Change Request Chart for FEMA Form 024-0-1

FEMA Form 024-0-1, TITLE: EHP Screening Form

LOCATION

CURRENT TEXT

REVISED TEXT

Intro Instructions

This form should be attached to all project information sent to the Grant Programs Directorate (GPD) to initiate an environmental and historic preservation (EHP) regulatory compliance review. Complete sections A – D of this form, as applicable; completion of this form does not conclude the EHP review process and FEMA may need to go back to you for further information. When questions are not applicable to the project, leave the field blank. This form is intended to be completed electronically. Refer to Appendix B (page 10) for guidance on how to make an aerial map (if required for your project), and refer to Appendix C (page 11) for a list of online resources to help you provide visual documentation. Contact GPD-EHP for a version of this form that is suitable for printing and completing by hand. To check (X) a box, left double-click using your mouse and a Check Box Form Field Box will appear. On the Check Box Form Field Box, select the default value as Checked and press OK. To write in a text field (     ), select the text field with your mouse and begin typing.

Your completed screening form with necessary attachments must be submitted to the Centralized Scheduling and Information Desk (CSID) at [email protected]  with the following information in the subject line of the e-mail: EHP Submission: Project Name, Subgrantee Name; Grant Award Number (i.e., EHP Submission: Camera Installation, Anytown Courthouse, 2010-AB-C1-2345).

Directions for completing this form: This form is designed to initiate and facilitate the environmental and historic preservation (EHP) compliance review for your FEMA preparedness grant-funded project(s). FEMA conducts its EHP compliance reviews in accordance with National Environmental Policy Act (NEPA) and other EHP-related laws and executive orders. In order to initiate EHP review of your project, you must complete all relevant sections of this form and submit it to the Grant Programs Directorate (GPD) along with all other pertinent project information. Failure to provide requisite information could result in delays in the release of grant funds. Be advised that completion of this form does not complete the EHP review process. You will be notified by FEMA when your review is complete and/or if FEMA needs additional information.

There is no need to complete and submit this form if the grant scope is limited to planning, management and administration, classroom-based training, tabletop exercises and functional exercises, or purchase of mobile and portable equipment where no installation is needed. Information Bulletin 345, Grant Programs Directorate Programmatic Environmental Assessment, September 1, 2010, provides details on these activities.

This form should be completed electronically. The document is available in both Word and Adobe Acrobat (pdf) formats at this website: (http://www.fema.gov/library/viewRecord.do?fromSearch=fromsearch&id=4802. The following website has additional guidance and instructions on the EHP review process and the information required for the EHP review: http://www.fema.gov/plan/ehp/ehpreview/index.shtm

Submit completed form through your grant administrator who will forward it to [email protected]. Please use the subject line: EHP Submission: Project Title, location, Grant Award Number (Example, EHP Submission: Courthouse Camera Installation, Any Town, State, 12345; 2011-SS-0xxxx).

A. PROJECT INFORMATION

Grant Program Name:       DHS Grant Award Number:       

Project Name:       Grant Fiscal Year:       (Provide if no award number is available)

Project Type (Check all that apply): Physical security enhancements (i.e., installation of fencing, cameras, TWIC readers, bollards, motion detection systems, x-ray machines, lighting, etc.)

New installation/construction/renovation (i.e., emergency operations centers, docks, piers, security guard buildings, etc.)

Renovations/upgrades/modifications to structures 50 years old or older

Communication towers, related equipment, and equipment shelters

Other ground disturbing activities (i.e., trenching, excavation, etc.)

Training and exercises (specify whether discussion-based or operations-based; operations-based only require further information below)      

Purchase of equipment (specify type, and whether mobile/ portable, or installation will be required)      

Other (specify)      

Grantee Name (SAA):       Sub grantee Name:      

State:       County:       City:       Agency:      

Dollar value of grant (optional):      

DHS Grant Award Number:    

Grant Program:    

Grantee    

Grantee POC:    

Mailing address:    

E-mail:    

Sub grantee:    

Subgrantee POC:    

Mailing address:    

E-mail:    

Estimated cost of project:    

Project title:    

Project location (physical address or latitude-longitude):    

B. PROJECT DESCRIPTION/LOCATION

The following information will be required in order to complete a review for each project type. If multiple “project types” describe the same project, [i.e., physical security enhancements AND renovations of structures 50 years old or older AND other ground disturbing activities], it is not necessary to repeat information; please make a note to refer back to the previous entry.

