CELCP Project Application and Checklist

OMB Control # 0648 -0459

Expires xx/xx/20xx

CELCP Project Application and NEPA Checklist

CELCP Lead Agency Review and Certification

1. Name of CELCP Lead Agency: _____________________

2. Project Title: _____________________

3. Project Location (Address or Major Intersections, City, County, State): _____________________

4. Congressional District(s): _____________________

5. Amount of CELCP Funding Requested: _____________________

6. Project Eligibility Screen: (Check all that apply)

The proposed project:

___ is located in a coastal or estuarine area that has been designated as a Project Area in the state’s or territory’s approved Coastal and Estuarine Land Conservation Plan;

___ matches federal funds with non-federal funds at a ratio of at least 1:1;

___ will be held in public ownership and provide conservation in perpetuity;

___ will be accessible to the general public or provide other public benefit, as appropriate and consistent with resource protection;

___ protects important coastal and estuarine areas that have significant conservation, ecological, historical, aesthetic, or recreation values, or that are threatened by conversion from their natural or recreational state to other uses;

___ can be effectively managed and protected;

___ is consistent with the state’s approved coastal management program.

7. Consistency with CELCP Plan:

Briefly describe how the project advances the goals of your state/territory CELCP plan (e.g., priority types of land and/or values that will be conserved). Please include citations to your state/territory plan.

_____________________________________________________________________________________

Signature of CELCP Lead Date

Name and Title of Signatory (please print or type): ___________________________________________

Project Applicant Review and Certification

8. Name of Applicant/Sub-applicant: _____________________ (i.e., Name of the public agency that will receive the grant funds to execute the project.)

9. Applicant Type: (Check one)

__ State or Territorial Agency

__ Local Government (county, municipality, city, town, township, local public authority, school district, special district, council of governments, or agency or instrumentality of a local government)

__ Regional or interstate government entity

__ Area-wide agency designated under Chapter 41, Subchapter II, Section 3334 of Title 42

I ATTEST THAT: THE STATEMENTS MADE AND OTHER INFORMATION PROVIDED IN THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE; I UNDERSTAND THE CONSEQUENCES OF NON-COMPLIANCE WITH THE SPECIAL AWARD CONDITIONS THAT WILL BE PLACED ON A CELCP GRANT, IF ONE IS AWARDED FOR THIS PROJECT.

_____________________________________________________________________________________

Signature of Applicant Date

Name and Title of Signatory (please print or type): ___________________________________________

Address: _____________________

Phone Number: _____________________

Email: _____________________

Project Summary

10. Budget Overview:

CELCP Federal share (requested amount): $ _____

CELCP State/Local Match Contributions: $ _____

Other Federal: $ _____

Other Non-Federal: $ _____­_ ___________________________________________________

Total Project Cost: $ _____

11. Project Description/Abstract: (Briefly summarize the project, describing property features, acreages, environmental significance, location of the property in relationship to the coast or estuary, expected benefits, and other salient details. Please limit the abstract to 2,500 characters (including spaces).

1. Program Purpose/ Relevance to program goals:

12. What is the primary value to be conserved by this project? (Check one)

___ Ecological ___Conservation ___ Recreational ___ Historic ___Aesthetic

13. What values are contained within the proposed property to be acquired? (Please use the guidance provided below to describe the ecological, conservation, recreation, historic, and aesthetic values contained on the property.)

(a.) Ecological Value:

Guidance:

• Describe the different habitat types that are found on the project site (e.g. upland forest, scrub/shrub, fields) and provide information on the habitat quality, including any impairments such as invasive/exotic species.

• Describe the ecological importance of the acquisition for the region, particularly in relation to coastal and estuarine resources and ecosystems such as: species diversity on the site(s); whether the site contains habitat of specific importance to the region; and whether and how the project will enhance linkages among ecologically important areas in the region.

• Describe how the habitat supports, or may support, Federal- or state-listed threatened or endangered species or species of greatest conservation need. For example, does the site provide enough acreage to support a viable population of an endangered species or will it enhance existing protected areas that already provide habitat for a viable population of an endangered species?

