Activities funded by Grants Effects Determination Table Template

OMB No.: 1093-0012
Expires: XX/XX/XXXX

Effects Determination Table
Identified Species and Critical Habitats with Potential to Occur within the Action Area

Species Common
& Scientific
Names

Orphaned Well Program Office
U.S. Department of Interior
v.20240430

Taxon

Status

Critical
Habitat

Potential
Occurrence

Season of
Occurrence

Exclusion
Rationale

Habitat Description & Determination
- Discuss sp. life stage, potential occurrence, foraging, shelter, protection, & mates
- Describe habitat quality and presence of essential physical biological features.
- Substantiate rationale for exclusion to dismiss from further analysis.
- Cite all references used (Author Year) and provide in bibliography

Conservation Measures

Effect Determination(s)
Species

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Habitat

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Bipartisan Infrastructure Law (BIL)
Infrastructure Investment and Jobs Act (IIJA)

Key
Status
C

Candidate

CS
DL

Species under
Conservation Agreement
Delisted

E

Endangered

EP

Endangered, Proposed

EX

Experimental
Population; Nonessential
Threatened
Threatened, Proposed

T
TP

Critical Habitat
None

OP
NOP
OF
NOF

Potential
Occurrence

Exclusion Rationale

Effect Determination(s)

No critical habitat

Presence
Likely

ELE

Outside of elevational range of species

NE

Proposed critical habitat;
overlaps with action area
Proposed critical habitat; no
overlap with action area
Final critical habitat; overlap
with action area
Final critical habitat; no overlap
with action area

Presence
Confirmed
Unknown

HAB

No habitat (or critical habitat) present in
action area
Outside of known distributional range of
the species.
No essential Physical Biological Features
of critical habitat present in action area.
Species not expected to occur during the
season of use/impact
If other, exclusion rationale is used
provide reasoning and justification in
Habitat Description &
Retain for further consideration to
identify conservation measures resulting
in No Effect or in preparation of a
Biological Assessment

NLAA

ODR
PBF
SEA
Other

Retain

LAA
N/A

Species
No Effect.
Rationale fully supports exclusion
from Biological Assessment.
May affect, NOT Likely to Adversely
Affect.
May affect, LIKELY to Adversely
Affect.
Not Applicable

NLJE

NOT likely to jeopardize
the continued existence

NDAM

LJE

LIKELY to jeopardize the
continued existence
Not Applicable

WDAM

N/A

N/A

Habitat
Will NOT destroy or
adversely modify

WILL destroy or
adversely modify
Not Applicable

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 8 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.

Orphaned Well Program Office
U.S. Department of Interior
v.20240430

Bipartisan Infrastructure Law (BIL)
Infrastructure Investment and Jobs Act (IIJA)