Enter Project Description:      

The project description should contain a brief summary of what specific action is proposed, where it is proposed, and how it will be implemented. If this proposed project will be part of a larger project, please state the funding source. If the funding source is another GPD grant, please include the award number.

Project Type: Physical security enhancements (i.e., installation of fencing, cameras, TWIC readers, bollards, motion detection systems, x-ray machines, lighting, etc.)

Project Location (physical project address or latitude/longitude of project location):      

Year existing building(s) or structure(s) involved in the proposed project was built:      

Color site photos attached?

Ground-level site photos (showing where installations are proposed): Yes No

Aerial photograph with project limits outlined and with the location of any proposed installations identified (refer to Appendix B for guidance): Yes No

Will ground disturbance be required?

Yes (provide total extent (depth, length, and width)       No

Has the ground been previously disturbed? Yes No

If yes, please describe the current disturbed condition of the area (i.e., parking lot, commercial development, etc.):      

If no, include other visual documentation (see Appendix C for a list of online mapping resources):

Technical drawings/site plans (if available) Yes No

FEMA Flood Insurance Rate Map (FIRM), with project limits outlined Yes No

U.S. Fish and Wildlife Service, National Wetlands Inventory (NWI) Map, with project limits outlined Yes No

U.S. Department of Agriculture (USDA) Soil Survey Map, with project limits outlined

Yes No

Will any equipment or structures need to be installed? Yes No

If yes, please explain how and where this installation is proposed to be done (include site-specific photographs, and attach additional pages, if needed):      

Will the equipment use the existing infrastructure for electrical distribution systems?

Yes No

Are there any known structures or buildings that are 50 years old or older in the project area or immediate vicinity?  (If yes, please provide the location of the structure(s), ground-level color photos of these structures, and identify their location(s) on the aerial map; see Appendix C for the web address of the National Register of Historic Places) Yes No

Is there any previously completed environmental documentation for this project (i.e., environmental assessment, wetland delineation, archaeological study)? Yes (please attach documentation) No

Is there any previously completed agency coordination for this project (i.e., correspondence with the U.S. Fish and Wildlife Service, State Historic Preservation Office, Tribal Historic Preservation Office)?

Yes (please attach documentation) No

Project Type: New installation/construction/renovation (i.e., emergency operations centers, docks, piers, security guardhouse, etc.)

Project Location (physical project address or latitude/longitude of project location):      

Year existing building(s) or structure(s) involved in the proposed project was built:      

Describe the setting of the area where the new installation/construction/renovation is proposed (i.e., urban, suburban, or rural; forested or open field):      

Color site photos attached?

Ground-level site photos (showing where installations are proposed): Yes No

Aerial photograph with project limits outlined and with the location of any proposed installations identified (refer to Appendix B for guidance): Yes No

Will ground disturbance be required?

Yes (provide total extent (depth, length, and width)       No

Has the ground been previously disturbed? Yes No

If yes, please describe the current disturbed condition of the area (i.e., parking lot, commercial development, etc.):      

If no, include other visual documentation (see Appendix C for a list of online mapping resources):

Technical drawings/site plans (if available) Yes No

FEMA Flood Insurance Rate Map (FIRM), with project limits outlined Yes No

U.S. Fish and Wildlife Service, National Wetlands Inventory (NWI) Map, with project limits outlined Yes No

U.S. Department of Agriculture (USDA) Soil Survey Map, with project limits outlined

Yes No

Will any equipment or structures need to be installed? Yes No

If yes, please explain how and where this is proposed to be done (include site-specific photographs, and attach additional pages, if needed):      

Are there any known structures or buildings that are 50 years old or older in the project area or immediate vicinity? (If yes, please provide the location of the structure(s), ground-level color photos of these structures, and identify their location(s) on the aerial map; see Appendix C for the web address of the National Register of Historic Places)? Yes No

Is there any previously completed environmental documentation for this project (i.e., environmental assessment, wetland delineation, archaeological study)? Yes (please attach documentation) No

Is there any previously completed agency coordination for this project (i.e., correspondence with the U.S. Fish and Wildlife Service, State Historic Preservation Office, Tribal Historic Preservation Office)?