(b.) Conservation Value:

Guidance:

• Describe how acquisition of the site will help establish corridors and/or linkages among areas of significant conservation, ecological, recreational or aesthetic values that are already protected and/or whether the project exhibits a mix of ecological, recreation, historic and aesthetic values that together contribute important benefits to the coastal and estuarine environment that are not provided by those values individually.

• Indicate whether restoration is planned for the site, and if so, describe the potential for successfully restoring ecological values that have been impaired due to circumstances that have affected the site's integrity (such as invasive/exotic species and/or other alterations such as dikes or clearing for agricultural and silvicultural uses). Please also describe the plan, timeline and source of financial support for the proposed restoration.

(c.) Recreational Value:

Guidance:

• Describe the property’s significance or contribution with regard to coast-dependent or nature-based recreation and whether the project supports priorities for recreational access identified in a state’s CELCP plan or other assessment of needs for coastal recreation.

• Describe whether the site’s coastal access is located in an area of determined need at the local, regional, or national level.

• Describe whether the project site will be easily accessible to many people and/or whether there will be any limits on accessibility for recreation, for example, only allowing guided tours or having the site open only at certain times of the year.

(d.) Historic Value:

Guidance:

• Describe any historical, cultural, or archaeological features of significant value found on the property. For example, does the property contain features that are listed, or eligible to be listed, on the National Register of Historic Places, or a comparable State Register? Does this property contain any features designated or eligible to be designated as National Historical Landmarks? Please include information about any formal designation the property has received or been evaluated for.

• If applicable, explain whether the site contains evidence of historical, cultural, or archaeological features, and describe if they have been formally evaluated or such evaluation is warranted.

(e.) Aesthetic Value:

Guidance:

• Describe the views to be preserved by this acquisition and the contribution this property makes to the surrounding area.

• Describe whether the project protects a site designated nationally as a scenic byway or wild and scenic river, or a buffer adjacent to designated areas.

• Describe whether the project supports a local or state designated scenic route, river trail, or other cultural landscape.

• Describe any other significant contribution(s) this property makes to the aesthetic character of the surrounding area.

14. Strategic Importance/ Relevance to Conservation Plans: (If applicable, address relevance to each plan or type of plan referenced in (a) through (e) below. Please include citations wherever possible.)

(a.) State/Territory CELCP Plan: (Please describe the specific project area and priority land type(s) or value(s) in the state CELCP plan that the proposed acquisition supports, and include references to maps or page numbers wherever possible.)

(b.) State/Territory Coastal Management Plan approved under the CZMA:

(c.) National Estuarine Research Reserve (NERR) approved under the CZMA (if applicable):

(d.) Regional or State Watershed Planning Efforts:

(e.) Local Watershed or Coastal Planning Effort:

15. Are region and site location maps attached? __ Yes __ No

Attach a regional map showing the general location of the property or properties associated with the project, as well as a site map for each property to be acquired. Maps should illustrate the location and extent of the proposed acquisition, as well as its relationship to significant natural features (slope, wetlands, dunes, floodplains, public access, etc.).

16. Photographs: (If available, please attach photographs of the project site that document the values described below.)

PROPERTY INFORMATION

Please complete this section (questions #14-26, below) for EACH property to be acquired with CELCP funding or being used as in-kind match.

17. Name of Property: _____________________

18. What are the legal rights that will be acquired? (Check one)

­ ___ Fee Title ___ Conservation Easement/Restriction

If an easement, is the term in perpetuity? __ Yes __ No

19. Current Ownership: The site is currently owned by (Check one):

___ Individual ___ Corporation ___ Public

20. What entity will hold title to the property (fee title) or easement? _________________________

21. Property will be: (Check one)

___ Purchased with CELCP funding; ___ Used as an in-kind match contribution

(a.) Please briefly summarize the features of the property/easement in terms of the values described above. If an in-kind match property, please also describe when the property/easement was or will be acquired and how (purchase or donation); whether it was acquired from a willing seller; who holds or will hold the fee title or easement; and the relationship of the property to the property(ies) to be acquired with CELCP funds, i.e., shared conservation values, physical (including distance) or strategic conservation connections, and other attributes that warrant its consideration as a like-kind contribution.)

