LWCF Proposal Description and Environmental Screening Fo

OMB Control No. 1024-0031
Expires: XX/XX/2016

LWCF Proposal Description and Environmental Screening Form
The purpose of this Proposal Description and Environmental Screening Form (PD/ESF) is to provide descriptive and
environmental information about a variety of Land and Water Conservation Fund (LWCF) state assistance proposals submitted
for National Park Service (NPS) review and decision. The completed PD/ESF becomes part of the “federal administrative
record” in accordance with the National Environmental Policy Act (NEPA) and its implementing regulations. The PD portion
of the form captures administrative and descriptive details enabling the NPS to understand the proposal. The ESF portion is
designed for States and/or project sponsors to use while the LWCF proposal is under development. Upon completion, the ESF
will indicate the resources that could be impacted by the proposal enabling States and/or project sponsors to more accurately
follow an appropriate pathway for NEPA analysis: 1) a recommendation for a Categorical Exclusion (CE), 2) production of an
Environmental Assessment (EA), or 3) production of an Environmental Impact Statement (EIS). The ESF should also be used
to document any previously conducted yet still viable environmental analysis if used for this federal proposal. The completed
PD/ESF must be submitted as part of the State’s LWCF proposal to NPS.
Except for the proposals listed below, the PD/ESF must be completed, including the appropriate NEPA document, signed by
the State, and submitted with each new federal application for LWCF assistance and amendments for: scope changes that alter
or add facilities and/or acres; 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 Program Manual
(www.nps.gov/lwcf) for detailed guidance for your type of proposal and on how to comply with NEPA.
For the following types of proposals only this Cover Page is required because these types of proposals are administrative in
nature and are categorically excluded from further NEPA environmental analysis. NPS will complete the NEPA CE Form.
Simply check the applicable box below, and complete and submit only this Cover Page to NPS along with the other items
required for your type of proposal as instructed in the LWCF Program 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
□ To make an administrative change that does not change project scope

Name of LWCF Proposal:

Date Submitted to NPS:

Prior LWCF Project Number(s) List all prior LWCF project numbers and all park names associated with assisted site(s):
Local or State Project Sponsoring Agency (recipient or sub-recipient in case of pass-through grants):
Local or State Sponsor Contact:
Name/Title:
Office/Address:
Phone/Fax:

Email:

Paperwork Reduction Act Statement: This information collection is authorized by the Land and Water Conservation Fund Act of 1965 (16
U.S.C. 4601-4 et seq.). Your response is required to obtain or retain a benefit. We use this information to obtain descriptive and
environmental information about the proposal. Completion times vary widely depending on the use of the form, from approximately 30
minutes to complete the cover page only to 500 hours for a difficult conversion of use. We estimate that the average completion time for
this form is 8 hours for an application, 2 hours for an amendment, and 112 hours for a conversion of use, including the time necessary to
review instructions gather data and review the form. You may send comments on the burden estimate or any aspect of this form to the
Information Collection Clearance Officer, National Park Service, 1849 C Street, NW. (2601), Washington, DC 20240. We may not collect
or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number.

Cover Page

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Using a separate sheet for narrative descriptions and explanations, address each item and question in the order it is presented,
and identify each response with its item number 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 funding
source. 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, the number of acres
to be acquired with LWCF assistance, and a description of 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.

How and when will the site be made open and accessible for public outdoor recreation use (signage, entries,
parking, site improvements, allowable activities, etc.)?

3.

Describe development plans for the proposal for the site(s) for public outdoor recreation use within the next
three (3) years.

4.

SLO must complete the State Appraisal/Waiver Valuation Review form in Step 7 certifying that the
appraisal(s) has been reviewed and meets the “Uniform Appraisal Standards for Federal Land Acquisitions” or
a waiver valuation was approved per 49 CFR 24.102(c)(2)(ii). State should retain copies of the appraisals and
make them available if needed.

5.

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 a site sketch depicting improvements, where and how the public will access the site, parking, etc.
Indicate entrances on 6(f) map. Indicate to what extent the project involves new development, rehabilitation,
and/or replacement of existing facilities.

2.

When will the project be completed and open for public outdoor recreation use?

3.

Address each item in “D” below.

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C.

