BOEM-0142 Environmental Impact Analysis Worksheet

U.S. Department of the Interior OMB Control Number: 1010-0151

Bureau of Ocean Energy Management OMB Approval Expires: XXXXX

ENVIRONMENTAL IMPACT ANALYSIS WORKSHEET

Identify the IPF’s that can cause impacts to the listed environmental resources by placing an “x” in the space under each IPF category associated with your proposed activities that may impact a particular environmental resource. If you determine an IPF would not impact a particular environmental resource, leave the space blank. For those cells that are footnoted, provide a statement as to the applicability to your proposed operations, and, where there may be an effect, provide an analysis of the effect. If you are aware of other environmental resources at or near your activity’s site that are not included on the worksheet, address them too.

Environmental Resources	Impact Producing Factors (IPFs) Categories and Examples Refer to a recent GOM OCS Lease Sale EIS for a more complete list of IPFs
	Emissions (air, noise, light, etc.)		Effluents (muds, cuttings, other discharges to the water column or seafloor)		Physical disturbances to the seafloor (rig or anchor emplacements, etc.)		Wastes sent to shore for treatment or disposal		Accidents (e.g., oil spills, chemical spills, H2S releases)		Other IPFs you identify
Site-specific at Offshore Location
Designated topographic features		(1)		(1)				(1)
Pinnacle Trend area live bottoms		(2)		(2)				(2)
Eastern Gulf live bottoms		(3)		(3)				(3)
Chemosynthetic communities				(4)
Water quality
Fisheries
Marine mammals	(8)							(8)
Sea turtles	(8)							(8)
Air quality	(9)
Shipwreck sites (known or potential)				(7)
Prehistoric archaeological sites				(7)
Vicinity of Offshore Location
Essential fish habitat								(6)
Marine and pelagic birds
Public health and safety								(5)
Coastal and Onshore
Beaches								(6)
Wetlands								(6)
Shore birds and coastal nesting birds								(6)
Coastal wildlife refuges
Wilderness areas
Other Resources You Identify

NOTE: The numbers in parentheses refer to the footnotes on page 2 of this form.

Form BOEM-0142 (month year) PAGE 1 OF 2 Previous Editions are Obsolete.

Footnotes for Environmental Impact Analysis Matrix

1. Activities that may affect a marine sanctuary or topographic feature. Specifically, if the well or platform site or any anchors will be on the seafloor within the:

(a) 4-mile zone of the Flower Garden Banks, or the 3-mile zone of Stetson Bank;

(b) 1000-m, 1-mile or 3-mile zone of any topographic feature (submarine bank) protected by the Topographic Features Stipulation attached to an OCS lease;

(c) Essential Fish Habitat (EFH) criteria of 500 ft from any no-activity zone; or

(d) Proximity of any submarine bank (500 ft buffer zone) with relief greater than 2 meters that is not protected by the Topographic Features Stipulation attached to an OCS lease.

2. Activities with any bottom disturbance within a OCS lease block protected through the Live Bottom (Pinnacle Trend) Stipulation attached to an OCS lease.

3. Activities within any Eastern Gulf OCS block where seafloor habitats are protected by the Live Bottom (Low-Relief) Stipulation attached to an OCS lease.

4. Activities on blocks designated by the BOEM as being in water depths 400 meters or greater.

5. Exploration or production activities where H₂S concentrations greater than 500 ppm might be encountered.

6. All activities that could result in an accidental spill of produced liquid hydrocarbons or diesel fuel that you determine would impact these environmental resources. If the proposed action is located a sufficient distance from a resource that no impact would occur, the EIA can note that in a sentence or two.

7. All activities that involve seafloor disturbances, including anchor emplacements, in any OCS block designated by the BOEM as having high-probability for the occurrence of shipwrecks or prehistoric sites, including such blocks that will be affected that are adjacent to the lease block in which your planned activity will occur. If the proposed activities are located a sufficient distance from a shipwreck or prehistoric site that no impact would occur, the EIA can note that in a sentence or two.

8. All activities that you determine might have an adverse effect on endangered or threatened marine mammals or sea turtles or their critical habitats.

9. Production activities that involve transportation of produced fluids to shore using shuttle tankers or barges.

Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501et seq.) requires us to inform you that BOEM collects this information as part of an applicant’s Exploration Plan (EP) or Development Operations Coordination Document (DOCD) submitted for BOEM approval. We use the information in our review and data entry for OCS plans. Reponses are mandatory (43 U.S.C 1334). We will protect proprietary data according to the Freedom of Information Act and 30 CFR 550.197. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid Office of Management and Budget Control Number. The public reporting burden for this form is included in the burden for preparing EPs and DOCDs. We estimate that burden to average 600 hours per response for EPs and 700 hours per response for DOCDs, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the forms associated with subpart B. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Bureau of Ocean Energy Management, 381 Elden Street, Herndon, VA 20170.

Form BOEM-0142 (month year) PAGE 2 OF 2 Previous Editions are Obsolete.