22. Acreage of Property:

Total Acreage of the property: _______________

Acres of Floodplain, if applicable: ____________ (please indicate if this is an estimate)

Total Shoreline Length: If the property has water frontage (beach or river shoreline), please indicate the length (specify whether in feet or miles) _________ and the name of the waterbody: _____________________

23. Classify the types of habitat that comprise the property. If possible, please provide specific details as to the habitat types found on the property. If uncertain, leave blank or otherwise indicate that the information is an estimate. Further information on land classifications can be found at http://www.csc.noaa.gov/crs/lca/tech_cls.html.

Habitat Classification	Acreage or percentage	Other Details (such as quality)
Palustrine Forested Wetland
Palustrine Emergent Wetland
Palustrine Aquatic Bed
Estuarine Forested Wetland
Estuarine Scrub/Shrub Wetland
Estuarine Emergent Wetland
Estuarine Aquatic Bed
Beach/Unconsolidated Shore
Open Water
Tundra
Perennial Ice/Snow
Moss
Lichens
Developed, High or Medium Intensity
Developed, Low Intensity
Developed, Open Space
Cultivated Crops
Pasture/Hay
Grassland/Herbaceous
Sedge/Herbaceous
Deciduous Forest
Evergreen Forest
Mixed Forest
Scrub/Shrub
Dwarf Scrub
Barren Land
Other

2. Scientific/ Technical Merit

24. Manageability and Long-term Use of the Property:

(a.) Condition of property: Please describe the current condition of the property. Is the property already in the desired state or is restoration or clean-up/remediation needed? Are surrounding uses (e.g. development plans or uses allowed by zoning) compatible?

(b.) Current uses of property: What type of activities/uses, including structures and/or leases, currently occur on the property?

25. Long-term Use of the Property:

(a.) Proposed long-term use(s): What types of activities/uses are intended for the property after acquisition? For each activity/use described, please indicate the extent (e.g., acreage or percentage of the property) and location of the activity/use, and how they are compatible with the primary purpose of the project. If restoration or remediation is needed, please describe plans for completing restoration/remediation and whether funding has been secured for that purpose (or how it will be secured).

(b.) Will the property will be leased or rented? ___Yes ___No If yes, please explain. If there is an existing lease and/or life estate that will transfer with the property, please describe the nature, duration and terms of the lease and/or life estate.

(c.) Long-term stewardship/management strategy: Has a long-term stewardship or management strategy been developed that describes how the ecological, conservation, recreation, historic, and aesthetic values present on the project site will be maintained or improved and the proposed method for ensuring long-term operations, maintenance and safety needs related to the property? ___Yes ___No If yes, please attach. If no, please describe the plan/timeline for developing a management strategy.

(d.) Terms of conservation easements: For conservation easements, have the terms of the easement been negotiated and drafted? ___Yes ___No If yes, please attach.

(e.) Public Access/Benefit: Will the property will be accessible to the general public? ___Yes ___No If no, please explain the reason why access will be limited (e.g., resource protection, conservation easement, public safety, geographic isolation/inaccessibility) and describe other public benefits that exist that offset the lack of public access.

(f.) User Fees or Access Fees: Will the public be charged a user fee for access to or activities on the proposed property? ___Yes ___No If yes, provide a description of the user fee which includes: how much, differential fees (if any), the need for the fees, and proposed use of the revenue.

26. Threat of Conversion:

(a.) Development Pressures: Please describe the current development pressures on the property (e.g., population trends and/or proximity to major infrastructure, such as roads or availability of water/sewer, that indicate the area’s threat of conversion, or whether development plans been approved by a local governing body and regulatory agencies).

(b.) Development Potential: Please describe the development potential of each property to be acquired, including current zoning and developable area.

(c.) Status of the Property: Please describe the current status of each property to be acquired, such as whether listed for sale and/or whether any subdivision or development plans are pending for the site.

