NEPA Environmental Analysis

Forms and Documents

Document Name	Status
Form DOE F 540 EERE Environmental Questionnaire - Private Form and Instruction	New
Form DOE F 540 EERE Environmental Questionnaire - Government Form and Instruction	New
2014-06-17_30 Day FRN (Published).pdf Supplementary Document	2014-06-17
Supporting Statement_8_11_2014-Final.doc Supporting Statement A	2014-08-13
2014-02-12_60 Day FRN (Published).pdf Supplementary Document	2014-06-10

IC Document Collections

IC ID	Document Title	Status
211748	EERE Environmental Questionnaire - Private Form and Instruction	New
211747	EERE Environmental Questionnaire - Government Form and Instruction	New

ICR Details

OMB Control No: 1910-5175	ICR Reference No: 201405-1910-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Lisa Jorgensen (EERE)
Title: NEPA Environmental Analysis
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/13/2014
	Date Received in OIRA: 06/17/2014
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2017	36 Months From Approved
Responses	300	0	0
Time Burden (Hours)	150	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The National Environmental Policy Act (NEPA) of 1969 (42 U.S.C. 4321 et seq.) requires that an environmental analysis be completed for all major Federal actions significantly affecting the environment including projects entirely or partly financed by Federal agencies. To effectively perform environmental analyses for these projects, DOE needs to collect project-specific environmental information from Federal financial assistance awardees.

---

Authorizing Statute(s): US Code: 42 USC 4321 Name of Law: National Environmental Policy Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 8445	02/12/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 116	06/17/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
EERE Environmental Questionnaire - Government	DOE F 540	Office of Energy Efficiency and Renewable Energy Environmental Questionniare
EERE Environmental Questionnaire - Private	DOE F 540	Office of Energy Efficiency and Renewable Energy Environmental Questionnaire

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	300	0	0	0	300	0
Annual Time Burden (Hours)	150	0	0	0	150	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $20,250

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/17/2014

---