Yes (please attach documentation) No

Project Type: Renovations/upgrades/modifications to structures 50 years old or older

Is the building or structure listed in the National Register of Historic Places, or has it previously been determined eligible for listing in the National Register of Historic Places? (See Appendix C for the web address of the National Register of Historic Places) Yes No Unknown

Project Location (physical project address or latitude/longitude of project location):      

Year existing building(s) or structure(s) involved in the proposed project was built:      

Color site photos attached?

Ground-level site photos (showing where installations are proposed): Yes No

Aerial photograph with project limits outlined and with the location of any proposed installations identified (refer to Appendix B for guidance): Yes No

Will ground disturbance be required?

Yes (provide total extent (depth, length, and width)       No

Has the ground been previously disturbed? Yes No

If yes, please describe the current disturbed condition of the area (i.e., parking lot, commercial development, etc.):      

If no, include other visual documentation (see Appendix C for a list of online mapping resources):

Technical drawings/site plans (if available) Yes No

FEMA Flood Insurance Rate Map (FIRM), with project limits outlined Yes No

U.S. Fish and Wildlife Service, National Wetlands Inventory (NWI) Map, with project limits outlined Yes No

U.S. Department of Agriculture (USDA) Soil Survey Map, with project limits outlined

Yes No

Will any equipment or structures need to be installed? Yes No

If yes, please explain how and where this is proposed to be done (include site-specific photographs, and attach additional pages, if needed):      

Are there any known structures or buildings that are 50 years old or older in the project area or immediate vicinity? (If yes, please provide the location of the structure(s), ground-level color photos of these structures, and identify their location(s) on the aerial map; see Appendix C for the web address of the National Register of Historic Places) Yes No

Is there any previously completed environmental documentation for this project (i.e., environmental assessment, wetland delineation, archaeological study)? Yes (please attach documentation)? No

Is there any previously completed agency coordination for this project (i.e., correspondence with the U.S. Fish and Wildlife Service, State Historic Preservation Office, Tribal Historic Preservation Office)?

Yes (please attach documentation) No

Project Type: Communication towers, related equipment, and equipment shelters

Project Location (physical project address or latitude/longitude and elevation above mean sea level of project location):      

Year existing building(s) or structure(s) involved in the proposed project was built:      

Color site photos attached?

Ground-level site photos (showing where installations are proposed): Yes No

Aerial photograph with project limits outlined and with the location of any proposed installations identified (refer to Appendix B for guidance): Yes No

For projects involving antenna (e) installations on existing towers, provide the height of the existing tower       and the height of the tower following the installation of the new antenna (e)      .

For new projects, state the total height (in feet) of the communication tower or structure, including any antennae to be mounted:      ­­­

If the proposed tower height is greater than 199 feet above ground level, state why this is needed to meet the requirements of the project:      

Will the tower be free-standing or require guy wires? Free standing Guy wires

If guy wires are required, state number of bands and how many:      

State why a guyed tower is needed to meet the requirements of this project:      

What kind of lighting will be installed, if any (e.g., white strobe, red strobe, or steady burning)?      

Have measures been incorporated for minimizing impacts to migratory birds? Yes No

If yes, describe:      

Has an FCC registration been obtained for this tower? Yes No Registration #:      

Has the FCC E106 process been completed? Yes No

Has the FCC TCNS process been completed? Yes No If yes, attach all relevant environmental documentation submitted as part of the registration process, including use of the Tower Construction Notification System (TCNS), if applicable.

FRN#     

Will ground disturbance be required?

Yes (provide total extent (depth, length, and width)       No

Has the ground been previously disturbed? Yes No

If yes, please describe the current disturbed condition of the area (i.e., parking lot, commercial development, etc.):      

If no, include other visual documentation (see Appendix C for a list of online mapping resources):

Technical drawings/site plans (if available) Yes No

FEMA Flood Insurance Rate Map (FIRM), with project limits outlined Yes No

U.S. Fish and Wildlife Service, National Wetlands Inventory (NWI) Map, with project limits outlined Yes No

U.S. Department of Agriculture (USDA) Soil Survey Map, with project limits outlined

Yes No

Will any equipment or structures need to be installed? Yes No

If yes, explain how and where this is proposed to be done (include site-specific photographs,

and attach additional pages, if needed):      

Are there any known structures or buildings that are 50 years old or older in the project area or immediate vicinity? (If yes, provide the location of the structure(s), ground-level color photos of these structures, and identify their location(s) on the aerial map; see Appendix C for the web address of the National Register of Historic Places) Yes No

Is there any previously completed environmental documentation for this project (i.e., environmental assessment, wetland delineation, archaeological study)? Yes (attach documentation) No

Is there any previously completed agency coordination for this project (i.e., correspondence with the U.S. Fish and Wildlife Service, State Historic Preservation Office, Tribal Historic Preservation Office)?