27. Project Readiness:

(a.) Parcel Identification: Please describe whether target parcels or project sites have been identified and the stage of discussion with landowners, such as whether preliminary contacts have been made and/or whether negotiations have resulted (or are likely to result) in a purchase and sale agreement.

(b.) Willing Seller: Is the landowner a willing participant in negotiations to sell at a mutually agreeable price? __ Yes __ No If yes, is documentation available, such as in the form of a letter of intent, option letter, contract, or similar form? __ Yes __ No (If yes, please attach.)

(c.) Title Review: Has a title review and opinion/ certificate been completed? __ Yes __ No If yes, please describe any liens, judgments or other encumbrances that could interfere with the acquisition of the property or its long-term conservation under the CELCP within the award period.

(d.) Appraisal: Has a complete, self-contained appraisal prepared to the Federal “Yellow Book” appraisal standards been completed? __ Yes __ No If yes, what is the date of the appraisal? __________

(e.) Legal Issues: Is the project subject to litigation, bankruptcy or other legal proceedings that could interfere with the acquisition of the property within the award period? __ Yes __ No If yes, please explain.

(f.) Environmental Hazards: Does the site currently have, or has it had, contamination or other environmental hazards that must be resolved before it would be suitable for public use? __ Yes __ No If yes, please explain.

3. Qualifications of Applicants

28. Ability to Acquire Land:

1. Please describe the agency’s legal authority, personnel, expertise, and previous experience in acquiring lands for long-term conservation, either directly or through partnerships with another organization:

2. Will the recipient contract (formally or informally) with a private or non-profit organization to complete part or all of the acquisition(s) for this project? If yes, please provide the name of the organization and describe the organization’s ability to acquire lands.

3. Please list other organizations that will be involved in or provide support for completing this project? What role or kind of support will each partner provide?

Name of Partner Organization	Role of Partner Organization

29. Ability to Manage Land:

(a.) Please describe the organization’s capacity, in terms of personnel, expertise, and funding, to manage the property for conservation purposes, either directly or through a partnership or stewardship agreement with another organization. Please describe your agency’s current experience in managing other properties for conservation purposes.

(b.) Has a dedicated source of funding and staff for long-term conservation been identified?

(c.) Will your agency contract with or pursue other arrangement with a private organization (such as a land trust) to support long-term management and stewardship of property(ies) acquired through this project? If yes, please provide the name of the organization and describe the organization’s ability to manage lands.

4. Project costs and Timeline

30. Project Timeline:

Please identify the proposed timeline for the project with discrete benchmarks for completing the project within the award period (which should assume an 18-month period with a start date between June 1, 20XX and October 1, 20XX).

31. Project Budget:

1. Budget Overview Table:

Using the table below, please identify the overall costs associated the project, accounting for funding from all likely sources. You only need to fill out this table if the total cost of the project is greater than the requested CELCP funding (including required matching funds). Otherwise, you only need to fill out the CELCP Budget Table (#30b, below).

Category (Examples below)	Amount (Note if cash or in-kind value of land/ services)	Funding Source(s) (Include information from all contributors to the project)	Funds Already Expended? (yes/no) If so, when?
Other - Land Purchase	$
Contractual - Title Review
Contractual - Appraisals
Personnel
Contractual - Closing costs
Total Cost:

2. CELCP Budget Table:

Using the table below, identify the costs associated only with requested Federal CELCP funding and required non-Federal matching funds.

Category	Federal Share from CELCP	State/Local Matching Share	Total	Funding Source (for Non-Federal share) (Note whether funding is from cash or in-kind value of land or services)	Funds Already Expended? (yes/no) If so, when?
	$	$	$
Total:

Federal Share of Budget:

32. Please explain the basis for the requested Federal share of CELCP funds, including:

1. The basis for establishing the land acquisition cost, such as an appraisal or other basis for estimating fair market value, such as research on comparable sales. If based on appraised value, please explain when the appraisal was conducted and what appraisal standards were used; and

2. The basis for any other costs included within the requested Federal share of CELCP. Please describe the nature of those costs to document that they are reasonable costs and necessary for the successful completion of the project. Please also describe the basis for the amounts requested (for example, if personnel costs are requested, detail the number of staff and level of effort).