For a Combination Project

1.

For the acquisition part of the proposal:
a. 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.)
b. How and when will the site be made open and accessible for public outdoor recreation use (signage,
entries, parking, site improvements, allowable activities, etc.)?
c. Describe development plans for the proposed for the site(s) for public outdoor recreation use within the
next three (3) years.
d. SLO must complete the State Appraisal/Waiver Valuation Review form in Step 7 certifying that the
appraisal(s) has been reviewed and meets the “Uniform Appraisal Standards for Federal Land
Acquisitions” or a waiver valuation was approved per 49 CFR 24.102(c)(2)(ii). 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 a site sketch depicting improvements, where and how the public will access the site, parking,
etc. Indicate entrances 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 open for public outdoor recreation use?

3.

Address each item in “D” below.

D.

Additional items to address for a new application and amendments

1.

Will this proposal 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 #3) No ____ (go to #2)

2.

a. What is the name of the pre-existing public area that this new 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 ___

3.

What will be the name of this new public park/recreation area?

4.

a. Who will hold title to the property assisted by LWCF? Who will manage and operate the site(s)?
b. What is the sponsor’s type of ownership and control of the property?
____ Fee simple ownership
____ Less than fee simple. Explain:
____ Lease. Describe lease terms including renewable clauses, # of years remaining on lease, etc.
Who will lease area? Submit copy of lease with this PD/ESF. (See LWCF Manual for program
restrictions for leases and further guidance.)

5.

Describe the nature of any rights-of-way, easements, reversionary interests, etc. to the Section 6(f) park
area? Indicate the location on 6(f) map. Do parties understand that a Section 6(f) conversion may occur if
private or non-recreation activities occur on any pre-existing right-of-way, easement, leased area?

6.

Are overhead utility lines present, and if so, explain how they will be treated per LWCF Manual.

7.

As a result of this project, describe new types of outdoor recreation opportunities and capacities, and short
and long term public benefits.

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8.

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.

9.

Describe the planning process that led to the development of this proposal. Your narrative should address:
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, including any 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 for the public to participate in the planning
process and/or to provide comments on the completed proposal.
b. What information was made available to the public for review and comment? Did the sponsor provide
written responses addressing the comments? If so, include responses with this PD/ESF submission.

10.

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).

11.

List all 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. The federal LWCF share and financial
matches must result in a viable outdoor recreation area and not rely on other funding not mentioned here.
Other federal resources may be used as a match if specifically authorized by law.
Source

Type of Match

Value
$
$
$

12.

Is this LWCF project scope 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.

13.

List all required federal, state, and local permits/approvals needed for the proposal and explain their purpose
and status.

Proceed to Steps 5 through 7
Step 3. Project Amendment (See LWCF Manual for guidance.)
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)(3) Conversion Proposal

Prior to developing your Section 6(f)(3) conversion proposal, you must consult the LWCF Manual and 36 CFR 59.3
for complete guidance on conversions. Local sponsors must consult early with the State LWCF manager when a
conversion is under consideration or has been discovered. States must 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. A critical first step is for the State and NPS
to agree on the size of the Section 6(f) park land impacted by any non-recreation, non-public use,

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especially prior to any appraisal activity. Any previous LWCF project agreements and actions must be identified
and understood to determine the actual Section 6(f) boundary.
The Section 6(f)(3) conversion proposal including the required NEPA environmental review documents (CE
recommendation or an EA document) must focus on the loss of public outdoor recreation park land and recreational
usefulness, and its replacement per 36 CFR 59, and not the activities precipitating the conversion or benefits
thereof, such as the impacts of constructing a new school to relieve overcrowding or constructing a hotel/restaurant
facility to stimulate the local economy. Rather, the environmental review must 1) focus on “resource impacts” as
indicated on the ESF (Step 6), including the loss of public park land and recreation opportunities (ESF A-15), and
2) the impacts of creating new replacement park land and replacement recreation opportunities. A separate ESF
must be generated for the converted park area and each replacement site. Section 6(f)(3) conversions always
have more than minor impacts to outdoor recreation (ESF A-15) as a result of loss of parkland requiring an EA,
except for “small” conversions as defined in the LWCF Manual Chapter 8.
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.