Yes (attach documentation) No

Will equipment be co-located on existing FCC licensed tower or other structure? Yes No

If yes, type of structure:      

If no, please complete Appendix A.

Project Type: Other ground disturbing activities (i.e., trenching, excavation, fiber optics, etc.)

Project Location (physical project address or latitude/longitude of project location):      

Year existing building(s) or structure(s) involved in the proposed project was built:      

Color site photographs and maps attached?

Ground-level site photos (showing where ground disturbance are proposed): Yes No

Aerial photograph with project limits outlined and with the location of any proposed ground disturbance identified (refer to Appendix B for guidance): Yes No

What type of ground disturbance is needed and why (i.e., utility trenching, etc.)?      

Provide the total extent of ground disturbance required (depth, length, and width):      

Has the ground been previously disturbed? Yes No

If yes, please describe the current disturbed condition of the area (i.e., parking lot, commercial development, etc.):      

If no, include other visual documentation (see Appendix C for a list of online mapping resources):

Technical drawings/site plans (if available) Yes No

FEMA Flood Insurance Rate Map (FIRM), with project limits outlined Yes No

U.S. Fish and Wildlife Service, National Wetlands Inventory (NWI) Map, with project limits outlined Yes No

U.S. Department of Agriculture (USDA) Soil Survey Map, with project limits outlined

Yes No

Will any equipment or structures need to be installed? Yes No

If yes, please explain how and where this is proposed to be done (include site-specific photographs, and attach additional pages, if needed):      

Are there any known structures or buildings that are 50 years old or older in the project area or immediate vicinity? (If yes, provide the location of the structure(s), ground-level color photos of these structures, and identify their location(s) on the aerial map; see Appendix C for the web address of the National Register of Historic Places) Yes No

Is there any previously completed environmental documentation for this project (i.e., environmental assessment, wetland delineation, archaeological study)? Yes (please attach documentation) No

Is there any previously completed agency coordination for this project (i.e., correspondence with the U.S. Fish and Wildlife Service, State Historic Preservation Office, Tribal Historic Preservation Office)?

Yes (please attach documentation) No

Project Type: Training and Exercises (field-based only)

If the training is discussion-based or an operations-based functional exercise, then no further information is required. If the training is operations-based, then provide the following:

Will the operations-based training take place at an existing facility having established procedures for that particular proposed exercise, and that conform with existing land use designations (refer to Information Bulletin #329 Clarification for further information)? Yes No

If yes, please provide the name and location of the facility:      

Does the training exercise differ in any way (frequency, amount of facilities/land used, materials or equipment used, number of participants, type of activities, etc.) from previously permitted training exercises and training practices? Yes No

If yes, explain any differences between the proposed activity and those that have been approved in the past, and the reason(s) for the change in scope.      

If yes, the operations-based training is taking place at an existing facility (as described above), no further information is required. If the operations-based training is not occurring at an existing facility, provide the following:

Project Location (physical project address or latitude/longitude of project location):      

Year existing building(s) or structure(s) involved in the proposed project was built:      

Will ground disturbance be required to prepare the training site? Yes No

If yes, give total extent (depth, length, and width), and provide visual documentation:      

Color site photos attached?

Ground-level site photos (showing where installations are proposed): Yes No

Aerial photograph with project limits outlined and with the location of any proposed installations identified (refer to Appendix B for guidance): Yes No

Has the ground been previously disturbed? Yes No

If yes, please describe the current disturbed condition of the area (i.e., parking lot, commercial development, etc.):      

If no, include other visual documentation (see Appendix C for a list of online mapping resources):

Technical drawings/site plans (if available) Yes No

FEMA Flood Insurance Rate Map (FIRM), with project limits outlined Yes No

U.S. Fish and Wildlife Service, National Wetlands Inventory (NWI) Map, with project limits outlined Yes No

U.S. Department of Agriculture (USDA) Soil Survey Map, with project limits outlined

Yes No

Will any equipment or structures need to be installed to facilitate training? Yes No

If yes, explain how and where this is proposed to be done (include site-specific photographs, and attach additional pages, if needed):      

Describe the scope of the proposed training (purpose, frequency, facilities/location needed, materials and equipment needed, number of participants, and type of activities required) (Attach additional pages, if needed):      

Is there any previously completed environmental documentation for this project (i.e., environmental assessment, wetland delineation, archaeological study)? Yes (please attach documentation) No

Is there any previously completed agency coordination for this project (i.e., correspondence with the U.S. Fish and Wildlife Service, State Historic Preservation Office, Tribal Historic Preservation Office)?

