Tribal Program Development Grants - Consolidated Workplan Template

OMB No. 1093-0012

Expires: XX/XX/XXXX

U.S. Department of the Interior

Financial Assistance

Tribal Orphaned Wells Program

PROJECT NARRATIVE/WORKPLAN:

PROGRAM DEVELOPMENT GRANT

(Optional Template)

Tribes may use this optional template in fulfillment the Project Narrative/Workplan (Workplan) requirement as part of application for an Implementation Grant. Mandatory elements of the required Workplan are described in Section 16E of the Phase 2 OWP Tribal Grants announcement and listed below, in the body of this document.

A Workplan may include a brief introduction and shall include sufficient information to determine whether the proposed activities are consistent with requirements described in the Phase 2 announcement.

Workplans are limited to 10 numbered pages, inclusive of all text and references and excluding this cover page, with at least 1-inch margins on all sides and 11-point font. Supporting documents may be submitted as separate attachments.

NOTE: Use this optional template only for Program Development Grant applications. A separate template for Implementation Grant applications is available in the application package for the Phase 2 announcement.

.

Tribe:
Prepared by:
Submitted by:
Announcement ID:	(DOI to populate)
Proposed Period of Performance (from SF 424, item 17):

INTRODUCTION/BACKGROUND

(Optional) Provide a brief introductory or background statement about the Tribe, oil & gas activities, and any other relevant information that is not included under specific workplan elements or in the budget narrative (limit 300 words).

1. UNEMPLOYMENT RATE

Provide the Tribe’s current unemployment rate:

(Optional narrative explanation)

2. ORPHANED WELL INVENTORY/ESTIMATES

Describe (below), including a numerical estimate (at right), known orphaned wells on Tribal land or of evidence that points to the likelihood of orphaned wells on Tribal land that not yet been identified and/or assessed.

3. PROJECT PERSONNEL

List the number and purpose/duties of each personnel supported under this grant.
Name (for incumbents)	Title	Purpose/duties

4. TRAINING AND EQUIPMENT

Describe training and equipment to be received by each personnel and how they relate to an orphaned well program.
Name/Title	Training	Purpose

Name/Title Equipment Purpose

5. INVENTORY, ASSESSMENT & REPORTING METHODS

Describe the methodology for conducting and reporting inventory and assessment of undocumented orphaned wells.

6. ENVIRONMENTAL COMPLIANCE

Describe how the Tribe will comply with all applicable federal statutes, regulations, and executive orders (EOs) and with all applicable Tribal, state, and local statutes and regulations to ensure that potential impacts to the environment are considered before undertaking any grant-funded action with the potential to impact the environment, including resources and personnel who may assist with NHPA Section 106 and ESA Section 7 reviews.

7. IMPLEMENTATION PLAN

Describe how the Tribal Program Development Grant will evolve into a Tribal Implementation Grant proposal or other orphaned well plugging, remediation, and reclamation actions within 2 years of the effective date of the developmental project

8. JOB CREATION/CONTINUITY

Describe how the Tribe plans to fund personnel to be hired under proposed activities after Phase 2 grant funds are expended and/or the window to obligate funds within five years of receipt of funds (or, the effective date of the award) expires.

PAPERWORK REDUCTION ACT STATEMENT: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number and expiration date. The OMB control number for this template is 1093-0012 (expiration date: XX/XX/XXXX).

BURDEN ESTIMATE STATEMENT: Public reporting for this form is estimated to average 10 hours per response. Please direct comments regarding the burden estimate or any other aspect of this information collection to: U.S. Department of the Interior Information Collection Clearance Officer, 1849 C St., N.W., Washington, DC 20240.