DOE F 540.6 E&I Form - Historic Preservation

DOE Form 540.6

(01/22)

This version supersedes all other versions

U.S. Department of Energy

OMB Control Number 1910-5157

Expiration Date: xx/xx/2023

HISTORIC PRESERVATION REPORT

Historic Preservation Reporting Period: Grant Number:

1a. State where recipient is located:

1b. Name of Recipient:

1c. Have you utilized a U.S. DOE-executed Historic Preservation Programmatic Agreement (PA) in order to comply with National Historic Preservation Act requirements for all or some of your U.S. DOE-funded EECBG, WAP, or SEP activities? Yes No

1d. If your answer to 1c above is no, then for any activities for which you did NOT utilize a PA for historic preservation review have you otherwise complied with National Historic Preservation Act requirements for those activities?

Yes No N/A

1e. Total number of activities being undertaken with DOE funds:

If your answer to question 1c above is “yes” then please answer questions 2a through 3a:
2a. Identify the number of activities that were exempt from further historic preservation review under the PA due to property age:
2b. Identify the number of activities exempt from further historic preservation review per the PA list of exempt activities:
2c. Identify the number of activities exempt from further historic preservation review under the PA due to a prior review under a Section 106 Agreement for Community Development Block Grants (CDBG):
3. For any activities that you did not identify as exempt from further review under questions 2a, 2b, 2c, or 2d, please list the following:
3a. Number of Section 106 reviews completed under the PA:

Paperwork Reduction Act Burden Disclosure Statement

This data is being collected to verify compliance with Section 106 of the National Historic Preservation Act (NHPA). The data you supply will be used to demonstrate that projects implemented through the Department of Energy’s (DOE) Office of Weatherization and Intergovernmental Programs are not adversely effecting historic properties pending compliance with Section 106.

Public reporting burden for this collection of information is estimated to average 2 hrs per response for WAP recipients, 4 hours per response for SEP recipients and 2 hrs per response for EECBG recipients, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records Management Division, IM-11, Paperwork Reduction Project (1910-5155), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (1910-5155), Washington, DC 20503.

Historic Preservation Report Instructions

Line Item Instructions for the Historic Preservation Report

Item #

Reporting Item Instructions

Historic Preservation Reporting Period

Recipients must report to DOE through the PAGE system annually no later than 9/15. The annual reporting period is 8/31 through 9/1.

Grant Number The grant number begins with four letters followed by 7

numerical digits (e.g. DE-EE0000000)

1a State where recipient is located

Enter State abbreviation from SF424

1b Name of Recipient Enter Grantee Legal Name from SF424

1c Utilization of U.S. DOE executed Historic Preservation Programmatic Agreement (PA)

1d Activities for which a PA was not utilized to meet the requirements of the National Historic Preservation Act.

1e Total number of activities being funded in whole or in part with DOE funds

2a Activities exempt from further historic preservation review under the PA due to property age

2b Activities exempt from further historic preservation review per the PA list of exempt activities.

A Programmatic Agreement (PA) is an agreement covering the recipients in the State identified in question 1(a) and which is executed between the United States Department of Energy, the State Agency Recipient(s) receiving financial assistance from

U.S. DOE for EECBG, WAP, and SEP and the State Historic Preservation Office.

The term “activities” as used in this report refers to the individual tasks that comprise a project funded in whole or in part by U.S.DOE through EECBG, WAP or SEP.

User entry is required and it must be numeric.

(see also, definition of “activities” in the instructions to 1d above)

User entry is required and it must be numeric.

The PA should identify in a list or Appendix those activities that are exempt from further historic preservation review. User entry is required and it must be numeric.

2c	Activities exempt from further historic preservation review under the PA due to a prior review under a Section 106 Agreement for Community Development Block Grants (CDBG).	User entry is required and it must be numeric. (Note that the PA executed in your state may not have this exemption)
3	Activities not identified as exempt from further review under questions 2a, 2b, 2c, or 2d.	If activities are not exempt from further review under at least one of the categories identified in questions 2a, b, c or d, then the Recipient is required to conduct a historic preservation review in accordance with the remaining Stipulations in the PA.
3a	Number of Section 106 reviews completed under the PA.	User entry is required and it must be numeric.