Non-Federal Matching Funds:

33. What is the source of non-Federal matching funds? (Check all that apply)

• Cash $______________

• Value of donated lands $ ______________

• Value of in-kind services $ _______________

(a.) Cash sources - If cash, please describe the source of these funds and explain what actions have been taken to secure these funds and, if not yet in hand, when these funds are likely to be available.

(b.) In-kind land contribution - If an in-kind land contribution is being proposed for match, explain the basis for the value of the contribution (e.g., an appraisal or other estimate of fair market value that still must be confirmed by appraisal).

(c.) Other in-kind services - If other in-kind services are included as match, such as direct staff support, acquisition-related expenses (e.g., title, appraisal, etc.) or restoration or remediation of the property to be acquired with CELCP funds, please explain the nature of these costs and provide details to document that they are reasonable and necessary for the successful completion of the project.

34. Has the match been used previously as match for another federal grant? __ Yes __ No If yes, please explain.

35. Is/was the acquisition of the property required in order to compensate for or offset damage to other resources, either in the past or will it be used as such in the future? __ Yes __ No

36. Other Funding Sources and Partnerships:

(a.) Has the proposed project been submitted to or is it currently under consideration by other programs for funding? If yes, please list which program(s) and for which funding year(s), and whether the funding requested from other programs duplicates (i.e., substitutes for) or complements (i.e., would be needed in addition to) the funding requested under CELCP.

(b.) If the requested funding from CELCP is only a portion of the total purchase price of the property, please explain whether or how the project would be viable if remaining funds cannot be secured. For example, could the property be acquired in phases? Would the CELCP funds be used to acquire an easement on a portion of the property?

Compliance with Other Federal Authorities

37. National Historic Preservation Act/State Historic Preservation Officer’s (SHPO’s) Clearance:

a. Will the project affect sites listed or eligible to be listed on the National Register of Historic Places (www.cr.nps.gov/nr/) or a similar State registry? _____ Yes _____ No

b. Does the recipient have the SHPO’s clearance on file? _____ Yes _____ No

(If No, the Recipient certifies, by signing this checklist, they will assist NOAA in obtaining the SHPO clearance and that the property will not be purchased until SHPO clearance is received by NOAA and the Recipient.)

38. National Flood Insurance Program:

a. Is the property located in a Special Flood Hazard Area shown on National Flood Insurance Program (NFIP) Flood Insurance Rate Map? ____ Yes _____ No

If Yes, which zone? ______ _ (If No, go to 33)

b. Is the community in which the property is located participating in the NFIP? ____ Yes ____ No

39. Coastal Barriers Resource Act: The property is located on a coastal barrier island designated as a unit of the Coastal Barriers Resources System (www.fws.gov/cep/cbrunits.html). ____ Yes ____ No

If the answer is Yes, attach to this checklist a brief analysis as to how the proposed project is consistent with the three CBRA purposes: to minimize (1) the loss of human life, (2) wasteful federal expenditures, and (3) damage to fish, wildlife and other natural resources.

40. Endangered Species Act:

1. Are there known listed threatened or endangered plant or animal species or their critical habitat (as defined by the Endangered Species Act) that are under the jurisdiction of the National Marine Fisheries Service (NMFS) or U.S. Fish and Wildlife Service (USFWS) on the proposed property? ____ Yes ____ No

If the answer is yes, please attach a list of the species and/or their critical habitats.

2. Will the proposed project have adverse effects on species listed or proposed for listing as threatened or endangered species or on their designated critical habitats. _____ Yes _____ No (www.fws.gov/endangered) or (www.nmfs.noaa.gov/pr/species)?

If the answer is yes, please attach a description of the species and/or habitats affected, the adverse effects (minor and significant effects), and any coordination that has occurred between the state and the USFWS or NMFS. CPD will not approve a project that USFWS or NMFS has determined will have significant adverse effects on listed species or their critical habitat.

41. Magnuson-Stevens Fishery Conservation and Management Act.

(a.) Does the proposed project include essential fish habitat for federally managed fish?