A detailed explanation of 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.

An explanation of how the conversion is in accord with the State Comprehensive Outdoor Recreation Plan
(SCORP).

4.

Completed “State Appraisal/Waiver Valuation Review form in Step 7 for each of the converted and
replacement parcels certifying that the appraisals meet the “Uniform Appraisal Standards for Federal Land
Acquisitions.” States must retain copies of the appraisals/waiver valuations and make them available for
review upon request.

5.

For the park land proposed for conversion, a detailed description including the following:
a. Specific geographic location on a map, 9-digit zip code, and name of park or recreation area proposed for
conversion.
b. Description of 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 activity precipitating the conversion, but how the precipitating activity will impact the entire 6(f) park
area. In many cases the size of the converted area is larger than the physical footprint. Include a
description of 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) park land must remain recreationally viable and not be impacted by the activities that
are precipitating the conversion. If it is anticipated that the precipitating activities impact the remaining
Section 6(f) area, the proposed area for the conversion should be expanded to encompass all impacted
park land.
c. Description of the community and population served by the park, including users of the park and uses.
d. For partial conversions, a revised 6(f) map clearly indicating both the portion that is being converted and
the portion remaining intact under Section 6(f).

6.

For each proposed replacement site:
a. Specific geographic location on a map, 9-digit zip code, and geographical relationship of converted and
replacement sites. If site will be added to an existing public park/outdoor recreation area, indicate on
map.
b. Description of the site’s physical characteristics and resource attributes with number and 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.

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c. Identification of the owner of the replacement site and its recent history of use/function up to the present.
d. Detailed explanation of how the proposed replacement site is of reasonably equivalent usefulness and
location as the property being converted, including a description of 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. Identification of owner and manager of the new replacement park?
f.

Name of the new replacement park. If the replacement park is 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. Timeframe for completing the new outdoor recreation area(s) to replace the recreation
opportunity lost per the terms of conversion approval and the date replacement park(s) will be
open to the public.
h. New Section 6(f) map for the new replacement park.
7.

NEPA environmental review, including NHPA Section 106 review, for both the converted and
replacement sites in the same document to analyze how the converted park land and recreational
usefulness will be replaced. Except for “small” conversions (see LWCF Manual Chapter 8),
conversions usually require an EA.

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 indoor and/or non-recreation facility within a Section 6(f)
area. In certain cases NPS may approve the construction of public facilities within a Section 6(f) area where it can
be shown that there will be a net gain in outdoor recreation benefits and enhancements for the entire park. In
most cases, development of a non-recreation public facility within a Section 6(f) area constitutes a conversion. For
NPS review, the State/sponsor must submit a proposal to NPS under a letter of transmittal from the SLO that:
1.

Describes the purpose and all proposed uses of the public facility such as types of programming, recreation
activities, and special events including intended users of the new facility and any agency, organization, or
other party to occupy the facility. Describe the interior and exterior of the facility, such as office space,
meeting rooms, food/beverage area, residential/lodging area, classrooms, gyms, etc. Explain how the facility
will be compatible with the outdoor recreation area. Explain how the facility and associated uses will
significantly support and enhance existing and planned outdoor recreation resources and uses of the site, and
how outdoor recreation use will remain 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.)

2.

Indicates the exact location of the proposed public facility and associated activities on the site’s Section 6(f)
map. Explain the design and location alternatives considered for the public facility and why they were not
pursued.

3.

Explains who will own and/or operate and maintain the facility? Attach any 3 party leases and operation and
management agreements. When will the facility be open to the public? Will the facility ever be used for
private functions and closed to the public? Explain any user or other fees that will be instituted, including the
fee structure.

4.

Includes required documents as a result of a completed NEPA process (Steps 5 – 7).

rd

Proceed to Steps 5 through 7

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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 and all associated activities, 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 Section 6(f) area affected by the temporary non-conforming use activities and
expected impacts to public outdoor recreation areas, facilities and opportunities. Explain efforts to keep the
size of the area impacted 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.
Consult with NPS for early determination on the need for a formal review. NPS approval is only required for
proposals that will significantly change the use of a LWCF-assisted site (e.g., from passive to active recreation).
The proposal must include and address the following items:
1.