Yes (please attach relevant documentation) No

Project Type: Purchase of equipment (specify what equipment, and the quantity; for generators, please state the capacity)      

Will any equipment need to be installed? Yes No

If yes, please explain how and where this is proposed to be done (include site-specific photographs, and attach additional pages, if needed):      

Year existing building(s) or structure(s) involved in the proposed project was built:      

Based on the proposed project activities, determine which project type applies below and complete the corresponding sections that follow. For multi-component projects or those that may fit into multiple project types, complete the sections that best apply and fully describe all major components in the project description. If the project involves multiple sites, information for each site (such as age of structure, location, ground disturbance, etc.) must be provided. Attach additional pages to this submission, if needed.

1. Purchase of equipment. Projects in this category involve the purchase of equipment that will require installation on or in a building or structure. Complete other portions of Section B as needed. Complete Section C.1.

2. Training and exercises. Projects in this category involve training exercises with any field-based components, such as drills or full-scale exercises. Complete Section C.2.

3. Renovations/upgrades/modifications or physical security enhancements to existing structures. Projects in this category involve renovations, upgrades, retrofits, and installation of equipment or systems in or on a building or structure. Examples include, but are not limited to: interior building renovations; electrical system upgrades; sprinkler systems; vehicle exhaust systems; closed circuit television (CCTV) cameras; security fencing; access control for an area, building, or room; bollards; motion detection systems; alarm systems; security door installation or upgrades; lighting; and audio-visual equipment (projectors, smart boards, whiteboards, monitors, displays, and projector screens). Complete Section C.3.

4. Generator installation. Projects in this category involve installation of new or replacement generators, to include the concrete pads, underground fuel and electric lines, and if necessary, a fuel storage tank. Complete Section C.4.

5. New construction/addition. Projects in this category involve new construction, addition to, or expansion of a facility. These projects involve construction of a new building, or expansion of the footprint or profile of a current structure. Complete Section C.5.

6. Communication towers, antennas, and related equipment. Projects in this category involve construction of new or replacement communications towers, or installation of communications-related equipment on a tower or building or in a communications shelter or building. Complete Section C.6.

7. Other. Projects that do not fit in any of the categories listed above. Complete Section C.7.

SECTION C. PROJECT TYPE DETAILS

Re-formated section from Section B above and added to new form.

Check the box that applies to the proposed project and complete the corresponding details.

0 Purchase of equipment. If the entire project is limited to purchase of mobile/portable equipment and there is no installation needed, this form does not need to be completed and submitted.

Specify the equipment, and the quantity of each:

Provide the Authorized Equipment List (AEL) number(s) (if known):

Complete Section D.

0 Training and exercises. If the training is classroom and discussion-based only, and is not field-based, this form does not need to be completed and submitted.

Describe the scope of the proposed training or exercise (purpose,

materials, and type of a activities required):

Provide the location of the training (physical address or latitude-

longitude):

Would the training or exercise take place at an existing facility which has

established procedures for that particular proposed training or exercise,

and that conforms with existing land use designations? For further

information refer to Information Bulletin #345, http://www.fema.gov/pdf/government/grant/bulletins/info345.pdf : 0 Yes 0 No

If Yes, provide the name of the facility and the facility point of

contact (name, telephone number, and email address):

If No, provide a narrative description of the area where the training

or exercise would occur (e.g., exercise area within four points

defined by latitude/longitude coordinates):

Does the field-based training/exercise differ from previously permitted training or exercises in any way, including, but not limited to frequency, amount of facilities/land used, materials or equipment used, number of participants, or type of activities? 0 Yes 0 No

If Yes, explain any differences between the proposed activity and

Those that were approved in the past, and the reason(s) for the change

in scope:

If No, provide reference to previous exercise (e.g., FEMA grant

name, number, and date):

Would any equipment or structures need to be installed to facilitate

training? 0 Yes 0 No

If Yes, complete Section D

0 Renovations/upgrades/modifications, or physical security enhancements to existing structures.

Complete Section D.

