determined, and why the chosen impact level is appropriate. If an
environmental review has already been conducted on your proposal and it includes planned mitigation, explain this
for each applicable resource and choose an impact level as mitigated. If the resource does not apply to your
proposal, mark NA in the first column. Add any relevant resources (see A23) if not included in the list.
Part B: This is a list of mandatory impact criteria that preclude the use of categorical exclusions. If you answer
“yes” or “maybe” for any of the mandatory criteria, you must proceed to develop an EA or EIS regardless of your
answers in Part Section A.
Use a separate sheet to explain all potential negative impacts (negligible, minor and those exceeding minor) as well
as to indicate the type of data that still needs to be determined for each of the applicable resources listed below.
Describe direct, indirect and cumulative impacts as well as explain any planned mitigation already addressed in
previous environmental reviews. For the Mandatory Criteria, explain all “yes” and “maybe”answers.
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A. ENVIRONMENTAL RESOURCES
No Impacts
or Not
Applicable
Negligible
Impacts
Minor
Impacts
Impacts
Exceed Minor
More Data Needed
to Determine
EA/EIS required
EA/EIS required
1. Geological resources: soils,
bedrock, slopes, streambeds,
landforms, etc.
2. Air quality
3. Sound (noise impacts)
4. Water quality/quantity
5. Streamflow characteristics
6. Marine/estuarine
7. Floodplains/wetlands
8. Land use/ownership patterns;
property values; community
livability
9. Circulation, transportation
10. Plant/animal/fish species of
special concern and habitat; state/
federal listed or proposed for listing
11. Unique ecosystems, such as
biosphere reserves, World Heritage
sites, old growth forests, etc.
12. Unique or important wildlife/
wildlife habitat
13. Unique or important fish/habitat
14. Introduce or promote invasive
species (plant or animal)
15. Recreation resources, including
parks, open space, conservation
areas, rec. trails, facilities, services,
opportunities, public access, etc.)
16. Overall aesthetics, special
characteristics/features
17. Historical/cultural resources,
including landscapes, ethnographic,
archeological, structures, etc.
Attach SHPO determination.
18. Socioeconomics, including
employment, occupation, income
changes, tax base, infrastructure
19. Minority and low-income
populations
20. Energy resources (geothermal,
fossil fuels, etc.)
21. Other agency or tribal land use
plans or policies
22. Land/structures with history of
contamination/hazardous materials
even if remediated
23. Other important environmental
resources that should be addressed
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B. MANDATORY CRITERIA
If your LWCF proposal is approved, would it…
Yes
No
To be
determined
1. Have significant impacts on public health or safety?
2. Have significant impacts 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 (E.O. 11990);
floodplains (E.O 11988); and other ecologically significant or critical areas.
3. Have highly controversial environmental effects or involve unresolved conflicts
concerning alternative uses of available resources [NEPA section 102(2)(E)]?
4. Have highly uncertain and potentially significant environmental effects or
involve unique or unknown environmental risks?
5. Establish a precedent for future action or represent a decision in principle
about future actions with potentially significant environmental effects?
6. Have a direct relationship to other actions with individually insignificant, but
cumulatively significant, environmental effects?
7. Have significant impacts on properties listed or eligible for listing on the
National Register of Historic Places, as determined by either the bureau or
office.(Attach SHPO Comments)
8. Have significant impacts on species listed or proposed to be listed on the List
of Endangered or Threatened Species, or have significant impacts on designated
Critical Habitat for these species.
9. Violate a federal law, or a state, local, or tribal law or requirement imposed for
the protection of the environment?
10. Have a disproportionately high and adverse effect on low income or minority
populations (Executive Order 12898)?
11. Limit access to 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)?
12. 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)?
Environmental Reviewers
The following individual(s) provided input in the completion of the environmental screening form.
List all reviewers including name, title, agency, field of expertise. Keep all environmental review records
and data on this proposal in state compliance file for any future program review and/or audit.
1.
2.
3.
The following individuals conducted a site inspection to verify field conditions.
List name of inspector(s), title, agency, and date(s) of inspection.
1.
2.
3.
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Step 7. NEPA Pathway Recommendation and Certifications
First consult the attached list of “Categorical Exclusions (CEs) for Which a Record is Needed,” If you find your
action in the CE list, and you have determined in Step 6A that impacts will be minor or less for each applicable
environmental resource on the ESF, and you answered “no” to all of the “Mandatory Criteria” questions in Step 6B,
the proposal qualifies for a CE. Complete the following “State LWCF Environmental Recommendations” box
indicating the CE recommendation.
If you find your action in the CE list, and you have determined in Step 6A that impacts will be greater than minor or
that more data is needed for any of the resources, and you answered “no” to all of the “Mandatory Criteria”
questions, your environmental review team may choose to do additional analysis to determine the context,
duration, and intensity of the impacts of your project or may wish to revise the proposal to minimize impacts. If
impacts remain at the greater than minor level, an EA must be prepared for your proposal. Complete the following
“State Environmental Recommendations” box indicating the need for an EA.
If you do not find your action in the CE list, regardless of your answers in Step 6, you must prepare an EA
or EIS. Complete the following “State Environmental Recommendations” box indicating the need for an
EA or EIS.
State LWCF Environmental Recommendations and Appraisal Certification
□ I certify that a site inspection was conducted for each site involved in this proposal and to the best of my
knowledge, the information provided in this LWCF Proposal Description and Environmental Screening Form
(PD/ESF) is accurate based on available resource data. All resulting notes, reports and inspector signatures
are stored in the state’s NEPA file for this proposal and available upon request.
On the basis of the environmental impact information for this LWCF proposal as presented in this LWCF
PD/ESF with which I am familiar, I recommend the following NEPA pathway:
□ This proposal qualifies for a Categorical Exclusion (CE).
CE Item #:
Explanation:
□ This proposal requires an Environmental Assessment (EA) which is attached and
has been produced in accordance with the LWCF Grants Manual.
□ This proposal may require an Environmental Impact Statement (EIS). NPS guidance
is requested per the LWCF Grants Manual.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
State Appraisal Review-If applicable, complete this certification for each appraisal.
□ I certify that the State has reviewed the appraisal and has determined that it was prepared in conformity
with the Uniform Appraisal Standards for Federal Land Acquisitions.
Property Address:
Date of appraisal transmittal letter:
Fair market value: $
Effective Date of Value:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
SLO/ASLO Original Signature: ______________________________________ Date: _________________
Typed Name, Title, Agency:
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