A letter of transmittal from the SLO recommending the proposal.

2.

Description of the proposed changes and how they significantly contravene the original plans or intent of
LWCF agreements.

3.

Explanation of the need for 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
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 regardless of funding source. The proposal must demonstrate that there is an
increased benefit to public recreation opportunity. Describe the sheltering proposal in detail, including the following:
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.

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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

(including E.O. 12372 - Intergovernmental Review)

To avoid duplication of effort and unnecessary delays, describe any prior environmental review undertaken at any
time and still viable for this proposal or related efforts that could be useful for understanding potential environmental
impacts. Consider previous local, state, federal (e.g. HUD, EPA, USFWS, FHWA, DOT) and any other
environmental reviews. At a minimum, address the following:
1.

Date of environmental review(s), purpose for the environmental review(s) and for whom they were conducted.

2.

Description of the proposed action and alternatives.

3.

Who was involved in identifying resource impact issues and developing the proposal including the interested
and affected public, government agencies, and Indian tribes.

4.

Environmental resources analyzed and determination of impacts for proposed actions and alternatives.

5.

Any mitigation measures to be part of the proposed action.

6.

Intergovernmental Review Process (Executive Order 12372): Does the State have an Intergovernmental
Review Process? Yes _____ No _____. If yes, has the LWCF Program been selected for review under the
State Intergovernmental Review Process? Yes _____ No _____. If yes, was this proposal reviewed by the
appropriate State, metropolitan, regional and local agencies, and if so, attach any information and comments
received about this proposal. If proposal was not reviewed, explain why not.

7.

Public comment periods (how long, when in the process, who was invited to comment) and agency response.

8.

Any formal decision and supporting reasons regarding degree of potential impacts to the human environment.

9.

Was this proposed LWCF federal action and/or any other federal actions analyzed/reviewed in any of the
previous environmental reviews? If so, what was analyzed and what impacts were identified? Provide
specific environmental review document references.

Use resource impact information generated during previous environmental reviews described above and from
recently conducted site inspections to complete the Environmental Screening Form (ESF) portion of this PD/ESF
under Step 6. Your ESF responses should indicate your proposal’s potential for impacting each resource as
determined in the previous environmental review(s), and include a reference to where the analysis can be found in
an earlier environmental review document. If the previous environmental review documents contain proposed
actions to mitigate impacts, briefly summarize the mitigation for each resource as appropriate. The appropriate
references for previous environmental review document(s) must be documented on the ESF, and the actual
document(s) along with this PD/ESF must be included in the submission for NPS review.

Proceed to Steps 6 through 7

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Step 6. Environmental Screening Form (ESF)
This portion of the PD/ESF is a working tool used to identify the level of environmental documentation which must
accompany the proposal submission to the NPS. By completing the ESF, the project sponsor is providing support
for its recommendation in Step 7 that the proposal either:
1. meets criteria to be categorically excluded (CE) from further NEPA review and
no additional environmental documentation is necessary; or
2. requires further analysis through an environmental assessment (EA) or an environmental
impact statement (EIS).
An ESF alone does not constitute adequate environmental documentation unless a CE is recommended. If an EA
is required, the EA process and resulting documents must be included in the proposal submission to the NPS. If an
EIS may be required, the State must request NPS guidance on how to proceed.
The scope of the required environmental analysis will vary according to the type of LWCF proposal. For example,
the scope for a new LWCF project will differ from the scope for a conversion. Consult the LWCF Manual for
guidance on defining the scope or extent of environmental analysis needed for your LWCF proposal. As early as
possible in your planning process, consider how your proposal/project may have direct, indirect and cumulative
impacts on the human environment for your type of LWCF action so planners have an opportunity to design
alternatives to lessen impacts on resources, if appropriate. When used as a planning tool in this way, the ESF
responses may change as the proposal is revised until it is ready for submission for federal review. Initiating or
completing environmental analysis after a decision has been made is contrary to both the spirit and letter of the law
of the NEPA.
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
be invited to participate in scoping out the proposal (see LWCF Manual Chapter 4). 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 must justify the NEPA pathway
that was followed: CE recommendation, production of an EA, or production of an EIS. The resource topics and
issues identified on the ESF for this proposal must be presented and analyzed in an attached EA/EIS. Consult the
LWCF Manual for further guidance on LWCF and NEPA.
The ESF contains two parts that must be completed:
Part A. Environmental Resources

