Preliminary Environment & Social Screening Document

Facility Guarantee Program (FGP) Preliminary
Environmental and Social Screening Document
The information provided on this form will be used to categorize the proposed project/transaction and
determine the additional information needed (if any) for FAS to evaluate the environmental and social
effects of the project/transaction.
What is the project or transaction? Please give a brief description of the proposed
project/transaction, including a summary of the goods and/or services to be exported.

Estimated Guaranteed Value to be requested (USD):

Are the products goods and/or services to be covered in your application destined for an
identified physical project?
No. Please explain: what is the specific use of the goods/services if they are not intended for a
specific project? (Then skip to “Project or Transaction Sector/Industry” section)

Yes, a) Identify the project:

b) Provide a brief description of the project:

c) Output and capacity/size of the project:

d) Indicate whether this is a new project, a rehabilitation, or an expansion in size or
output of an existing project:

e) Estimated date of project completion:

f) Project location (physical address, including city and country):

(g) Is the project located in or near an environmentally sensitive site or area? (Check all
applicable, if any):
Tropical Forests or Other Areas with High Biological Diversity
Nationally or Internationally Designated Protected Areas, such as Wetlands, Seashores, Wildelands or Refuges, National Parks
Habitat of Endangered Species
Location Affecting Indigenous, Tribal or Other Vulnerable Populations
Location having Historical / Archaeological Significance
Large Scale Resettlement (Potential Number of People Affected:
Properties on the UNESCO World Heritage Site List

)

Project or Transaction Sector/Industry
Check classification(s) describing sector/industry of the project and/or specific goods or
services:
Airport Facilities
Ports/harbors/Upgrades
Highways
Other Large Infrastructure
Transportation (please specify)
Cold Storage Facility/Refrigerated Warehouse
Pulp & Paper Plant
Flour Mill
Poultry Production/Processing Facility
Grain Discharge and Handling
Oil/Meal Processing
Warehouse Facility
Grocery Store
Beef Cattle Operations
Food Packaging and Labeling
Agricultural Production Facility
Refrigerated Trucks
Storage Bins
Other, specify:
Name of Seller:

Date:

Applicant Signature and Title

If the information contained on this form changes or becomes clarified after initial submission, it must
be resubmitted to the FAS Credit Programs Division.
For inquiries and information please contact the FAS Credit Programs Division at (202) 720-6211.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0551-0032. The time required to completed this information is
estimated to average 30 minutes per response, including the time for reviewing instruction, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information.