3135-0112 NEPA NHPA Form

NHPA / NEPA Questionnaire
8/4/16

If you are recommended for a grant, your project may be subject to the National Environmental Policy Act (NEPA)
and/or the National Historic Preservation Act (NHPA). The NEA will conduct a review of your project to ensure that it is
in compliance with NEPA/NHPA. The review and approval process for projects requiring NEPA/NEPA review may take up
to several months to complete.
Some of the common project types that garner a NHPA review are:
 A project involving or occurring near a district, site, building, landscape, structure or object that is 50 years old
and therefore eligible for inclusion in the National Register of Historic Places.
 The commissioning and installation of temporary or permanent outdoor furnishings such as benches or market
structures or art such as a sculpture or mural.
 An arts festival in a park.
 Design planning and services for projects that may involve a historic site, structure, or district.
This is the first step in the NHPA review process. Based in your responses, the NEA will determine one of the following
outcomes:
1. There are no anticipated adverse effects on historic properties or resources;
2. Based on an agreement that the NEA has with the Advisory Council on Historic Preservation (ACHP), one or
more approved exemptions can be applied to the project, confirming that there are no anticipated adverse
effects on historic properties or resources; or
3. The project has the potential to have adverse effects on historic properties or resources. You are asked to
contact and work directly with your State Historic Preservation Office (SHPO), and potentially initiate a Section
106 Review.

INSTRUCTIONS
Applicants:
Fill out the following form for every project location. Return it along with the Project Budget to the Specialist indicated
on the tentative funding notification.
If you have revised your project as a result of the tentative funding notification, clearly indicate such on the Project
Budget form under "Project Description." Specifically indicate if the revised project no longer involves activities that
require NEPA/NHPA review. For example, because of the reduced funding amount a three-pronged project that
included an outdoor mural was reduced to a two-pronged project without the mural.
Current Award Recipients:
Fill out the following form for every project location. Submit it to the Grants & Contracts Office at [email protected]. If
you are revising the budget too, indicate if the revised project no longer involves activities or locations that require
NEPA/NHPA review.
For All:
Include maps and photographs of each location and property. Be as concise as possible.
If you have questions regarding NHPA / NEPA or the process please contact [email protected].

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GENERAL INFORMATION
A. Organization Name. Enter the legal name of your organization.

B. NEA Application/Award Number. Enter the application or award number.

C. Contact Information. Identify the person who can answer specific questions about NEPA or NHPA.
Name
Title
Email
Phone Number

ANSWER THE FOLLOWING NHPA / NEPA QUESTIONS
1. Provide a very clear description of the district, building, site, landscape, structure, or object in which you will be
working, including the address(es). If you don’t have a physical address, provide the block or other area of potential
effect. Describe the nature of your site, whether activities will take place in public space, streets, vacant lots, historic
structures, etc. Include a map.

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2. Describe your project activities, including whether the planned activities are temporary or permanent. Provide a
short assessment of whether your project has the potential to have an effect on environmental or historic resources
and whether that effect is an adverse effect.
If your project will physically alter a district, site, building, landscape, structure or object, or if you are working on a
plan or design for such a site, describe. For example, if you are commissioning permanent public art, murals, or the
design of a permanent structure, your project has the potential to have an adverse effect on environmental or
historic resources under NEPA/NHPA.

3. For the purposes of questions (a)-(i) below, a National Historic Register Place (NHRP) includes any district, site,
building, structure, landscape or object that is included or eligible for inclusion on the NHRP, whether individually or
as a contributing element. Generally, NHRP Sites will include
(1) any place 50 years old or older,
(2) any place included or eligible for inclusion in the NHRP, or
(3) located in a historic district.
Additionally, understand that for a project to be temporary it must be 100% reversible.
a. Does your project involve a festival/public event of limited size or duration? If so, will there be any permanent
effects on a NHRP Site(s) or any structures/installations erected or installed on an NHRP Site(s)?

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b. Does your project involve outdoor murals or other art on a NHRP Site(s) or adjacent to a NHRP Site(s)?

c. Does your project involve temporary public art on a building 50 years or older (e.g., sculpture, statuary, banners,
mixed media, painting)? If so, does the project necessitate the installation of hardware on a NHRP Site(s)?

d. Does your project involve erecting or placing permanent wayfinding signs (e.g., artistic directional signs) adjacent
to or on a NHRP Site(s)?

e. Does your project involve installing small structures (e.g., benches, bus shelters, produce stands) attached to or
dependent on a NHRP Site(s)? If so, describe the ground disturbance necessary for such an installation.

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f. Does your project involve landscape maintenance or rehabilitation (e.g., community garden, urban park) on a
NHRP Site(s)? If so, where? Will it include the addition of new large scale landscape elements?

g. Does your project involve in-kind replacements or repairs?

h. Does your project involve conceptual planning/design/research (e.g., feasibility and planning studies, early design
development work/conceptual drawings and renderings, asset mapping, design charrettes)?

i. Does your project involve information gathering/data analysis/information dissemination (e.g., historic and
cultural demonstrations, public affairs actions, studies, reports, document mailings, data analysis)?

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4. If you are proposing a temporary or permanent public art project, or you are designing or planning a district,
building, site, landscape, structure or object, you must provide us with the following detailed information:
If any element of the district, building, site, landscape, structure or object (or adjacent properties) is 50 years old or
older, describe that element in detail. For example, if you are working on a historic building or district (or there is
one adjacent), describe the age (give year built if available), whether or not it's included in or eligible for inclusion in
the National Register of Historic Places, and the type of activities being planned or designed for your project.

5. Provide a detailed description of any project activities that might now or someday have an effect on the
environment so that we may review the actions under the NEPA. Be very specific. For example, if you will be doing
cleanup of a site, describe exactly what needs to be cleaned. Is it litter on the site or toxic waste that needs to be
cleaned up? If you will be installing public art, describe the previous use of the property and why you think the land
is not likely to be contaminated.

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6. If an Indian tribe or Native Hawaiian organization might attach religious and/or cultural significance to historic
properties touched by your project, describe.

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