Part 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 for each listed resource that may occur directly,
indirectly and cumulatively as a result of federal approval of your proposal. For each impacted resource provide 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 is still
viable, include the citation including any planned mitigation 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 A.24 on the ESF) if not included in the list.
Use a separate sheet to briefly clarify how each resource could be adversely impacted; any direct, indirect, and
cumulative impacts that may occur; and any additional data that still needs to be determined. Also explain any
planned mitigation already addressed in previous environmental reviews.
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 develop an EA or EIS regardless of your answers in
Part A. Explain all “yes” and “maybe” answers on a separate sheet.

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For conversions, complete one ESF for each of the converted and replacement sites.
A. ENVIRONMENTAL RESOURCES
Indicate potential for adverse impacts. Use a
separate sheet to clarify responses per
instructions for Part A on page 9.

Not
ApplicableResource does
not exist

No/Negligible
ImpactsExists but no or
negligible
impacts

Minor
Impacts

Impacts
Exceed Minor
EA/EIS required

More Data Needed
to Determine
Degree of Impact
EA/EIS required

1. Geological resources: soils, bedrock,
slopes, streambeds, landforms, etc.
2. Air quality
3. Sound (noise impacts)
4. Water quality/quantity
5. Stream flow 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, land, parks,
open space, conservation areas, rec.
trails, facilities, services, opportunities,
public access, etc. Most conversions
exceed minor impacts. See Step 3.B
16. Accessibility for populations with
disabilities
17. Overall aesthetics, special
characteristics/features
18. Historical/cultural resources,
including landscapes, ethnographic,
archeological, structures, etc. Attach
SHPO/THPO determination.
19. Socioeconomics, including
employment, occupation, income
changes, tax base, infrastructure
20. Minority and low-income
populations
21. Energy resources (geothermal,
fossil fuels, etc.)
22. Other agency or tribal land use
plans or policies
23. Land/structures with history of
contamination/hazardous materials
even if remediated
24. Other important environmental
resources to address.

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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/THPO 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 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. The ESF may be completed as part of
a LWCF pre-award site inspection if conducted in time to contribute to the environmental review process for the
proposal.
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.
State may require signature of
LWCF sub-recipient applicant here: ___________________________________________Date_____________

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Step 7. Recommended NEPA Pathway and State Appraisal/Waiver Valuation
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 to
meet the CE criteria. If impacts remain at the greater than minor level, the State/sponsor must prepare an EA for
the 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 NEPA Pathway Recommendation

□ 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 are available upon request. On the basis of the
environmental impact information for this LWCF proposal as documented in this LWCF PD/ESF with which I
am familiar, I recommend the following LWCF 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 by the State/sponsor in accordance with the LWCF Program Manual.

□ This proposal may require an Environmental Impact Statement (EIS). NPS guidance
is requested per the LWCF Program Manual.

Reproduce this certificate as necessary. Complete for each LWCF appraisal or waiver valuation.

State Appraisal/Waiver Valuation Review
Property address:

Date of appraisal transmittal letter/waiver:

Real property value: $

Effective date of value:

I certify that:

□ a State-certified Review Appraiser has reviewed the appraisal and has determined that it
was prepared in conformity with the Uniform Appraisal Standards for Federal Land
Acquisitions.
OR

□ the State has reviewed and approved a waiver valuation for this property per
49 CFR 24.102(c)(2)(ii).

SLO/ASLO Original Signature: ___________________________________________ Date: _________________
Typed
Name,
Title,
Agency:

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OMB Control No. 1024-0031
Expires: XX/XX/2016

National Environmental Policy Act
National Park Service-Land and Water Conservation Fund State Assistance Program