0 Generator installation.

Provide capacity of the generator (kW):

Identify the fuel to be used for the generator (diesel/propane/natural gas):

Identify where the fuel for the generator would be stored (e.g. stand-alone

tank, above or below ground, or incorporated in generator):

Complete Section D.

0 New construction/addition.

Provide detailed project description (site acreage, new facility square

footage/number of stories, utilities, parking, stormwater features, etc):

Provide technical drawings or site plans of the proposed project: 0 Attached

Complete Section D.

0 Communication towers, antennas, and related equipment.

Provide the current net height (in feet above ground level) of the existing

tower or building (with current attached equipment):

Provide the height (in feet above ground level) of the existing tower or

building after adding/replacing equipment:

Complete items 6.c through 6.q below ONLY if this project involves construction of a new or replacement communications tower. Otherwise continue to Section D.

Information Bulletin 351, National Historic Preservation Act Section 106 Review Requirements for Communications Facilities, January 4, 2011 has additional guidance and information on EHP requirements for communications towers. Available at: http://www.fema.gov/pdf/government/grant/bulletins/info351.pdf

Provide the ground-level elevation (feet above mean sea level) of the site

of the proposed communications tower:

Provide the total height (in feet above ground level) of the proposed

communications tower or structure, including any antennas to be mounted:

If greater than 199 feet above ground level, state why this is needed

to meet the requirements of the project:

Would the tower be free-standing or require guy wires? 0 Free standing 0 Guy wires

If guy wires are required, state number of bands and the number of

wires per band:

Explain why a guyed tower is needed to meet the requirements of

this project:

What kind of lighting would be installed, if any (e.g., white strobe, red

strobe, or steady burning)?

Provide a general description of terrain (e.g., mountainous, rolling hills,

flat to undulating):

Describe the frequency and seasonality of fog/low cloud cover:

Provide a list of habitat types and land use at and adjacent to the tower

site (within ½ mile), by acreage and percentage of total (e.g., woodland

conifer forest, grassland, agriculture) water body, marsh:

Is there evidence of bird roosts or rookeries present within ½ mile of the proposed site? 0 Yes 0 No

Describe how presence/absence of bird roosts or rookeries was

determined:

Identify the distance to nearest wetland area (e.g., forested swamp,

marsh, riparian, marine) and coastline if applicable:

Distance to nearest existing telecommunication tower:

Have measures been incorporated for minimizing impacts to migratory birds? 0 Yes 0 No

If Yes, describe:

Has a Federal Communications Commission (FCC) registration been obtained for this tower? 0 Yes 0 No

If Yes, provide Registration #:

If No, why?

Has the FCC E106 process been completed? 0 Yes 0 No

Has the FCC Tower Construction Notification System (TCNS) process been completed? 0 Yes 0 No

If Yes, attach the environmental documentation submitted as part of

the registration process including use of the Tower Construction

Notification System (TCNS), if applicable. FRN#:

Would any related equipment or structures need to be installed (e.g., backup

generator and fuel source, communications shelter, fencing, or security measures)? 0 Yes 0 No

If Yes, explain where and how each installation would be done. Provide

details about generator capacity (kW), fuel source, fuel location and

tank volume, amount of fencing, and size of communication shelter:

Complete Section D.

0 Other. Complete this section if the proposed project does not fit any of the categories above.

Provide a complete project description:

Complete Section D.

C. CONSIDERATION OF RESOURCE IMPACTS

When completing this section, state a specific reason [i.e., “there will be no impacts to geology and soils because this project will not involve any ground disturbance”] and cite a source [i.e., local master plan, previous environmental assessment, correspondence with US Fish and Wildlife Service, correspondence with State Historic Preservation Office, FEMA Floodplain Insurance Rate Map (FIRM), etc.] to support a response of “no impact” or “potential to impact.” This section is not required for the purchase of mobile and portable equipment or classroom-based training, or field exercises to be conducted at an existing facility having established procedures for that particular proposed exercise.

Identify potential impacts to the following resources	No Impact	Potential to Impact	Reason/ Data Source/Agency
Noise
Air quality
Water resources, including surface water, groundwater, wetlands, coastal areas, and floodplains
Geology and soil resources, including prime and unique farmlands and hydric soils
Biological resources, including general vegetation, wildlife, wildlife habitat, migratory birds, and wetland habitat
Threatened and endangered species and critical habitat
Cultural resources, including architectural resources, archaeological resources, and Traditional Cultural Properties
Buildings or structures 50 years old or older
Socioeconomic resources, including economic development, demographics, and demand for housing and public services
Environmental justice (minority and low-income populations)
Aesthetics and visual resources
Human health and safety
Infrastructure, utilities, transportation and waste mgt.
Land use planning and zoning
Hazardous waste/ contamination
Community facilities and services

Removed from new form.