_____ Yes ____ No ____ Not yet determined (please explain).

If yes, which species?

(b.) Could the proposed project have adverse effects on essential fish habitat for federally managed fish? _____ Yes _____ No

Please explain the basis for this conclusion:

42. National Environmental Policy Act:

(a.) Will the proposed project significantly affect the quality of the human environment?

_____ Yes _____ No

(b.) Does the proposed project involve unresolved conflicts concerning alternative uses of available resources? _____ Yes _____ No

(c.) Will this project have significant adverse effects on public health and safety? ____ Yes ____ No

(d.) Will this project have highly controversial environmental effects on the human environment? ____Yes ____ No

(e.) Will this project have highly uncertain and potentially significant environmental effects or involve unique or unknown risks? _____ Yes _____ No

(f.) Will this project have significant adverse impacts on other natural resources not covered elsewhere in this checklist, e.g., beaches and dunes, wetlands, estuarine areas, wildlife habitat, wild or scenic rivers, reefs, or other coastal resources? _____ Yes _____ No

(g.) Will the effects of this project be cumulatively significant when added to existing and reasonably foreseeable actions, even if the effects from this project individually might be insignificant? ____ Yes ___ No

If the answer to any one subpart of 36. is Yes, then additional NEPA review and documentation may be required. Attach a description of the resource(s) affected, the nature and scope of the effects, and information explaining why the applicant believes an Environmental Assessment (EA) or an Environmental Impact Statement (EIS) should not be required. OCRM may require additional information in cases where potential impacts are not clearly described or where probable impacts require an EA or EIS.

43. Environmental Justice. Will the project have disproportionately high and adverse human health or environmental effects on minority or low-income populations? _____ Yes _____ No

44. Americans with Disabilities Act: Will the proposed project be accessible to people with disabilities? _____ Yes _____ No _____ N/A

If No or N/A, provide a brief explanation below (or attach separately) as to how the project would or should not be required to conform with ADA requirements.

45. Uniform Relocation Assistance and Real Property Acquisitions Policies Act of 1970. Will the proposed acquisition cause the displacement of:

Persons, _____ Yes _____ No

Businesses, or _____ Yes _____ No

Farm Operations? _____ Yes _____ No

If yes to any of the above, please explain: the number of displaced persons, including businesses and farm operations; what fair and reasonable relocation payments and advisory services will be provided to any displaced persons; and what provisions will be made to ensure that safe, decent, and sanitary replacement dwellings will be available to such persons within a reasonable period of time prior to displacement.

46. State, and Local Laws. The project will be consistent with applicable state and local laws. _____ Yes _____ No

47. Tribal Interests:

(a.) The property is located on or will affect Tribal lands. ___ Yes ___ No (If No, go on to 42)

(b.) The project will be consistent with applicable tribal laws. ___ Yes ___ No

If No, the project will not be approved.

48. Contamination/Environmental Hazards (CERCLA/RCRA)

(a.) Has the site been investigated, identified and/or designated as having hazardous waste contamination issues by a federal, state, or local agency (for example, is the property Superfund site)? _____ Yes ____ No

If yes, please explain the basis for the designation, the status of clean-up activities, and whether there are any legal liens or judgments affecting the property.

(b.) Are there any known or suspected contaminants on the property? _____ Yes ____ No

If yes, please discuss what type of contamination is on or suspected to be on the property, and if applicable, the status of any clean-up activities.

49. Public Coordination

Has the project for which you propose to use CELCP funds been subject to public review and coordination through a notice or other review process? _____Yes _____No

If "yes", please describe the results of that process and note when the coordination occurred.

If “no”, please explain.

_____________________________________________________________________________

NOAA is requesting this information in order to adequately assess the eligibility of proposed projects. Public reporting burden for this collection of information is estimated to average 10 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Elaine Vaudreuil, OCRM, 1305 East-West Hwy (N/ORM7), Silver Spring, Maryland 20910. This reporting is authorized under P.L. 111-11and has been approved under OMB #0648 -0459. Information submitted will be treated as public record. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection displays a currently valid OMB Control Number.