Categorical Exclusions for Which a Record is Needed
Note: The following are the NEPA Categorical Exclusions approved for use with all NPS programs. Only
the unshaded categories apply to LWCF proposals. Before selecting a categorical exclusion (CE),
complete the PD/ESF for the LWCF proposal to support the CE selection.
A. Actions related to general administration
(1) Changes or amendments to an approved action when such changes would cause no environmental
impact. LWCF actions that are covered include amendments for:
- time extensions with no change in project scope or with a reduction
in project scope;
-deleting work and no other work is added back into the project scope;
-changing project cost with no change in project scope or with a reduction in project scope;
-making administrative changes that do not affect project scope.
(2) Minor boundary changes that are accomplished through existing statutory authorities and that result
in no change in land use.
(3) Re-issuance/renewal of permits, rights-of-way, or easements not involving new environmental
impacts provided that the impacts of the original actions were evaluated in an environmental document.
(4) Conversion of existing permits to rights-of-way, when such conversions neither continue nor
potentially initiate adverse environmental conditions, provided that the impacts of the original actions
were evaluated in an environmental document.
(5) Issuances, extensions, renewals, re-issuances, or minor modifications of concession contracts or
permits that do not entail new construction or any potential for new environmental impact as a result of
concession operations.
(6) Incidental business permits (formerly called commercial use licenses) involving no construction or
potential for new environmental impact.
(7) Leasing of historic properties in accordance with 36 CFR 18 and NPS-38.
(8) Modifications or revisions to existing regulations, or the promulgation of new regulations for NPSadministered areas, provided the modifications, revisions, or new regulations do not:
(a) increase public use to the extent of compromising the nature and character of the area or cause
physical damage to it.
(b) introduce non-compatible uses that might compromise the nature and characteristics of the area or
cause physical damage to it.
(c) conflict with adjacent ownerships or land uses.
(d) cause a nuisance to adjacent owners or occupants

