3135-0112 NHPA-NEPA Form and Instructions

OMB No. 3135-0112
Expires TBD

NHPA / NEPA Questionnaire

6/28/19

If you received an offer for a grant, your project may be subject to the National Historic Preservation Act
(NHPA) and/or the National Environmental Policy Act (NEPA). The Arts Endowment will conduct a review of
your project to ensure that it is in compliance with NHPA/NEPA.
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, potentially 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 public art such as a sculpture or mural.
 An outdoor arts festival.
 Design planning and services for projects that may involve a properties that are 50 years old and,
therefore, potentially eligible for inclusion in the National Register of Historic Places.
This questionnaire is the first step in the NHPA review process. Based on your responses, the Arts Endowment
will determine one of the following outcomes:
(1) There is no potential to affect historic properties older than 50 years of age;
(2) Based on an agreement that the Arts Endowment 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 will be
required to contact and work directly with your State Historic Preservation Office (SHPO), and potentially
initiate a Section 106 Review.

GENERAL INFORMATION
A. ORGANIZATION. Enter the legal name of your organization.

B. NEA APPLICATION/AWARD NUMBER. Enter the application or award number.

C. DATE

D. CONTACT INFORMATION. Identify the person who can answer specific questions about NEPA or NHPA
Name

Email

Title

Phone
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INSTRUCTIONS
I. APPLICANTS:
Fill out the following form including every project location. Return it along with the Project Budget to the
Specialist indicated on the tentative funding notification. One form may be used for multiple locations and/or
activities.
If you have revised your project as a result of the offer, clearly indicate such on the Project Budget form under
"Project Description." Specifically, indicate which activities have been removed from the revised budget. 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.
II. CURRENT AWARDEES:
Fill out the following form including every project location. Submit it to the Office of Grants Management 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. One form may be used for multiple locations and/or activities.
III. 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, contact [email protected].
Once the review is concluded you will receive an email indicating that your grant has been “cleared”.
Funds cannot be released until you have received the “cleared” email. Therefore, prompt and thorough
responses are appreciated.

ANSWER THE FOLLOWING NHPA / NEPA QUESTIONS
1. Provide a very clear description of all location(s) for all grant activities, including the address(es) and construction
dates, and historic significance designations, if known. If you don’t have a physical address, provide the block or other
geographic boundaries within which grant activities occur (area of potential effect). Describe the site(s), whether they
are public spaces, streets, vacant lots, buildings, parks, riverbanks, walking trails, etc. Include a map and/or
photographs.
For the purposes of this review, historic properties are:
(1) any place* 50 years old or older,
(2) any place included in or eligible for inclusion in the National Register of Historic Places (NRHP), or
(3) any place located in a NRHP historic district.
*Places include those property types associated with the NRHP including districts, sites, buildings, structures,
landscapes or objects.
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ANSWER THE FOLLOWING NHPA / NEPA QUESTIONS
If your activities and/or locations are not yet determined, indicate here when they will be known. Once
locations/activities are determined, you must update this form, upload the new version to the specific My Offer or My
Award in REACH. In most cases, we cannot clear your project until exact locations/activities are identified.

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ANSWER THE FOLLOWING NHPA / NEPA QUESTIONS
2. Describe all grant project activities, including whether the planned activities are temporary or permanent. Provide
sufficient detail to enable us to determine whether grant activities will produce permanent physical alterations or
physical additions to properties that may be historic. For example, physical additions may result from permanent art,
small structures, or design activities.

3. a. Does your project involve an outdoor festival/public event of limited size or duration?
 Include information on temporary staging, rigging, tents and other equipment for festivals, performances,
film screenings, etc. Indicate whether such equipment would require ground disturbance, such as digging or
trenching, if any, for stages and/or tents, and other equipment.
 Determine whether tents are self-ballasted (requiring no ground disturbance).
 Determine whether staging/equipment/tents will be placed temporarily on hardscaped surfaces (such as
streets, pavement, or sidewalks), or directly on the ground.
 Is permanent hardware necessary?

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ANSWER THE FOLLOWING NHPA / NEPA QUESTIONS
3.b. Does your project involve outdoor murals or other permanent art on a historic property or adjacent to historic
properties?
 Would any such permanent art be free standing or would it require anchoring to the building or site?

3.c. Does your project involve temporary public art on a building 50 years or older (e.g., sculpture, statuary, banners,
mixed media, paintings)?
 If so, does the project necessitate the installation of permanent or temporary hardware on historic
property(ies)?
 If so, briefly describe the hardware. Provide a brief description of the temporary art, such as number of
installations, size, scale, and medium.

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ANSWER THE FOLLOWING NHPA / NEPA QUESTIONS
3.d. Does your project involve erecting or placing permanent wayfinding signs (e.g., artistic directional signs) adjacent to
or on historic properties?
 Provide a brief description of the signs, such as number, size, scale, and medium, extent of digging/ground
disturbance (if any), or whether permanent hardware is necessary, if any.

3.e. Does your project involve installing small structures (e.g., benches, bus shelters, produce stands) attached to,
dependent on, or adjacent to historic property(ies)?
 If so, describe the ground disturbance necessary (if any) for such an installation.

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ANSWER THE FOLLOWING NHPA / NEPA QUESTIONS
3.f. Does your project involve landscape maintenance or rehabilitation (e.g., community garden, urban park) on a historic
property(ies)?
 If so, where? Briefly describe the activities.
 Will it include the addition of new large scale landscape elements?

3.g. Does your project involve in-kind replacements or repairs? In other words, would any replacements or repairs be of
the same kind of materials? For instance, if repairing a staircase railing, would the railing be of similar materials and
design?

3.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)?
 Will grant activities result in development of schematic designs, design development, or construction
documents?

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ANSWER THE FOLLOWING NHPA / NEPA QUESTIONS
3.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)?

4. 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.

5. Would grant activities occur on Tribal Lands (Reservations)? Also, 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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Paperwork Reduction Act Statement
The public reporting burden for this collection of information is estimated at an average of one hour per response.
This includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. We welcome any suggestions that you
might have on improving the guidelines and making them as easy to use as possible. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to: [email protected], attention: Reporting Burden. Note: Applicants are not required to respond to the
collection of information unless it displays a currently valid U.S. Office of Management and Budget (OMB) control
number.

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