D. OTHER INFORMATION

Are personnel preparing this form familiar with the site? 0 Yes 0 No

Did personnel visit site? 0 Yes 0 No

Is this project one component of a larger proposed project? 0 Yes 0 No

If yes, please provide a description of the entire project, including funding sources (i.e., state funds, fund from another Federal agency, etc.) and, the award number, if the funding source is another GPD grant program.

Is the project part of an approved plan such as a Master Plan or an Implementation Plan or any larger action with an accompanying National Environmental Policy Act (NEPA) document?

0 Yes (provide the plan name, and include a copy of the NEPA document) 0 No

Is the project still consistent with the approved plan? 0 Yes 0 No

(If no, additional EHP compliance requirements may apply.)

Is the environmental document accurate and up-to-date? 0 Yes 0 No

(If no, additional EHP compliance requirements may apply.)

What was the decision of the NEPA document? (Check one, and please attach):

0 Finding of No Significant Impact (FONSI) OR

0 Record of Decision (ROD)

Agency Name Date approved

Removed from new form.

SECTION D. PROJECT DETAILS

Complete all of the information requested below.

1. 0 Project installation

a. Explain how and where renovations/upgrades/modifications would take

place, or where equipment/systems will be installed:

b. Would ground disturbance be required to complete the project or training? 0 Yes 0 No

• If Yes, provide total extent (depth, length, and width) of each ground-

disturbing activity. Include both digging and trenching. For example,

light poles and fencing have unique ground-disturbing activities (e.g.,

six light poles, 24” dia. x 4’ deep; trenching 12” x 500’ x 18" deep;

22 fence posts, 12” diameter x 3’ deep, and 2 gate posts, 18” diameter

x 3’ deep):

• If Yes, describe the current disturbed condition of the area (e.g.,

parking lot, road right-of-way, commercial development):

c. Would the equipment use the existing infrastructure for electrical distribution systems? 0 Yes 0 No

• If No, describe power source and detail its installation at the site:

2. 0 Age of structure/building at project site

a. Provide the year existing building(s) or structure(s) on/in/nearest to the

location involved in the proposed project was built:

• If the building or structure involved is over 45 years old and

significant renovation, rehabilitation, or modification has occurred,

provide the year(s) modified and briefly describe the nature of

the modification(s):

b. Are there any structures or buildings that are 50 years old or older in or adjacent to the project area? 0 Yes 0 No

• If yes, provide the location of the structure(s), ground-level color

photographs of the sructure(s), and identify their location(s) on an

aerial map:

c. Is the project site listed in the National Register of Historic Places

(National Register), or in/near a designated local or National Register

Historic District? The internet address for the National Register

is: http://nrhp.focus.nps.gov 0 Yes 0 No

• If Yes, identify the name of the historic property, site and/or district

and the National Register document number:

3. 0 Site photographs, maps and drawings

a. Attach site photographs. Site photographs are required for all projects. Use the following as a checklist for photographs of your project. Attach photographs to this document or as accompanying documents in your submission.

• Labeled, color, ground-level photographs of the project site: 0 Required

• Labeled, color photograph of each location where equipment would be attached to a building or structure: 0 Required

• Labeled, color aerial photograph of the project site: 0 Required

• Labeled, color aerial photographs that show the extent of ground disturbance (if applicable): 0 Attached

• Labeled, color ground-level color photographs of the structure from each exterior side of the building/structure (applicable only if building/structure is more than 45 years old): 0 Attached

b. Are there technical drawings or site plans available? 0 Yes 0 No

• If yes, attach: 0 Attached

Appendix A has guidance on preparing photographs for EHP review

4. 0 Environmental documentation

a. Is there any previously completed environmental documentation for this project at this proposed project site (e.g., Environmental Assessment, or wetland delineation, or cultural/archaeological study)? 0 Yes 0 No

• If Yes, attach documentation with this form: 0 Attached

b. Is there any previously completed agency coordination for this project (e.g., correspondence with the U.S. Fish and Wildlife Service, State Historic Preservation Office, Tribal Historic Preservation Office)? 0 Yes 0 No