(9) At the direction of the NPS responsible official, actions where NPS has concurrence or co-approval
with another bureau and the action is a CE for that bureau, and where NPS agrees that there is no potential
for environmental impact.
(10) Routine transfers of jurisdiction between the NPS and the District of Columbia accomplished
through existing statutory authority, where no change of use in the land is anticipated upon transfer.
B. Plans, studies, and reports
(1) Changes or amendments to an approved plan, when such changes have no potential for
environmental impact.
(2) Cultural resources maintenance guides, collection management plans, and historic furnishings
reports.
(3) Interpretive plans (interpretive prospectuses, audio-visual plans, museum exhibit plans, wayside
exhibit plans).
(4) Plans, including priorities, justifications, and strategies, for non-manipulative research, monitoring,
inventorying, and information-gathering.
(5) Agreements between NPS offices for plans and studies.
(6) Authorization, funding, or approval for the preparation of statewide comprehensive outdoor
recreation plans (SCORPs).
(7) Adoption or approval of academic or research surveys, studies, reports, and similar documents that
do not contain and will not result in NPS recommendations.
(8) Land protection plans that propose changes to existing land or visitor use when the changes have no
potential for environmental impact.
C. Actions related to development
(1) Land acquisition within established park boundaries, if future anticipated uses would have no
potential for environmental impact.
(2) Land exchanges that will not lead to anticipated changes in the use of land and that have no potential
for environmental impact. For LWCF, some small conversions may meet this criterion. See the LWCF
Manual Chapter 8 for further guidance.
(3) Routine maintenance and repairs to non-historic structures, facilities, utilities, grounds, and trails.
(4) Routine maintenance and repairs to cultural resource sites, structures, utilities, and grounds if the
action falls under an approved Historic Structures Preservation Guide or Cyclic Maintenance Guide or if
the action would not adversely affect the cultural resource.
(5) Installation of LWCF eligible signs, displays, and kiosks.
LWCF State Assistance Program NEPA Categorical Exclusions
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(6) Installation of navigation aids.
(7) Experimental testing of short duration (no more than one season) of mass transit systems, and
changes in operation of existing systems, that have no potential for environmental impact.
(8) Replacement in kind of minor structures and facilities with little or no change in location, capacity,
or appearance--for example, comfort stations, pit toilets, fences, kiosks, signs and campfire circles.
(9) Repair, resurfacing, striping, installation of traffic control devices, and repair/replacement of
guardrails, culverts, signs, and other minor existing features on existing roads when no potential for
environmental impact exists.
(10) Changes in sanitary facilities operation resulting in no new environmental effects.
(11) Installation of wells, comfort stations, and pit or vault toilets in areas of existing use and in
developed areas.
(12) Minor trail relocation or development of compatible trail networks on logging roads or other
established routes.
(13) Upgrading or adding new overhead utility facilities on existing poles, or on replacement poles that do
not change existing pole line configurations.
(14) Issuance of rights-of-way for overhead utility lines to an individual building or well from an existing
line where installation will not result in visual intrusion and will involve no clearance of vegetation other
than for placement of poles.
(15) Issuance of rights-of-way for minor overhead utility lines not involving placement of poles or towers
and not involving vegetation management or visual intrusion in an area administered by NPS.
(16) Installation of underground utilities in areas showing clear evidence of recent human disturbance or
areas within an existing road prism or within an existing overhead utility right-of-way.
(17) Minor landscaping in areas showing clear evidence of recent human disturbance.
(18) Installation of fencing enclosures, exclosures, or boundary fencing posing no effect on wildlife
migrations.
D. Actions related to visitor use
(1) Minor changes in amounts or types of visitor use for the purpose of ensuring visitor safety or
resource protection in accordance with existing regulations.
(2) Minor changes in programs and regulations pertaining to visitor activities.
(3) Issuance of permits for demonstrations, gatherings, ceremonies, concerts, arts and crafts shows, and
so forth, entailing only short-term or readily remediable environmental disturbance.
LWCF State Assistance Program NEPA Categorical Exclusions
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(4) Designation of trailside camping zones with minimal or no improvements.
E. Actions related to resource management and protection
(1) Archeological surveys and permits involving only surface collection or small-scale test excavations.
(2) Restoration of non-controversial (based on internal scoping requirements in section 2.6) native
species into suitable habitats within their historic range.
(3) Removal of individual members of a non-threatened/endangered species or populations of pests and
exotic plants that pose an imminent danger to visitors or an immediate threat to park resources.
(4) Removal of non-historic materials and structures in order to restore natural conditions when the
removal has no potential for environmental impacts, including impacts to cultural landscapes or
archeological resources.
(5) Development of standards for, and identification, nomination, certification, and determination of,
eligibility of properties for listing in the National Register of Historic Places, the National Historic
Landmark and National Natural Landmark Programs, and biosphere reserves.
(6) Non-destructive data collection, inventory (including field, aerial, and satellite surveying and
mapping), study, research, and monitoring activities (this is also a Departmental CE).
(7) Designation if environmental study areas and research natural areas, including those closed
temporarily or permanently to the public, unless the potential for environmental (including
socioeconomic) impact exists.
F. Actions related to grant programs
(1) Proposed actions essentially the same as those listed in paragraphs A-E above not shaded in gray.
(2) Grants for acquisition to areas that will continue in the same use or lower density use with no
additional disturbance to the natural setting or type of use.
(3) Grants for replacement or renovation of facilities at their same location without altering the kind and
amount of recreational, historical, or cultural resources of the area or the integrity of the existing setting.
(4) Grants for construction of facilities on lands acquired under a previous NPS or other federal grant,
provided that the development is in accord with plans submitted with the acquisition grant, and that
environmental documents have been completed on the impacts of the proposal funded by the original
grant.
(5) Grants for the construction of new facilities within an existing park or recreation area, provided that
the facilities will not:
(a) conflict with adjacent ownerships or land use, or cause a nuisance to adjacent owners or
occupants, such as would happen if use were extended beyond daylight hours.

LWCF State Assistance Program NEPA Categorical Exclusions
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(b) introduce motorized recreation vehicles, including off-road vehicles, personal water craft, and
snowmobiles.
(c) introduce active recreation pursuits into a passive recreation area.
(d) increase public use or introduce non-compatible uses to the extent of compromising the nature
and character of the property or causing physical damage to it.
(e) add or alter access to the park from the surrounding area.
(6) Grants for the restoration, rehabilitation, stabilization, preservation, and reconstruction (or the
authorization thereof) of properties listed on or eligible for listing on the National Register of Historic
Places, at their same location, and provided that such actions:
(a) will not alter the integrity of the property or its setting
(b) will not increase public use of the area to the extent of compromising the nature and character o
the property.

LWCF State Assistance Program NEPA Categorical Exclusions
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