• If Yes, attach documentation with this form: 0 Attached

c. Was a NEPA document was prepared for this project? 0 Yes 0 No

• If Yes, what was the decision? (Check one, and please attach):

0 Finding of No Significant Impact (FONSI) from an Environmental Assessment (EA) or

0 Record of Decision (ROD) from an Environmental Impact Statement (EIS).

• Name of preparing agency:

• Date approved:

Appendix A. Guidance for Supporting Photographs for EHP Grant Submissions

Appendix B. Aerial Photography Guidance

1. Obtain aerial photo; there are multiple online sources for aerial photos that are either free or request a nominal fee.

2. Copy the aerial image.

3. Open Microsoft Paint, Power Point, or other graphics-oriented software and paste the aerial image on the canvas.

4. Using drawing tools such as line drawing, shapes, and fill colors, label exactly where facility security enhancements will be installed i.e. fencing, lighting, cameras.

5. Cut and paste completed drawing into Word document and explain details of the facility security enhancements.

6. An example of a completed product is provided below.

Applicant Name: X Bus Company

Grant Program: FY 2008 Intercity Bus Security Grant Program

Grant Number: 2008-XX-XX-0000

Project Description: Facility Security Enhancements was awarded to X Bus Company in January 2009. Above are the enhancements that we wish to make to our facility. One camera will be installed. The building that the camera will be mounted on was built in 1975. The installation will include 6,412 linear feet of chain link security fencing. A total of 4 light posts will be installed. The light posts holes will cause 12” in diameter and 36” deep of ground disturbance.

If there are known historic resources (buildings, structures, districts, sites, etc.) within sight of the facility, indicate their location on the aerial photograph also. The National Register of Historic Places can be reviewed at: http://nrhp.focus.nps.gov/natreghome.do?searchtype=natreghome.

Photographs are a vital component of the EHP review process and add an additional level of understanding about the nature and scope of the project. They also provide pre-project documentation of site conditions. Please follow the guidance provided below when preparing photographs for your EHP submission. The following pages provide examples of best practices used in earlier EHP submissions.

Minimum requirements for photographs.

1. Photographs should be in color.

2. Label all photographs with the name of facility, location (city/county, state) and physical location (physical address or latitude-longitude).

3. Label the photographs to clearly illustrate relevant features of the project, such as location of installed features (e.g., cameras, fences, sirens, antennas, generators) and ground disturbance. See examples below.

4. Identify ground disturbance. Adding graphics to a digital photograph is a means to illustrate the size, scope and location of ground disturbing activities.

Best Practices

1. Provide photographs in a separate file.

2. Place no more than 2 pictures per page.

3. Compressing pictures files (such as with Microsoft Picture Manager) or saving the file in pdf format will reduce the size of the file and facilitate e-mail submissions.

4. Identify the photograph file with the project name so that it can be matched to the corresponding FEMA EHP screening form.

5. Maximum file size for enclosures should not exceed 12 MB. If the total size of files for an EHP submission exceeds 12 MB, send the submission in multiple e-mails.

6. If necessary, send additional photographs or data in supplemental e-mails. Please use the same e-mail subject line with the additional label: 1 of x, 2 of x, . . . x of x.

Options for Creating Photographs

1. Obtain an aerial photo. There are multiple online sources for aerial photographs.

2. For the aerial photo, use the screen capture feature (Ctrl + Print Screen keys) and copy the image to photo editing software, such as Paint, or PhotoShop.1 Use that software to crop the image so the photo has the content necessary.

3. Open PowerPoint, or other graphics-oriented software, and paste the aerial or ground-level photograph on the canvas.

4. Use drawing tools, such as line drawing and shapes, to indicate the location of project features (for example: fencing, lighting, sirens, antennas, cameras, generators).

5. Insert text to label the features and to label the photograph.

6. Use drawing tools to identify ground-disturbing activities (if applicable).

7. Save the file with the project name or grant number so that it can be appropriately matched to the corresponding FEMA EHP screening form. Include this file with the EHP screening when submitting the project.

Example Photographs

Ground-level photographs of nearby historic structures and buildings. Consultation with the State Historic Preservation Office (SHPO) may be required for projects involving structures that are more than 50 years old, or are on the National Register of Historic Places. In that event, it will be necessary to provide a color, ground-level photograph of each side of the building/structure.